Mechanism of the relationship between stigma and help-seeking intention among university students

Abstract

Objectives. Despite the growing prevalence of mental health problems among university students, nearly half continue to manage their symptoms independently rather than seeking help, underscoring the need to understand the factors that influence help-seeking intention. Although stigma is associated with help-seeking intention among university students, the mechanisms behind this relationship remain unclear. Guided by the Theory of Planned Behavior (TPB) and the Integrative Model of behavioral prediction (IM), the study specifically sought to explore the mechanisms underlying the association between social stigma, self-stigma, and help-seeking intention.
Sample and settings. A total of 383 university students participated in the survey, including 321 Slovak students (83.8%) and 62 international students (16.2%). The sample comprised 64.0% women and 36.0% men, with a mean age of 21.83 years (SD = 2.42). Data were analyzed using hierarchical multiple regression, and the mechanisms underlying the relationship between stigma and help-seeking intention were explored through mediation analysis (PROCESS macro for SPSS, Version 4.2). Social stigma was specified as the independent variable, with self-stigma as the first mediator, followed by four parallel mediators: attitudes toward help-seeking, perceived behavioral control, subjective norm, and self-efficacy. Help-seeking intention was entered as the dependent variable. Gender, help-seeking experience, and student status were included as covariates.
Results. Female students, students with prior help-seeking experience, and international students reported higher levels of help-seeking intention. The direct association between social stigma and help-seeking intention was not statistically significant when mediators were included in the model. Social stigma was positively and significantly associated with self-stigma. In turn, self-stigma, serving as the first mediator, was negatively and significantly associated with attitudes toward help-seeking, perceived behavioral control, and self-efficacy. Consequently, higher levels of attitudes toward help-seeking and lower levels of perceived behavioral control and self-efficacy were associated with greater help-seeking intention. Notably, social stigma did not demonstrate a significant direct association with these three parallel mediators. Additionally, a higher level of social stigma was associated with stronger subjective norm, which, in turn, was linked to greater intention to seek help.
Limitations. The cross-sectional design of the study limits causal interpretation. Most international students were from Ukraine, which may affect generalizability. Additionally, subjective norms were measured with a single item due to the low reliability of the original scale, possibly reducing measurement accuracy.