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Relation of Depression and Help-Seeking History to Attitudes Toward Seeking Professional Psychological Help
Halgin, Richard P.1,2; Weaver, Dana D.1; Edell, William S. 1; Spencer, Peter G.1 Volume 34(2), April 1987, p 177185 [Professional Issues and Training] 1987 by the American Psychological Association
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ISSN: 0022-0167 Registro: 00001192-198704000-00009 Texto completo (PDF) 724 K

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University of MassachusettsAmherst Correspondence concerning this article should

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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).

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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 term professional 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 counselor is a generic label and serves as an umbrella, 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 Action

The 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 Attitudes
Fischer 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 and that 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 the factor 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 the contradictory 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.

Method
Pilot 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. Procedure Participation 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 into categories. 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 Pilot Study and Ranked According to Frequency of Use

Main Study
Subjects 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. Participation was 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 good and -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 probability item 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 from good (+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 total set 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 (summative score) 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.

Results
Results of the MANOVA indicated a significant main effect for group, Wilks's lambda = .66, F(6, 184) = 7.04, p < .0001. There were no significant differences for the main effect for sex (p = .26) or for the interaction effect of Sex X Group ( p = .29). Box's M test for homogeneity of variance was passed, F(30, 3624) = 1.08, p = .34. Because the MANOVA yielded no differences on the dependent variables as a function of sex, in subsequent univariate tests we combined the sexes when comparing the three groups. The groups differed significantly on intention to seek professional psychological help, F(2, 119) = 21.43, p < .001; on global attitude score, F(2, 105) = 4.76, p < .01; and on the summative score of the outcome probability and evaluation products, F(2, 108) = 6.75, p < .002. Means, standard deviations, and ANOVA results for the three dependent variables across the three groups are presented in Table 2.

Table 2 Means, Standard Deviations, and Analysis of Variance Results for the Three Dependent Variables Across the Three Groups Pairwise comparisons using the Tukey-Kramer test for significance were performed for each dependent variable. For the intention measure, critical differences were found at the .01 significance level on all intergroup comparisons, with the DS group (M = 1.17) showing the highest intention to seek professional psychological help, followed by the DNS group (M = -.79) and the NDNS group (M = -1.82). For the global attitude score, a critical difference was found at the .01 significance level between the NDNS ( M = .83) and DS (M = 1.64) groups and at the .05 level between the DNS ( M = .96) and DS groups. In other words, the DS subjects had a more positive attitude about seeking professional help

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than did other subjects. For the summative score of the outcome evaluation and probability products, a significant difference at the .01 level was found between the NDNS (M = 18.40) and DS ( M = 42.89) groups, and a significant difference at the .05 level was found between the DNS (M = 21.09) and DS groups. The DS subjects had the most positive overall beliefs, and the NDNS subjects had the least positive beliefs. Because the DS group was found to differ significantly from the other two groups on the summative score of the outcome probability and evaluation products, we conducted stepwise discriminant analyses to determine which of the 28 items composing this score (i.e., 14 outcome probability items and 14 outcome evaluation items) best differentiated pairs of groups. Three two-group discriminant analyses were performed. For the NDNS group and the DNS group, one variable maintained a minimum F value of 4.00 and could be entered into the discriminant function (see Table 3). This variable was the outcome evaluation item on which students rated the outcome of preventing psychological distress from getting worse. A classification procedure was performed by using this variable in which the group membership of each student was predicted. We correctly classified 71.2%. For the NDNS group alone, 77.8% of the students were correctly classified; for the DNS group, 61.1% were correctly classified, canonical correlation = .53, Wilks's lambda = .71, [chi]2(11, N = 107) = 29.92, p < .002.

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Table 3 Discriminant Analyses Summary Table

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Table 3 (continued) Four items were entered into the analysis for the DNS group and the DS group (see Table 3). Using these variables, the discriminant function correctly classified 76.3% and 84.2% of the DNS and DS groups, respectively, canonical correlation = .67, Wilks's lambda = .55, [chi]2(4, N = 58) = 28.83, p < .001. The overall rate of correct classification was 78.95%. We performed a final discriminant analysis to determine which items were the best discriminators between nondepressed students and depressed students, regardless of help-seeking history. We combined the DNS and DS groups and performed the analysis by using this combined group and the NDNS group. Five items maintained a minimum F value of 4.00 and were, therefore, entered into the function (see Table 3). An overall classification accuracy level of 76.07% was achieved, with 72.2% of the NDNS group and 75.9% of the DNS + DS group correctly classified, canonical correlation = .59, Wilks's lambda = .65, [chi]2(14, N = 126) = 44.53, p < .001. Classification procedures results for each of the discriminant analyses are presented in Table 4.

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Table 4 Prediction of Results of Discriminant Function Analysis

Discussion
In this study, we attempted to come to a better understanding of college students' perceptions and decisions about seeking professional psychological help. To accomplish this goal, we looked at their beliefs, their attitudes, and their intentions about such help seeking. We chose to look at depressed college students because depression has come to be regarded as a prevalent mental health problem among people this age (Hammen, 1980; Hammen et al., 1985). We intended to study how the experience of depression or the experience of having sought professional psychological help or both relate to differential attitudes about such help seeking. Because our subject pool did not contain enough nondepressed individuals who had sought help, we were unable to determine clearly what role help-seeking history per se played. We were able, however, to determine that currently depressed students, as measured by the BDI, regardless of whether they had previously sought help or not, had a higher intention to seek help than those who were not depressed. Furthermore, depressed college students who actually had sought help in the past were even more intent than their depressed but nonseeking peers to seek help again. These depressed seekers had more positive attitudes about such help seeking than did both depressed and nondepressed peers who had never sought help. These findings hold true regardless of sex, which is consistent with other reports of no differences in help seeking according to sex of the student (Christensen & Magoon, 1974; Parish & Kappes, 1979; Snyder et al., 1972). The experience of having sought professional psychological help in the past was significantly related to how one felt about seeking such help again. This finding supports the conclusion of Cash et al. (1978) and of Fischer and Turner (1970) that individuals reporting prior professional assistance espouse more favorable attitudes toward seeking help. Students who are not depressed and have no help-seeking history are unlikely to have positive intentions or attitudes about the pursuit of professional psychological help. Even people who are depressed but have never previously sought help have a low intention to seek help and relatively neutral attitudes about such help. To more fully understand how experiences of help seeking and depression relate to perceptions of help seeking, we performed discriminant analyses. Interestingly, there was virtually no difference in beliefs about the outcome of

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seeking help between depressed students who had never sought help and nondepressed students who had never sought help. Thus, the experience of depression alone did not seem to be significantly related to how one perceived help seeking. Students who had no help-seeking experience held beliefs comparable with those of nondepressed students with help-seeking histories. However, when we compared the beliefs of depressed students who had previously sought help and those of depressed students with no such experience, we found four items that differentiated these two groups. Though both groups positively evaluated the behavior of seeing a competent mental health professional, those depressed students with experience evaluated it as much more positive. Thus, the conclusions of others (Cash et al., 1978) regarding the salience of certain perceptions about the professional were confirmed. Depressed seekers predicted that help seeking would be more likely to lead them to confront painful feelings and issues; however, they believed that it would be less likely to leave them feeling as if they were unable to deal with problems autonomously and less likely to be costly. Thus, the experience of having sought help informed these depressed students that though help seeking can be quite provocative, it does not necessarily leave one feeling personally ineffective and need not be that costly. The first two differential perspectives seem quite reasonable; those who have sought help can better appreciate the emotional toll exacted when consulting a mental health professional. These subjects also may have had an opportunity to use their student health coverage to find out firsthand that help seeking does not necessarily involve personal expense. Though inexpensive or free mental health services are commonly available at universities, it is possible that only the experienced students are aware of it. These findings are especially interesting in the light of a study of college students' help-seeking preferences by Tinsley et al. (1982). The majority of their sample of nonseeking students reported the intention to deal with personal concerns themselves rather than seeking professional help. These students also reported doubt that a counselor could help them should they seek help. The inclusion of seekers in the present study highlights the positive impact of help-seeking experience on the relation between preferences and perceptions and help seeking. Additionally, Tinsley and Harris (1976) and Tinsley and Benton (1978) suggested that potential clients who do not seek professional help have lower expectations of being helped through counseling than those who do seek help. As the present study indicated, help-seeking history is positively related to perceived positive outcome of the help-seeking experience. We also looked at the relation between depression and beliefs, regardless of help-seeking experience. Depressed students (both seekers and nonseekers) were compared with nondepressed students (none of whom had sought help), and although depressed students viewed the confrontation of painful issues as much more likely, they did not evaluate such a confrontation as positively as did those students who were neither depressed nor experienced with help seeking. It is possible that the experience of depression leaves one feeling quite apprehensive about the possibility of adding more pain to an already onerous burden of depression. When asked to make other predictions, depressed students saw help seeking as more likely to involve a commitment of their time and less likely to be costly. It may be that depression leaves one feeling that the resolution of pain will involve a significant investment of time. In conclusion, our findings suggest that it is not the experience of depression alone but its combination with having sought help that is quite significantly related to the beliefs, attitudes, and intentions of college students about seeking help. Tinsley et al.'s (1984) findings suggest that students are more likely to seek assistance from a counseling psychologist if they do anticipate correspondence between their expectancies and preferences (p. 159). The findings of the present study suggest that those who have sought help before are more likely to expect and to prefer the same outcomes from the therapeutic experience, as seen in the belief in the competence of the professional. It would have been most helpful to have had a group of nondepressed but experienced students to confirm this hypothesis, but it is interesting in and of itself to recognize that only a handful of nondepressed students have ever sought help. Our findings have significance for mental health professionals wanting to reach out to those students who are depressed but have not yet pursued professional help. These students seem to be troubled by feelings that seeing a professional is not such a good thing, possibly because doing so might make them feel less effective and prove to be too costly. Educative interventions, in a format similar to that recommended by Gelso and McKenzie (1973), addressing specific concerns might attract these students to a mental health agency. The pragmatic concern about cost could easily be addressed by means of better information regarding mental health coverage, which quite commonly provides professional help at no cost. The emotional concern is a more difficult matter to address, but presenting the pursuit of professional help as a wise and healthy thing to do might be effective. Focusing on the specific symptomatology of

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depression and documenting therapeutic methods that might alleviate such symptomatology could be quite effective in communicating to depressed students that problem resolution is a good thing to undertake and that it need not involve great cost or feelings of incompetence. Such communication might result in a closer correspondence between those expectations and preferences uncovered in this study. Finally, this study calls for replication to ascertain whether those beliefs identified are an artifact of sample characteristics or are representative of college students' beliefs about the outcome of seeking professional psychological help. Additionally, although the investigation of the relation between depression and decision to seek help proved informative, the reader should remain aware of the fact that the scope of conclusions and interpretations of the study are limited. Until further research proves otherwise, the final suggestions made here are constrained to students who can be described as depressed according to scores on the BDI. Further information should be gathered on the relation of other types of personal distress to the decision to seek help and to attitudes about professional help. Bosmajian and Mattson (1980) found that among college students, differences between seekers and nonseekers interact with level of personal adjustment; these researchers also raised the possibility that differences between adjusted and nonadjusted seekers are due more to the kinds of problems for which they seek help rather than to their different levels of adjustment. Future investigation of college students' perceptions and decisions about seeking professional psychological help needs to encompass a broader definition of personal distress, not limited to depression as a reason to seek help, before a more complete understanding of intentions, attitudes, and beliefs about seeking help can be obtained.

References
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting behavior. Englewood Cliffs, NJ: Prentice-Hall. [Context Link] Ajzen, I., & Timko, C. (in press). Correspondence between health, attitudes, and behavior. Basic and Applied Social Psychology. [Context Link] American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. [Context Link] Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory measuring depression. Archives of General Psychiatry, 4, 5363. Texto Completo Otros recursos Texto Completo [Context Link] Bordin, E. S. (1955). The implications of client expectations for the counseling process. Journal of Counseling Psychology, 2, 1721. Texto Completo OVID [Context Link] Bosmajian, C. P., Jr., & Mattson, R. E. (1980). A controlled study of variables related to counseling center use. Journal of Counseling Psychology, 27, 510519. Texto Completo OVID [Context Link] Bumberry, W., Oliver, J. M., & McClure, J. N. (1978). Validation of the Beck Depression Inventory in a university population using psychiatric estimate as the criterion. Journal of Consulting and Clinical Psychology, 46, 150153. [Context Link] Calhoun, L. G., Dawes, A. S., & Lewis, P. M. (1972). Correlates of attitudes toward help seeking in outpatients. Journal of Consulting and Clinical Psychology, 38, 153. [Context Link] Calhoun, L. G., & Selby, J. W. (1974). Help-seeking attitudes and severity of psychological distress. Journal of Clinical Psychology, 30, 247248. Texto Completo [Context Link] Cash, T. F., Kehr, J., & Salzbach, R. F. (1978). Help-seeking attitudes and perceptions of counselor behavior. Journal of Counseling Psychology, 4, 264269. [Context Link] Christensen, K. C., & Magoon, T. (1974). Perceived hierarchy of help-giving sources for two categories of student problems. Journal of Counseling Psychology, 21, 311314. Texto Completo OVID [Context Link]

12 de 14

18/01/2009 21:38

Ovid: Relation of Depression and Help-Seeking History to Attitude...

http://0-ovidsp.tx.ovid.com.columbus.uhu.es/spb/ovidweb.cgi

Cook, E. P., Park, W., Williams, G. T., Webb, M., Nicholson, B., Schneider, D., & Bassman, S. (1984). Students' perceptions of personal problems, appropriate help sources, and general attitudes about counseling. Journal of College Student Personnel, 25, 139145. [Context Link] Fischer, E. H., & Cohen, S. L. (1972). Demographic correlates of attitude toward seeking professional psychological help. Journal of Consulting and Clinical Psychology, 39, 7074. [Context Link] Fischer, E. H., & Turner, J. L. (1970). Orientations to seeking professional help: Development and research utility of an attitude scale. Journal of Counsulting and Clinical Psychology, 35, 7990. [Context Link] Gelso, C. J., & Karl, N. (1974). Perceptions of counselors and other help-givers: What's in a label? Journal of Counseling Psychology, 21, 243247. Texto Completo OVID [Context Link] Gelso, C. J., & McKenzie, J. D. (1973). Effect of information on students' perceptions of counseling and their willingness to seek help. Journal of Counseling Psychology, 20, 406411. Texto Completo OVID [Context Link] Getsinger, S. H., & Garfield, N. J. (1976). Male students' perceptions of counselors, guidance counselors, and counseling psychologists. Journal of College Student Personnel, 17, 710. [Context Link] Goodman, S. H., Sewell, D. R., & Jampol, R. C. (1984). On going to the counselor: Contributions of life stress and social supports to the decision to seek psychological counseling. Journal of Counseling Psychology, 31, 306313. Texto Completo OVID [Context Link] Greenley, J. R., & Mechanic, D. (1976). Social selection in seeking help for psychological problems. Journal of Health and Social Behavior, 17, 249262. [Context Link] Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 5662. [Context Link] Hammen, C. L. (1980). Depression in college students: Beyond the Beck Depression Inventory. Journal of Consulting and Clinical Psychology, 48, 126128. [Context Link] Hammen, C. L., & Cochran, S. D. (1981). Cognitive correlates of life stress and depression in college students. Journal of Abnormal Psychology, 90, 2327. Texto Completo OVID [Context Link] Hammen, C., Marks, M., Mayol, A., & deMayo, R. (1985). Depressive self-schemas, life stress, and vulnerability to depression. Journal of Abnormal Psychology, 94, 308319. Texto Completo OVID [Context Link] Hummers, J., & DeVolder, J. P. (1979). Comparisons of male and female students' use of a university counseling center. Journal of College Student Personnel, 20, 243249. [Context Link] Jaccard, J., Becker, M. A., & Wood, G. (1984). Pairwise multiple comparison procedures: A review. Psychological Bulletin, 94, 589596. [Context Link] Kessler, R. C., Brown, R. L., & Broman, C. L. (1981). Sex differences in psychiatric help-seeking: Evidence from four large-scale surveys. Journal of Health and Social Behavior , 22, 4964. [Context Link] Kulka, R. A., Veroff, J., & Douvan, E. (1979). Social class and the use of professional help for personal problems: 1957 and 1976. Journal of Health and Social Behavior, 20, 217. [Context Link] Mechanic, D. (1975). Sociocultural and social-psychological factors affecting personal responses to psychological disorder. Journal of Health and Social Behavior , 16, 393404. [Context Link] Parish, T. S., & Kappes, B. (1979). Affective implications of seeking psychological counseling. Journal of Counseling

13 de 14

18/01/2009 21:38

Ovid: Relation of Depression and Help-Seeking History to Attitude...

http://0-ovidsp.tx.ovid.com.columbus.uhu.es/spb/ovidweb.cgi

Psychology, 26, 164165. Texto Completo OVID [Context Link] Sharp, W. H., & Kirk, B. A. (1974). A longitudinal study of who seeks counseling when. Journal of Counseling Psychology, 21, 4350. Texto Completo OVID [Context Link] Snyder, J. F., Hill, C., & Derksen, T. (1972). Why some students do not use university counseling facilities. Journal of Counseling Psychology, 4, 263268. [Context Link] Subich, L. M., & Coursol, D. H. (1985). Counseling expectations of clients and nonclients for group and individual treatment modes. Journal of Counseling Psychology, 32, 245251. Texto Completo OVID [Context Link] Tinsley, H. E. A., & Benton, B. (1978). Expectations and preferences in counseling. Journal of College Student Personnel, 19, 537543. [Context Link] Tinsley, H. E. A., Brown, M. T., de St. Aubin, T. M., & Lucek, J. (1984). Relation between expectancies for a helping relationship and tendency to seek help from a campus help provider. Journal of Counseling Psychology, 31, 149160. Texto Completo OVID [Context Link] Tinsley, H. E. A., de St. Aubin, T. M., & Brown, M. T. (1982). College students' help-seeking preferences. Journal of Counseling Psychology, 29, 523533. Texto Completo OVID [Context Link] Tinsley, H. E. A., & Harris, D. (1976). Client expectations for counseling. Journal of Counseling Psychology, 3, 173177. [Context Link] Tinsley, H. E. A., Workman, L. R., & Kass, R. A. (1980). Factor analysis of the domain of client expectancies about counseling. Journal of Counseling Psychology, 27, 561570. Texto Completo OVID [Context Link] Tracey, T. J., Sherry, P., Bauer, G. P., Robins, T. H., Todaro, L., & Briggs, S. (1984). Help seeking as a function of student characteristics and program description: A logit-loglinear analysis. Journal of Counseling Psychology, 31, 5462. Texto Completo OVID [Context Link] Utz, P. W. (1983). A comparison of three groups of vocationally indecisive students. Journal of Counseling Psychology, 30, 262266. Texto Completo OVID [Context Link] Yuen, R. K., & Tinsley, H. E. A. (1981). International and American students' expectancies about counseling. Journal of Counseling Psychology, 28, 6669. Texto Completo OVID [Context Link]

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