{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:51:15Z","timestamp":1780357875027,"version":"3.54.1"},"reference-count":71,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":579,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:00Z","timestamp":1527811200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["europsy-journal.com","clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","em-consulte.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Eur. psychiatr."],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0924933800015455_abst1\" sec-type=\"other\"><jats:title>Background:<\/jats:title><jats:p>The stigma of mental illness, especially personal attitudes towards psychiatric patients and mental health help-seeking, is an important barrier in healthcare utilisation. These attitudes are not independent of each other and are also influenced by other factors, such as mental health literacy, especially the public\u2019s causal explanations for mental problems. We aimed to disentangle the interrelations between the different aspects of stigma and causal explanations with respect to their association with healthcare utilisation.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800015455_abst2\" sec-type=\"methods\"><jats:title>Methods:<\/jats:title><jats:p>Stigma and causal explanations were assessed cross-sectional using established German questionnaires with two unlabelled vignettes (schizophrenia and depression) in a random-selection representative community sample (N = 1375, aged 16\u201340 years). They were interviewed through a prior telephone survey for current mental disorder (n = 192) and healthcare utilisation (n = 377). Structural equation modelling was conducted with healthcare utilisation as outcome and stigma and causal explanations as latent variables. The final model was additionally analysed based on the vignettes.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800015455_abst3\" sec-type=\"results\"><jats:title>Results:<\/jats:title><jats:p>We identified two pathways. One positive associated with healthcare utilisation, with high psychosocial stress and low constitution\/personality related causal explanations, via positive perception of help-seeking and more help-seeking intentions. One negative associated with healthcare utilisation, with high biogenetic and constitution\/personality, and low psychosocial stress related explanations, via negative perception of psychiatric patients and a strong wish for social distance. Sensitivity analysis generally supported both pathways with some differences in the role of biogenetic causal explanation.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800015455_abst4\" sec-type=\"conclusions\"><jats:title>Conclusion:<\/jats:title><jats:p>Our results indicate that campaigns promoting early healthcare utilisation should focus on different strategies to promote facilitation and reduce barriers to mental healthcare.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.eurpsy.2017.12.027","type":"journal-article","created":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T07:20:23Z","timestamp":1520320823000},"page":"48-56","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":27,"title":["The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model"],"prefix":"10.1017","volume":"51","author":[{"given":"N.","family":"Schnyder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Michel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Panczak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Ochsenbein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.G.","family":"Schimmelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Schultze-Lutter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,1,1]]},"reference":[{"key":"S0924933800015455_bib0170","doi-asserted-by":"publisher","DOI":"10.3109\/08039488.2015.1109140"},{"key":"S0924933800015455_bib0010","doi-asserted-by":"publisher","DOI":"10.1080\/09540260701797837"},{"key":"S0924933800015455_bib0230","first-page":"5936","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"S0924933800015455_bib0020","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61611-6"},{"key":"S0924933800015455_bib0310","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12423"},{"key":"S0924933800015455_bib0300","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2008.01251.x"},{"key":"S0924933800015455_bib0195","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2013.06.002"},{"key":"S0924933800015455_bib0180","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-015-0681-9"},{"key":"S0924933800015455_bib0075","doi-asserted-by":"publisher","DOI":"10.1017\/S1121189X00002669"},{"key":"S0924933800015455_bib0105","volume-title":"The handbook of social psychology","author":"Fiske","year":"1998"},{"key":"S0924933800015455_bib0080","doi-asserted-by":"publisher","DOI":"10.1017\/S1121189X00002621"},{"key":"S0924933800015455_bib0275","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.88.3.588"},{"key":"S0924933800015455_bib0095","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.116.189464"},{"key":"S0924933800015455_bib0325","doi-asserted-by":"publisher","DOI":"10.1002\/ejsp.2420150303"},{"key":"S0924933800015455_bib0005","doi-asserted-by":"publisher","DOI":"10.1080\/09540260701797894"},{"key":"S0924933800015455_bib0090","doi-asserted-by":"crossref","first-page":"5235","DOI":"10.1111\/pcn.12267","article-title":"Barriers to mental health care in Japan: results from the World Mental Health Japan survey","volume":"69","author":"Kanehara","year":"2015","journal-title":"Psychiatry Clin Neurosci"},{"key":"S0924933800015455_bib0320","doi-asserted-by":"publisher","DOI":"10.1177\/1077558709335173"},{"key":"S0924933800015455_bib0270","first-page":"53","article-title":"Structural equation modelling: guidelines for determining model fit","volume":"6","author":"Hooper","year":"2008","journal-title":"EJBRM"},{"key":"S0924933800015455_bib0290","volume-title":"international standard classification of education, ISCED 2011","year":"2012"},{"key":"S0924933800015455_bib0165","doi-asserted-by":"publisher","DOI":"10.1080\/17437199.2010.521684"},{"key":"S0924933800015455_bib0285","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v048.i02"},{"key":"S0924933800015455_bib0150","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2016.00547"},{"key":"S0924933800015455_bib0200","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.04.013"},{"key":"S0924933800015455_bib0135","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-009-0870-y"},{"key":"S0924933800015455_bib0160","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201500164"},{"key":"S0924933800015455_bib0255","volume-title":"Confirmatory factor analysis for applied researchers","author":"Brown","year":"2006"},{"key":"S0924933800015455_bib0345","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00350.x"},{"key":"S0924933800015455_bib0115","doi-asserted-by":"publisher","DOI":"10.1177\/0004867412442406"},{"key":"S0924933800015455_bib0220","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00298-6"},{"key":"S0924933800015455_bib0350","doi-asserted-by":"publisher","DOI":"10.1023\/A:1025023600517"},{"key":"S0924933800015455_bib0015","doi-asserted-by":"publisher","DOI":"10.1007\/BF03403706"},{"key":"S0924933800015455_bib0055","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291713001943"},{"key":"S0924933800015455_bib0025","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2011.08.008"},{"key":"S0924933800015455_bib0110","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.9.1328"},{"key":"S0924933800015455_bib0215","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.114.151944"},{"key":"S0924933800015455_bib0225","article-title":"Prevalence and clinical relevance of interview-assessed psychosis risk symptoms in the young adult community","author":"Schultze-Lutter","year":"2017","journal-title":"Psychol Med"},{"key":"S0924933800015455_bib0045","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2011.10.004"},{"key":"S0924933800015455_bib0050","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2011.10.001"},{"key":"S0924933800015455_bib0060","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000000488"},{"key":"S0924933800015455_bib0210","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20129"},{"key":"S0924933800015455_bib0175","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1997.tb140071.x"},{"key":"S0924933800015455_bib0030","first-page":"6556","article-title":"The size and burden of mental disorders and other disorders of the brain in Europe 2010","volume":"2","author":"Wittchen","year":"2011","journal-title":"Eur Neuropsychopharmacol"},{"key":"S0924933800015455_bib0145","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-009-0050-4"},{"key":"S0924933800015455_bib0190","doi-asserted-by":"publisher","DOI":"10.1017\/S003329171300072X"},{"key":"S0924933800015455_bib0140","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-013-0764-1"},{"key":"S0924933800015455_bib0305","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796011000266"},{"key":"S0924933800015455_bib0205","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201400291"},{"key":"S0924933800015455_bib0315","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-010-0300-5"},{"key":"S0924933800015455_bib0040","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.113.127753"},{"key":"S0924933800015455_bib0260","volume-title":"Testing structural equation Models","author":"Muth\u00e9n","year":"1993"},{"key":"S0924933800015455_bib0130","doi-asserted-by":"publisher","DOI":"10.1097\/01.NMD.0000066157.47101.22"},{"key":"S0924933800015455_bib0125","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-11-52"},{"key":"S0924933800015455_bib0085","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-10-113"},{"key":"S0924933800015455_bib0100","doi-asserted-by":"crossref","DOI":"10.4135\/9781446200919","volume-title":"Prejudice, stereotyping and discrimination","author":"Dividio","year":"2010"},{"key":"S0924933800015455_bib0155","doi-asserted-by":"publisher","DOI":"10.1016\/0749-5978(91)90020-T"},{"key":"S0924933800015455_bib0250","doi-asserted-by":"publisher","DOI":"10.1086\/228672"},{"key":"S0924933800015455_bib0295","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.schbul.a007098"},{"key":"S0924933800015455_bib0070","doi-asserted-by":"publisher","DOI":"10.1177\/1529100614531398"},{"key":"S0924933800015455_bib0120","doi-asserted-by":"publisher","DOI":"10.1176\/ps.2010.61.4.373"},{"key":"S0924933800015455_bib0035","first-page":"1771","article-title":"Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization\u2019s World Mental Health Survey Initiative","volume":"6","author":"Wang","year":"2007","journal-title":"World Psychiatry"},{"key":"S0924933800015455_bib0065","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291714000129"},{"key":"S0924933800015455_bib0265","volume-title":"Principles and practices of structural equation modelling","author":"Kline","year":"2011"},{"key":"S0924933800015455_bib0245","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-9964(03)00186-5"},{"key":"S0924933800015455_bib0185","doi-asserted-by":"publisher","DOI":"10.1177\/0004867414528054"},{"key":"S0924933800015455_bib0330","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbt171"},{"key":"S0924933800015455_bib0340","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717000344"},{"key":"S0924933800015455_bib0235","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170002239X"},{"key":"S0924933800015455_bib0355","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.52.1.27"},{"key":"S0924933800015455_bib0280","volume-title":"Discovering structural equation modeling using stata","author":"Acock","year":"2013"},{"key":"S0924933800015455_bib0240","first-page":"22","article-title":"Diagnostic sychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin. Psychiatry"},{"key":"S0924933800015455_bib0335","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0047.2004.00325.x"}],"container-title":["European Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0924933818300257?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0924933818300257?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0924933800015455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T19:29:06Z","timestamp":1719862146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0924933800015455\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":71,"alternative-id":["S0924933800015455"],"URL":"https:\/\/doi.org\/10.1016\/j.eurpsy.2017.12.027","relation":{},"ISSN":["0924-9338","1778-3585"],"issn-type":[{"value":"0924-9338","type":"print"},{"value":"1778-3585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model","name":"articletitle","label":"Article Title"},{"value":"European Psychiatry","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.eurpsy.2017.12.027","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 Elsevier Masson SAS. All rights reserved.","name":"copyright","label":"Copyright"}]}}