1- Relation of Depresion and Help Seeking History to Attitudes

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Relation of Depression and Help-Seeking History to Attitudes TowardSeeking Professional Psychological Help

Autor(es):Halgin, Richard P.1,2; Weaver, Dana D.1; Edell,

William S.1; Spencer, Peter G.1

Nmero: Volume 34(2), April 1987, p 177185

Tipo de publicacin: [Professional Issues and Training]

Editor:

1987 by the American Psychological

Association

Instituciones:

1University of MassachusettsAmherst

2Correspondence concerning this article should

be addressed to Richard P. Halgin, University of

Massachusetts, Psychological Services Center,

Tobin Hall, Amherst, Massachusetts, 01003.

Received Date: April 7, 1986; Revised Date:

September 19, 1986

Abstract

We investigated the relation of help-seeking history, sex, and depression to college students' attitudes, beliefs,and intentions about obtaining professional psychological help. College students completed questionnaires that

included the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), an inquiry about

help-seeking history, and an attitude scale constructed according to the method posited in the theory of reasoned

action (Ajzen & Fishbein, 1980). Of these 429, 126 who represented extremes of the depression continuum were

selected as subjects for data analyses. Though sex differences were not found, results indicated that the experience

of having sought help is positively related to how one feels about seeking help and that the experience of depression,

regardless of help-seeking history, is also related to more positive attitudes, beliefs, and intentions. Implications for

educative interventions are considered.

Research in counseling psychology is replete with efforts to better understand and describe potential clients of

counseling services. One particular question that continues to provoke empirical examination concerns the factors

that are most influential in the decision to seek professional counseling. Approaches to this issue are varied and have

included work on client expectations about the nature of counseling (Bordin, 1955; Subich & Coursol, 1985; Tinsley &

Benton, 1978; Tinsley, Brown, de St. Aubin, & Lucek, 1984; Tinsley & Harris, 1976; Tinsley, Workman, & Kass, 1980;

Yuen & Tinsley, 1981); college students' help-seeking preferences (Cook et al., 1984; Tinsley & Benton, 1978; Tinsley,

de St. Aubin, & Brown, 1982); college students' perceptions of counselors and problems appropriate for counselors

(Gelso & Karl, 1974; Gelso & McKenzie, 1973; Getsinger & Garfield, 1976); the relation among help seeking, life stress,

and social support systems (Goodman, Sewell, & Jampol, 1984); the relation among help seeking, student

characteristics, and program descriptions (Tracey et al., 1984); the relation of demographic factors to the use of

counseling services (Greenley & Mechanic, 1976; Hummers & DeVolder, 1979; Kessler, Brown, & Broman, 1981; Kulka,

Veroff, & Douvan, 1979); and the relation of personality variables to the incidence of help seeking (Sharp & Kirk,

1974).

Ovid: Relation of Depression and Help-Seeking History to Attitude... http://0-ovidsp.tx.ovid.com.columbus.uhu.es/spb/ovidweb.cgi

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Tinsley, de St. Aubin, and Brown (1982) reported that investigations regarding the issue of who uses or does not

use counseling services generally fall into three categories(a) the types of problems for which clients seek help, (b)

the influence of characteristics of the helpers on the decision of prospective clients to seek help, and (c) the

characteristics of the potential clients. Utz (1983), in reviewing literature concerning characteristics of potential

clients, reported that researchers have attempted to differentiate seekers of counseling services from nonseekers

according to differences in personality characteristics, level of personal adjustment, and demographic and attitudinal

variables.

For the present study, we focused on the characteristics of potential clients of counseling services. More

specifically, we looked at college students as potential clients and focused on the relation between intention to seek

professional psychological help and factors such as attitudinal variables, level of depression, and help-seeking history.

This study differs from previous work in that the method, based on social psychological theory (Ajzen & Fishbein,

1980), permits an empirical analysis of those beliefs about the outcome of professional help that determine attitudes

toward seeking and intention to seek such help.

For the present study, we used the termprofessional psychological help instead of the terms counseling and

counselor. We made this choice in an attempt to reduce possible confusion about the latter terms that was

documented by Gelso and Karl (1974), who asserted that the term counseloris a generic label and serves as anumbrella, subsuming a variety of professionals differing in the type of degree and the amount of graduate training (p.

243). When it is used in surveys, students probably do not attribute appropriate levels of psychological and

professional training to the broad conception of the counselor.

Theory of Reasoned ActionThe method used for this study is based on the theory of reasoned action (Ajzen & Fishbein, 1980), which states

that the decision to engage in a particular behavior (seeking professional psychological help) is primarily a function of

the individual's intention to engage in the behavior. Furthermore, the intention to engage in the behavior is largely

determined by the individual's attitude toward the behavior. Attitude, in turn, is a function of specific beliefs

regarding the consequences of performing the behavior and evaluations of those consequences.

The Ajzen and Fishbein (1980) method has proved effective in providing the means for successful prediction of

health-related behavior in a number of areas, including weight loss, family planning, and treatment of alcoholism

(Ajzen & Fishbein, 1980), and was considered especially suited for this study because it provides a model for

uncovering which beliefs contribute to the formation of attitude toward seeking and intention or tendency to seek

professional psychological help.

Help-Seeking AttitudesFischer and Turner (1970) and Fischer and Cohen (1972), in the administration of their Attitudes Towards Seeking

Professional Psychological Help Scale among nonclinical student samples, found more favorable attitude scores among

more educated, Jewish and female subjects. Calhoun, Dawes, and Lewis (1972) failed to find the same demographic

correlates with the scale among a sample of outpatients at a psychological clinic. Cash, Kehr, and Salzbach (1978)determined that Fischer and Turner's inventory successfully discriminated college undergraduates who had sought

professional psychological help from those who had not. They found that people with more favorable attitudes toward

seeking such help also had more positive perceptions of the counselors' expertise, trustworthiness, regard, empathy,

genuineness, and helpfulness. Positive attitudes also influenced willingness to return after the first interview and the

expectation for improvement in personal problems. It was unclear, however, whether such positive attitudes

preceded or resulted from the help-seeking behavior.

Greenley and Mechanic (1976) found that the factors that had the strongest influence on college students'

decisions to seek help were global attitudes; respondents were more likely to seek help if they had a psychological

readiness to do so and also had relatives with more positive attitudes toward psychiatry. Bosmajian and Mattson

(1980), on the other hand, found that level of personal adjustment interacted with seeker-nonseeker differences andthat attitudinal variables were not good predictors of help-seeking behaviors of college students. Utz (1983),

however, in a study of students with vocational problems, found that people who used the services of a counseling

center had significantly more positive attitudes toward counseling centers and counselors. Because level of


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adjustment was not measured, it was not possible to ascertain whether there was an interactive role between this

variable and attitude.

Related to the issue of level of personal adjustment is the impact of distress on attitude toward seeking

professional psychological help. Sharp and Kirk (1974) found specified anxiety level to be a strong correlate to positive

attitudes, whereas other researchers have found severity of disturbance to be inversely related to positive

help-seeking attitudes (Calhoun et al., 1972; Calhoun & Selby, 1974). Mechanic (1975), however, suggested that thefactor that most influences help-seeking decisions among college students is level of subjective distress. Distress has

been defined differently by researchers in this area. As Hammen (1980) and Hammen, Marks, Mayol, and deMayo

(1985) have shown, college students have relatively high rates of diagnosable depressive disorders. Depressive

symptomatology appears to be a common manifestation of stress or distress in the college population. In the present

study, we chose the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) as the measure

of depression because this scale has been shown to correlate highly with psychiatric ratings of depression among

college students (Bumberry, Oliver, & McClure, 1978). Additionally, Hammen (1980) found that within her college

student sample, BDI scores were highly correlated with scores on the Hamilton Rating Scale for Depression (Hamilton,

1960), an interviewer-administered scale.

The relation between sex of the student and help-seeking attitudes was also investigated in the light of thecontradictory literature in this area. For example, Hummers and DeVolder (1979) found that women are more likely

than men to use counseling services, and Cook et al. (1984) found that women have a greater willingness to seek help

and more favorable attitudes about counseling than do men. Others, however, have found no sex differences related

to help seeking (Christensen & Magoon, 1974; Parish & Kappes, 1979; Snyder, Hill, & Derksen, 1972).

In conclusion, we believe that attitudes toward help seeking should not be approached as an isolated predictor of

tendency, or intention, to seek counseling. Thus, in the present study, we addressed the additional factors of

help-seeking history and depression. Attitude was conceptualized as multidimensional in nature and encompassing a

variety of beliefs or evaluations about the counseling experience. In addition to investigating possible sex differences,

we hypothesized that prior help-seeking experience and current distress, operationalized as depression, would

increase intention and lead to more positive attitudes and beliefs regarding professional psychological help.

MethodPilot Study

We conducted the pilot study to assess college students' salient beliefs about the advantages and disadvantages of

seeking professional psychological help. The lists of advantages and disadvantages generated in the pilot study were

used to formulate the items of the attitude measure administered in the main study.

Subjects

The subjects for the pilot study were 127 undergraduate students enrolled in an introductory psychology course

at a large, northeastern state university. The sample was 69% female, and the mean age for all subjects was 20.1

years.

Instrument

The pilot-study questionnaire was designed to elicit salient beliefs about the potential outcome of seeking

professional psychological help. Respondents first read a vignette describing a depressed person based on Diagnostic

and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) criteria for dysthymic

disorder. In a procedure similar to that used by Ajzen and Timko (in press), respondents were instructed to imagine

that the vignette approximated their current condition. They were asked to then list advantages and disadvantages of

seeking professional psychological help if depressed. Students were not limited in the number of advantages and

disadvantages that could be listed.

ProcedureParticipation in the study was voluntary, and participants received extra credit to apply toward course

requirements. A total of 155 questionnaires were administered during a regularly scheduled class meeting; 14 students

opted not to participate, and 14 questionnaires were eliminated because they were partially completed.


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All responses to the questionnaire were reviewed by three raters working independently (three of us authors).

Each rater thematically grouped all responses, formulated a frequency distribution of responses for each group, and

gave each response group or category a descriptive label. This intercoder procedure was designed by Ajzen and

Fishbein (1980) and has been used in studies of weight loss, family planning, voting patterns, and behavior of

alcoholics.

Because of the straightforward responses, raters differed less than 20% of the time in grouping responses intocategories. A discussion among the raters resulted in consensual agreement regarding the most concise label for each

category. The 14 categories of advantages and disadvantages of seeking professional psychological help are listed in

Table 1 and were used to construct the decision measure described later.

Table 1 Categories of Advantages and Disadvantages of Seeking Professional Psychological Help, Derived From the PilotStudy and Ranked According to Frequency of Use

Main StudySubjects and Procedure

A total of 429 subjects participated in the main study, conducted approximately 3 months after the pilot study. All

subjects were undergraduate students enrolled in an introductory psychology course at the same large, northeastern

university. The sample was 51.7% female, and the mean age of all subjects was 19.1 years. A total of 63 students

(14.8%) answered positively to the question whether they had sought professional psychological help in the past. The

mean number of therapy sessions reported by these subjects was 8.5 (range = 160).

As in the pilot study, questionnaires were administered during a regularly scheduled class meeting. Participationwas voluntary, and extra credit was offered. Of 500 questionnaires distributed, 445 were returned. Of these, 16 were

eliminated because they were partially completed. The nonparticipation rate was approximately 11%.


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Instruments

Decision measure.

We constructed decision measure about seeking professional psychological help according to Ajzen and Fishbein's

(1980) method. The following scores represented antecedents to the hypothetical decision to seek professional

psychological help. All items were answered according to a 7-point Likert scale, ranging from -3 to +3, with higher

scores indicating more positive responses.

1. Intention to seek professional psychological help was measured with a single item, I intend to seek professional

psychological help within the next month. Item anchors were highly unlikely(-3) and highly likely(+3), and the

middle choice was neither.

2. The global attitude score was a composite of six bipolar adjective items, each phrased as follows: If I felt

psychologically distressed, seeking professional psychological help within the next month would be . Responses

ranged from (a) good to bad (with +3 representing extremely goodand -3 representing extremely bad), (b) rewarding

to unrewarding, (c) beneficial to harmful, (d) wise to foolish, (e) pleasant to unpleasant, and (f) interesting to boring.

Scale ratings were averaged in computing a single global attitude score.

3. Following Ajzen and Fishbein's (1980) method, we obtained the summative score of the outcome probability and

evaluation items by means of a multistep procedure. First, we used each of the 14 salient beliefs about seeking

professional psychological help generated in the pilot study to form a pair of related items, an outcome probabilityitem and an outcome evaluation item. Each outcome probability item consisted of a rating of the likelihood of

occurrence of a particular outcome of seeking help, for example, Seeking professional psychological help within the

next four weeks would give me an objective opinion about my concerns scored from extremely likely, +3, to

extremely unlikely, -3. Each corresponding outcome evaluation item consisted of a rating fromgood(+3) to bad(-3)

of the same outcome, for example, Obtaining an objective opinion about my concerns is . Scores of corresponding

outcome probability items and outcome evaluation items were multiplied, thus yielding 14 products (possible range =

-9 to +9). To simplify the data, we summed these products to form a single index of beliefs underlying decision about

seeking professional psychological help, called the summative score of the outcome probability and evaluation

items. This summative process is in accordance with Ajzen and Fishbein's (1980) methodological specifications and

reflects the theoretical assumption that attitudes toward a specific behavior are based on the total set of an

individual's salient beliefs; attitudes toward the behavior correspond to the favorability or unfavorability of the totalset of consequences (outcome evaluation), and each [is] weighted by the strength of the person's beliefs that

performing the behavior will lead to each of the consequences (outcome probability; p. 67).

We estimated the internal consistency of the decision measure. The six items composing the global attitude score,

the outcome evaluation and outcome probability items, and the products of the outcome evaluation and probability

items had coefficient alpha values of .78, .83, and .83 respectively.

Beck Depression Inventory.

The BDI consists of 21 items covering affective, cognitive, motivational, and physiological areas of depressive

symptomatology. Each item is scored from not at all depressed(0) to most depressed(3). An individual's total score is

the sum of his or her score on each item (possible range = 063). The BDI criterion for defining depression is consistent

with cutoffs used by Hammen (1980); Hammen and Cochran (1981), and Hammen et al. (1985) and with Beck et al.'s(1961) suggested cutoffs. Depression was defined in the present study as scores greater than or equal to 12 (M 1 SD;

M = 5.77, SD = 5.90). Nondepression was represented by scores less than or equal to 3. The depressed group consisted

of 68 subjects (M = 17.37, SD = 5.47). The nondepressed group consisted of 182 subjects (M = 1.31, SD = 1.10).

Three groups of subjects (N= 126) were formed for the purposes of data analysis. Groups were comparable in age

and sex distribution.

Of the 182 subjects who scored 3 or lower on the BDI, only 13 had sought professional psychological help in the

past. From the 169 who had not sought help, 68 subjects were randomly selected to form the nondepressed

nonseekers (NDNS) group (28 male and 40 female).

Of the 68 subjects who scored 12 or higher on the BDI, 45 were nonseekers. These 45 subjects formed the

depressed nonseekers (DNS) group. We eventually eliminated 6 from the sample because of incomplete data, leaving

39 depressed nonseekers (19 male and 20 female).


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Of the 68 subjects who scored as depressed 23 had sought professional psychological help in the past. They

formed the depressed seekers (DS) group. We eventually eliminated 4 of them because of incomplete data, leaving 19

depressed seekers (7 male and 12 female).

Data were analyzed with a 2 3 (Sex Group) multivariate analysis of variance (MANOVA) for the three

dependent variables(a) the intention statement, (b) the global attitude score, and (c) the summative score of the

outcome probability and evaluation products. Given that intention, attitude, and the total set of beliefs (summativescore) are antecedents to the decision to seek help, it followed to assessing whether the groups differed on a linear

combination of these variables. MANOVA was the statistic of choice because it produces the best linear combination of

the given dependent variables and tests for groups differences. Significant differences (according to Wilks's lambda)

were further examined with univariate analyses of variance (ANOVA s). When the ANOVA was significant, post hoc

pairwise comparisons were conducted by using the Tukey-Kramer procedure; this is the test of choice in the presence

of homogeneity of variance and unequal group size (Jaccard, Becker, & Wood, 1984).

To determine which beliefs about seeking professional psychological help best differentiated the three groups,

we performed stepwise discriminant analyses by using the Statistical Package for the Social Sciences discriminant

analysis subprogram with minimum Wilks's lambda as the selection criterion. The variables entered in the discriminant

analyses were the 28 outcome probability and outcome evaluation items.

ResultsResults of the MANOVA indicated a significant main effect for group, Wilks's lambda = .66, F(6, 184) = 7.04,p

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1- Relation of Depresion and Help Seeking History to Attitudes