Date of Graduation

Spring 2027

Document Type

Dissertation

Degree Name

Doctor of Clinical Psychology (PsyD)

Department

Psychology

Committee Chairperson

Lauren Brumley, Ph.D.

Committee Member

Stevie N. Grassetti, Ph.D.

Committee Member

Bridget Asempapa, Ph.D.

Abstract

In Ghana, cultural beliefs often silence open discussion about mental health. Many view emotional struggles as spiritual weakness, leading to stigma and avoidance of care. For adults who experienced Adverse Childhood Experiences (ACEs), this silence can worsen the long-term impact of trauma. While Western research links stigma to reduced help-seeking and shows that trauma knowledge can promote openness, little is known about how these relationships function within Ghana’s cultural context. This cross-sectional study examined how stigma and trauma knowledge influence help-seeking behaviors among 103 Ghanaian adults (ages 19-62, M = 30.0; 49% women) with childhood adversity histories. Participants completed anonymous surveys assessing ACEs, internalized and perceived stigma, trauma knowledge, and help-seeking attitudes. Analyses included correlations and mediation/moderation using the PROCESS Macro. Results revealed that participants reported an average of 3.93 ACEs, with internalized stigma fully mediating the ACEs-help-seeking relationship (indirect effect = -.03, 95% CI [-.06, -.004]). Women demonstrated more favorable help-seeking attitudes than men. While trauma knowledge did not moderate perceived stigma's effects, it independently predicted more positive help-seeking attitudes. Findings suggest that ACEs influence help-seeking primarily through internalized stigma, highlighting psychological mechanisms by which early adversity creates care barriers. Implications include multi-level interventions integrating psychoeducation, school-based literacy curricula, and media campaigns to reduce stigma and strengthen trauma awareness. Policy recommendations emphasize structural interventions addressing ACE determinants, including anti-poverty initiatives and positive parenting supports. This study contributes to limited literature on ACEs and help-seeking in sub-Saharan Africa and provides foundation for culturally responsive, trauma-informed mental health services in Ghana.

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