Theory of Planned Behavior, Self‑Stigma, and Perceived Barriers Explains the Behavior of Seeking Mental Health Services for People at Risk of Affective Disorders

Introduction: To use the theory of planned behavior (TPB) incorporated with self‑stigma and perceived barriers to investigate the nature of help‑seeking behaviors in a community sample at risk of anxiety or depression in Iran. Methods: Participants at risk of anxiety or depression screened by Hospital Anxiety and Depression Scale (n = 1011) completed the following questionnaires at baseline: Factors in TPB, Self‑Stigma in Seeking Help Scale, and perceived barriers in seeking help. Two years later, their help‑seeking behavior (i.e., visiting a specialist) was retrieved from their medical records. Models using TPB concepts and incorporated with self‑stigma and perceived barriers were tested by structural equation modeling. Results: The effects of TPB concepts, self‑stigma and perceived barriers on help‑seeking behaviors (i.e., visiting a specialist for mental health problems) were supported by the excellent data‑model fit indices: Comparative fit index = 0.997; Tucker–Lewis index = 0.965; root mean square of error approximation (RMSEA) = 0.028; and weighted RMSEA = 0.386. All the path coefficients were significant, except for the path between perceived barriers and help‑seeking behavior. Perceived behavioral control had the strongest coefficient (standardized coefficient = 0.547); subjective norm had the weakest coefficient (standardized coefficient = 0.061). In addition, perceived barriers were indirectly associated with help‑seeking behaviors. Conclusion: TPB is an effective model to explain the help‑seeking behaviors for people at risk of anxiety or depression. In addition, self‑stigma and perceived barriers may be simultaneously considered when clinicians want to prevent an individual with depression or anxiety from not seeking proper help on their mental health problems.