Depressive Symptoms and Anticipated Help-seeking Stigma as Mental Healthcare Navigation Barriers Among People Who Use...

Depression is prevalent among people who use opioids (PWUO) and may hinder mental healthcare access not only through reduced engagement but also through difficulty identifying where to obtain services. Information about available mental health care is often obtained through disclosure of symptoms and help-seeking interactions with providers or others. Concerns about how others may react to seeking care may discourage these interactions and limit guidance opportunities for care. However, few studies have examined whether depressive symptoms and anticipated stigma related to help-seeking perceived as a barrier to care are associated with reporting a mental health care service navigation knowledge barrier among PWUO. We analyzed data from a cross-sectional survey of 199 PWUO conducted in New Haven, Connecticut. Participants reported whether "being unsure where to go to get mental healthcare" was perceived as a barrier (mental health care service navigation knowledge barrier) and whether "being concerned about what others might think, say, or do" was perceived as a barrier (anticipated stigma related to help-seeking perceived as a barrier). Depressive symptoms were assessed with the PHQ-9 (score ≥ 10). Using adjusted multivariable logistic regression models, we examined separate and jointly adjusted associations and tested an interaction by depression screening status. Nearly 59% of participants screened positive for depressive symptoms. Depressive symptoms were associated with higher odds of reporting the service navigation knowledge barrier (aOR = 4.00; 95% CI: 2.10-7.88). Anticipated stigma related to help-seeking perceived as a barrier was also associated with higher odds of reporting the service navigation knowledge barrier (aOR = 5.16; 95% CI: 2.75-10.00). In a jointly adjusted model, both depressive symptoms (aOR = 3.50; 95% CI: 1.77-7.15) and anticipated stigma related to help-seeking perceived as a barrier (aOR = 4.67; 95% CI: 2.43-9.26) remained independently associated with the outcome. The interaction was not statistically significant (p = 0.052). Findings suggest that improving mental healthcare access for PWUO may require attention to both depressive symptoms and anticipated stigma related to help-seeking perceived as a barrier to care, alongside practical navigation and linkage supports embedded in harm reduction and substance use treatment settings.