Whom to ask for help in case of a mental disorder? Preferences of the lay public

Background: Although socio-cultural factors have been recognised as an impo rtant predictor in shaping help-seeking behaviour, few attempts have been m ade in this regard to specify the nature and impact of socio-cultural facto rs such as attitudes and belief systems prevalent in society. Methods: We i nvestigated the lay public's attitudes toward help-seeking regarding psychi atric disorders, and their determinants, in a cross-sectional national surv ey in Germany (n = 1564), using structured interviews with vignettes depict ing a person either suffering from depression or from schizophrenia. Two di stinct methodological approaches (rating vs ranking) were applied. Results: Public opinion considers mental health professionals helpful in treating s chizophrenia but not in the treatment of depression. For depression, public opinion clearly favours the lay support system and believes in involving t he family physician if the former resource is exhausted. Determinants of he lp-seeking recommendations were problem definition, perception of the cause of distress and anticipated prognosis, as well as resentment against menta l health professionals. Conclusion: Our results suggest that attitudes and belief systems prevalent in society have a major impact on help-seeking beh aviour, both through transmission to the person suffering from mental distr ess via his/her social network and through the person's own attitudes forme d in the process of socialization. Implications are pointed out for the dai ly work of mental health care providers, health care planning and public di scussion of mental health issues.