Navigating mental health issues: exploring cultural causal attribution, stigmatization, and care recommendation...

Evidence has shown that the use of mental health services is less common among Pakistani adolescents and young adults compared to their peers in Western and English-speaking countries, despite a higher prevalence of mental health issues. This disparity suggests the presence of cultural and societal stigma affecting help-seeking behaviors. Our study aims to explore the prevalent forms of mental health causal attributions and help-seeking care recommendations in this population. Additionally, we investigated how these causal attributions influence help-seeking care recommendations and in what way perceived stigmatizing attitudes play a mediating role.

The self-administered cross-sectional study included 1,328 college undergraduates aged 15-24 years in Layyah, Pakistan. Causal attributions were measured using 28 items distributed into five groups. Help-seeking care recommendations were assessed on a 20-item scale divided into four groups. Public stigmatizing attitudes were measured using items from the Eurobarometer 64.4 survey. The effect of causal attributions on help-seeking care recommendations was analyzed through multiple linear regression. Finally, we estimated the mediation effect of perceived public stigmatizing attitudes using PROCESS v4.0 macros for SPSS.

More than half (51.7%) of the adolescents demonstrated stereotypical attitudes, and one in four underestimated the severeness of the complaints. Psychosocial causes were the most prevalent mental health attribution, identified in 98% of the responses. Similarly, self-care (97.8%) and informal social support (97.7%) were the most common help-seeking care recommendations. Our findings revealed that labeling mental health issues as having religious and supernatural causes relates to formal social support from religious healers [β = 0.23, 95% CI 0.17-0.29, p < 0.001], and participants who attributed psychosocial causes also recommended support from religious healers [β = 0.19, 95% CI 0.10-0.27, p < 0.001]. The mediation model indicated an indirect association consistent with a partial mediating role of perceived public stereotypical attitudes, as adolescents and young adults attributing psychosocial causes to mental health were more likely to recommend formal social support from religious healers (β = 0.31, p ≤ 0.001) and informal social support (β = 0.29, p ≤ 0.001).

The study confirmed that attributing causes to mental health strongly relate to care recommendation patterns. Furthermore, the mediating role of perceived public stereotypical attitudes was recognized in determining the relationship between mental health causal attribution and help-seeking care recommendations.