In our study, the mean score of ATSPPH-SF scale was 15.04 ± 3.45, indicating that the attitude towards seeking professional psychological help was relatively negative among Chinese medical students. Compared with the results in Chinese community-dwelling population (18.13 ± 5.63)[26], Chinese medical students had even more negative attitudes towards seeking psychological help. In addition, the total score on ATSPPH-SF scale in this survey was also lower than some European countries, such as Germany (17.2 ± 4.4), Ireland (18.4 ± 5.4) and Portugal (20.0 ± 5.7)[27], which indicated more negative attitudes toward psychological help-seeking among Chinese medical students. Given the gaps, it is essential to explore the factors influencing help-seeking attitudes.
In parallel with the literature, our research found that women showed more positive attitudes toward seeking professional psychological help than men[28]. Specifically, statistically significant gender differences were found in 8 items, all of which showed that women had a more positive attitude. This gender gap may be explained as a consequence of traditional gender norms. It is widely recognized that women are more emotional than men. Women tend to be more willing to disclose their emotions, and the association between distress disclosure and positive help-seeking attitudes had been well established[29]. Besides, as early as 1981, Kessler et al. had noted that women were more likely to seek psychiatric help than men, and attributed this difference to the fact that that women were more inclined than men to translate nonspecific feelings of psychiatric distress into conscious recognition[30]. However, influenced by the prevailing masculinity in the social environment, men’s attitudes towards seeking help were more negative[31]. Hegemonic masculinity is characterized by emotional control and bravery[32], while suffering from psychological distress, such as depression, is usually considered powerless and uncompetitive. Therefore, in order to demonstrate and strengthen masculinity, men tend to hold a rejection attitude towards emotional disclosure, let alone seek professional help.
The multivariable linear regression models suggested that the Family APGAR Index was a predictor of ATSPPH-SF for both male and female groups, indicating that students with lower family care are more likely to hold a negative attitude towards professional psychological help-seeking. This is consistent with previous research among Chinese community population[26]. As an important form of social support, family care plays an irreplaceable role in Chinese students’ decision-making. A survey has shown that when people experienced depression symptoms, family members were the first choice for most people to seek help from, and most importantly, mothers would provide advice on problem-solving[33]. Considering this, we can believe that family members have a direct impact on people’s attitudes towards seeking professional psychological help.
Utilizing the GHQ-20 for assessment, our study discerned that higher cumulative scores among Chinese students—both male and female—indicative of increased psychological distress, were associated with progressively negative attitudes towards seeking professional help. This observation raises concerns, especially given that those most in need of psychological interventions appear more hesitant to pursue them. Past research has pinpointed an association between elevated psychological distress and heightened stigma scores[34]. Numerous studies consistently highlight a marked inverse relationship between stigma and the propensity to seek professional psychological assistance[26, 35]. Furthermore, an evaluation involving 220 medical students revealed a significant indirect influence of mental distress on help-seeking attitudes, mediated by self-stigma[36]. These findings are in alignment with our own.
Our findings are congruent with extant literature, underscoring a pronounced negative association between a diminished self-assessment of psych knowledge and attitudes towards procuring mental health support. A limited self-assessment of psychological health knowledge often implies a lack of confidence in recognizing mental disorders’ symptoms, potential misconceptions or biases about psychological health, and possibly a reluctance or skepticism towards professional therapeutic interventions. Empirical evidence from the Western Pacific region substantiates this connection, indicating that those with a more informed self-perception of depression knowledge exhibit a more positive orientation toward mental health interventions[37]. This pattern echoes prior findings in the Chinese context[26, 38]. Importantly, our analysis reveals that students acknowledging the merits of psychological interventions, such as counseling and pharmacotherapy, manifest a more open-minded perspective on their utility. This underscores the critical role of rectifying misconceptions and enhancing accurate self-evaluation of one’s psychological health literacy to foster more constructive help-seeking behaviors.
Our study elucidated a gender-specific discrepancy in the correlation between prior psycho-help experiences and attitudes towards seeking psychological assistance. Among female university students, a pronounced positive association was identified: those with prior psycho-help experiences displayed a more favorable disposition towards future psychological interventions. This suggests that initial therapeutic encounters potentially frame subsequent perceptions and receptivity in females[39, 40]. Conversely, such a relationship was absent among their male counterparts. This could be attributed to entrenched socio-cultural norms, which often encourage males to mask their emotional vulnerabilities, thereby rendering them less susceptible to the influences of past therapeutic interactions[36]. These findings accentuate the paramount importance of gender considerations in mental health practices and underscore the necessity for tailored approaches when addressing the mental health needs of distinct gender groups.
Our study is underscored by several limitations that warrant acknowledgment. To begin with, the cross-sectional nature of our research design precludes the determination of definitive causal relationships between attitudes towards psychological help-seeking and their potential determinants. This inherent limitation accentuates the need for future longitudinal investigations to ascertain causality and corroborate our preliminary findings. Additionally, our study’s sample is predominantly sourced from a single province in the southernmost region of China. While this provides a nuanced understanding of the specific demographic, it simultaneously raises concerns about the generalizability of our results. It is prudent to approach our findings with caution when extrapolating to broader populations or diverse cultural contexts. Future research endeavors spanning a more diverse geographic scope would provide a more comprehensive insight into this domain.