It is not always feasible to predict an individual’s future behaviors. Instead, one way to infer one’s future behavior is to identify factors that underlie and best predict the behavior and to assess these factors. A theory of reasoned action is a model that was introduced by Ajzen and Fishbein in 1980. This model proposes that one’s attitude and subjective norm affect one’s intention, which affects one’s behavior. In developing a measure that assesses attitudes toward seeking professional psychological help, based on this model, Fischer & Turner (1970) postulated that help-seeking attitudes precede and, thus, predict actual help-seeking behaviors.
Because there was little research conducted at that time regarding help-seeking mechanisms, they provided anecdotal evidence to support their assumption. According to Fischer and Turner, an individual may seek professional psychological help for a minor problem if the individual has a positive view or expectation of psychotherapy, while another individual may not seek out help even when having a problem that needs to be treated because he or she views receiving help as a personal weakness or failure (1970).
Later, other researchers empirically supported this assumption that help-seeking attitudes underlie help-seeking behaviors. For example, Rickwood, Deane, Wilson, and Ciarrochi (2005) conducted a study that examined help-seeking attitudes and intentions among Australian young adults. To investigate reasons that young Australians do not seek help when they are distressed or suicidal, Rickwood et al. (2005) reviewed a total of 19 studies that were conducted between 2000 and 2002. These studies aimed to identify 1) reasons that young Australians, particularly young males, do not seek help, 2) reasons that they become reluctant to seek help when suicidal, 3) ways to better engage with young adults in services, and 4) community gatekeepers’—teachers, youth workers, and general practitioners—readiness for supporting young adults to seek appropriate help.
Their sample included a total of 2,721 Australians aged 14 to 24 years. Most of the studies used self-report questionnaires to collect data, and some of the studies ran focus groups that consisted of 18-23 people of Australian high school students and high school teachers. Results revealed that lack of emotional competence, fear of stigma, negative beliefs about seeking professional psychological help, and negative help-seeking attitudes inhibit young Australians from seeking help. More specifically, Rickwood et al. (2005) found that those who had negative help-seeking attitude were not likely to seek psychological help when they had suicidal thoughts or emotional problems. The results also indicated that community gatekeepers’ negative attitudes toward seeking professional psychological help affect young Australians’ seeking psychological help.
Later, Vogel, Wade, and Hackler (2007), in a study of intentions to seek counseling among 680 U.S. college students, proposed a model that help-seeking attitudes would predict help-seeking intentions. This model was hypothesized based on Ajzen and Fishbein’s (1980) theory of reasoned action, which was discussed earlier. Vogel et al. measured perceived public stigma, self-stigma, attitudes toward seeking professional help, and willingness to seek counseling for psychological and interpersonal concerns. Their measures included the Perceived Devaluation-Discrimination Scale, Self-Stigma of Seeking Help Scale, Attitudes Towards Seeking Professional Psychological Help scale, and Intentions to Seek Counseling Inventory.
Vogel et al. (2007) used structural equation modeling (SEM) analyses to examine the relationship between help-seeking attitudes and intentions. In particular, they examined mediational effects of self-stigma on the relationship between perceived public stigma and help-seeking attitudes and mediational effects of attitudes on the relationship between perceived public stigma and willingness to seek counseling. Results of the study indicated that perceived public stigma of mental illness predicted self-stigma associated with seeking help, which in turn, predicted help-seeking attitudes. Furthermore, attitudes toward seeking help were found to significantly predict willingness to seek counseling. Along with the limitation that the sample of the study was 90% Caucasian and mostly 1st-year college students, Vogel et al. (2007) suggested that other potential mediating factors could be examined with relation to the relationships among the variables examined in this study.
Help-Seeking Attitudes Among Asians
Compared to the number of studies conducted in Western countries, there have been fewer studies exploring help-seeking attitudes toward mental health services among Asians. With regard to attitudes toward seeking professional psychological help among Asians, some researchers have examined cultural factors to understand the underutilization of mental health services. Yoo (1997) conducted a comparative study between 88 American and 95 Korean college students regarding the underutilization of mental health services and attitudes toward seeking professional psychological help. She included individualism and collectivism as cultural variables in her study and subdivided individualism and collectivism into four variables: vertical collectivism, horizontal collectivism, vertical individualism, and horizontal individualism. Verticality indicated an emphasis on authority and hierarchy within interpersonal relationships, and horizontality an emphasis on equality within interpersonal relationships. Some of the hypotheses of the study were:
- Korean students are expected to show a higher level of collectivism than American students,
- American students are expected to show a higher level of individualism than Korean students,
- Korean students are expected to have a more negative attitude toward seeking professional psychological help than American students,
- It is expected that attitudes toward seeking professional psychological help will differ according to ethnicity, collectivism/individualism, and attribution styles of mental illness.
Yoo (1997) used the scale of Vertical-Horizontal Individualism-Collectivism (VHIC) by Singelis and Triandis (1995; as cited in Yoo, 1997, p. 33) to measure vertical and horizontal individualism and vertical and horizontal collectivism. She used the ATSPPH by Fischer and Turner (1970) to assess attitudes toward seeking professional psychological help. Findings revealed that there was no significant difference in individualism-collectivism between the American sample and the Korean sample.
However, the results indicated that the American college students reported higher levels of horizontal individualism and horizontal collectivism than the Korean students. Based on Triandis’ theory that most collectivistic cultures exhibit verticality and most individualistic cultures exhibit horizontality (as cited in Yoo, 1997, p. 83), Yoo (1997) concluded that the American sample, who reported a higher level of horizontality, indirectly supports that American culture is more individualistic than Korean culture. Furthermore, the results revealed that the American students who reported higher levels of horizontality, reported more positive attitudes toward seeking professional psychological help than Korean college students, who reported higher levels of verticality. Yoo (1997) noted that only 8% of the Korean sample, compared to 45% of the American sample, reported having previous counseling experience and stated that the idea of seeking professional psychological help in Korea is foreign.
Asian values have also been identified as a cultural factor that affects help-seeking attitudes. In studying underutilization of mental health services among Asians/Asian Americans, Shea and Yeh (2008) discovered that adherence to Asian values was negatively related to help-seeking attitudes among Asian American college and graduate students in the U.S. Their sample consisted of 219 Asian Americans, and 69.4% of the participants were first generation Asian Americans born outside of the U.S. Shea and Yeh (2008) assessed participants’ adherence to Asian cultural values using the Asian Value Scale (AVS) by Kim, Atkinson, and Yang (1999) (as cited in Shea & Yeh, 2008, p. 162). This scale consists of six factors: conformity to norms, family recognition through achievement, emotional self-control, collectivism, humility, and filial piety. Shea and Yeh measured stigma of receiving psychological help using the Stigma Scale for Receiving Psychological Help (SSRPH) by Komiya, Good, and Sherrod (2000) (as cited in Shea & Yeh, 2008, p. 162) and measured attitudes toward seeking professional psychological help using the ATSPPH.
In this study, Shea and Yeh hypothesized that 1) adherence to Asian cultural values will be inversely related to attitudes toward seeking professional psychological help, 2) stigma of receiving psychological help will be inversely related to attitudes toward seeking professional psychological help, 3) female students will present more positive attitudes toward seeking professional psychological help, 4) adherence to Asian values will predict attitudes toward seeking professional psychological help regardless of demographic factors and stigma, and 5) stigma will mediate the relationship between adherence to Asian values and attitudes toward seeking professional psychological help.
Shea and Yeh conducted correlational analyses to investigate the first three hypotheses and conducted multiple regression analyses for the last two hypotheses. Results indicated that all the hypotheses except for the last one, which aimed to examine a mediational effect of stigma, were supported. They suggested that the negative relationship between adherence to Asian values and help-seeking attitudes is accounted for by Asian values that may perceive seeking professional psychological help as bringing shame to the family or a deviation from social norms.
This result is similar to a study on acculturation and help-seeking attitudes among Asian students in the U.S. by Zhang and Dixon (2003). Aiming to investigate the relationship between acculturation and attitudes toward seeking professional psychological help, they hypothesized that 1) Asian international students’ acculturation is related to attitudes toward seeking professional psychological help, 2) Asian international students’ acculturation is related to their recognition of need for psychological help and stigma tolerance, and 3) demographics of Asian international students are not related to their attitudes toward seeking professional psychological help. The researchers explained that examining Asian international students’ acculturation level is important because cultural differences, which involve different cultural values, may hinder their help-seeking attitudes toward seeking psychological help.
The researchers assessed acculturation levels of 400 Asian international undergraduate students using the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a lower acculturation level indicated stronger adherence to Asian values. Attitudes toward seeking professional psychological help were assessed using the ATSPPH. Results revealed that higher levels of acculturation among Asian students were positively correlated with higher levels of help-seeking attitudes toward professional psychological services.
The results also indicated that higher acculturation levels among Asian students are positively related to their level of stigma tolerance. These findings revealed that a stronger adherence to Asian values might be a barrier to help-seeking attitudes. Based on the results, Zhang and Dixon (2003) suggested that Asian international students who are less acculturated may be more guarded in counseling than American students because they may view receiving counseling as disgraceful on themselves and their families.
