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Psychotherapy is used today, in addition to its use in drug treatment, as the main treatment method for numerous mental disorders, and the use of psychotherapy depends strongly on the attitude toward it. With increasing interest in research on stigma associated with and attitudes toward psychotherapy, studies in recent decades have shown that relevant stigma and attitudes show intercultural differences. It has been shown that Asians, including Chinese, have a more negative attitude toward the use of psychotherapy than people from Western countries. However, most of these results have been based on samples of Chinese living in Western countries. Only a few studies have directly investigated, in comparative fashion, the attitudes of mainland Chinese and Westerners toward psychotherapy. The aim of the present dissertation is therefore to investigate this difference, with individuals from Western countries being represented by Germans.
For this purpose, Study 1 first examined the measurement invariance of the following questionnaires: the Stigma Scale for Receiving Psychological Help (SSRPH), the Self-Stigma of Seeking Help (SSOSH), and the Inventory of Attitudes to Seeking Mental Health Services (IASMHS). Measurement invariance is a prerequisite for the use of these questionnaires in comparative cultural studies. It was found that the SSOSH did not have measurement invariance. The SSRPH and the IASMHS both showed acceptable partial measurement invariance and could thus be used for intercultural comparison. However, when using these scales for group comparisons, the results should be interpreted with caution, as only two items demonstrated cultural invariance.
In order to investigate the relationship between the extent of subjective suffering and attitudes toward psychotherapy, Study 2 examined the measurement invariance of three patient health questionnaires (PHQ-15, PHQ-9, and GAD-7). Thus, the prerequisite for the use of those questionnaires was checked in an intercultural comparison. It was found that PHQ-9 and GAD-7 are measurement-equivalent for Chinese and German students, with some items showing cultural differences. Thus, both questionnaires fulfilled the prerequisite for use in culture-comparative studies with regard to the groups investigated in this study. PHQ-15 showed no scalar measurement invariance. The question of how the extent of subjective suffering is related to attitudes toward psychotherapy will be investigated in a follow-up study after the present study.
Study 3 examined the differences between the attitudes toward psychotherapy of Chinese and German students and the effect of a cultural value-based intervention (collectivism vs. individualism). The results showed that Chinese students have a more negative attitude toward psychotherapy than do German students, both before and after a cultural value-based intervention. However, no differences were found between the effect of individualistic and collectivistic interventions, although both interventions contributed to improving attitudes toward psychotherapy in the two cultural groups.