help-seeking and non-help-seeking students' perceptions of own and peers' mental health...

Journal of College Counseling ■ Spring 2005 ■ Volume 8 65

Help-Seeking and Non-Help-Seeking Students’Perceptions of Own and Peers’ Mental Health

Functioning

Bruce S. Sharkin, Paula M. Plageman, and Lisa P. Coulter

Help-seeking (HS) students and non-help-seeking (NHS) students were compared on their percep-tions of (a) their own level of mental health functioning and (b) the average level of mental healthfunctioning of their (NHS or HS) peers. Results showed that NHS students’ perceptions of HSstudents’ self-ratings were similar to HS students’ self-ratings of functioning but that HS studentsunderestimated the level of functioning of their NHS peers. Implications of the findings for campusoutreach and future research are discussed.

College counselors can greatly benefit from knowing about factors thatmay influence college students’ willingness to seek professional coun-seling help. Previous research has identified some factors that can

increase or decrease the likelihood of help seeking, also referred to as approachand avoidance factors (Kushner & Sher, 1989; Vogel & Wester, 2003).Examples of factors that have been found to increase help seeking are prior helpseeking (Deane & Todd, 1996) and level of psychological distress (Deane &Chamberlain, 1994). Examples of factors found to decrease help seeking are thedesire to conceal distressing information (Cepeda-Benito & Short, 1998) oravoid painful emotions during counseling (Komiya, Good, & Sherrod, 2000).The perceptions that help-seeking (HS) students and non-help-seeking (NHS)students have about each other’s mental health are a relatively unexploredvariable that could play a role as an approach or avoidance factor in collegestudents’ help-seeking attitudes and behavior. Although college students in treatmenthave been found to be more distressed and dysfunctional than students not intreatment (Green, Lowry, & Kopta, 2003), little is known about how NHSstudents perceive the level of functioning of their HS peers, and vice versa.

The perceptions that college students have about themselves in comparisonwith their perceptions of peers can play a key role in understanding their help-seeking behavior. In other words, such perceptions (or misperceptions) mayinfluence decisions about whether or not to seek help. The theory of reasonedaction (Ajzen & Fishbein, 1980) suggests that an individual’s behavior can bedetermined in part as a function of his or her subjective perceptions of norma-tive behavior. According to the theory, whether or not people seek counselingwill partly depend on whether they perceive counseling as normative or

Bruce S. Sharkin and Lisa P. Coulter, Department of Counseling and Psychological Services, and Paula M. Plageman,Advising Department, all at Kutztown University. The authors thank Nick Ladany and Roger Phillips for theirthoughtful comments on an earlier draft of this article. Correspondence concerning this article should be ad-dressed to Bruce S. Sharkin, Department of Counseling and Psychological Services, Kutztown University, 205Stratton Administration Center, Kutztown, PA 19530 (e-mail: [email protected]).

66 Journal of College Counseling ■ Spring 2005 ■ Volume 8

nonnormative. Thus, knowing how students perceive social norms might pro-vide information about their help-seeking behavior.

Moreover, it has been found that students are more likely to seek counselingwhen they perceive their problems to be more serious than their peers’ problems(Goodman, Sewell, & Jampol, 1984). This suggests that students who seek coun-seling might be vulnerable to overestimating the level of mental health functioningof their peers who do not seek counseling, which could intensify any existing feel-ings of stigma associated with seeking professional help. Conversely, students whodo not seek counseling may be vulnerable to underestimating the level of mentalhealth functioning of their peers who do seek counseling, thereby reducing thelikelihood of their seeking counseling for themselves if needed. That is, they mayconvince themselves that their problems are not serious enough for counseling.

In an early study, Dreman and Dolev (1976) assessed the self-perceptions of stu-dents who were not in counseling and asked them to give their perceptions of coun-seling center clients. These students perceived their peers who were in counseling ashaving more psychological and interpersonal difficulties than they, themselves, did.Unfortunately, this study did not determine the accuracy of the participants’ percep-tions of students in counseling by comparing them with the self-perceptions of theactual counseling center clients. Would the clients have rated themselves as havingmore psychological and interpersonal difficulties than did their peers who were notin counseling? Do HS students generally assume that their NHS peers are betteradjusted and higher functioning (in terms of mental health) than they are them-selves? Such questions can only be answered if the perceptions of students who seekcounseling are compared with the perceptions of students who do not seek counsel-ing in terms of how they perceive each other’s mental health functioning.

Understanding the perceptions that HS and NHS college students have abouteach other might be particularly informative for college counseling outreachprogramming efforts. For example, “social norms” programming has beenused successfully to alter students’ perceptions of normative behavior in orderto decrease binge drinking (Barnett, Far, Mauss, & Miller, 1996; Haines &Spear, 1996). Similar types of programming could be applied to mental healthas a way to facilitate help seeking when needed. Hence, the primary purpose ofthis study was to compare students who sought counseling on campus, or HSstudents, with students who had never sought counseling, or NHS students, intheir perceptions of (a) their own level of mental health functioning and (b) thelevel of mental health functioning of their peers.

Method

Participants

A total of 278 undergraduate students (91 men and 187 women) at a medium-size northeastern university served as participants in this study. The majority ofparticipants were White (more than 90%), between the ages of 18 and 22 years(M = 20.18, SD = 3.35), and in their 1st or 2nd year of college (64%).


HS students (n = 109) were first-time users of the university counseling ser-vice during the fall and spring semesters of 2002. The sample of HS studentsconsisted of 23 male and 86 female students. In the total sample of HS stu-dents, there were 62 students who had no previous counseling and 47 who hadprevious counseling elsewhere. NHS students (n = 169) were obtained from asample of undergraduate classes during the fall semester of 2002. There were68 male and 101 female students in the sample of NHS students. Participationwas voluntary, and no incentives were offered.

Research Questionnaire

A three-item questionnaire was developed specifically for this study. For eachitem, respondents were asked to indicate their response on a 10-point scalefrom 1 (very poor) to 10 (very good). The midpoint of 5 was labeled average.Items were as follows:

1. Please rate your current level of mental health functioning.2. Please indicate what you believe is the average level of mental health

functioning of students who seek counseling.3. Please indicate the level of mental health functioning at which you

believe an individual should seek counseling.

Mental health functioning was defined as psychological and emotional function-ing. For the second item, NHS students were asked to rate their peers who hadsought counseling, whereas the HS students were instructed to rate their peerswho had not sought counseling. The term peer was defined as college students ingeneral and not limited to cohort year or specific peers such as friends.

We chose to use brief, single items as opposed to a multiple-item measure inorder to keep participation time to a minimum for new counseling center cli-ents who also need time to complete intake forms. Before commencing thestudy, we first asked three counseling center psychologists and three studentsto evaluate the items in terms of face validity (i.e., whether the items appearedto assess what they were intended to assess). All of them evaluated the items tohave good face validity for the purpose of this study.

Participants were also asked to provide demographic information about age,gender, race/ethnicity, and year in school. In addition, HS students were askedif they had had any previous counseling, whereas NHS students were askedwhether they had ever been in counseling. To ensure that the group of NHSstudents consisted of individuals who had never been in counseling, partici-pants who answered “yes” (n = 18) were excluded from the analyses.

Procedure

All students who had an intake appointment for the first time in the universitycounseling service during the spring and fall semesters of 2002 were asked toparticipate in the study. The questionnaire was included in the packet of formsthat all new clients are asked to complete at the time of their intake appoint-


ment. The majority of clients (more than 95% of new intakes during the twosemesters) agreed to participate by completing the questionnaire.

In order to obtain a sample of NHS students, we conducted a random sampleof 10 courses across all disciplines during the fall semester of 2002. The pro-fessors of these courses were contacted and asked if we could administer ourquestionnaire during class time. Eight of the 10 professors contacted agreed toparticipate. There was some variability in the time during the semester whenwe administered the questionnaire in each class, but all questionnaires wereadministered by the middle of the semester.

Results

HS students were first-time users of the counseling center, but some indicatedthat they had had previous counseling elsewhere. In order to assess for anydifferences between HS students who had previous counseling and those who didnot, we performed t tests of means of the two subgroups regarding their percep-tions of their own mental health functioning, perceptions of peer mental healthfunctioning, and belief about the level of mental health functioning when helpshould be sought. No significant differences were observed on these three vari-ables, and therefore the data for the two subgroups of HS students (n = 109)were combined for all subsequent analyses.

Because there were unequal distributions of men and women in the two groups,we performed a chi-square test to determine if gender could be a potentialcovarying factor with group. The chi-square test was significant, χ²(1) = 11.02,p < .01, and therefore gender was examined as a factor in the analyses.

The means and standard deviations for ratings of male and female students inthe groups of HS students and NHS students are presented in Table 1. Two-way analyses of variance (ANOVAs) with group (HS students, NHS students)and gender (men, women) as fixed factors were used to assess for differencesin ratings between the two groups. For student perceptions of their own mentalhealth functioning, a significant main effect was obtained for group, F(1, 273)= 85.0, p < .001, η² = .32, but not for gender. The interaction effect was notsignificant. Examination of the means revealed that the group of HS studentsrated their own level of mental health functioning significantly lower in com-parison with the group of NHS students.

For perceptions of peer mental health functioning, a significant main effectwas obtained for group, F(1, 274) = 42.53, p < .001, η² = .18, but not forgender. The interaction effect was not significant. Examination of group meansshowed that the group of HS students rated their peers as functioning at asignificantly higher level in comparison with the group of NHS students.

The two groups were compared on their beliefs about the level of mentalhealth functioning at which someone should seek counseling. A significant maineffect was obtained for group, F(1, 274) = 25.11, p < .001, η² = .10, but notfor gender. The interaction effect was not significant. Comparison of meansrevealed that the help-seeking group rating was significantly higher (i.e., counseling


should be sought at higher level of functioning) than the non-help-seeking grouprating. Because the ANOVAs revealed no significant effects for gender and nointeraction between group and gender, the data for men and women werecollapsed within each group for subsequent analyses.

In order to assess the level of agreement between perceptions of peer mentalhealth and actual peer ratings, the HS students’ ratings of their own mental healthfunctioning were compared with the NHS students’ ratings of peer (HS students’)mental health functioning. The mean peer ratings of the non-help-seeking group(M = 5.00) did not differ significantly from the HS students’ ratings of their ownfunctioning (M = 5.13), t(276) = –.632, p = .528. The NHS students’ ratings oftheir own functioning were compared with the HS students’ ratings of peer (NHSstudents’) mental health functioning. HS students rated the level of functioning oftheir NHS peers (M = 6.36) significantly lower than the level at which NHSstudents rated themselves (M = 7.53), t(276) = 6.22, p < .001.

Discussion

In this study, several statistically significant differences were found between HSand NHS students. First, HS students’ ratings of their own mental health func-tioning were significantly lower than NHS students’ ratings of their own mentalhealth functioning. Second, HS students rated their NHS peers as functioningat a significantly higher level in terms of general mental health compared withhow the NHS students rated the HS students. Third, HS students rated thelevel of mental health functioning at which someone should seek counselingsignificantly higher than did the group of NHS students. Gender was not asignificant factor in any of these group differences.

These results are not surprising given the differences in perceptions one wouldexpect between students who seek counseling and those who have never sought

TABLE 1

Means and Standard Deviations of Ratings for Men and Women inthe Help-Seeking and Non-Help-Seeking Groups

Variable

HS studentsMen (n = 23)Women (n = 86)Total (n = 109)

NHS studentsMen (n = 68)Women (n = 101)Total (n = 169)

M

5.455.055.13

7.517.537.53

Note. HS students = help-seeking students; NHS students = non-help-seeking students.Rating scale: 1 = very poor; 5 = average; 10 = very good.

SD M SD M

6.306.376.36

4.595.275.00

4.914.644.70

3.763.673.71

1.991.871.89

1.771.491.60

1.291.441.40

1.471.691.63

1.781.631.66

1.481.301.37

SD

Self Peers Seek Counseling

Level of Perceived Mental Health Functioning


counseling. Particularly for students who seek counseling for the first time oncampus, they may assume that their own mental health functioning is lowerthan that of their peers who have not sought counseling. This is consistent withfindings on actual differences in functioning between students in counselingand students not in counseling (Green et al., 2003). In addition, as expected,HS students did not rate the level of mental health functioning as needing to beas low before seeking counseling as did the NHS students. The NHS studentsbelieved that functioning would need to be between 3.0 and 4.0 before coun-seling should be sought. In contrast, HS students rated the level at whichcounseling should be sought, on average, closer to 5.0 (i.e., an average level offunctioning). This suggests that HS students, compared with NHS students,may view counseling as an option even when functioning is not severely im-paired. Conversely, it may indicate that NHS students are reluctant to seekcounseling unless functioning is severely impaired.

The primary purpose of this study was to examine the perceptions that HSand NHS students experience about each other (in terms of level of mentalhealth functioning) in order to assess for potential misperceptions that stu-dents may have about peers who do or do not seek counseling. We pre-dicted that NHS students would underestimate the level of mental healthfunctioning of their HS peers, but NHS students’ perceptions were foundto be quite close to the actual HS students’ self-ratings of functioning. It isinteresting that the NHS students perceived their HS peers to be at a levelhigher than the level at which they believed counseling should be sought(mean ratings of 4.99 vs. 3.71).

It was expected that HS students would overestimate the mental health func-tioning of their NHS peers. On the contrary, HS students actually underesti-mated the level of functioning of their NHS peers. Even though HS studentsperceived themselves as functioning at a lower level than their NHS peers,they did not see their peers functioning at the level the peers rated them-selves. Indeed, the difference between HS students’ ratings of their own func-tioning and their perceptions of peer functioning, on average, was relativelysmall. This suggests that HS students, despite having sought professionalhelp, may not necessarily assume that their NHS peers are functioning at asignificantly higher level than they, themselves, are in terms of mental health.

Implications for Outreach

Outreach is considered a critical component of college counseling (Kern, 2000).Given the reports (e.g., Benton, Robertson, Tseng, Newton, & Benton, 2003) ofgrowing numbers of students using counseling for problems such as anxiety anddepression, outreach that promotes the benefits of counseling for everyday studentproblems and dispels the stigma associated with seeking counseling is especiallyrelevant. The results of this study may be incorporated into campus outreachprogramming to accomplish the latter objectives. For example, students could beinformed that both HS students and NHS students viewed HS students as func-


tioning at an “average” level, suggesting that students need not worry about beinglabeled “crazy” or severely disturbed by their peers for seeking counseling.

The results of this study may also be used to educate students about the use ofcounseling services. In this study, what differentiated HS students from NHS stu-dents was their perception of the level of deficit in functioning required before coun-seling should be sought, with NHS students rating this level to be significantly higherthan HS students. This finding could be used to educate students that counselingmay be helpful at any level of functioning, including obtaining help with problemsolving, obtaining objective feedback, or simply obtaining support from a good lis-tener. Indeed, students can be informed that counseling may be most helpful whenused as a preventive measure before the student’s problems reach a crisis level.

The use of research results in outreach programming, as described in theprevious paragraph, is similar to “social norms” programming that is used tochange students’ perceptions of peer norms to reduce drinking (Barnett et al.,1996; Haines & Spear, 1996). Theoretically, this type of programming is basedon the theory that behavior is influenced by perceptions of normative behavior(Ajzen & Fishbein, 1980). In this vein, outreach programmers may presentthe actual survey questions from this study for students to answer individuallyor in groups. In the latter case, students could be asked to respond to itemsindividually and then, via discussion with other group members, arrive at agroup consensus response for each item. A representative from the groupcould then report on the group’s ratings and how the members of the grouparrived at them, including issues and topics that emerged in arriving at re-sponses. In such an exercise, the results could be compared with the actualresults found in this study to generate further discussion. This could also serveto educate students about how the use of counseling is perceived by peers andabout the utility of counseling for problems of any magnitude.

Limitations and Directions for Future Research

Limitations in the methodology of this study affect generalization of the results.First, the sample was limited to one college and may not reflect the perceptionsof college students at other institutions. Second, the sample was predominantlyWhite and thus limited in terms of racial/ethnic diversity. Third, students intheir 1st or 2nd year of college were overrepresented in the sample, whichcould have contributed to potential biases in responses. Fourth, we obtainedHS students’ ratings of their own functioning at the time of their intake (beforeactually meeting with a counselor), which may not be representative of allstudents who seek help. Even though we found no differences in HS students’ratings as a function of prior counseling experience, students who seek coun-seling for the first time on campus may be more anxious than those who havesought help on campus before. Fifth, we needed to use brief individual ratingscale items in order to conduct the study, but we recognize that this method ofassessment was less reliable than a multiple-item instrument. Despite theselimitations, the findings are an important first step in understanding how col-


lege students’ perceptions of their own versus peer mental health functioningmay play a role in their help-seeking behavior.

The findings of this study suggest several directions for future research. Thisstudy relied on a subjective measure to assess self-versus-peer functioning, butfuture studies could include objective measures that would allow conclusions tobe drawn about the accuracy of self-versus-peer perceptions. Such research couldyield important information for counselors to use in correcting any misperceptionsabout the level of functioning of those who use or do not use counseling.

Whereas in this study we examined the perceptions of HS students beforethey actually saw a counselor, it would be interesting to investigate how theactual process of counseling might influence HS students’ perceptions of theirown-versus-peer mental health functioning. We would expect that HS students’self-perceptions regarding mental health functioning to change as a result ofparticipating in counseling, but would this necessarily be in a positive directionwhen comparing themselves with NHS peers? Could HS students subsequentlysee themselves as functioning at an equal or even higher level than their “aver-age” NHS peers after they had been in counseling for some period of time, orcould they end up perceiving themselves as functioning at a lower level as aresult of being in counseling? It would also be interesting to assess and com-pare the perceptions of students seeking help for the first time with studentswho have sought help multiple times.

Another issue that could be explored is how campus climate relates to men-tal health. For example, some campuses conduct regular outreach programson mental health issues and/or national screenings for depression, anxiety,and other mental health problems. What impact do campuses that are moreactive in this way have on students’ perceptions of help seeking and on theirhelp-seeking behavior?

Conclusion

This study represents an initial attempt to understand how college students’perceptions of their own versus their peers’ mental health functioning mightrelate to help-seeking behavior. An increased understanding of these percep-tions and their influence on help seeking might help counselors to be betterequipped to educate students about counseling, destigmatize and normalizethe use of counseling, and increase the likelihood that students will seek helpfor their problems when needed.

References

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior.Englewood Cliffs, NJ: Prentice Hall.

Barnett, L. A., Far, J. M., Mauss, A. L., & Miller, J. A. (1996). Changing perceptions of peernorms as a drinking reduction program for college students. Journal of Alcohol and DrugEducation, 41, 39–62.


Benton, S. A., Robertson, J. M., Tseng, W.-C., Newton, F. B., & Benton, S. L. (2003). Changesin counseling center client problems across 13 years. Professional Psychology: Research andPractice, 34, 66–72.

Cepeda-Benito, A., & Short, P. (1998). Self-concealment, avoidance of psychological ser-vices, and perceived likelihood of seeking professional help. Journal of Counseling Psychol-ogy, 45, 58–64.

Deane, F. P., & Chamberlain, K. (1994). Treatment fearfulness and distress as predictors ofprofessional psychological help-seeking. British Journal of Guidance and Counselling, 22,207–217.

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Haines, M., & Spear, S. F. (1996). Changing the perception of the norm: A strategy to de-crease binge drinking among college students. Journal of American College Health, 45,143–140.

Kern, C. W. (2000). Outreach programming from the college counseling center. In D. C.Davis & K. M. Humphrey (Eds.), College counseling: Issues and strategies for a new millen-nium (pp. 205–219). Alexandria, VA: American Counseling Association.

Komiya, N., Good, G. E., & Sherrod, N. B. (2000). Emotional openness as a predictor ofattitudes toward seeking psychological help. Journal of Counseling Psychology, 47, 138–143.

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