613103

research-article2015
CJBXXX10.1177/0093854815613103Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICESCRIMINAL JUSTICE AND BEHAVIOR

Stigma, Pluralistic Ignorance, and

Attitudes Toward Seeking Mental
Health Services Among Police Officers

Kerry M. Karaffa
Julie M. Koch
Oklahoma State University

Due to stressors in the police profession, officers may be at risk for a variety of personal and mental health–related concerns.
However, they have historically refrained from seeking professional mental health services. Several factors have been identi-
fied to explain their hesitance, including stigma regarding mental health issues. In this study, 248 police officers completed
a 62-item online survey related to their attitudes toward seeking mental health services, mental health stigma, and perceptions
of other officers’ willingness to seek services. The results indicate that public stigma and self-stigma were negatively corre-
lated with attitudes toward seeking psychological help. Self-stigma fully mediated the relationship between public stigma and
attitudes toward seeking help, and the model explained 56% of the variance in attitude scores. The results also suggest that
police officers tended to believe that their peers were less willing to seek mental health services for several common present-
ing issues than they actually were.

Keywords: police; law enforcement; stigma; mental health; pluralistic ignorance

P olice work is regarded as one of the most stressful occupations (Finn & Tomz, 1997;
Liberman et al., 2002). Officers are routinely exposed to violence, human suffering, and
tragedy, and they must confront dangerous situations on a regular basis (Bartol & Bartol,
2008; Bonifacio, 1991; Kirschman, Kamena, & Fay, 2013; Miller, 1995; Toch, 2002).
Widely recognized organizational stressors involved in police work include unconventional
shifts, excessive paperwork, and poor administrative support (Finn & Tomz, 1997; Stratton,
1984; Toch, 2002). Unique task-related stressors include responding to use of force encoun-
ters, exercising discretion in ambiguous situations, and role ambiguity (Finn & Tomz, 1997;
Kirschman et al., 2013). Furthermore, skewed presentations of the police in the media tend
to encourage public hostility and alienate officers from the public (Blum, 2002).

Mental Health Issues

Police officers generally develop effective coping mechanisms to adapt to the psycho-
logical stressors they experience at work. However, sometimes the accumulation of stress

AUTHORS’ Note: Correspondence concerning this article should be addressed to Kerry M. Karaffa, School
of Applied Health and Educational Psychology, Oklahoma State University, 434 Willard Hall, Stillwater, OK
74078 Email: [email protected].
CRIMINAL JUSTICE AND BEHAVIOR, 201X, Vol. XX, No. X, Month 2015, 1­–19.
DOI: 10.1177/0093854815613103
© 2015 International Association for Correctional and Forensic Psychology

1
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2 Criminal Justice and Behavior

can overwhelm even the most resilient officers (Miller, 1995; Shearer, 1993). Researchers
have found relatively high prevalence rates of depression in police samples (Lawson,
Rodwell, & Noblet, 2012), and officers are also especially prone to developing posttrau-
matic stress disorder (PTSD), because they are exposed to so many instances of violence,
many of which threaten their immediate safety (Darensburg et al., 2006; Kates, 2008).
Some evidence suggests that police officers have historically used alcohol as a means of
self-medicating after exposure to traumatic events, to numb depressive feelings, or to help
them relax or sleep (Bonifacio, 1991; Kirschman, 2007; Kirschman et al., 2013), and Swatt,
Gibson, and Piquero (2007) found that higher levels of anxiety and depression were associ-
ated with higher levels of problematic drinking among officers. Furthermore, officers may
not get to spend much time with their families (Borum & Philpot, 1993; Kirschman, 2007;
Kirschman et al., 2013), and work–family conflict has also been shown to negatively cor-
relate with measures of psychological health (Mikkelsen & Burke, 2004).
Job-related stress may also produce physiological effects. For example, officers may
experience gastrointestinal problems as a result of the body’s suppression of the digestive
process during the “fight or flight” response. They may be more likely to develop illnesses,
due to deficiencies in their immune system from chronic stress (Blum, 2000), and they are
also particularly susceptible to sleep disorders (Rajaratnam et al., 2011; Vila, 2009). Police
stressors and their physical and psychological consequences ultimately harm the police
organization (More, 1998) through reduced efficiency, greater absenteeism, and excessive
aggressiveness among officers (Finn, Talucci, & Wood, 2000). When officers become
burned out, they demonstrate little commitment to their work tasks or toward their col-
leagues (More, 1998), and job stress has been associated with lower levels of performance
(Chen, 2009; Shane, 2010).
Despite these issues, police officers have generally refrained from asking for help
(Violanti, 1995) or pursuing professional mental health interventions (Blau, 1994;
Kirschman et al., 2013). Greenstone (2000) noted that officers may not use mental health
services, even when they are available. Several factors have been identified to explain hesi-
tance among police officers toward seeking help, including ethos of autonomy and emo-
tional control (Blum, 2000; Kappeler, Sluder, & Alpert, 1998; Kirschman et al., 2013;
Kureczka, 1996; Stratton, 1984), lack of confidence in mental health providers (Blau, 1994),
and concerns regarding cost and accessibility of services (Karaffa & Tochkov, 2013; Meyer,
2000). Officers may also refrain from seeking services because of stigma within the police
agency (Blum, 2000; Fair, 2009).

Mental Health Stigma

Stigma is one of the reasons that people who might benefit from receiving mental health
services do not use them (Corrigan, Druss, & Perlick, 2014). They may seek to avoid the label
of mental illness that sometimes results from seeking services, because of its impact on their
sense of identity (Corrigan, 2004; Kushner & Sher, 1989). Corrigan (2004) distinguished
between two kinds of stigma: public stigma and self-stigma. Both forms have been found to
be negatively associated with attitudes toward seeking psychological help (Conner et al.,
2010; Hackler, Vogel, & Wade, 2010; Komiya, Good, & Sherrod, 2000; Nam & Choi, 2013).
Public stigma refers to awareness of how the general public reacts to individuals with
mental health concerns (Corrigan & Watson, 2002). In a study of more than 12,000 partici-
pants from the United States and Canada, Jagdeo, Cox, Stein, and Sareen (2009) found that
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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 3

almost 50% of respondents indicated that they would be embarrassed if their friends knew
about their use of mental health services. Self-stigma refers to an individual’s perception
that his or her own behaviors or attitudes are not socially acceptable (Corrigan, 2004). Self-
stigma requires stereotype agreement, which involves accepting stereotypes that seem to be
endorsed by the public. Individuals then have to believe that these public beliefs personally
apply to them (Corrigan, Watson, & Barr, 2006). Evidence suggests that public stigma may
be internalized as self-stigma. For example, several researchers have found that self-stigma
mediates the relationship between public stigma and attitudes toward seeking services (e.g.,
Bathje & Pryor, 2011; Vogel, Shechtman, & Wade, 2010; Vogel, Wade, & Hackler, 2007),
and Vogel, Bitman, Hammer, and Wade (2013) concluded that self-stigma develops from
public stigma.
Stigma may keep police officers from discussing things that are distressing to them,
because officers do not want to seem as if they cannot handle their jobs or be relied upon for
backup (e.g., Blum, 2000; Fair, 2009; Kureczka, 1996; Miller, 1995). Kirschman (2007)
noted that officers are warned throughout their training that losing control of their emotions
could jeopardize their career. Officers may agree that there is a legitimate need for psycho-
logical services, but they are also cognizant of stigma and the potential professional impli-
cations of seeking treatment (Toch, 2002). Officers may also underestimate their colleagues’
personal willingness to seek mental health services, thus demonstrating pluralistic igno-
rance (Karaffa & Tochkov, 2013).

Pluralistic Ignorance
Pluralistic ignorance describes a phenomenon in which individuals in a group privately
reject a belief, feeling, or behavior, yet they believe that other group members privately
accept it (Prentice & Miller, 1996). Researchers have found pluralistic ignorance in numer-
ous areas including drinking behaviors (Prentice & Miller, 1993; Segrist, Corcoran, Jordan-
Fleming, & Rose, 2007), sexual behaviors (Reiber & Garcia, 2010), body image (Park, Yun,
McSweeney, & Gunther, 2007), and ethics (Halbesleben, Buckley, & Sauer, 2004), among
others. Prentice and Miller (1996) hypothesized that group identification is the primary
cause of pluralistic ignorance in many situations. Group members may act in accordance
with group norms so that others accept them. However, they may then interpret others’ simi-
larly motivated behaviors as a reflection of their internal beliefs. Essentially, pluralistic
ignorance may occur because people have difficulty recognizing how others’ norm-congru-
ent behaviors are motivated by their desire to belong to the group.
The occurrence of pluralistic ignorance within a group could have several effects.
Individuals may feel a sense of inferiority or shame if they mistakenly believe that their
internal attitudes are different from those of the majority (Miller & Morrison, 2009).
Pluralistic ignorance also increases the likelihood that members will not share their true
opinions within the group (Halbesleben, Wheeler, & Buckley, 2007), so it may preserve the
status quo in instances in which group members no longer support certain attitudes or val-
ues (Miller & Morrison, 2009). Last, group members experiencing pluralistic ignorance
may also change their attitudes or behaviors to be more in line with their perceptions of the
group norm (Halbesleben et al., 2007).
Strong identification with other officers is an important element in the police culture
(Kirschman et al., 2013; Murray, 2005), and Kirschman et al. (2013) indicated that one of the
most common fears among police officers is thinking that they are the only ones experiencing
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4 Criminal Justice and Behavior

unfavorable internal reactions to stress. Miller and Morrison (2009) suggested that indi-
viduals in highly cohesive groups are most susceptible to pluralistic ignorance. Therefore,
police officers may incorrectly believe that their personal attitudes toward seeking services
are unique, when their colleagues’ attitudes are actually quite similar to their own. In a study
of police officers’ attitudes toward seeking professional mental health treatment, Karaffa
and Tochkov (2013) found that officers tended to perceive their colleagues’ willingness to
seek mental health services as lower than they actually were. Furthermore, Millar (2002)
found that some officers who had participated in a police counseling program chose not to
disclose their participation to their colleagues, because they were fearful of criticism from
others. However, the majority of officers who participated and shared their reasons for
counseling with colleagues received support for their decisions. This finding provides fur-
ther support for the notion that officers may misperceive their peers’ attitudes toward seek-
ing mental health services.

Purpose of the Study

To this point, researchers have not formally investigated the role of public and self-
stigma in predicting attitudes toward seeking mental health treatment among police offi-
cers, nor have they established the occurrence of pluralistic ignorance as it relates to
help-seeking attitudes for specific issues. These data are needed to develop focused inter-
ventions to reduce stigma toward seeking psychological services. The first objective of this
study was to identify the role of public stigma and self-stigma in predicting attitudes toward
seeking mental health services among police officers. The second objective of the study was
to develop a more comprehensive understanding of the pluralistic ignorance phenomenon
as it pertains to help-seeking attitudes among police officers, with regard to several com-
mon presenting concerns.
We evaluated four hypotheses in the study:

Hypothesis 1 (H1): Self-stigma will negatively correlate with attitudes toward seeking mental
health services among police officers.
Hypothesis 2 (H2): Public stigma will negatively correlate with attitudes toward seeking mental
health services among police officers.
Hypothesis 3 (H3): Self-stigma will mediate the relationship between public stigma and attitudes
toward seeking mental health services among police officers.
Hypothesis 4 (H4): Police officers will underestimate their colleagues’ willingness to seek men-
tal health services for several presenting concerns, including (a) family issues, (b) depression, (c)
posttraumatic stress disorder, (d) substance abuse, and (e) physiological complaints.

Method
Participants

The participants in this study were 248 sworn police officers employed full-time by
municipal, county, state, and university police agencies in Texas and Oklahoma. We invited
several tribal police agencies to participate in the study, although we did not receive any
responses from administrative officers regarding the request for participation. Furthermore,
we did not recruit participants from federal or military police agencies. Participation in the
study was entirely voluntary and confidential, and participants did not receive any payment

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 5

or other benefits for participating in the study. The participants’ median age was 42 years
(range = 24-63), and their median time in law enforcement was 17 years (range = 2-42). The
majority of the respondents were male (n = 204, 82.3%) and predominantly White (n = 222,
89.5%). Most were married (n = 189, 76.2%), and approximately 68% (n = 169) had com-
pleted a college degree. Officers of various ranks were represented in the sample, but officers
of higher ranks were overrepresented in the sample. Approximately 52% (n = 129) were
sergeants, lieutenants, captains, or chiefs. The majority of the participants were employed by
municipal agencies (n = 186, 75.0%), and the sample had more officers from larger depart-
ments. Almost 37% (n = 91) reported that their agency employed more than 1,000 sworn
officers, and 24.4% (n = 62) reported that their agency employed between 100 and 499 offi-
cers. Detailed demographic characteristics of the participants are presented in Table 1.

Instruments

The participants responded to a 62-item online survey. The research survey included
items related to participants’ attitudes toward seeking mental health services, mental health
stigma, willingness to seek services, and perceptions of other officers’ willingness to seek
services. The survey also included a brief demographic questionnaire. Survey components
were presented in randomized order to reduce potential order effects. Definitions adapted
from Meyer (2000) were provided to clarify terminology used in the research survey.

Pluralistic Ignorance

Although pluralistic ignorance is a widely recognized phenomenon, there has been rela-
tively little empirical research to measure, evaluate, or clarify the construct (Flezzani &
Benshoff, 2003). Pluralistic ignorance has generally been operationalized as a difference
score between individuals’ ratings of their own attitudes or behaviors and their perceptions
of others’ attitudes or behaviors (Halbesleben et al., 2004; Prentice & Miller, 1993;
Schroeder & Prentice, 1998; Suls & Green, 2003). Validity for the construct is usually
established by clearly reporting how it will be measured (Flezzani & Benshoff, 2003). In
the current study, we operationalized pluralistic ignorance as the difference score between
officers’ self-reported willingness to seek mental health services for five presenting prob-
lems (family issues, depression, PTSD, substance abuse, and physiological complaints due
to stress) and their perceptions of other officers’ willingness to seek services for the same
concerns. We created 10 new items for the current study (see Table 2).
Participants rated their personal willingness to seek mental health services and their per-
ceptions of others’ willingness to seek services for each of the five presenting issues on an
11-point scale (0 = very unwilling, 5 = neutral, 10 = very willing). We subtracted officers’
estimations of others’ willingness to seek mental health services for each presenting prob-
lem from their personal willingness to seek services for each problem. Therefore, a differ-
ence score of 0 indicates that officers’ perceptions of others’ willingness to seek mental
services are accurate, whereas deviations from 0 in either direction indicate inaccurate per-
ceptions. Underestimations of other officers’ willingness to seek services were indicated by
positive errors for each item.
Although we were primarily interested in examining the difference scores individually
for each presenting issue, we conducted a principal components analysis with varimax rota-
tion to determine the component structure among the 10 pluralistic ignorance items

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6 Criminal Justice and Behavior

Table 1: Demographic Characteristics of Participants (N = 248)

Variable n %

Sex
Male 204 82.3
Female 39 15.7
Missing 5 2.0
Race
White 222 89.5
Black/African American 14 5.6
American Indian 14 5.6
Asian 1 0.4
Missing 4 1.6
Ethnicity
Non-Hispanic/Latino 207 83.5
Hispanic/Latino 23 9.3
Missing 4 1.6
Age (median = 42, range = 24-63)
20-29 14 5.6
30-39 66 26.4
40-49 91 36.5
50-59 61 24.4
60-69 7 2.8
Missing 9 3.6
Years of experience (median = 17, range = 2-42)
0-9 47 18.8
10-19 96 38.5
20-29 65 26.0
30-39 30 12
40-49 3 1.2
Missing 7 2.8
Number of officers in agency (median = 350, range = 3-4,500)
1-49 34 13.6
50-99 37 14.8
100-499 61 24.4
500-999 13 5.2
1,000+ 91 36.6
Missing 12 4.8
Marital status
Single 16 6.5
Married 189 76.2
Divorced 36 14.5
Separated 3 1.2
Missing 4 1.6
Education
High school 10 4.0
Some college 64 25.8
Associate’s degree 41 16.5
Bachelor’s degree 82 33.1
Some graduate school 18 7.3
Graduate degree 28 11.3
Missing 5 2.0

(continued)

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 7

Table 1: (continued)

Variable n %

Professional rank
Patrol officer 56 22.6
Detective 33 13.3
Sergeant 66 26.6
Lieutenant 33 13.3
Captain 15 6.0
Chief 15 6.0
Deputy 14 5.6
Other 11 4.4
Missing 5 2.0
Type of agency
City 186 75.0
County 43 17.3
University 7 2.8
Missing 4 1.6
Population of jurisdiction (median = 350,000, range = 25-8,000,000)
0-49,999 58 23.2
50,000-99,999 18 7.2
100,000-499,999 39 15.6
500,000-999,999 62 24.9
1,000,000+ 46 18.5
Missing 25 10.1

Table 2: Pluralistic Ignorance Items

1. I would want to seek psychological help if I were experiencing problems in my family relationships.
2. I would want to seek psychological help if I were experiencing depression.
3. I would want to seek psychological help if I were experiencing PTSD.
4. I would want to seek psychological help if I were experiencing problems with substance abuse.
5. I would want to seek psychological help if I were experiencing physical symptoms due to stress.
6.  Other officers would want to seek psychological help if they were experiencing problems in their family
relationships.
7. Other officers would want to seek psychological help if they were experiencing depression.
8. Other officers would want to seek psychological help if they were experiencing PTSD.
9.  Other officers would want to seek psychological help if they were experiencing problems with substance
abuse.
10.  Other officers would want to seek psychological help if they were experiencing physical symptoms due to
stress.

Note. PTSD = posttraumatic stress disorder.

(n = 244). The Kaiser–Meyer–Olkin statistic of 0.78 verified the sampling adequacy for the
analysis (Kaiser, 1974), and Bartlett’s test of sphericity, χ2(45) = 1,358.25, p < .001, indi-
cated that the correlations between items were sufficiently large for principal components
analysis (Field, 2009). Two components had eigenvalues greater than one and collectively
explained 65.6% of the variance. As expected, the first component included the five items
representing officers’ personal willingness to seek help (M = 38.76, SD = 10.15, α = .83),
with loadings from 0.76 to 0.86. The second component included the five items

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8 Criminal Justice and Behavior

representing officers’ perceptions of others’ willingness to seek help (M = 28.97, SD = 9.27,

α = .88), with loadings from 0.63 to 0.87.

Attitudes Toward Seeking Professional Psychological Help–Short Form (ATSPPH-SF)

The ATSPPH-SF (Fischer & Farina, 1995) is a 10-item self-report instrument developed
to assess respondents’ attitudes toward seeking professional mental health treatment. Fischer
and Farina (1995) concluded that the 10 items represent one internally consistent construct,
with internal consistency of 0.84. Using a sample of police officers, Karaffa and Tochkov
(2013) found that the internal consistency of the ATSPPH-SF was fair (α = .78). In the cur-
rent sample, the scale showed good internal consistency (α = .86).
We asked participants to respond according to the degree in which they agree with each
statement on a 4-point Likert-type scale. Items on the ATSPPH-SF are scored 0 to 3, where
a higher score indicates a more favorable attitude toward seeking professional psychologi-
cal help (0 = disagree, 1 = partly disagree, 2 = partly agree, 3 = agree). Scoring is reversed
for several items (3 = disagree, 0 = agree). Total scores on this scale can range from 0 to 30.
We replaced the term psychologist with professional mental health provider in the research
survey, as clinicians with various training backgrounds may provide mental health services
to police officers.

Military Stigma Scale (MSS)

The MSS (Skopp et al., 2012) is a 26-item self-report instrument developed to measure
stigma related to seeking mental health services. The MSS was developed using a sample
of active duty Army soldiers. Given the quasi-military nature of police work and the simi-
larities between police and military culture (Paoline, 2003), the MSS seems to be appropri-
ate for use with police officers. Some items include terminology that is common in the
police culture (e.g., “chain of command”), and they evaluate specific concerns about job
promotions (Shearer, 1993) and perceived reliability (Blum, 2000) that have been reflected
in previous police literature.
Skopp et al. (2012) concluded that the MSS consists of two factors that measure the con-
structs of public stigma and self-stigma. The 16 public stigma items focus on participants’
concerns about their public image if they were to seek mental health services, ramifications
on their career, and confidentiality concerns. Skopp et al. found strong internal consisten-
cies for the Public Stigma Scale for both the scale development sample (α = .94) and the
confirmatory sample (α = .95). In the current sample, the Public Stigma Scale showed
excellent internal consistency with an alpha of .93.
The 10 self-stigma items were closely adapted from the previously developed Self-
Stigma of Seeking Help (SSOSH) scale and focus on concerns about the loss of self-esteem
associated with seeking mental health treatment (Vogel, Wade, & Haake, 2006). Skopp
et al. (2012) found internal consistencies of α = .89 in the scale development sample and α
= .87 in the confirmatory sample. In the current sample, the Self-Stigma Scale of the MSS
also showed strong internal consistency (α = .91).
We asked participants to respond according to the degree in which they agree with each
statement on a 4-point Likert-type scale. Items on the MSS are scored 1 to 4, where a higher
score indicates greater perceptions of stigma for seeking mental health services (1 = defi-
nitely disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = definitely agree). Scoring

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 9

is reversed for several items (4 = definitely disagree, 1 = definitely agree). Total scores on
the Public Stigma Scale can range from 16 to 64, and scores on the Self-Stigma Scale can
range from 10 to 40. We modified the term military to police in one item.

Demographic Questionnaire

This questionnaire was used to obtain information from participants including their age,
sex, marital status, race, ethnicity, level of education, professional rank, years of experience
as a police officer, type of agency, the number of officers in their agency, employment sta-
tus, the approximate number of citizens in their immediate jurisdiction, and prior use of
mental health services. Before we administered the survey to participants, we asked four
experienced police officers to assess the readability and face validity of the items. The offi-
cers’ feedback was favorable; therefore, we did not make any revisions.

Procedures

We used convenience sampling to identify municipal, county, state, tribal, and university
police agencies in Texas and Oklahoma. We identified agencies by referring to law enforce-
ment employment tables compiled as part of the Federal Bureau of Investigation’s Uniform
Crime Reporting Program (U.S. Department of Justice, 2012), as well as regional maps. We
then attempted to locate contact information for each agency online. Agencies were excluded
from participating if email addresses were not provided online to contact administrative
officers in each agency. We contacted 345 agencies via email to establish whether partici-
pants could be recruited within the agency, and 28 agencies responded to the request. Of
these 28 agencies, 21 agreed to participate in the study and seven declined. Therefore,
approximately six percent of the agencies we initially contacted agreed to participate. If
consent was offered, we presented materials for the study to the administrative officers and
asked them to email the informed consent statement and electronic survey link to potential
participants. The link directed them to a password-protected Qualtrics™ account, and offi-
cers completed the research survey online. Although we asked administrators to provide
information regarding the number of sworn officers in their agency, most did not do so.
Consequently, we were unable to calculate the officer response rate among participating
agencies.

Data Analysis

Prior to conducting statistical analyses, we screened the data to ensure that the underly-
ing assumptions of each analysis were met. We describe the assumptions in greater detail
below. An alpha level of .05 was used for the analyses, unless otherwise noted. The first two
hypotheses related to whether self-stigma (H1) and public stigma (H2) would negatively
correlate with attitudes toward seeking mental health services among police officers. To
evaluate the first two hypotheses, we conducted bivariate correlation analyses to examine
these relationships. Scatterplots indicated linear relationships between the variables, and an
analysis of the histograms and Q–Q plots of the sampling distribution for each variable sug-
gested that they were normally distributed.
The third hypothesis involved the mediating relationship of self-stigma between public
stigma and attitudes toward seeking mental health services among police officers. Mediation

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10 Criminal Justice and Behavior

exists when a predictor influences a dependent variable indirectly through an intervening

variable (Preacher & Hayes, 2008). To evaluate the third hypothesis, we used multiple
regression analysis and applied the Hayes (2013) PROCESS macro in SPSS, which for-
mally tests the significance of the indirect effect nonparametrically with bootstrapping and
generates measures of effect size.
A plot of the standardized residuals and a Q–Q plot suggested that the residuals were
normally distributed, and the homoscedasticity assumption was met. However, we identi-
fied two cases with residuals greater than three standard deviations from the mean (z =
−3.01 and z = 3.41) and removed them as outliers (Warner, 2012). The Durbin–Watson test
value of 2.10 suggested that the error terms were uncorrelated (Durbin & Watson, 1951),
and there were also no issues with multicollinearity, as indicated by a variance inflation fac-
tor of 1.62 (Cohen, Cohen, West, & Aiken, 2003). We used listwise deletion to address
missing values in the regression model.
The last set of hypotheses (H4a-H4e) related to whether police officers would underesti-
mate their colleagues’ willingness to seek mental health services for several presenting
issues, thus demonstrating a pluralistic ignorance effect with regard to help-seeking atti-
tudes. We conducted five dependent-sample t tests to determine whether there were statisti-
cally significant differences between officers’ self-reported willingness to seek mental
health services and their perceptions of other officers’ willingness to seek services for the
same presenting issues. We applied an unweighted Bonferroni correction (Shaffer, 1995) to
protect the familywise Type I error rate among the set of tests and evaluated each test at an
alpha level of .01. Underestimations of other officers’ willingness to seek services were
indicated by positive errors. Histograms and Q–Q plots suggested that the sampling distri-
bution of the differences between scores was approximately normal.

Results
The results indicate that public stigma was negatively correlated with attitudes toward
seeking professional psychological help, r(221) = −.43, p < .001. In other words, participants
who endorsed greater public stigma reported more negative attitudes toward seeking profes-
sional psychological help. Self-stigma was also negatively correlated with attitude scores
r(224) = −.72, p < .001. That is, participants who endorsed greater self-stigma also reported
more negative attitudes toward seeking help. Therefore, H1 and H2 were supported.
The results of the path model with standardized coefficients are displayed in Figure 1.
Results suggest that public stigma was negatively associated with attitudes toward seek-
ing professional psychological help, B = −0.25, β = −.42, t(209) = −6.87, p < .001 (c path),
and public stigma was positively associated with self-stigma, B = 0.39, β = .62, t(209) =
11.37, p < .001 (a path). The mediator (self-stigma) was negatively associated with attitudes
toward seeking help, B = −0.72, β = −.77, t(209) = −13.29, p < .001 (b path). Because both
the a path and b path were significant, we tested the mediation effect using the bootstrap-
ping method with bias-corrected confidence estimates (Preacher & Hayes, 2008). The 95%
confidence interval (CI) of the indirect effect was obtained with 5,000 bootstrap resamples
(Preacher & Hayes, 2008). Descriptive statistics and a zero-order correlation matrix includ-
ing each variable used in the regressions are presented in Table 3.
Results of the mediation analysis confirm the mediating role of self-stigma in the rela-
tionship between public stigma and attitudes toward seeking professional psychological

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 11

Figure 1: Indirect Effect of Public Stigma on ATSPPH-SF Through Self-Stigma

Note. Standardized coefficients are shown. Model 1: F(1, 209) = 129.20, p < .001, R2 = .38. Model 2: F(2, 208) =
131.84, p < .001, R2 = .56. ATSPPH-SF = Attitudes Toward Seeking Professional Psychological Help–Short Form;
Public Stigma = Military Stigma Scale (Public Stigma); Self-Stigma = Military Stigma Scale (Self-Stigma).
***p < .001.

Table 3: Zero-Order Correlation Matrix for Regression Variables (n = 214)

Variable M SD 1 2 3

1. ATSPPH-SF 18.00 6.26 —

2. Public Stigma 39.96 10.69 −.43*** —
3. Self-Stigma 20.08 6.77 −.75*** .62*** —

Note. ATSPPH-SF = Attitudes Toward Seeking Professional Psychological Help–Short Form;

Public Stigma = Military Stigma Scale (Public Stigma); Self-Stigma = Military Stigma Scale (Self-Stigma).
***p < .001.

help, B = −0.28, β = −.48, CI = [−0.35, −0.23], Kappa-squared (κ2) = 0.45 (ab path). κ2 is
the ratio of the indirect effect relative to its maximum possible value, given the constraints
of the data (Preacher & Kelley, 2011). A κ2 value of 0.45, CI = [0.38, 0.53], suggests that the
observed unstandardized indirect effect of ab = −0.28 is 45% as large as its maximum pos-
sible value. This may be interpreted as a large effect size (Preacher & Kelley, 2011). In
addition, results indicate that the direct effect of public stigma on attitudes toward seeking
professional psychological help became nonsignificant, B = 0.03, β = .05, t(209) = 0.89,
p = .376, when controlling for self-stigma (c′ path), which suggests full mediation.
Furthermore, the overall model explained 56% of the variance in ATSPPH-SF scores, R2 =
.56, F(2, 208)= 131.84, p < .001.
As displayed in Table 4, there were statistically significant differences for each present-
ing issue, with medium to large effect sizes. Officers perceived themselves as more willing
than their colleagues to seek mental health services for family issues, depression, PTSD,
substance abuse, and physiological complaints. This demonstrates a pluralistic ignorance
effect with regard to help-seeking attitudes. Therefore, H4a to H4e were supported.
We asked participants whether they had ever voluntarily received any mental health ser-
vices, including individual counseling, family therapy, group therapy, crisis intervention, or

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12 Criminal Justice and Behavior

Table 4: Descriptive Statistics and t Test Results for Each Presenting Issue

Paired
Self Others Differences

Presenting Issue n M SD M SD M SD t df p d

Family 245 6.80 2.81 5.38 2.12 1.42 2.98 7.46 244 <.001 0.48
Depression 246 7.39 2.48 5.73 2.14 1.67 2.79 9.37 245 <.001 0.60
PTSD 245 8.48 2.46 6.42 2.28 2.06 2.77 11.64 244 <.001 0.74
Substance abuse 246 8.86 2.55 5.91 2.48 2.95 3.10 14.92 245 <.001 0.95
Physical 246 7.20 2.68 5.50 2.16 1.70 2.84 9.22 245 <.001 0.60
Combined 244 38.77 10.17 28.97 9.27 9.80 12.03 12.72 243 <.001 0.81

Note. PTSD = posttraumatic stress disorder.

medication. Participants could select all that apply, so some officers endorsed multiple
treatment modalities. They also rated the quality of their experience on a 7-point Likert-
type scale (1 = very negative, 7 = very positive). The results indicate that 59.3% (n = 147)
of the sample had voluntarily participated in some form of mental health services in the
past, including individual (n = 94, 37.9%), family (n = 89, 35.9%), group (n = 19, 7.7%)
crisis intervention (n = 20, 8.1%), or medication (n = 27, 10.9%) services. Officers who had
voluntarily sought mental health services in the past tended to rate the experience posi-
tively. Approximately 19% (n = 28) of the respondents reported that their experience using
mental health services was very positive, 32.2% (n = 48) reported that it was positive, and
26.8% (n = 40) indicated that it was somewhat positive. Nine percent of officers (n = 14)
described their experience as neutral, whereas 12.8% described it as either somewhat nega-
tive, negative, or very negative.
We also asked participants whether they had ever been mandated to receive any of the
aforementioned mental health services. Participants also rated the quality of these experi-
ences. Some officers reported that they had been mandated to participate in mental health
services in the past (almost 20%, n = 50), including individual (n = 16, 6.5%), group (n =
21, 8.5%), crisis intervention (n = 15, 6.0%), and medication (n = 1, 0.4%) services. Twenty-
four percent (n = 12) of the respondents who had been mandated to participate in services
reported that their experience was positive, 14.0% (n = 7) reported that it was somewhat
positive, and 18.0% (n = 9) described their experience as neutral. On the other hand, 22.0%
(n = 11) described it as somewhat negative, 12.0% (n = 6) as negative, and 10.0% (n = 5) as
very negative.
Considering the unitary component structure and good reliability among each set of plu-
ralistic ignorance items, we combined the five items pertaining to officers’ personal willing-
ness to seek help into one scale (M = 38.76, SD = 10.15, α = .83) and the five items pertaining
to their perceptions of others’ willingness to seek help into another (M = 28.97, SD = 9.27,
α = .88). Then, we compared the difference in total scores using a dependent-sample t test.
In line with the individual-level analyses, officers perceived themselves as more willing
than their colleagues to seek mental health services when several presenting issues were
combined and analyzed simultaneously, t(243) = 12.72, p < .001, d = 0.81.
To investigate the construct validity of the ATSPPH-SF and the MSS among police offi-
cers, we compared scores obtained on each measure between officers who had voluntarily
sought mental health services in the past and those who had not, including those who had

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 13

been mandated to complete services or had not sought services at all. Officers who had
voluntarily sought services in the past reported significantly higher attitude scores (M =
19.41, SD = 5.88) than officers who had not (M = 15.74, SD = 6.15), t(232) = 4.58, p < .001,
d = 0.60. Officers who had voluntarily sought services in the past also reported significantly
lower self-stigma scores (M = 18.53, SD = 6.30) compared with officers who had not (M =
22.38, SD = 6.54), t(224) = 4.42, p < .001, d = 0.59. The difference in public stigma scores
between officers who had voluntarily sought services in the past (M = 39.51, SD = 11.06)
and officers who had not (M = 41.20, SD = 9.41) was nonsignificant, t(223) = 1.19, p = .237.

Discussion
The main objectives of this study were to identify the role of public stigma and self-
stigma in predicting attitudes toward seeking mental health services among police officers
and to develop a more comprehensive understanding of the pluralistic ignorance phenom-
enon as it pertains to help-seeking attitudes.

Mental Health Stigma

As expected, participants who felt that the general public reacts negatively to individuals
with mental health concerns reported more negative attitudes toward seeking professional
psychological help. This relationship is consistent with previous studies on public stigma and
attitudes toward seeking mental health services (e.g., Komiya et al., 2000). Self-stigma was
also negatively associated with attitudes. That is, participants who perceived that their own
behaviors or attitudes are not socially acceptable also reported more negative attitudes toward
seeking help. Once again, these findings have been supported in previous studies (e.g., Conner
et al., 2010; Hackler et al., 2010). Importantly, officers in the current study who had volun-
tarily sought services in the past also reported significantly lower self-stigma scores compared
with officers who had been mandated to complete services or had not sought services at all.
Furthermore, officers’ endorsement of self-stigma was able to explain the relationship
between public stigma and attitudes toward seeking help. This is also consistent with previ-
ous research (e.g., Bathje & Pryor, 2011; Vogel et al., 2010; Vogel, Wade, & Hackler, 2007).
These findings are important for planning interventions with police officers, because they
suggest that awareness of public stigma, in itself, does not seem to relate to attitudes toward
seeking professional psychological help. Vogel et al. (2013) indicated that, although chang-
ing the public’s views of mental illness and help seeking is important, targeting the negative
effects of self-stigma through individual interventions may also be possible. If mental health
professionals are able to intervene in the stigma internalization process and replace self-
stigmatizing attitudes with positive beliefs regarding self-efficacy (Corrigan et al., 2014),
officers may be more likely to seek services and engage in treatment.
Some researchers have suggested that mental health stigma could be reduced by normal-
izing symptoms or providing an explanation for them (Blum, 2000; Schreiber & Hartrick,
2002). For example, officers experiencing job-related stress reactions may feel lower stigma
if they are informed that their distressing emotions are logical or physiological reactions to
the situation (Blum, 2000). This could be incorporated into seminars designed to help offi-
cers recognize signs and symptoms of stress and other mental health problems (Finn et al.,
2000; Finn & Tomz, 1997) and could be facilitated by mental health professionals who are
familiar with the nature of police work.

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14 Criminal Justice and Behavior

Officers experiencing mental health concerns may be less likely to feel a sense of shame
or embarrassment if they are informed that their concerns are treatable (Mann & Himelein,
2004). Therefore, it could also be beneficial for mental health professionals to share infor-
mation about treatment approaches for common presenting problems, including empirical
support for their efficacy. This information could be included during recruits’ academy
training and throughout officers’ careers, in the form of continuing education seminars. To
ensure that this content is accessible to officers, police administrators could be responsible
for consulting with mental health professionals to coordinate resources, applying for grant
money to support training, and working with accrediting bodies to gain approval for new
mental health–oriented continuing education units.
Social support may also be helpful in reducing mental health stigma. Vogel, Wade,
Wester, Larson, and Hackler (2007) found that knowing someone who had sought help pro-
moted positive expectations about the treatment process and increased intentions to seek
help. In line with these findings, it could be very beneficial for officers who have used mental
health services in the past to share their experiences with other officers, perhaps explaining
what the process looked like, potential challenges, and benefits. In the current study, officers
who had voluntarily sought mental health services at some point in the past generally reported
positive experiences. Therefore, the testimony of a respected peer or supervisor could go a
long way in demystifying the process and reducing stigma (Karaffa & Tochkov, 2013).

Pluralistic Ignorance

In this study, officers tended to believe that their peers were less willing to seek mental
health services than they actually were. This replicates Karaffa and Tochkov’s (2013) find-
ings with another police sample. Some researchers have suggested that misperceiving oth-
ers’ attitudes in such a way could have several effects within a group, including increasing
the likelihood that members will not share their true opinions (Halbesleben et al., 2007), or
leading group members to change their behaviors to coincide with the false norm (e.g.,
Halbesleben et al., 2007; Prentice & Miller, 1993).
However, evidence suggests that if attitudes and behaviors are encouraged or maintained
by inaccurate perceptions of others’ attitudes, then correcting misperceptions could ulti-
mately influence group members’ behaviors (Prentice & Miller, 1996). Researchers (e.g.,
Halbesleben, Wheeler, & Buckley, 2005; Schroeder & Prentice, 1998) have found that pro-
grams designed to reduce pluralistic ignorance with regard to problematic behaviors are
effective if they challenge misperceptions and encourage dialogue about group norms and
beliefs. With regard to interventions, mental health professionals or training officers in
police agencies could encourage active discussions about perceived norms, stigma, and
other barriers to seeking mental health services, while also presenting information about
actual attitudes and the pluralistic ignorance phenomenon. Future research should also
investigate how pluralistic ignorance interacts with public and self-stigma to drive help-
seeking behaviors among police officers.

Attitudes Toward Seeking Mental Health Services

The current findings suggest that officers who had voluntarily sought services in the past
reported significantly higher scores on the ATSPPH-SF than officers who had not. The
results of the survey indicate that more than half of the sample had voluntarily participated

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 Karaffa, Koch / ATTITUDES TOWARD MENTAL HEALTH SERVICES 15

in some form of mental health services in the past, with individual counseling and family
counseling being the most frequently endorsed services. Rates of previous voluntary ser-
vice utilization were higher than we expected. It is possible that these figures reflect a trend
toward more positive attitudes about seeking mental health services in the general popula-
tion (Mojtabai, 2007). However, participants were self-selected on a voluntary basis.
Therefore, it is also possible that the attitude scores and rates of prior mental health service
use in this study are inflated. The fact that officers in the current sample who had voluntarily
sought mental health services rated the experience positively could be useful in encourag-
ing other officers to seek services when warranted.

Strengths and Limitations

Overall, this study has several strengths. The measures used in this study demonstrated
strong internal consistency, and the MSS (Skopp et al., 2012) included items that are more
consistent with how officers may experience stigma compared with other scales designed to
measure mental health stigma among civilians. We also included items related to previous
use of mental health services, which helped demonstrate the utility of the MSS (Skopp
et al., 2012) and the ATSPPH-SF (Fischer & Farina, 1995) in differentiating between offi-
cers who had sought services in the past from those who had not.
We created 10 new items to evaluate pluralistic ignorance, and although prior research
regarding their psychometric properties was not available, we asked four experienced police
officers to assess the readability and face validity of the items and received favorable feed-
back before administering the survey. The five items pertaining to officers’ personal will-
ingness to seek help and the five items pertaining to their perceptions of others’ willingness
to seek help each formed a unitary component with good internal consistency. Therefore,
these items may be useful to other police psychology researchers in the future.
Despite these strengths, several limitations must also be addressed. The agency response
rate, the nonprobability sampling methods used in the study, and the characteristics of the
participants limit the generalizability of the findings. We only included sworn officers who
were currently employed full-time by a police agency; therefore, these data may not be
applicable to officers employed on a part-time or reserve basis or to retired officers. While
some diversity was achieved by sampling from departments throughout Texas and
Oklahoma, almost 90% of the current sample was White, compared with 75% in the Bureau
of Justice Statistics’ (BJS) nationally representative survey of state and local police agen-
cies (Reaves, 2010).
The data set included officers from municipal, county, state, and university agencies,
although it did not include military police, tribal officers, or officers employed by federal
law enforcement agencies. Officers from municipal agencies were overrepresented in the
sample. For example, they made up 75% of the sample, yet they account for about 60%
of law enforcement personnel nationwide (Reaves, 2011). Furthermore, officers from
smaller departments were underrepresented. The BJS (Reaves, 2010) reported that
approximately half of the police agencies in the United States employed less than 10 offi-
cers, but only a few of the officers in the sample reported being employed by an agency
with fewer than 10 sworn officers. The BJS report noted that 61% of full-time police
officers were employed by agencies with at least 100 officers, compared with about 66%
in the current sample.

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16 Criminal Justice and Behavior

In addition, officers of higher ranks were overrepresented. According to the BJS report,
about two-thirds of police officers regularly respond to calls for service, although this tends
to differ depending on the size of the agency. In the current sample, only 28% of partici-
pants were patrol officers or deputies, whereas almost 27% were sergeants and about 25%
were lieutenants, captains, or chiefs. This is important for a few reasons. Although con-
ventional understanding of the police culture tends to focus on homogeneity among offi-
cers with regard to cultural attitudes and beliefs, Paoline (2003) suggested that officers
may differ depending on their specific organizational cultures, rank, and ideological
styles.
Reuss-Ianni (1983) suggested that distinct cultures may exist among street cops and offi-
cers in management positions. Likewise, Farkas and Manning (1997) described that offi-
cers’ values, norms, and concerns differ depending on their rank in the organization. For
example, officers at lower ranks (e.g., patrol officers and first-line supervisors) may identify
more closely with the traditional street cop culture, those in mid-level management posi-
tions may be more focused on serving as mediators between street-level officers and upper-
level management, and those in upper management positions may be most concerned about
politics and public perceptions (Paoline, 2003). Although we did not find statistically sig-
nificant differences between participants in lower-level positions and those in management,
the low representation of patrol officers and deputies in this study could reflect attitudinal
differences in terms of even choosing to participate in the study. Collectively, the current
findings may be biased to reflect the attitudes of predominantly higher ranked officers from
larger municipal agencies.

Conclusion
Until now, researchers had not formally investigated the role of public stigma and self-
stigma in predicting attitudes toward seeking mental health treatment among police offi-
cers, nor had they studied pluralistic ignorance with regard to officers’ attitudes toward
seeking services in sufficient depth to make sound program or policy recommendations.
The current study contributes new knowledge to the police psychology literature and poses
several important theoretical and clinical considerations for researchers, practitioners pro-
viding mental health services to police officers and their families, and police administrators.
These findings may be particularly useful to police agencies, because untreated physical,
interpersonal, and psychological consequences of police stress can impact the entire police
organization (Chen, 2009; Finn et al., 2000; More, 1998; Shane, 2010).

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Kerry M. Karaffa, MS, is a PhD candidate in Counseling Psychology at Oklahoma State University. His research interests
include police psychology, mental health stigma, and exoneree issues.

Julie M. Koch, PhD, is an associate professor and director of training in the Counseling and Counseling Psychology program
at Oklahoma State University. Her research interests include social justice, multicultural issues, international psychology, and
counselor development and training.

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