Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 1

The Problem and Its Background

Introduction

Seeking help for psychological problems is a means of maintaining ones emotional and
psychological well-being. It is an adaptive mechanism that is being encouraged by mental health
workers for people to resort to when distressed. Seeking psychological help is the act of talking
and consulting a professional for emotional and personal concerns. To some individuals, it is the
initial step in the healing process.

Help-seeking behaviour of adolescents has been an interesting topic to study. This is so

because despite the existence of counseling centers in schools, students seldom seek help from
counselors. Instead, they seek help for emotional problems from their peers and shy away from
authorities.

Help-seeking can be a highly adaptive behavior as it could be a mechanism for coping

with difficulties (Rickwood et.al., 2005). When individuals seek help, they experience relief from
the emotional baggage. For adolescents, having friends to cling on when they are disturbed or
troubled is indeed a great help. They think that friends temporarily ease the burden away.
Nonetheless, many of them still experience distress as this temporary relief at times does not lead
them to effective solutions.

While adolescents are in the process of developing their identity, they are faced with
multifarious problems that may arise from biological, interpersonal, environmental changes and
the occurrence of increasing number of stressful life events ( Ovaresch, et.al., 1995). Hence, they
are in special need of help because these significant life events may lead to psychological
disturbance and significant personality shifts (DOH, 2007). These changes may be manifested in
symptoms such as distress or psychological discomfort. The distress may be attributed to
academics, peers, family and financial difficulties.

As defined by Azjen & Fishbaum (1980), help-seeking is a behavior that is directly

influenced by one's intention to act, which is determined by ones attitude towards the act and the
felt subjective norm that one should act. In an attempt to explain the help-seeking process,
studies in the remote past looked into certain variables such as age, gender, socio-economic
status and attitudes toward help-seeking. Recent studies on the otherhand looked into
psychological factors such as emotional expressiveness (Vogel,2007), self-concealment and
distress (Leech, 2007), effects of culture (Leung, Bond, 2004; Yeh, 2002; Yoo, M., Goo,M. &
Yoon, E., 2005) and other variables such as type of problem, effects of prior counseling and
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 2

social support were also explored. These studies proved that indeed seeking help for
psychological problems may be influenced by various factors and may vary across cultures.

In the study, social and psychological factors are explored. Self-concealment is one of the
factors that affect an individuals decision to seek help (Leech, 2007). It acts as a barrier in the
helping process because when individuals tend to hide personal distress and disturbing emotions,
the more anxious he feels about opening up. According to Cramer & Lake (1998), self-
concealment is significantly correlated with loneliness, low self-esteem and social anxiety.

Social support and help-seeking attitudes are among the social-cognitive factors that may
affect help-seeking behavior. Although little studies proved the direct link of social support to
help-seeking, this study considers it as a mediating variable. The basic assumption that Filipinos
value cooperative effort and familism, this factor may influence how they handle psychological
problems. Hence, seeking support from others if the support network is perceived to be favorable
may likewise be a promoting factor.

Help-seeking attitude refers to ones positive or negative evaluation about seeking help
from a professional ( Azjen, 1985). In numerous studies, it was found to have a direct effect on
decision to seek psychological help from professionals. Likewise, it was found to have direct
links with psychological distress, self-disclosure and help-seeking intentions. By determining
students attitudes toward seeking psychological help, psycho educational intervention that
would promote mental health and shaping help-seeking attitude can be one of the primary goals.

A number of studies in the Philippines were conducted to ascertain the factors that predict
help-seeking behaviors of college students ( Chan, 2001). These studies looked into factors of
help-seeking such as social support, attitudes, gender role and problem type. With the gap in the
literature, this study was conceived to test a model to explain help-seeking behavior of
adolescents to understand the construal and attributions they make in deciding to seek
professional help. The results of this study will help counselors in universities to understand
better the dynamics underlying the help-seeking process.

The present study therefore aims to investigate the factors that influence the likelihood of
students in seeking help from professionals. It determined how factors such as self-concealment,
and perceived social support affect their attitudes in seeking professional help. The study will
further test the role of social support on the link between self-concealment and help-seeking
attitudes.

Conceptual Framework
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 3

Help-seeking for psychological problems among adolescents is one of the concerns of

many school counselors nowadays. Studies on the use of counseling services showed that a small
number of the student population coe for counseling. This small percentage therefore may be
indicative of some factors that prevent them from seeking help for psychological problems.
This study is anchored from Cramers (1999) and Leech (2007) studies which tested the
model using four predictors of help-seeking such as: self-concealment, psychological distress,
social support and help-seeking attitudes. By re analyzing previous studies on help-seeking
behaviors using psychological variables such as self-concealment and distress, Cramer predicted
that individuals are likely to seek help if distress is high and attitudes toward counseling are
positive; distress is higher when social support is impaired and concealing personal information
is high when individuals tend to hold negative attitudes toward help-seeking.
Parallel to Cramers model of help-seeking, this study conceived three major variables,
excluding distress as a factor. Self-concealment which denotes ones propensity to hide
distressing information from others is conceived as having direct relationship with help-seeking
attitude. The influence of self-concealment on help-seeking is central to this study as this
behavior may explain why college students seldom seek help for personal and interpersonal
concerns.
One form of self-concealment that may be especially relevant to Asian population is
loss of face. In Asian social relations, face represents a persons social position or prestige
gained by performing social roles that are well recognized by others ( Hu, 1994). It serves as a
mechanism to maintain group harmony. To some, loss of face has been associated with
psychological difficulties. Because of the underlying psychological and cognitive factors of self-
concealment, it may directly or indirectly influence the help-seeking process.
The criterion variable which is ones tendency to seek help is indicated by obtaining help
from formal sources. Although actual help-seeking behavior will not be measured, it is assumed
that when the intention and willingness to seek help is high, the higher is the likelihood to seek
help. Help-seeking attitude refers to the positive and negative cognitions regarding seeking help
from professionals. In this study, it is assumed that help-seeking attitude is conceived to be
influenced by self-concealment. An individuals predisposition to hide or reveal distressing
experience directly influence his/her attitude towards seeking help from professionals.
Social support refers to the perceptions of the quality of social support network. Similar
to Cramers concept, it refers to how a person construes his social support to be in relation to felt
attachment, social integration, reassurance of worth, reliable alliance, and the guidance that the
individual receives form his support group. Furthermore, perceived social support is conceived to
have mediating effect on self-concealment and help-seeking. Although Cramer (1999) was not
able to establish a mediating effect, this study conceived it to be a mediating variable because it
is assumed that students are likely to be group-oriented and rely more on others when they are in
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 4

distress. Being in the collectivist culture, Filipino students may consider the role of social
support system as a vital mechanism in obtaining psychological help. Hence, it is postulated that
a positive perception of social support is likely to reduce the likelihood of concealing distressing
information; thus increasing the propensity to seek help.
To further understand the help-seeking process, the socio-demographic profile of the
respondents was also considered as a factor that may directly or indirectly influence the
likelihood to seek help. For instance, adolescents with parents who have higher educational
attainment and higher income are more encouraged to seek psychological help when they feel
disturbed or distressed. Other factors that are considered in this study are course and previous
experience in counseling. It can be assumed that students enrolled in the social and behavioral
sciences have more positive attitudes toward seeking help. Additionally, if an adolescent sought
help in the past, he/she is more likely to seek help from a professional.

Paradigm of the Study

Help-seeking
attitudes
Help-seeking
Self-concealment
Intention
Perceived social
support

Profile of the
Respondents

IV DV

Fig. 1. A schematic diagram showing the relationship among the variables in the study.

The diagram shows the relationship of independent and dependent variables in the study.
Self-concealment is conceived to have a direct negative relationship with help-seeking intention.
Social support and help-seeking attitudes are conceived to have direct positive relationship to
help-seeking intention. Students socio-demographic profile such as parents income and
educational attainment are associated with the respondents likelihood to seek professional help.
Moreover, social support and help-seeking attitudes may strongly predict help-seeking intion.

Statement of the Problem:

Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 5

The study aims to explain the relationship of social psychological factors on help-seeking
intentions of students. To achieve this objective, it seeks to answer the following questions:
1. What is the profile of the respondents in terms of:
a. course
b. net monthly income of parents
c. parents occupation
d. previous experience in counseling
2. What is the respondents level of self-concealment?
3. What are the respondents attitudes toward seeking professional help for psychological
problems?
4. How do the respondents perceive their social support system?
5. Are self-concealment, help-seeking attitude, perceived social support and socio-
demographic profile significantly related to the help-seeking intention of the
respondents?
6. Which of the variables predict the respondents intention to seek help for psychological
problems?

Hypotheses:
1. There is no significant relationship between the respondents profile and their help-
seeking intention.
2. There is no significant relationship of self-concealment, help-seeking attitudes, and
perceived social support and their help-seeking intention.
3. Self-concealment, help-seeking attitudes and social support system strongly predict
respondents intention to seek professional help for psychological problems.

Definition of Terms:

Help-seeking attitude refers to how frequently positive or negative cognitions regarding seeking
help from professionals for emotional problems and interpersonal problems are experienced by
students.

Help-seeking intention is ones propensity to seek professional help for psychological problems.
It refers to ones willingness and decision to seek help from formal sources such as counsellors,
psychologists, spiritual leaders and psychiatrists.

Previous counselling experience refers to whether or not respondents submitted themselves for
counselling to a professional such as a guidance counsellor, psychologist or a psychiatrist.
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 6

Self-concealment refers to ones propensity to hide distressing information from others.

Social support refers to the perceptions of the quality of social support network that the
respondents have. It refers to how a person construes the source of his/her social support to be in
relation to felt attachment, social integration, reassurance of worth, reliable alliance and the
guidance that he/she receives from the support group.

Significance of the Study:

The study will be beneficial to the following:

Administrators. The study will provide information about the help-seeking attitudes and
behaviors of students. This information serves as a basis for formulating interventions that will
shape the attitude of students towards seeking help from professional.

Students. The results of the study will make them understand the dynamics of their help-
seeking behaviour. It will generate insights about the importance of seeking professional help for
personal and interpersonal problems.

Guidance Counselors. The study will shed light into their roles in the help-seeking process.
The information that will be derived from the study will serve as bases for the counsellors to
come up with psychoeducational interventions that will shape the attitudes of the students toward
help-seeking.

Teachers. The results of the study will help teachers coordinate with counsellors to facilitate
help-seeking for psychological problems among adolescents or students.. Teachers will be able to
carry out their roles by collaborating with the guidance center in implementing programs that
will enhance their growth through psycho education, and counselling.

Future Researchers. This study may serve as a basis for future researchers who intend to
develop new models that will explain the help-seeking process.

Chapter 2

Review of Related Literature

The Need for Mental Health Services

Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 7

Counseling is one of the student services that aims to protect , maintain and develop
student wellness. Because most college students are in their adolescent years, they may
experience certain difficulties due to a number of biological, interpersonal, cognitive and
environmental changes; and the increasing number of stressful life events. Although it is
important to note that majority of adolescents do not experience persistent and disruption during
this period; there is nonetheless a relatively high prevalence rate of mental illness among
them(Orvaschel et.al., 1991; Sawyer, et.al, 2000).

Mental health problems for children and adolescents refer to the range of all diagnosable
emotional, behavioural and mental disorders (WHO, 2000). It may be caused by environmental
risk factors such as exposure to environmental toxins such as high to levels of lead, exposure to
violence, stress related to poverty and loss of important people through death, divorce or broken
relationships (WHO,2000).The growing demand of psychological services in schools and in the
community is a signal to mental health professionals to extend the boundaries of their services.

The need for counselling/psychotherapy may vary among individuals. In schools,

students visit the guidance center for a number of reasons. Some would want to be counselled
about their chosen courses, academic matters, emotional and relationship problems. In some
extreme cases, students may seek psychological help if they are victims of abuse and violence.
The study also showed that psychiatric services use among college students increase per year;
however the increase is not steady and remarkable. In a large epidemiological study, Shaffer et.al
( 1996) concluded that almost 11% of American children and adolescents aged between 9 and 17
years old met DSM IV-R criteria for a mental health problem which was associated with
significant functional impairment. Another study investigating prevalence rates in Munich ample
concluded that 17.5% of adolescents and young adults ( 14-24 years of age) met DSM-IV (APA,
1994) criteria for at least one mental disorder in the past year ( Witchen et.al., 1998). In addition
to the relatively high prevalence rates for mental illness, a significant number of adolecents
experience mental health problems, which constitute a diagnosable syndrome ( Sheffield, J.,
Florenza, E., Sfornoff, K., 2004). Likewise, Reiffler (2006), in his epidemiological study on the
incidence of mental health problems among college students in America, found that about 5% of
college freshmen manifested newly developed psychiatric symptomatology over the course of
the year.

In a narrative review on mental health problems and help-seeking of college students in

the United States, studies showed that more than one in three undergraduate students report
feelings of depression and difficulty to function in at least once in the previous year; and nearly
one in 10 reported seriously considering attempting suicide in the previous year (Hunt, J. &
Eisenberg, D., 2010)
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 8

Despite the prevalence and impact of mental health problems among adolescents, a large
proportion of disturbed adolescents do not receive the help that they need. In most cases, instead
of getting professional psychological help, they seek help from family and friends. This is an
issue that raises serious concern for counsellors and mental health workers. Lim, (2000) with her
study of Chinese-Filipino students reported that perceived barriers are: concern for stigma,
personal inadequacy, insufficient information about psychotherapy and mistrust for professional
helpers.

With the growing need of psychological services among adolescents, it is therefore

important to look into the factors that predict their willingness to seek help.

Help-Seeking Attitudes

Attitude is a positive or negative evaluation of an object (Franzoi, 2000). Objects

include people , things, events, and issues . Attitudes are being formed by ones beliefs about the
attitude object and by ones behavioural responses toward the object. According to Franzoi
(2000), these sources of evaluative judgment can determine attitudes singly or in combination.
Additionally, attitudes are believed to be formed through behavioural, affective and cognitive
processes. The ideas that evaluations are based on behavioural responses are reflected in
instrumental conditioning principles, self-perception theory and the facial feedback hypothesis.
The assumption that attitudes are formed from affective and emotional experiences is reflected in
classical conditioning principles and the mere exposure effect. Finally, the claim that attitudes
derive from the process of cognitive learning can be explained by the theory of planned
behaviour.

According to the theory of reasoned action or planned behaviour, a model of

determinants of volitional behaviour, is directly influenced by the intention to act; in turn, the
intention to act is determined by ones attitude to act and the felt subjective norm that one should
act (Azjen & Fishbaum, 1980). In addition, Cristopher et.al. (2006) holds that an individuals
attitude toward the act is his/her favourable or unfavourable evaluation of performing the act.
Subjective norm on the otherhand, refers to the persons perceptions of the social pressure put on
the individual by significant others.

In line with this model of help-seeking attitudes and behaviour, Skogstad et.al (2004)
contend that intentions to seek help fro personal-emotional probles including suicidal feelings
can be predicted using the variables from theory of planned behaviour. In a similar study among
depressed young women, Van Vorhees et.al.(2006) claim that attitudes toward treatment are the
principal determinants of mental health care-seeking behaviour in developed countries. Also,
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 9

Mckenzie et.al.(2006) found that help-seeking attitudes do not appear to be a barrier to seeking
professional among older adults but their intentions to visit primary care physicians might be
unfavourable.

Attitudes toward seeking help may play an important role in willingness to seek
professional psychological help. In a study by Carlton and Deane (2000) of high school students,
it was concluded that attitudes toward seeking psychological help was a significant predictor of
intentions to seek help for both personal and emotional problems and suicidal thoughts.
However, stigmatizing attitudes toward mental illness appear to be widely and persistently in
general community. ( Crisp et.al, 2000 , Green et.al., 1987). These stigmatizing attitude towards
mental illness negatively influence the way people react to those with mental illness ( Holmes et.
Al., 1999). Further, negative attitudes toward mental illness have been shown to affect
willingness to seek professional psychological help ( Leong and Zacher, 1999). Moreover, other
than attitudes, Hunt and Eidenberg ( 2010), found that common barriers to help-seeking include
a lack of perceived need for help, being unaware of services or insurance package and scepticism
about treatment effectiveness. The researchers likewise found that service use was infrequent
among students from lower socio-economic status, international students and Asian-Americans.
Additionally, they found that stigmatizing attitudes about mental illness were associated with
lower help-seeking behaviour.

Previous studies have proven that attitude toward seeking help is closely associated with
help-seeking intentions and behaviour. In this study, attitude is hypothesized to be a strong
predictor of help-seeking behaviour.

Help-Seeking Behavior

Several models have been developed to determine how, where and when individuals seek
help for mental disorders (Goldsmith, 1988, Jackson & Hough, 1988, Pescosolido, 1991, Jackson
& Mazuca & Crain, 2005). An important assumption of early and subsequent models of
treatment used was that, when faced with a general health or mental health problem, individuals
first accept the idea that they have a problem. Subsequently, they have to weigh pros and cons of
different ways of dealing with the problem and decide whether they are willing to seek help. In
the final stage, individuals select and then apply the type of service they think they need.
Specifically, the help-seeking stages are: problem recognition, decision to seek help and service
selection and service utilization ( Veroff, Kulka & Donovan, 1981).

Another very influential model of the study of access to medical care and help-seeking
behaviour is the Behavior Model of Health Service Use ( Andersen, 1995). Andersen observed
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 10

that use of health services is a function of the predisposition to use services, factors that enable
or impede their use and need for care ( Andersen and Newman, 1973). By focusing on specific
measures related to these factors such as health beliefs, ability to cope with environment,
educational level and perceived need, the model advance the field by providing a better
understanding of the helping process.

Goldsmith et.al (1998), presented a reformulation and expansion of earlier models of

help-seeking. Goldsmith and colleagues emphasized the cognitive decision to seek services
involves a cost-benefit analysis They presented a three-stage help-seeking process ( i.e. problem
recognition, decision to seek help and decision to select specific service) and identified factors
that may influence each stage. Characteristics of the disorder and predisposing factors,
psychological resources and coping were thought to influence problem recognition and decision
to seek help. Enabling factors such as economic resources, the ability to count on others for help,
social pressure to seek help and barriers to care were thought to contribute to the decision to seek
help and select specific services ( Goldsmith et.al., 1988). Srebnik, Cauce and Baydar (1996),
proposed a further expansion of the mental help-seeking model by adopting the model for
children and adolescents. Previous models for help-seeking behaviour have been criticized for
not recognizing the role of social and cultural practices and attitudes to help-seeking
(Pescosolido, 1991,1992). For example, Pescosolido (1991,1992) maintained that the interactions
the individuals have for members of their social network form the principal mechanism through
which they recognize health problems, contact health facilities and comply with medical advice,
He further postulated that size and cohesion of social network determine the potential level of
influence on service use. Characteristic of the network such as degree of support, values and
beliefs about the disorder and about treatment influence the decision as to whether medical
treatment is sought.

In the Shebnik et.al. model, the influence of social networks on help-seeking behaviour
can be seen as a barrier or facilitator to service utilization. Social networks are hypothesized to
facilitate treatment when members of the network influence the parent to seek professional help
and constitute a barrier when they influence the parent not to seek treatment.

Cauce (2002) and colleagues proposed a further revision of the model to facilitate it
application to adolescents mental health help-seeking behaviour. The revised model was offered
as a framework for understanding cultural and contextual factors affecting ethnic minority
adolescents pathways into services for mental health disorders. Cauce and colleagues argued
that culture and context impact help-seeking through the influence of the community. In their
view, adolescents in need of mental health services are less likely to seek help depending on
prevalent cultural and other contextual influences present in the community ( Cauce et.al., 2002).
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 11

With the models developed in understanding help-seeking intentions and behaviour,

various studies were conducted to explore this phenomenon. For instance, Skogstad et.al ( 2004)
in his study of prison inmates showed that Theory of Planned Behavior ( TPB) variables
predicted help-seeking intentions for suicidal thoughts and emotional problems. Those with prior
contact with prison psychologists had lower intentions to seek help for suicidal feelings than
prisoners without such contact.

In another study with undergraduate respondents, Dean ( 2001) found that peers were
rated as the most likely source of help. Moreover, such study showed the help-negation was
suggested by higher levels of suicidal ideation being associated with lower help-seeking
intentions. Similarly, results revealed, that suicidal ideation being associated with lower help-
seeking intentions. Similarly, results revealed that suicidal ideation significantly predicted lower
help-seeking intentions and that although hopelessness could not explain the negation effect, it
moderated the effect for seeking help from family ( Wilson et.al., 2005). In addition, in a study
on adolescent help-seeking behaviour, Bolder and Failon (1995) found that half of the
respondents sought help for their problem, and problem type was not associated with help-
seeking behaviour.

The literature on help-seeking indicates that it is a complicated and poorly understood

behaviour that is influenced by demographic and psychosocial factors ( Kellam et.al., 1981), is
not homogenous across population ( Garland and Zigler, 1994), and may not conform to
previously held stereotypes of adolescent behaviour. Hence, the focus of this study is to explain
how social and psychological variables will predict the likelihood of college students in their
late adolescent years to obtain help for mental health problems.

Influence of Demographic Factors on Help-seeking Behavior

To explain how attitudes toward professional help-seeking behaviour is determined,

many studies looked into factors such as race, educational attainment, availability of mental
health services and type of problems as predictors . In the study on Korean Americans help-
seeking attitudes, gender was not a significant predictor,( Yi & Tidwell, 2005).As suggested by
the studys findings, gender only predicts preference for source assistance, with females showing
preference for professional assistance more than males. In a similar study conducted by Kwo
et.al ( 2006), male and female differences were found in help-seeking attitudes. Similar result
was obtained in a cross-sectional study designed to describe subgroup variation (Khan, 2007).

Previous studies on age and educational attainment as factors of help-seeking revealed

that the receptiveness toward psychological help increases with age (Vorhees et.al., 2007).
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 12

Similarly, Vogel (2003) and colleagues found that older participants have more positive attitudes
toward professional than their younger counterpart. Likewise, research addressing level of
education generally indicates that a higher level of education predicts more positive attitude
towards help-seeking ( So, Stefani & Romero, 2005). In addition, Marshall (2006) found in his
studyof help-seeking behaviour of Cambodian refugees, that certain socio-demographic factors
such as gender, pre migration status, health insurance, receiving government assistance influence
the help-seeking behaviour of the respondents..

Although it is appealing to think that family SES might impact upon adolescents
willingness to seek help, a review of literature shows little research and inconsistent findings
(Sheffield at. Al., 2002).

Self-Concealment, Social Support and Help-seeking

Self-concealment is ones predisposed refusal to share distressing information with

others. It has been an interesting topic to study as it confirms the help negation effect in suicidal
ideation. Help negation refers to not utilizing available help even when it is needed( Rickwood
et.al., 2005). In their study, it was consistently found that young peoples help-seeking intentions
tend to decrease as their levels of suicidal ideation tend to increase even if these ideation levels
are subclinical. Interestingly, the help negation effect for suicidal thoughts was strongest for
informal sources of help.

To develop a model on help-seeking, Cramer (1999) used path analysis in exploring the
roles of self-concealment and social support on help-seeking. According to this model,
individuals are likely to seek counseling when distress is high and attitudes toward counseling
are positive; distress is likely to be high when social support networks are impaired and
individuals conceal personal and distressing information from others. The model likewise tested
individuals who conceal information are likely to have negative attitudes and impaired social
support networks. A more interesting finding is that although the direct path of self-concealment
on help-seeking is inconsistent across samples, the indirect path was more consistent but
substantially consistent. Cramer further contends that based on his study, distress is likely to
mediate the indirect effect considering its relation to self-concealment. This finding would imply
that individuals who conceal personal negative information from others have more psychological
difficulties and that such difficulties if sufficiently severe, increase the likelihood of professional
help. In addition, Cramer (2000) found out that self-concealment leads to greater psychological
distress and possibly reduces the likelihood of recovery by deterring individuals from seeking
treatment. Self-concealment therefore deeply paves the road to intensification rather than relief
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 13

of psychological problems. The study though revealed that self-concelament and social support
are unrelated

Corollary to Cramers model is Vogels study on emotional expression and the perceived
risk and benefit of seeking psychological help. Using structural equation modeling, Vogel (2008),
explained how emotional expression, psychological distress and attitudes toward seeking help
would influence help-seeking behavior when mediated by the anticipated risk or benefit for
counseling is considered. The study showed that anticipated risks and benefits were then linked
with attitudes towards seeking therapy. Attitudes in turn, were positively related to willingness to
seek therapy for personal and interpersonal concerns. Thus, those who reported being less
emotionally expressive are more worried about such disclosure to a therapist ( anticipated greater
risks and fewer benefits), which in turn was related to less positive attitudes and willingness to
seek therapy (Vogel, 2008). In their study, Skogstad (2000), asserted that fear of emotions is one
factor that has received little empirical examination for its potential contribution to individuals
reluctance to seek professional psychological assistance. This is so because probably, fear of
treatment stems from clients fear of experiencing painful affect. Indeed, studies have found that
a sizable number of psychotherapy clients keep secrets from their therapist. The primary reason
for this was that their secrets were loaded with emotions , and they were afraid to express strong
emotions in psychotherapy sessions.

The link between social support and help-seeking has also been supported in the literature
in a few studies. People with weaker social support networks have generally been found to be
more likely to seek professional help. Some have argued that the reason people with less social
support seek help more is that social support contributes to an individuals experience of
psychological distress first and that distress then predicts help-seeking. Thus, the influence of
social support in the help-seeking process may occur because how an individual defines and acts
upon distressing symptoms is often shaped by the attitudes of family and friends ( Angermeyer,
Matschinger & Riedel-Heller, 2001). Similarly, Powell and Kotcheska (2000), suggested that the
decision to seek help seems to be influenced by individuals;s belief that they have a problem, and
that they can not deal with it on their own or without those close to them (e.g. they perceive less
social support). Because such individuals perceive that they have less social support from people
close to them, their distress experiences may remain or even worsten, whch in turn increases
their likelihood to obtain professional help. Consistent with this, studies have shown that
perceiving less social support is related to the likelihood of individuals to experience
psychological distress.
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 14

Chapter 3
Methodology

Research Design

This study will employ the descriptive correlational design . It explains the relationship
between the independent, dependent and mediating variables in the study. This was chosen
because it enables the researcher to describe and simultaneously generalize results from a sample
population to gain a deeper understanding of the phenomenon of interest.

Selection of Respondents

The respondents of the study will be 350 college students from the six colleges of CSU
Carig Campus. To satisfy the inclusion criteria of students from ages 17-19, only those who are
in the first year to third year from the different colleges will be included. The stratified random
sampling will be used because the study population is composed of subgroups of different sizes.
To ensure the representativeness of the group under study, the proportional sampling technique
will be employed as the sampling fraction is the same for each stratum.

Data Gathering Instruments

The main tools for gathering data consist of the following scales:

Attitudes Toward Help-seeking Inventory . The ATSHPS Short form developed by Fischer &
Farina (1995) is a 10-item scale for measuring attitudes toward seeking psychological help. Each
item is a statement that is scored on a 4-point Likert type scale, ranging from 1( strongly
disagree) to 4 (strongly agree). The instrument was developed from the original 29-item
inventory. Scores for the ATSHPS range from 10 to 40, and a higher score indicates a more
positive attitude. To increase validity of the scale, 4 of the items are reversed. Test-retest
reliability estimates as been found to be .86 (over 5 dsys) and .84 (over 2 months), with internal
consistency estimates ranging from .83 to .86. Cronbach alpha in Leechs study is.80.

Self-concealment scale( Larson & Chastain, 1990) is a measure of ones predisposition to

actively conceal from others personal information that one perceives as distressing or negative.
Participants answer 10 items on a Likert scale ranging from 1(strongly agree) to 5 ( strongly
disagree) . Thus, total score s on the questionnaire range from 10 to 50, with a greater score
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 15

indicating a higher level of self-concelament. The SCS alpha coefficient is .88 and its test re-test
reliability is .80.

The Social Provision Scale developed by Cutrona and Russell (1987) is a 4-point Likert type
scale used to assess the strength of ones social support. The scale consists of 24 items that
participants rate on a scale ranging from 1 (strongly disagree) to 4 ( strongly agree). Cutrona and
Russell found the SPS to correlate significantly with actual behavior and other self-report
measures of social support. The items are combined to create 6 subscales. Interitem correlation
coefficient ranges from .84 to .92. In Leechs study, the cronbach alpha ranges form .66 to .81.

Measurement of Help-Seeking Intention. To measure help-seeking intention the General Help-

seeking Questionnaire developed by Rickwood, Deane, Wilson And Ciarocchi (2005) was used
in the study. The GHSSQ is a 13-item questionnaire that assesses future help-seeking intention
and has supplementary items that assesses past help-seeking experience. Items are rated from a
scale of 1 (unlikely) and 7 (likely). Because the study only looked into the likelihood of the
respondents to seek help, only items 1 to 8 were included in the scale. The scale had an internal
consistency of .694.

Data Analysis

The data will be analyzed using mean and standard deviation to summarize the level of
self-concealment, help-seeking attitudes, social support and help-seeking intention. Pearson
product moment correlation will be utilized to the relationship between the variables. To further
determine the predictors in the help-seeking process, the hierarchical regression analysis will
used. The hierarchical regression analysis is a statistical technique applied to investigate how
blocks of variables act as predictors of the behavior under study.
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 16

References;

Atknison, D.R, Worthington, R.L., Dana, D.M., & Good, G.E. (1991). Etiology
beliefs, preferences for counseling orientations, and counseling effectiveness.
Journal of Counseling Psychology, 38, 258-264

Bolder, J., and Fallon, B., (1995). Adolescent help-seeking: what do they get help for and
from whom? , Journal for adolescence. 18:193-20carlton, P.A and Deane, F.P (2000) Impact of
attitudes and suicidal ideation on adolescents intension to seek professional psychological help
Journal of Adolescence, 23:35-45

Bond, M.H., Leung, A, Au, A., Tong, K.K., & Chemonges-Nielsen, Z., (2004). Combining social
axioms with values in predicting social behaviors, European Journal of Personality, 18, 177-
199

Carlton, P.A. & Dean, F.P. (2000). Impact of attitudes amd suicidal ideation on adolescents
intention to seek professional psychological help, Journal of Adolescence , 23: 35-45

Christopher, M.S., Skillman, G.D., Kirkhart ,M.,DSouza, J,B., (2006) The effect of
normative and behavioral persuasion on help-seeking in thai and American college
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 17

students Journal of Multicultural Counseling and Development, 34 2 80

Cramer, K. (1999). Psychological antecedents to help-seeking behaviour: Reanalysis using

path modelling structure, Journal of Counseling Psychology, 46: 381-387

Garland, A.F. and Zigler, E.F., (1994), Psychological correlates of help seeking attitudes
among children and adolescents, American Journal of Orthopsychiatry, 64: 586-593

Franzoi, S.L. (2000) Social Psychology Brown and Benchmark

Leong, F.T.L. and Zachar, P. (1999). Gander and opinions about mental illness as predictors
of attitudes toward seeking professional psychological help.

Br. J. (2007) Guid. Couns. 27:123-132

Leech, N., (2007). Cramers model of willingness to seek counseling: a structural equation
modeling, Journal of Counseling Psychology, 141(4(, 435-445

Lim, M., (2000) Help-seeking behavior of the Chinese and Chinese-Filipino in Davao City:
An exploratory study. Unpublished Masters Thesis

Lim, K., Ang, R., (2006). Relationship of primary versus secondary control beliefs to
attitudes toward seeking help. North American Journal of Psychology, 8(3), 557-566

Rickwood, D., Dean, F., Wilson, C., Ciarrochi, J.,(2005) Young peoples help-seeking for
mental health problems. Australian e-Journal for Mental Health Problems, 3:4

So, D.,Gilbert, S., Romero, S., (2005) Help-seeking attitudes among african-american college
students. College Student Journal, 39(4) 806-816

Shefield, J., Fiorenze, E, Sofronoff, K., (2004)Adolescents willingness to seek psychological

help: promoting and preventing factors, Journ of Youth and Adoles, 33: 495-507

Skogstad, P., Deane, F. Spicer, J. (2000), Social-cognitive determinants of help- seeking for
mental health problems among prison inmates, Criminal Behavior and Mental
Health, 1: 35-43
Adolescents Pathways to Seeking Help for Psychological Problems: The Case of

Cagayan State University 18

Vogel, D., Wade, N., & Hackler, A., (2007) Percieved public stigma and the willingness to
seek counseling. The mediating roles of self-stigma and attitudes toward counseling,
Journal of Counseling Psychology 54(1) 40-50

Adolescents Pathways to Seeking Help for Psychological Problems: The Role of Self-
Concealment and Social Support System

A Research Proposal Submitted

to the

Research and Extension Office of Cagayan State University

By:

Maria Benita Escobar-Balagan

College of Arts and Sciences

October 2014