Mental health stigma and internship nursing students’ attitudes toward seeking professional psychological help: a cross-sectional study

The tools consisted of three sections as follows:

The Self-Stigma of Seeking Help Scale (SSOSH), developed by Vogel and Wester in 2013, was employed to assess the self-stigma experienced by nursing students regarding seeking professional psychological help during their internship period. The scale comprises 10 items, with participants providing responses on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) [14].

The Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH), developed by Fischer and Farina in 1995, was utilized to gauge the attitudes of internship nursing students. The scale comprises 10 items, and participants provided responses on a 4-point Likert scale ranging from 1 (disagree) to 4 (agree) [15].

During the data collection phase, the researcher secured permission and arranged a meeting with faculty officials to outline the study’s objectives and procedures. Approval was obtained for accessing the desired sample. A panel of five experts reviewed and revised the study tools for content validity, which included a socio-demographic data sheet, the Self-Stigma of Seeking Help scale (SSOSH), and the Attitude toward Seeking Professional Psychological Help scale (ATSPPH). Participants were briefed on the study’s purpose, assured of confidentiality, and consented verbally before completing the tools. A pilot study was done to evaluate the comprehensibility, clarity, significance, and estimated time required to complete the research instruments. A subset comprising 10% of the recruited participants engaged in completing the questionnaire and providing feedback on any ambiguities or challenges encountered. It’s important to mention that participants who took part in the pilot study were later omitted from the final study sample to minimize the risk of bias or familiarity with the instruments influencing the results.

Data collection occurred during internship orientation sessions and involved careful examination by researchers and a statistical specialist for completeness. The implementation phase spanned three months, from August 2022 to October 2022, with fieldwork conducted over four months, concluding in November 2022.

Statistical analysis was performed using the Statistical Package of Social Sciences (SPSS) version 26.0. Frequencies and percentages were calculated to describe the data. One-way ANOVA was used to compare the stigma, psychological distress, and attitudes toward psychological help-seeking for independent variables containing multiple categories such as age groups, occupation, and marital status. An independent t-test was used for statistical testing of variables with only two categories (e.g., gender and past history of seeking treatment). Pearson’s correlation was calculated to find a correlation between stigma, psychological distress, attitudes toward psychological help-seeking, and symptoms of anxiety and depression. All the factors that were statistically significant at the univariate level were included in the multiple linear regression that influenced the attitude of a person toward seeking psychological help. Reliability statistics were concluded using Cronbach’s alpha value.

The present investigation presents that the cost of therapy is the most significant barrier that prevents nursing students from seeking professional psychological help. This finding underscores the economic considerations individuals face when contemplating mental health support.

In a systematic review exploring factors influencing children and adolescents’ access to mental health services, various systemic and structural barriers and facilitators were identified. Approximately 58% of the included studies addressed these themes. Among these barriers were financial costs associated with mental health services [16].

Similarly, in a systematic review investigating barriers, facilitators, and interventions targeting help-seeking behaviors for common mental health problems in adolescents, problems related to service and personnel availability, as well as other structural factors like cost, transportation, and waiting times, were identified as obstacles to help-seeking [17].

The current study reveals that slightly over half of the participants did not experience stigma, while approximately two-fifths of the participants reported experiencing stigma. It highlights the prevalence and varied experiences within the sample. This distribution underscores the complexity of attitudes toward seeking professional help for mental health issues. It suggests that while a significant portion of the participants may not feel stigmatized, a considerable proportion still face challenges and barriers associated with stigma, which could influence their willingness to seek psychological assistance.

Similarly [18], who studied Predictors of Attitude Toward Seeking Professional Psychological Help in Hong Kong, found a significant association between self-stigma and attitude toward professional help-seeking. The study underscored the persistent challenge of stigma, which could potentially deter individuals from utilizing mental health services in Hong Kong. This parallel underscores the global nature of the stigma surrounding mental health.

The present study shows that stigma is higher among participants aged twenty-three years. This may be due to a Lack of understanding, as participants aged twenty-three years may have less knowledge and understanding about mental health and the benefits of professional help-seeking, which could lead to a higher level of stigma. Furthermore, Fear of judgment, as they may be more concerned about the judgment of their peers, could lead them to be more stigmatized for seeking professional help.

Along similar lines [19], who studied, Mental health literacy among adolescents: Evidence from a community-based study in Delhi, reported that adolescent participants displayed high levels of stigma and exhibited limited engagement in seeking help behavior when it came to Common Mental Disorders.

In the present study, males have a higher level of stigma toward psychological help. This might be attributed to men perceiving that acknowledging a problem and asking for assistance could be seen as a sign of weakness, which could explain this phenomenon. Consequently, males may associate seeking psychological or emotional assistance with feelings of shame or weakness. In many societies, men are often socialized to suppress their emotions and avoid expressing vulnerability, while females are encouraged to openly discuss their issues and freely express their emotions.

Similarly [2], who studied, Attitudes and stigma toward seeking psychological help among Saudi Adults, in Saudi Arabia, found that males exhibited a greater degree of perceived stigma compared to females.

In contrast to our findings, a recent study conducted across 16 Arab countries found that females exhibited more favorable help-seeking attitudes compared to males. Specifically, being female, older, having higher knowledge, and maintaining positive attitudes toward mental illness were associated with more positive help-seeking attitudes. Conversely, having a family psychiatric history was linked to more negative help-seeking attitudes. These results suggest that gender differences in stigma toward psychological help may vary across different cultural contexts [20].

The present study shows that stigma toward seeking psychological help is higher among urban participants. Although rural areas are usually the ones who suffer from problems in accessing health services, contrary to expectations, it turns out that urban residents exhibit a higher level of stigma compared to individuals living in non-urban areas. This could be attributed to the restricted availability of traditional forms of support: In rural areas, individuals may have more access to traditional forms of support such as community members, religious leaders, or healers, which could make them less likely for professional help. Additionally, in rural areas, the community is more closely knit, people may have more trust in their family and friends and may rely on them more for help and support, making it more likely that they will receive help and support when they need it. In contrast, in urban areas where the community is more dispersed, individuals may have less trust and rely less on their family and friends for help and support, making it less likely that they will receive help and support when they need it.

The present study shows that stigma is higher among participants who didn’t have enough income. This may be due to financial constraints: Individuals with limited income may face financial constraints that prevent them from affording the expenses associated with seeking professional help, such as therapy sessions or medication. This could lead to them feeling stigmatized and ashamed for not being able to access the help they need. Additionally, prioritizing basic needs: Individuals with limited income may be focused on meeting their basic needs and may not prioritize professional help-seeking for their mental health.

The present study shows that stigma toward psychological help-seeking is higher among single participants. This may be due to a lack of social support from a partner or family Additionally, Single individuals may be more concerned about the judgment of their peers, which could lead them to be more stigmatized for seeking professional help.

On the contrary [2], who studied Attitudes and stigma toward seeking psychological help among Saudi Adults, in Saudi Arabia, found that married individuals exhibited a higher level of stigma toward psychological help-seeking.

In the present study, based on our findings, it was determined that the vast majority of the studied sample exhibited a positive attitude toward seeking professional help. This might be because the sample was composed of internship nursing students who have received education and training in mental health and the importance of professional help-seeking. Additionally, internship nursing students possess a comprehensive understanding of various diseases and the corresponding treatment approaches, as the curriculum of the mental health nursing course, which is typically offered during the final academic year, includes the coverage of these topics.

On the contrary [21], who studied Attitudes toward mental illness, mentally ill persons, and help-seeking among the Saudi public and sociodemographic correlates, found that negative attitudes towards professional help-seeking were prevalent among the Saudi public, with over half of the population reporting such attitudes.

In the present study, attitudes toward professional help-seeking according to age are favored by the group (23 years). This might be because students are at a stage in which they may be more open to exploring new ideas and experiences, including professional help-seeking for mental health issues. They may be more likely to be receptive to advice and education about mental health and ask for professional help-seeking.

On the contrary [22], who studied Knowledge, attitude, and behaviors toward mental illness and help-seeking in a large nonclinical Tunisian student sample, found that a minority of young individuals consider mental health professionals as the primary choice for seeking support.

In the present study, Attitudes are favored by females. This might be attributed to societal stereotypes and cultural expectations. Males might face societal pressures that discourage them from help-seeking for mental health or emotional concerns, as it may be interpreted as a manifestation of vulnerability. On the other hand, females may be more likely to help-seeking due to societal expectations for them to be more nurturing and emotional.

Similarly [22], who studied Knowledge, attitude, and behaviors toward mental illness and help-seeking in a large nonclinical Tunisian student sample, reported that females demonstrated significantly higher help-seeking intentions compared to males.

In the present study, Attitudes are favored by rural participants. This might be because people living in rural areas may be more likely to rely on family and community support for mental health issues. This can lead to a greater acceptance of seeking professional help as a complement to these other forms of support. Additionally, access to healthcare facilities and providers is often limited for individuals residing in rural areas, this creates additional challenges in their ability to access help when they require it. As a result, they may be more inclined to get professional help when they do have access to it.

On the contrary [23], who studied Stigma and Attitude towards Help-Seeking in Rural and Urban Adults, reported that the study did not reveal any significant statistical differences in stigma and attitudes towards help-seeking among adults residing in rural and urban areas.

In the present study, Attitudes are favored by Married participants. This might be due to marriage being considered a status symbol and a sign of stability and maturity, individuals who are married may be more willing to seek help to maintain their status and the stability of their relationship. Additionally, they may view therapy as a way to strengthen their relationship and resolve conflicts. Marriage can bring unique challenges and stresses, and therapy can provide a space for couples to work through those issues and improve their communication and connection.

In a similar vein [24], who examined mental health help-seeking in China, found that married older men with children showed a greater propensity to seek assistance for their mental health concerns.

In the present study, the observed negative correlation between the Self-Stigma of Seeking Help scale (SSOSH) and Attitudes toward Seeking Professional Help reflects a noteworthy trend. Despite the majority of participants demonstrating a positive attitude towards seeking professional help (95.2%), a substantial proportion still experience stigma associated with help-seeking (39.5%). This suggests that while many individuals possess positive attitudes, a significant minority may harbor internal barriers, potentially stemming from self-stigma, that hinder their willingness to seek professional assistance.

In a similar line [25], conducted a study on predictors of attitudes toward seeking professional psychological help among Turkish college students. The findings indicated that Turkish college students displayed favorable attitudes towards help-seeking for mental health concerns. Favorable attitudes towards professional psychological help-seeking among Turkish college students were found to be linked with several factors. These factors included being female and older in age, having prior experience with seeking help, lower levels of anticipated risks, self-stigma, self-esteem, and self-rated health, as well as higher levels of anticipated benefits.

The significance of this study spans various aspects and holds pivotal importance in tackling mental health stigma and encouraging help-seeking behaviors among nursing students during their internship. Primarily, the results emphasize the necessity for customized educational initiatives and awareness drives targeted at diminishing mental health stigma and improving students’ comprehension of the advantages of seeking professional psychological aid. Moreover, addressing financial obstacles to therapy and guaranteeing the accessibility of reasonably priced mental health services are crucial in facilitating students’ access to essential support. Additionally, empowering students to actively seek professional assistance and offering education on accessible mental health services are essential measures in fostering favorable attitudes toward seeking help.