Help-seeking Behavior among Working-age Adults with Suicidal Ideation: An integration of the Andersen Model of Health Care Utilization and the Three-stage Model of Mental Health Help-seeking

Abstract

Despite a high suicide rate among working-age adults, there is a significant lack of empirical evidence on suicide help-seeking among working-age adults. This dissertation examined help-seeking behavior among working-age adults between 26 and 65 years old who reported suicidal ideation in the past year (n = 1, 414). Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health (NSDUH) to examine three research questions: (1) What factors are related to help-seeking among adults with suicidal ideation; (2) Does the combined model of help-seeking fit for adults with suicidal ideation; and (3) What are the reasons for not receiving mental health treatment among the subset of adults with suicidal ideation who did not receive mental health treatment? Findings from multinomial logistic regression suggested that male gender, younger age, being non-white, being employed full-time, lower levels of mental health need, and not having health insurance were associated with not seeking help. The results also indicated where in the help-seeking pathway each risk factor is related to. Results from structural equational modeling analyses demonstrated that the combined model of help-seeking behavior fit reasonably well among the current sample. The examination of the relationships between predisposing/need/enabling factors and help-seeking behavior showed that each factor affects help-seeking behavior through its direct effects on help-seeking behavior and/or indirect effects on other factors. Among the subsample who reported unmet needs for mental health treatment, a burden of treatment cost, not knowing where to look for services, and negative attitudes toward treatment were most frequently reported reasons for not receiving treatment. The results provide a foundation for future help-seeking interventions and imply that health professionals need to continuously assess and respond to suicide risk among their clients. Efforts should be made to reach working-age adults with suicidal ideation but without a diagnosis of mental disorders as they are less likely to be in the mental health care system. Future studies should examine the role of suicidal ideation in the help-seeking pathway and how employment status and work environment impact help-seeking behavior among working-age adults with suicidal ideation.