Journal of Community Psychology Volume 20, January l Y Y 2

Where Do You Turn for Help? A Community Survey of the Use of Professionals, Reading Materials, and Group Programs for Three Problems in Living

John R. Walker

Nady A. el-Guebaly Department of Psychiatry, University of Calgary

Colin A. Ross Department of Psychiatry, University of Manitoba

Raymond F. Currie Department of Sociology, University of Manitoba

This paper reports the results of a community survey on the use of profes- sional help, reading materials, and group programs for three common prob- lems in living: coping with stress and anxiety, dealing with problems in child- rearing, and coping with problems with alcohol or drugs. Respondents were 581 residents of a city in the Canadian midwest. Reading material was the most commonly used source of help for child-rearing and stress and anxiety problems, followed by professional help and group programs. The three sources of help were used with approximately equal frequency for alcohol and drug problems. The results suggest that the self-help reading materials and group programs have a high degree of public acceptance and that the optimal utilization of these services should be studied in more depth.

Department of Psychiatry, University of Manitoba

The majority of persons with significant mental health problems are not receiving services from the mental health sector. This continues to be the case even though the availability of specialist mental health services is increasing and use of such professional services was found to have almost doubled between surveys in 1957 and 1976 (Veroff, Kulka, & Douvan, 1981). Persons with mental health problems tend to make increased use of general health services (Shapiro et al., 1984). Many, however, seek help from other sources such as family and friends, clergy, traditional healers, and self-help groups. Although there have been many studies of the utilization of the formal health system, there has been surprisingly little research on these informal, nonprofessional sources of help (Horowitz, 1987).

The research on help seeking has also given little consideration to two recent developments. First, there is a wider availability of self-help reading materials designed to help people deal with common problems in living. Starker (1986) surveyed self-help consumers, psychologists, psychiatrists, and internists in one region of the United States

This study was supported in part by a grant from the R. Hurd Fund, University of Manitoba. The authors would like to thank Robert McIlwraith, Gloria Eldridge, and Tim Aubry for their comments on an earlier draft of this paper. Correspondence concerning this paper should be addressed to John R. Walker, M4 - St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba, CANADA R2H 2A6.

84

COMMUNITY SURVEY 85

and found highly positive attitudes concerning self-help books among all four groups. Second, there is more and more reliance on groups for the delivery of programs designed to help people with common life problems. Reading materials and group programs may be delivered in self-help, educational, or health care settings. Although self-help reading materials and group programs for common life problems have only been evaluated to a limited degree, many of the initial studies are encouraging (e.g., Black & Threlfall, 1986; Ghosh & Marks, 1987; Marmar et al., 1988).

The focus of this study was to establish the extent to which individuals in the com- munity use reading materials and group programs for three common problems in liv- ing. In order to aid in relating the results of this study to existing research, a question was also included on the use of professional help.

Method The data reported here were collected as part of the 1987 Winnipeg Area Study,

an annual community survey carried out since 1981. Winnipeg is a city of 625,000 in- habitants located in the Canadian midwest. The random household sampling procedure and the dependent measures are described in detail in a previous paper (el-Guebaly, Walker, Ross, & Currie, 1990).

The survey contained demographic questions used annually. Information was ob- tained about the highest level of education completed, and a rank was assigned on a 1 to 15 scale with anchor points such as 1 - no schooling, 7 - complete high school, 9 - complete technical or nursing school, and 12 - complete bachelor’s degree. The Brad- burn Affect Balance Scale was used as a measure of positive and negative aspects of current psychological well-being (Bradburn, 1969). The Positive Affect and Negative Affect components are designed to be considered separately (changes in one are not necessarily accompanied by changes in the other) and each has a range of possible scores from 5 (lowest level) to 15 (highest level).

Two questions were used to establish frequency of alcohol consumption and heavy alcohol consumption (five or more drinks) over the previous 12 months. Nine alternatives were used to rank frequency of heavy alcohol consumption, for example, every day (9), 2-3 times per month (9, and never (1). The four items of the CAGE questionnaire (Bush, Shaw, Cleary, Delbanco, & Aronson, 1987) were used to establish the degree to which the respondent considered drinking to be a problem at some time. The score ranges from 0 to 4 with higher scores indicating greater difficulty. Detailed findings of the items on alcohol use and parental alcohol problems are described in an earlier paper (el-Guebaly et al., 1990).

Questions on the use of sources of help appeared in the interview once it was iden- tified that a particular situation was relevant to a respondent. For example, all respondents were asked: “Have you ever used the following kinds of help in coping with stress and anxiety? . . . Seen a professional person such as a doctor, a counselor, or a minister to discuss problems with stress and anxiety? . . . Tried an approach to cope with stress and anxiety based on something that you read? . . . Attended a group program for help in coping with stress and anxiety?” Respondents who had natural or adopted children were asked the same series of questions about “help in dealing with problems with child- rearing.” Respondents were asked a parallel question about use of help for alcohol or drug problems if they indicated that they had problems with alcohol at some time, prob- lems with prescribed or nonprescribed drugs for at least 2 weeks, or that one of their parents had an alcohol or drug problem for at least 2 weeks. The question began with the words: “Have you ever used the following kinds of help in coping with a problem

86 WALKER, EL-GUEBALY, ROSS, AND CURRIE

with alcohol or drugs? This may be for a parent’s problems, the effect of a parent’s prob- lem on you, or for your own problems.”

Results Table 1 indicates the proportion of males, females, and the combined sample report-

ing the use of help in each of the three areas. The most common source of help with stress and anxiety and with child-rearing was reading material, followed by professional help and group programs. This relationship was maintained for both male and female respondents. The pattern was different in the case of alcohol and drug problems, with the proportion reporting the use of reading material being much lower (17%) and the proportions using each source of help being much closer. A number of respondents used more than one source of help for a particular problem-20% of respondents for help with stress and anxiety, 21% for help with child-rearing, and 11% for help with alcohol or drugs.

Table 1 Proportion of Respondents Utilizing Help in Three Common Problem Areas by Gender

Type of help Male Female Overall

N N V O ) N (VO)

Stress and anxiety Number of respondents

Professional Reading

Group Any method*

Child-rearing

Number of respondents Professional

Reading

Group Any method*

Alcohol/Drug Number of respondents

Professional Reading

Group Any method*

257

45 (18)

76 (30)

23 ( 9) 101 (39)

141

20 (14)

45 (32)

14 (10)

53 (38)

101

14 (14)

1 1 (11)

13 (13)

26 (26)

322

107

135 36

177

224

63

107

28

124

102

22

24

16

40

579

152 (26)

211 (36)

59 (10)

278 (48)

365

83 (23)

152 (42)

42 (12)

177 (48)

203

36 (18)

35 (17)

29 (14)

66 (33)

*Number of respondents using any of the three types of help. Note that respondents often used more than one type of help.

Considering the proportion who used any method of help, significantly more females than males used help for stress and anxiety (x2 = 14.56, p < .001), child-rearing (x2 = 11.04, p < .001), and alcohol and drug problems (x2 = 4.20, p < .04).

Multivariate analysis of covariance (MANCOVA) was used to investigate the rela- tionship between use of specific types of help for each of the problems and the major

COMMUNITY SURVEY 87

continuous dependent variables. For each of these analyses, the grouping variables were gender and use of the specific source of help. Age was used as a covariate because it was systematically related to many of the other variables. In order to conserve space, the results of the multivariate and associated univariate analyses are summarized in Table 2. Univariate ANCOVAs are reported on the component variables only when there was a statistically significant overall multivariate F ratio for source of help. The results in- dicate that, as expected, age and gender were significantly related to the group of depen- dent variables considered in the analysis. The multivariate analyses also indicated a sig- nificant relationship between this group of variables and the use of each source of help except for professional help for problems in child-rearing and alcohol and drug problems. The results of the univariate analyses are discussed below for each of the person variables considered.

Table 2 Multivariate Analysis of Variance F Ratios with Type of Help by Gender as Grouping Variables and Age as a Covariate

Multivariate F ratios Related univariate F ratios

Source Source Education Positive Negative Heavy Type of help of help Gender Age x gender level affect affect CAGE drinking

Stress & anxiety Professional Reading Group

Child-rearing Professional Reading Group

Alcohol/Drug Professional Reading Group

2.51'

1 1 .5ga 6.42'

n.s. 6.04'

3.58'

n s . 3.29'

3.76b

7.70'

10.81'

2.74a

4.47c 8.58'

5.14'

4.36' 4.73'

2.61a

18.93' 18.19'

17.93'

5.74' 5.98'

6.47'

4.81' 5.08' 4.89'

n.s. n.s. n.s.

n.s. n.s. n.s.

n.s. n s . n.s.

n s . 49.10'

n.s.

-

28.57' 14.46'

- 9.95"

n.s.

n.s. n.s.

6.70"

-

n.s. n.s.

- n.s. n.s.

4.64"

n.s.

8.23"

-

n.s.

n.s.

-

n.s.

n.s.

n.s. n.s. n.s. n.s. 5.29" 4.88"

- -

n.s. n.s. n.s. n.s.

n.s. n.s. 15.57a n.s.

'p < .05; "p < .01; ' p < .001.

Educational Level Respondents who reported turning to reading materials for help with all three prob-

lems were the more highly educated members of the sample. Higher education was also related to increased use of group programs for help with problems in child-rearing. Those who used reading materials typically had completed either technical level or some univer- sity education, while those who did not usually did not have education beyond the high school level. A similar pattern was seen in respondents who used group programs for help with child-rearing problems.

Positive Aflect

In general, current positive affect was not related to history of help seeking for these three problems. An exception was the use of group help for problems with stress and

88 WALKER, EL-GUEBALY, ROSS, AND CURRIE

anxiety. Respondents who had used group help had a lower level of current positive affect (covariate adjusted means - 9.00 for males, 9.16 for females) than those who had not (adjusted means-9.75 for males, 9.67 for females).

Negative Afect Current negative affect was significantly related to the use of professional and group

help for problems with stress and anxiety. Respondents who had used professional help had lower levels of negative affect (adjusted means-10.92 for males and 11.20 for females) than those who had not (11.30 for males and 11.59 for females). Similarly, those who used group help had lower levels of negative affect (adjusted means- 10.42 for males, 10.95 for females) than those who had not (1 1.32 for males, 11.5 for females).

CAGE Those who participated in group programs for stress and anxiety had higher CAGE

scores (adjusted mean-0.96 for males, 0.52 for females) than those who had not (0.65 for males, 0.27 for females). Similarly, respondents who had participated in group pro- grams for alcohol or drug problems generally had higher CAGE scores (adjusted means - 2.08 for males, 1.33 for females) than those who had not (1.18 for males, 0.58 for females).

Heavy Drinking Respondents who had participated in group programs for stress and anxiety reported

a lower frequency of heavy drinking (adjusted mean ranks-2.78 for males, 2.70 for females) than those who had not (3.87 for males, 2.87 for females). Surprisingly, reports of current heavy drinking were not related to use of any of the three types of help for problems with alcohol and drugs in this analysis.

Discussion To our knowledge, this is the first community survey of the use of reading materials

and group programs for common problems in living. The results indicate that reading materials and group programs are frequently used sources of help for the mental health problems considered. The proportion of respondents who reported using professional help is quite consistent with that found in other community surveys. Veroff et al. (1981), for example, found that 14% of respondents in 1957 and 26% in 1976 used professional help in dealing with a range of problems.

The frequency of use of a particular source of help may be related to a variety of factors such as the availability of the help, the amount of time necessary to use the help, the degree of personal commitment and self-disclosure required, and a particular com- munity or group’s norms about appropriate sources of help.

Reading materials were used more commonly than other sources of help for prob- lems with stress and anxiety and with child-rearing. Reading material is readily available from magazines, newspapers, and self-help books and in some cases is used by providers of professional services or by self-help groups. Although group programs are not used as often as the other sources of help, they are used by a surprisingly high proportion of those surveyed-at least 10% in most areas. This is even more impressive when one considers that attending a group often requires considerably more time commitment and self-disclosure than reading about a problem area or speaking to a professional.

The relationships between these sources of help and various demographic variables are quite consistent with findings in other studies of help seeking. As in other studies,

COMMUNITY SURVEY 89

women were consistently found to seek help more often than men. Respondents who used reading materials for any of the three problems had a higher average level of educa- tion. Persons with a higher level of education were also more likely to use group help for problems in child-rearing.

The limited number of questions included in this survey did not allow an evalua- tion of the specific characteristics of each source of help, the extent to which they were used, and the degree to which they were seen as helpful. The results suggest that there is a reasonable degree of public acceptance of each of these approaches. Given the in- creasing availability of reading materials and group programs, this is clearly an area that warrants further study. Each of these areas is potentially important in increasing the availability and effectiveness of support for a variety of problems, particularly when used in a self-help context.

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