561491

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JMHXXX10.1177/1557988314561491American Journal of Men’s HealthWahto and Swift

Article
American Journal of Men’s Health

Labels, Gender-Role Conflict, Stigma,

2016, Vol. 10(3) 181­–191
© The Author(s) 2014
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DOI: 10.1177/1557988314561491

Psychological Help in Men ajmh.sagepub.com

Rachel Wahto, MS1, and Joshua K. Swift, PhD1

Abstract
Despite a comparable need, research has indicated that on average men hold more negative attitudes toward
psychological help seeking than women. Several researchers have suggested that the gender gap in service use and
attitudes could be addressed through efforts to better market psychological services to men; however, a limited
number of studies have tested this hypothesis. This study examined whether altering the labels for mental health
providers (psychologist or counselor), settings (mental health clinic or counseling center), and treatments (problem or
feeling focused) could result in less perceived stigma (social and self) by men. Participants, 165 male college students,
were asked to read one of eight randomly assigned vignettes that described a man who was experiencing symptoms
of depression and was considering seeking help. The vignettes differed in the labels that were used to describe the
help that was being considered. Participants then completed measures assessing the stigma (self and social) associated
with the treatment, and their preexisting experience of gender-role conflict and attitudes toward psychological help
seeking. In summary, perceived stigma did not depend on the type of label that was used; however, 59% of the variance
in attitudes was predicted by self-stigma (uniquely explaining 11%), gender-role conflict (uniquely explaining 10%), and
social stigma (uniquely explaining 5%). Specifically, higher levels of gender-role conflict, social stigma, and self-stigma
were associated with more negative attitudes toward psychological help seeking. Based on the demographics of the
sample, these findings primarily have implications for Caucasian college-educated young adult men. Further limitations
with the study and recommendations for future research are discussed.

Keywords
gender-role conflict, labels, men, psychological help–seeking attitudes, stigma

Despite comparable levels of stress, men, on average,
have been reported to be less likely to seek mental health
services compared with women (Ang, Lim, Tan, & Yau,
2004; Good & Wood, 1995; McKelley, 2007; Pederson &
Vogel, 2007). This finding has been demonstrated across
ethnic groups, disorders, and settings (Galdas, Cheater, &
Marshall, 2004; Husaini, Moore, & Caine, 1994; Pederson
& Vogel, 2007). Perhaps explaining the lower level of
service use by many men (Bayer & Peay, 1997;
Mackenzie, Gekoski, & Knox, 2006; Nam et al., 2013;
Vogel, Wade, & Hackler, 2007; Vogel & Wester, 2003),
studies have also consistently indicated that men, when
compared with women, hold more negative attitudes
toward help seeking for mental health problems (Ang
et al., 2004; Mackenzie et al., 2006; Pederson & Vogel,
2007). In one meta-analysis that included 16 studies and
5,713 participants, Nam et al. (2010) identified a signifi-
cant correlation (p < .001) between gender and attitudes
toward seeking professional psychological help. Given
these findings, it is important that researchers and
providers alike seek to gain a better understanding of the
variables that predict men’s help-seeking attitudes as well
as identify ways to improve attitudes toward psychologi-
cal service utilization in men.
Predicting Psychological Help–Seeking
Attitudes in Men
Based on the research indicating that men, on average, hold
more negative attitudes toward psychological service utili-
zation, several researchers have sought to identify the vari-
ables that act as barriers to seeking psychological help in
men. In one review, Möller-Leimkühler (2002) suggested
1
University of Alaska Anchorage, Anchorage, AK, USA
Corresponding Author:
Joshua K. Swift, Department of Psychology, University of Alaska
Anchorage, 3211 Providence Drive SSB303, Anchorage, AK 99508,
USA.
Email: joshua.keith.swift@gmail.com
182
that many men may be less likely to seek out psychological
help for problems such as depression because traditional
masculinity norms encourage them to suppress or deny
problems, because some symptoms of depression may be
masked by other expression styles that are deemed more
acceptable for men (i.e., anger, aggression, hostility),
because emotional expression (a central component to
many mental health treatments) in general is often discour-
aged in men, and because the act of help seeking can imply
a loss of status and autonomy particularly for men.
Similarly, several studies that have examined men’s rea-
sons for seeking or not seeking help through interviews,
focus groups, and analyses of media have similarly indi-
cated that asking a professional for help is often perceived
as a feminine activity and that men who do so would be
seen as weak and less manly (Courtenay, 2000; Johnson,
Oliffe, Kelly, Galdas, & Ogrodniczuk, 2012; O’Brien,
Hunt, & Hart, 2005; Oliffe & Phillips, 2008). Along these
lines, the two variables that have perhaps received the most
empirical attention examining their relation to help-seek-
ing attitudes in men are stigma and gender-role conflict
(Blazina & Marks, 2001; Good & Wood, 1995; Nam et al.,
2010; Pederson & Vogel, 2007; Robertson & Fitzgerald,
1992; Vogel, Wade, & Haake, 2006; Vogel et al., 2007).
The perception of stigma is one variable that likely
plays a strong role in the more negative attitudes that
some men hold toward mental health help seeking.
Stigma is defined as a mark of disgrace that is given to
individuals or groups that possess a socially undesirable
characteristic or engage in an unacceptable behavior
(Blaine, 2000; Vogel et al., 2007). According to Corrigan
(2004), stigma includes both perceptions about how oth-
ers might view an individual who engages in a certain
behavior (social stigma) as well as perceptions about one-
self for engaging in that behavior (self-stigma). In gen-
eral, a high level of stigma toward seeking professional
psychological help has been identified in both men and
women (Mackenzie et al., 2006; Nam et al., 2013; Vogel
et al., 2007). Research has indicated that, on average,
men perceive an even higher level of stigma associated
with mental health help–seeking behaviors than their
female counterparts (Vogel et al., 2006, 2007). This is
true for both perceptions of social stigma and self-
stigma—thus not only do some men believe that seeking
out psychological services would be frowned upon by
society but also many men would personally view them-
selves more negatively if they sought out this type of help
(Vogel et al., 2006, 2007; Vogel, Heimerdinger-Edwards,
Hammer, & Hubbard, 2011). Given that the perception of
stigma (both social and self) has been identified as one of
the best predictors of help-seeking attitudes and inten-
tions (Nam et al., 2013; Vogel et al., 2007), this variable
helps explain why men, on average, hold more negative
attitudes toward mental health treatments.
American Journal of Men’s Health 10(3)
Gender-role conflict is another variable that likely
plays a role in the more negative attitudes that men, on
average, hold toward seeking professional psychological
help (Addis & Mahalik, 2003). Gender-role conflict is
defined as the negative cognitive, emotional, and behav-
ioral consequences of engaging in acts that contradict ste-
reotypical gender-role norms (Pederson & Vogel, 2007).
The concept of hegemonic masculinity suggests that in
many societies the ideal behaviors and attitudes associ-
ated with manhood are ones that lead to power and con-
trol (Connell & Messerschmidt, 2005). Thus, for some
men (specifically those who more strongly espouse tradi-
tional masculine roles), many aspects associated with
seeking professional psychological help can produce
conflict—For those who espouse more traditional mascu-
line roles and beliefs, the act of asking another person for
help can be seen as a sign of weakness in men and talking
about ones feelings is often seen as a more feminine
activity (Good & Wood, 1995; Vogel et al., 2011).
Research has indicated that male gender-role conflict is
significantly associated with both stigma and attitudes
toward seeking professional psychological help (Blazina
& Marks, 2001; Robertson & Fitzgerald, 1992). In one
often cited study, Good and Wood (1995) with a sample
of 397 male college students reported that approximately
25% of the variance in attitudes could be explained by
gender-role conflict. More particularly, they indicated
that negative psychological help–seeking attitudes were
best predicted by a view that acknowledging and express-
ing feelings/emotions conflicts with male social norms.
Other studies examining the relationship between gender-
role conflict and attitudes have reported similar results
(Pederson & Vogel, 2007; Rochlen & O’Brien, 2002).
Addressing Negative Attitudes Toward Seeking
Professional Psychological Help in Men
Psychological help seeking in men is a complex phenom-
enon that has been conceptualized in several ways
(Wenger, 2011). In addition to the “rational choice”
research that has been conducted attempting to identify
the variables (such as stigma and gender-role conflict)
that predict which men seek help, Wegner (2011) indi-
cates that more dynamic research is needed “exploring
when and how one seeks help” (p. 491). Along these lines,
several researchers have suggested that methods for bet-
ter marketing psychological services to men may assist
with helping them become more comfortable with psy-
chological interventions (Addis & Mahalik, 2003;
McCarthy & Holliday, 2004; Rochlen & Hoyer, 2005;
Vogel et al., 2007). In one early study of marketing psy-
chological services to men, Robertson and Fitzgerald
(1992) had 435 college students view brochures that
described one of two types of psychological services. The
Wahto and Swift
first brochure described typical counseling services in
which a provider and a client met individually to discuss
the client’s concerns. The second brochure described
other nontraditional counseling services such as classes,
workshops, seminars, and videotapes that could be used
to address the same concerns. Robertson and Fitzgerald
reported that men with higher levels of gender-role con-
flict expressed a greater preference for the nontraditional
services. In another similar study, Blazina and Marks
(2001) had 110 college men read brochures that described
psychotherapy, psychoeducation, or a men’s support
group as potential treatments for a mental health problem.
Blazina and Marks reported that men with higher levels
of gender-role conflict had more negative reactions to the
support group compared with psychoeducation, but no
differences with traditional psychotherapy were identi-
fied. In a more recent study, McKelley and Rochlen
(2010) had 209 men listen to or read a vignette of a man
who was experiencing a conflict at work and was consid-
ering talking to either an executive coach or a psycholo-
gist. Contrary to their hypotheses, no differences in
attitudes or stigma associated with the type of provider
were reported.
While the previous three studies tested whether differ-
ent types of treatments and providers would be rated
more favorably and less stigmatizing by men, other
research has examined whether simply changing the label
and/or the description of the same treatment could pro-
duce similar effects. In a test of the “Real Men. Real
Depression” campaign, Rochlen, McKelley, and Pituch
(2006) had 209 college men read one of three brochures:
one that contained facts and pictures specific to men,
another identical brochure that was gender neutral, and a
completely different gender neutral brochure that also
addressed depression. They reported that the male spe-
cific brochure was rated more favorably by men with low
gender-role conflict and low attitudes toward psychologi-
cal help seeking compared with the other two types of
brochures; however, the ratings of the three brochures did
not differ for men with high gender-role conflict or low
gender-role conflict and preexisting positive attitudes.
More recently, Hammer and Vogel (2010) compared an
updated version of the Rochlen et al. (2006) “Real Men.
Real Depression” brochure with the original one. In their
updated brochure, Hammer and Vogel used more “male-
friendly” terms such as “mental health consultant” as an
example provider and “solution-focused” for a descrip-
tion of the treatment approach. Although both the old and
the new version of the brochure resulted in improved atti-
tudes and decreased stigma, the new brochure resulted in
greater improvements. In another study, Rochlen and
O’Brien (2002) had 302 college men evaluate two differ-
ent career counseling approaches—one that was described
as problem-focused and one that was described as
183
emotion-focused. In their study, a significant preference
for the problem-focused approach was identified.
In summary, the existing literature provides some
mixed support indicating that attempts to market psycho-
logical interventions so they are more “male-friendly”
can improve men’s attitudes toward seeking psychologi-
cal help. It appears that the positive effects may depend
on what types of labels/descriptions are used (e.g.,
McKelley and Rochlen [2010] reported no difference
between executive coach and psychologist, but Rochlen
and O’Brien [2002] did report a difference between
descriptions of the approach as having either a problem or
emotion focus) and the pre-existing attitudes of the par-
ticipants (e.g., Rochlen et al. [2006] reported that the
male-focused brochure was only effective for men with
low gender-role conflict and negative attitudes toward
help seeking).
Aims of the Current Study
Many have suggested that further research aimed at
addressing the barriers to seeking psychological help for
some men is needed, particularly focusing on stigma and
the gender-role conflict associated with help-seeking
behaviors (Addis & Mahalik, 2003; Johnson et al., 2012;
McCarthy & Holliday, 2004; Möller-Leimkühler, 2002;
Rochlen & Hoyer, 2005; Vogel et al., 2007). Although the
existing research does further our understanding of ways
psychological interventions can be marketed so they have
a greater appeal to men, some limitations with this
research exist. First, some of the existing studies have
only examined participants’ reactions/opinions about
their particular brochure or service description, rather
than examining whether the brochure/description could
result in improved attitudes or decreased stigma. Second,
those studies that have examined changes in stigma and
attitudes toward psychological help seeking have primar-
ily used a pre–post design. Participants may have been
reluctant to change their attitudes or perceptions of stigma
if they had already stated them earlier in the study. Third,
studies have focused on comparing only a couple of dif-
ferent labels/descriptions (e.g., consultant or counselor)
and further research is needed to examine whether other
provider, setting, and treatment labels might be more
appealing to men. Given these limitations and the mixed
findings that have been observed in the existing studies,
further research is needed to test other possible ways to
describe psychological interventions in a more “male-
friendly” way.
This study sought to test whether different provider
(psychologist vs. counselor), treatment setting (mental
health clinic vs. counseling center), and treatment focus
(coping with problems vs. coping with feelings) labels
could result in lower perceptions of both social and
184
self-stigma toward seeking psychological help by men.
Given the desire to test whether different ways of refer-
ring to the same/similar provider, setting, and treatment
focus options could result in less stigma (rather than test-
ing whether certain types of treatments and providers
were less stigmatizing to men); options were chosen that
could be used interchangeably by many clinicians, refer-
rers, and agencies. It was hypothesized that the labels of
psychologist, mental health clinic, and coping with prob-
lems would be associated with less stigma given that pre-
vious research has indicated that emotion/feeling focused
interventions are viewed less favorably by men (Rochlen
& O’Brien, 2002) and these labels imply a stronger disor-
der/problem focus compared with the emotion/feeling
focus that is often associated with counseling.
The focus of this study was to examine the effect of
these labels on perceptions of stigma rather than on atti-
tudes toward psychological help seeking. While attitudes
may be seen as a more stable construct and existing mea-
sures of attitudes ask about mental health treatments of all
types, this study was able to test the stigma associated
with the specific labels that were being compared. Given
the research indicating that the effectiveness of previous
brochures/descriptions depends to some degree on par-
ticipants’ preexisting help-seeking attitudes and gender-
role conflict (Rochlen et al., 2006), this study also tested
whether the labels would work differently depending on
participants’ scores on measures of these variables. With
these aims and hypotheses in mind, this study takes a
more “dynamic approach” (Wegner, 2011) to studying
help seeking in men in that it examines one possible
method for helping men recognize that professional psy-
chological help is an acceptable source of support when
there is a recognized need.
Method
Participants and Procedures
Participants were 165 male students who were recruited
through a psychology department subject pool at a large
Northwestern university. After providing informed consent
and demographic information, participants were randomly
presented with one of eight possible vignettes. Each
vignette described a man who had been experiencing
symptoms of depression for the past 6 months (e.g., feeling
down or blue most of the time, difficulty finding joy or
pleasure with previously enjoyable activities, concentra-
tion difficulties, fatigue, feelings of worthlessness) and
was now considering seeking professional help. The help
he was considering was either from a psychologist or a
counselor, at a mental health clinic or a counseling center,
and would focus on coping with problems or feelings.
Participants were then asked to complete measures
American Journal of Men’s Health 10(3)
assessing the stigma (self and social) associated with the
treatment conditions, their general attitudes toward seek-
ing professional psychological help, and their experience
of gender-role conflict. The study was approved by the uni-
versity’s institutional review board, was conducted entirely
online, and took approximately 30 minutes to complete.
Measures
Gender-Role Conflict Scale–1. Gender-role conflict, a
potential moderator for the hypotheses that were tested in
this study, was measured with the Gender-Role Conflict
Scale–1 (O’Neil, Helms, Gable, David, & Wrightsman,
1986). The Gender-Role Conflict Scale–1 is a 37-item
self-report scale that assesses negative cognitive, emo-
tional, and behavioral consequences associated with con-
forming to or violating male gender-role norms. Each of
the 37 items is rated on a 6-point Likert-type scale, rang-
ing from 1 (strongly disagree) to 6 (strongly agree). Total
scores on the measure range from 37 to 222, with higher
scores representing greater gender-role conflict and fear
of femininity. Adequate levels of convergent and diver-
gent validity for the measure have been reported (O’Neil,
2008). Furthermore, O’Neil et al. (1986) have reported a
test–retest reliability ranging from r = .72 to .86 and an
internal consistency of α = .89 for the measure. A simi-
larly high level of internal consistency, α = .90, was iden-
tified with our sample.
Inventory of Attitudes Toward Seeking Mental Health Ser-
vices. Attitudes toward psychological help seeking, a sec-
ond moderator for the hypotheses that were tested, were
measured with the Inventory of Attitudes Toward Seeking
Mental Health Services (IASMHS; Mackenzie, Knox,
Gekoski, & Macaulay, 2004). The IASMHS was developed
as an updated alternative to the Attitudes Toward Seeking
Professional Psychological Help Scale (Fischer & Turner,
1970), another common measure of help-seeking attitudes.
The IASMHS is a 24-item self-report measure with indi-
vidual items being rated on a 5-point Likert-type scale,
ranging from 0 (disagree) to 4 (agree). Total scores on the
IASMHS range from 0 to 96, with higher scores indicating
more positive attitudes toward mental health help–seeking
behaviors. Mackenzie et al. (2004) have reported a test–
retest reliability ranging from r = .64 to .91 and an internal
consistency of α = .87 for the measure. Mackenzie et al.
have also reported adequate convergent validity for the
measure in that it accurately predicts previous and future
use of mental health services. An internal consistency of
α = .87 was identified with our sample for this measure.
Self-Stigma of Seeking Help. Self-stigma, one of the depen-
dent variables of interest in this study, was measured with
the Self-Stigma of Seeking Help Scale (Vogel et al., 2006).
Wahto and Swift
The Self-Stigma of Seeking Help Scale is a 10-item scale
designed to measure a subjective sense of harm to self-
esteem that results from seeking professional psychologi-
cal help. Each item is rated on a 5-point Likert-type scale,
ranging from 1 (strongly disagree) to 5 (strongly agree).
Total scores on the measure range from 10 to 50, with
higher scores reflecting greater self-stigma. Vogel et al.
(2006) have reported a high level of internal consistency
for the measure, α =.91. In the current study, the measure
was adapted so that the wording was consistent with the
help-seeking vignettes that were provided to participants,
thus allowing for a test of the labels that were used as the
independent variables. As an example of this adaptation,
where the original measure included the item “Seeking
psychological help would make me feel less intelligent,”
for this study the item was adapted to read “Seeking help
like described in the previous scenario would make me
feel less intelligent.” As another example, while the origi-
nal measure included an item that read “My self-esteem
would increase if I talked to a therapist” (reverse coded),
this item was adapted to read “My self-esteem would
increase if I talked to a provider like the one described in
the previous scenario.” The internal consistency of our
adapted measure with our sample was α = .85.
Stigma Scale for Receiving Psychological Help. Social stigma,
another dependent variable of interest in this study, was
measured with the Stigma Scale for Receiving Psycho-
logical Help (Komiya, Good, & Sherrod, 2000). The
Stigma Scale for Receiving Psychological Help is a 5-item
self-report measure that was designed to assess worries of
how others would view an individual who seeks profes-
sional psychological help. Each item is rated on a 4-point
Likert-type scale, ranging from 1 (strongly disagree) to 4
(strongly agree). Total scores on the measure range from 5
to 20 with higher scores indicating a greater perception of
social stigma for help seeking. Komiya et al. (2000) have
reported an adequate level of internal consistency, α = .72,
for the measure. This measure was also adapted for our
study so that the wording was consistent with the help-
seeking vignettes that were provided to participants, again
allowing us to more adequately test the labels that were
used as the independent variables. While the original mea-
sure included the item “Seeing a psychologist for emo-
tional or interpersonal problems caries social stigma,” in
the current study the item was adapted to read “Seeking a
provider like the one described in the previous scenario
carries social stigma.” An internal consistency of α = .74
was identified with our sample.
Data Analyses
The purpose of this study was to test whether the level of
perceived stigma (social and self) differed depending on
185
the particular provider, setting, and treatment labels that
were used. Additionally, similar to the analyses that were
conducted by Rochlen et al. (2006) in their test of the
“Real Men. Real Depression” brochure, a focus of this
study was to also test whether the effects of the labels
depended on preexisting overall attitudes toward psycho-
logical help seeking and gender-role conflict. Using a
median-split method, participants were first categorized
as either having positive (n = 82) or negative attitudes
(n = 77) toward psychological help seeking and high (n =
76) or low (n = 74) levels of gender-role conflict.
Participants who did not complete the attitudes or the
gender-role conflict measures were excluded from the
remaining analyses. Two sets of 2 × 2 × 2 analyses of
variance (ANOVAs) examining the influence of our
labels on both social and self-stigma were then con-
ducted. In the first set of ANOVAs, perceived levels of
social and self-stigma for the two provider labels (psy-
chologist vs. counselor) were compared with attitudes
(positive vs. negative) and gender-role conflict (high vs.
low) also entered as independent variables. In the second
set of ANOVAs, perceived levels of social and self-stigma
for the two setting labels (mental health clinic vs. coun-
seling center) were compared, with attitudes and gender-
role conflict also entered as independent variables. Last,
in the third set of ANOVAs, perceived levels of social and
self-stigma for the two treatment labels (problem vs. feel-
ing-focus) were compared, with attitudes and gender-role
conflict also entered as independent variables. This
allowed for the testing of whether there was an overall
difference depending on the label that was used (label
main effects) as well as whether there was a difference
between the labels depending on the level of preexisting
attitudes and gender-role conflict (label by attitudes and
label by gender-role conflict interactions). Given that the
effects for both social and self-stigma were tested, a
Bonferonni-corrected alpha of .025 was adopted for each
set of tests.
Results
The average age of participants in this study was 25.97
years (SD = 8.50), ranging from 18 to 60 years. The sam-
ple was primarily single (78.2%) and identified as
Caucasian (64.8%), with 9.1% of participants self-identi-
fying as Asian American, 6.1% American Indian/Alaska
Native, 4.8% African American, 10.3% Asian American,
4.8% Hispanic/Latino, 4.8% bi-multiracial, and 3.0%
other. Significant differences between Caucasian and
racial/ethnic minority participants were not observed for
any of the main outcome and predictor variables included
in this study (membership in the different conditions,
self-stigma, social stigma, and attitudes), except for male
gender-role conflict, t(148) = 2.20, p < .05, with racial/
186 American Journal of Men’s Health 10(3)

Table 1. Means and Standard Deviations for the Different Label Conditions.

Provider Setting Treatment focus

Variable Psychologist Counselor MHC CC Problems Feelings

Self-stigma
N 84 81 87 78 73 92
M 26.18 26.11 26.16 26.13 25.75 26.46
SD 6.93 7.47 7.76 6.52 7.63 6.82
t(163) = 0.06 t(163) = 0.03 t(163) = 0.62
Social stigma
N 83 81 86 78 73 91
M 14.28 13.88 14.23 13.91 14.03 14.12
SD 4.28 4.27 4.43 4.11 4.41 4.18
t(162) = 0.60 t(162) = 0.48 t(162) = 0.14

Note. CC = counseling center; MHC = mental health clinic.

Table 2. Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Provider Labels.

F value p value Partial η2

Self-stigma
Provider main effect 0.03 .87 .00
Attitudes main effect 43.37 <.001 .24
GRC main effect 5.45 <.025 .04
Provider × attitudes interaction 0.23 .63 .00
Provider × GRC interaction 0.19 .66 .00
Social stigma
Provider main effect 0.33 .57 .00
Attitudes main effect 21.43 <.001 .13
GRC main effect 2.30 .13 .02
Provider × attitudes interaction 0.06 .80 .00
Provider × GRC interaction 0.56 .46 .00

Note. ANOVA = analysis of variance; GRC = gender-role conflict.

ethnic minority participants reporting greater experiences
of gender-role conflict compared with Caucasian partici-
pants. Only 11% of participants were psychology majors,
30.9% of the sample had never taken a psychology
course, and 92.1% had taken less than five.
Means and standard deviations for social and self-
stigma for the provider label, setting label, and treatment
label conditions are reported in Table 1. Independent-
samples t tests were first conducted to compare levels of
social and self-stigma between types of provider, setting,
and treatment labels (results also reported in Table 1). In
summary, significant differences in perceived levels of
social and self-stigma between the label conditions were
not present.
Although significant differences between the label
conditions were not indicated based on the results from
the independent samples t-tests, it is possible that the
influence of the labels on social and self-stigma depend
on the level of participants’ preexisting attitudes toward
mental health treatments and experience of gender-role
conflict. Results of the 2 × 2 × 2 ANOVAs for both social
and self-stigma are reported in Tables 2, 3, and 4. Similar
to the results from the independent samples t-tests, none
of the label main effects were significant for either social
or self-stigma. Additionally, none of the interactions
between the labels and attitudes or labels and gender-role
conflict were significant for either perceptions of social
or self-stigma.
Based on the findings from the ANOVAs indicating
that participants with high and low attitudes and high and
low gender-role conflict often differed in levels of social
and self-stigma, a follow-up post hoc analysis was con-
ducted to further examine the relationship between these
variables. Previous research has identified stigma (Nam
et al., 2013; Vogel et al., 2007) and gender-role conflict
(Blazina & Marks, 2001; Good & Wood, 1995; Pederson
& Vogel, 2007; Robertson & Fitzgerald, 1992; Rochlen &
O’Brien, 2002) as significant predictors of attitudes
Wahto and Swift 187

Table 3. Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Setting Labels.

F value p value Partial η2

Self-stigma
Setting main effect 1.65 .20 .01
Attitudes main effect 45.76 <.001 .25
GRC main effect 4.86 .03 .03
Setting × attitudes interaction 3.08 .08 .02
Setting × GRC interaction 0.33 .57 .00
Social stigma
Setting main effect 2.01 .16 .01
Attitudes main effect 22.38 <.001 .14
GRC main effect 2.02 .16 .01
Setting × attitudes interaction 0.26 .61 .00
Setting × GRC interaction 0.66 .42 .01

Note. ANOVA, analysis of variance; GRC = gender-role conflict.

Table 4. Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Treatment Labels.

F value p value Partial η2

Self-stigma
Treatment main effect 0.01 .94 .00
Attitudes main effect 41.59 <.001 .23
GRC main effect 5.59 <.025 .04
Treatment × attitudes interaction 0.00 .99 .00
Treatment × GRC interaction 0.01 .93 .00
Social stigma
Treatment main effect 0.13 .72 .00
Attitudes main effect 21.40 <.001 .13
GRC main effect 1.98 .16 .01
Treatment × attitudes interaction 0.34 .56 .00
Treatment × GRC interaction 0.84 .36 .01

Note. ANOVA, analysis of variance; GRC = gender-role conflict.

toward mental health interventions in men; however, the
existing research has primarily examined the relationship
between these two predictors and attitudes separately.
Thus, the purpose of this post hoc analysis was to exam-
ine the relative contributions of self-stigma, social stigma,
and gender-role conflict when combined in a single
model to predict attitudes in men. Given that none of the
label main effects or their interactions with attitudes and
gender-role conflict were significant, participants were
collapsed across all of the label groups for these post
hoc analyses. Correlations for these variables are
reported in Table 5. A regression analysis indicated that
for our male participants, variance in help-seeking atti-
tudes was significantly predicted by the included vari-
ables, R = .77, F(3,145) = 68.38, p < .001. Results from
this regression analysis are also reported in Table 5.
Specifically, 59% of the variance in attitudes toward psy-
chological help seeking was explained by the model.
Each of the three variables were significant unique pre-
dictors of help-seeking attitudes, with self-stigma
uniquely explaining approximately 11%, gender-role
conflict uniquely explaining approximately 10%, and
social stigma uniquely explaining approximately 5% of
the variance in participants’ attitudes toward seeking psy-
chological help. These results indicate that as men’s
experiences of gender-role conflict, social stigma, and
self-stigma increase, they experience more negative atti-
tudes toward seeking psychological help.
Discussion
The purpose of this study was to examine whether the
labels of psychologist compared with counselor, mental
health clinic compared with counseling center, and
problem-focus compared with emotion-focus would be
perceived as less stigmatizing (social and self) by men.
188
Table 5. Regression Results Predicting Help-Seeking Attitudes From Social Stigma, Self-Stigma, and Gender-Role Conflict.
Attitudes Social stigma Self-stigma
Social stigma −0.53*
Self-stigma −0.64* 0.44*
Gender-role conflict −0.59* 0.32*
M 54.17 14.12
SD 15.68 4.33
*p < .001.
Contrary to our hypotheses, the perceived social and
self-stigma did not differ significantly depending on
which label was used. Furthermore, the lack of differ-
ence between the labels was consistent for male partici-
pants who held both positive and negative preexisting
attitudes toward seeking professional psychological
help and those with differing levels of gender-role con-
flict. Given the research that suggests that some men
may avoid psychological help seeking because it is seen
as a stigmatizing activity that is not associated with tra-
ditional concepts of masculinity (Courtenay, 2000;
Johnson et al., 2012; Möller-Leimkühler, 2002; O’Brien
et al., 2005; Oliffe & Phillips, 2008), the results of our
study suggest that the various labels that we used did not
alter that perception.
Although contrary to our original hypotheses, our
results actually match the results of some other studies
that have tested whether label changes would result in
more positive help-seeking attitudes in men. McKelley
and Rochlen (2010) reported no difference in attitudes
toward seeking psychological help depending on whether
the provider was called an executive coach or a psycholo-
gist. The results from the current study do differ from
studies that have reported attitude differences toward
various treatment options (Blazina & Marks, 2001;
Robertson & Fitzgerald, 1992) in men. Additionally, our
results differ from studies that have tested full brochures
that have been designed to be more male-friendly
(Hammer & Vogel, 2010; Rochlen et al., 2006). Perhaps,
simply changing one or two labels (e.g., psychologist vs.
counselor vs. executive coach) is not enough to change
attitudes toward psychological interventions and the per-
ception of stigma in college-educated men. It is possible
that the studies that did identify differences did so because
they used multiple labels, terms, and wording changes in
their description of psychological services that could be
considered consistent with male gender norms.
Although not the original focus of this study, social
stigma, self-stigma, and gender-role conflict significantly
predicted men’s attitudes toward seeking psychological
American Journal of Men’s Health 10(3)
GRC b B sr2unique
−0.88* −0.24 .05
−0.83* −0.39 .11
0.39* −0.25* −0.36 .10
Intercept = 115.97
26.10 112.05
7.40 22.45
R = .77*
R2 = .59
help. Taken together, these variables predicted 59% of the
variance in men’s help-seeking attitudes and each predic-
tor explained a significant amount of unique variance in
attitudes. These results match previous research that has
separately reported that stigma (Nam et al., 2013; Vogel
et al., 2007) and gender-role conflict (Blazina & Marks,
2001; Good & Wood, 1995; Pederson & Vogel, 2007;
Robertson & Fitzgerald, 1992; Rochlen & O’Brien, 2002)
predict psychological help–seeking attitudes. The signifi-
cant relationship between gender-role conflict and atti-
tudes in particular also supports the literature indicating
that one of the reasons why men do not seek psychologi-
cal help is because for some men doing so does not fit
with beliefs about masculinity and male appropriate
behaviors (Courtenay, 2000; Johnson et al., 2012; Möller-
Leimkühler, 2002; O’Brien et al., 2005; Oliffe & Phillips,
2008) These results suggest that efforts to improve atti-
tudes in college men should address both social and self-
stigma as well as gender-role conflict.
Limitations
A number of limitations with this study should be consid-
ered. First, this study’s sample was composed of pre-
dominantly well-educated Caucasian men. Highly
educated Caucasian men may be more familiar with
mental health services, particularly those who have taken
psychology courses in college. As a result of familiarity,
our sample may have not identified the labels of “coun-
selor,” “counseling center,” and “talking about feelings”
as stigmatizing as a more diverse, less-educated group
of men who have had less exposure to these topics
(Addis & Mahalik, 2003; Gary, 2005; Good, Thomson,
& Braithwaite, 2005; Shim, Compton, Rust, Druss, &
Kaslow, 2009). Stigmatizing beliefs about mental health
problems have been identified as a significant barrier to
the utilization of mental health care for all populations;
however, this is noted to be particularly true when con-
sidering minority populations (Schraufnagel, Wagner,
Miranda, & Roy-Byrne, 2006). Racial/ethnic minority
Wahto and Swift
men who experience mental health problems may face
stigma and discrimination at multiple levels due their
experience of a mental illness, their race/ethnicity, and
the possibility of seeking help as a male. Thus, additional
research on mental health labels with a sample of racial/
ethnic minority men would be useful. Second, partici-
pants in this study were only asked to consider the labels
based on the possibility of seeking mental health help.
Although our participants indicated that the labels did not
influence the level of perceived stigma, it is not known if
the labels would have an influence on actual help-seeking
behavior. Third, there were only a few treatment labels
used for comparison in this study. Using more labels in a
study similar to this one may clarify whether it is the
labels used in this study, or labels in general, that do not
have an impact on men’s attitudes and intentions to seek
help. Along the same lines, the labels that were used in
this study may have been too similar for men to perceive
a difference in stigma. Although counseling center, coun-
selor, and seeking help with feelings were hypothesized
to be less consistent with male social norms, men may
actually see these terms as similar to psychologist, mental
health clinic, and seeking help with problems. Future
studies may want to use terms that are more distinct, such
as mental health consultant for the provider and doctor’s
office for the setting.
Conclusions and Future Directions
Even though this study failed to identify significant dif-
ferences between label conditions, some clinical implica-
tions may be present. Based on the null results from this
study, referrers, providers, and directors of agencies may
not have to worry too much about the specific labels that
they use when referring a Caucasian college-aged male
patient to a mental health specialist—it may not make a
difference if a general practitioner refers to the provider
as a psychologist or counselor. Also, those who run a col-
lege clinic may not need to worry too much about calling
the clinic a counseling center or a mental health clinic.
However, these suggestions should be taken with caution
given that they are based on null findings and given the
limitations of the study.
In addition to addressing some of the limitations with
this study, a number of future directions for this area of
research exist. This study did indicate that perceptions
of social and self-stigma and the experience of gender-
role conflict significantly predicted men’s attitudes
toward psychological help seeking. However, the labels
that were tested did not result in less perceived stigma.
Future research is needed to test other possible ways for
addressing the gender-role conflict and stigma that is
associated with help seeking for mental health problems
for many men. This may include going beyond simply
189
changing the labels of treatments and providing men
with more complete education about the actual nature of
many psychological interventions using male-friendly
terms. This education can focus on describing how ask-
ing for mental health help is a sign of confidence,
strength, and courage (characteristics that fit with male
gender-role norms), rather than weakness or vulnerabil-
ity. Additionally, efforts to raise awareness about the
number of men who experience mental health problems
and/or seek professional help for these types of issues
may have positive results. Also, further research testing
whether other activities that are more congruent with
male gender-roles (e.g., sports, hands-on service activi-
ties, social activities/groups focused on topics of inter-
est to men) can effectively be used as interventions for
psychological disorders. Overall, more research is
needed to gain a better understanding of the difficulty
some men experience asking for psychological help.
This research fits with a “dynamic approach” for under-
standing help seeking in men (Wegner, 2011), and could
result in greater service utilization by men when there is
a need, which in turn could result in healthier men who
can better contribute to the well-being of their families
and communities.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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