title: Help-seeking, stigma and attitudes of people with and without a suicidal past. A comparison between a low and a high suicide rate country.
abstract: BACKGROUND
  A significant proportion of suicidal persons do not seek help for their psychological problems. Psychological help-seeking is assumed to be a protective factor for suicide. However, different studies showed that negative attitudes and stigma related to help-seeking are major barriers to psychological help-seeking. These attitudes and stigma are not merely individual characteristics but they are also developed by and within society. The aim of this study is twofold. First, we investigate if persons with a suicidal past differ from people without a suicidal past with respect to help-seeking intentions, attitudes toward help-seeking, stigma and attitudes toward suicide. The second aim is to investigate if these attitudinal factors differ between people living in two regions with similar socio-economic characteristics but deviating suicide rates.
  
  
  METHODS
  We defined high (Flemish Community of Belgium) and low (The Netherlands) suicide regions and drew a representative sample of the general Flemish and Dutch population between 18 and 65 years. Data were gathered by means of a postal questionnaire. Descriptive statistics are presented to compare people with and without suicidal past. Multiple logistic regressions were used to compare Flemish and Dutch participants with a suicidal past.
  
  
  RESULTS
  Compared to people without a suicidal past, people with a suicidal past are less likely to seek professional and informal help, perceive more stigma, experience more self-stigma (only men) and shame (only women) when seeking help and have more accepting attitudes toward suicide. In comparison to their Dutch counterparts, Flemish people with a suicidal past have less often positive attitudes toward help-seeking, less intentions to seek professional and informal (only women) help and have less often received help for psychological problems (only men).
  
  
  CONCLUSIONS
  The main limitations are: the relatively low response rate; suicidal ideation was measured by retrospective self-report; and the research sample includes only participants between 18 and 65 years old.
  
  
  CONCLUSIONS
  Having a suicidal past is associated with attitudinal and stigmatizing barriers toward help seeking and accepting attitudes toward suicide. Prevention strategies should therefore target people with a suicidal history with special attention for attitudes, self-stigma and feelings of shame related to help-seeking.
authors.affiliation: LUCAS KU Leuven, Leuven, Belgium. Electronic address: alexandre.reynders@odisee.be.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Reynders
authors.affiliation: Department of Clinical Psychology, VU University and EMGO Institute, Amsterdam, The Netherlands.
authors.forename: Ad J F M
authors.initials: AJ
authors.lastname: Kerkhof
authors.affiliation: Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KU Leuven-UHasselt, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Molenberghs
authors.affiliation: LUCAS KU Leuven, Leuven, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Audenhove
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012189:Retrospective Studies; D057545:Social Stigma; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Attitudes; Cross-national; Help-seeking; Stigma; Suicidal past