Introduction
The prevalence and severity of mental health issues among students have been increasingly recognized as a serious health concern on college campuses. According to a recent survey, approximately 60% of respondents reported that they had experienced overwhelming anxiety in the past year, and 40% had experienced severe depression that made it difficult to function (ACHA, 2017). About 92% of university counseling center directors reported that students' mental health problems are on the rise (Gallagher, 2006). Despite these concerns, only a small percentage of students with mental health issues, less than a quarter, reported that they received treatment (Eisenberg et al., 2012). To make matters worse, the COVID-19 pandemic has negatively impacted students’ mental well-being, with 60% of students indicating that they have not sought to access mental health care (ACHA-NCHA, 2021). If left untreated, mental health issues in college students can directly affect their academic productivity (Eisenberg et al., 2012) and increase psychosocial concerns such as increased stress, poor body image, interpersonal problems and discrimination (Schofield et al., 2016). In addition, the negative consequences of these problems can continue to be detrimental after college, as mental health problems in early adulthood can negatively affect career development, relationships, and may lead to alcohol and substance abuse (Umberson & Montez, 2010). Given the increased prevalence of students' mental health-related needs, how to effectively support and promote student mental health is an important subject matter for many agencies, including public health communicators, policy makers, and campus personnel.
One important approach to understanding mental health issues on college campuses is to better understand social contexts and their association with mental well-being (Hefner & Eisenberg, 2009; Umberson & Montez, 2010). Feelings of social isolation and diminished contact with friends, a partner or family members are correlated with more severe psychological distress. Students without quality social support are more likely to experience mental health problems (Hefner & Eisenberg, 2009). Thus, social support is regarded as having a substantial impact on individuals' mental health issues (Birtel et al., 2017; Budenz et al., 2020; Hefner & Eisenberg, 2009; Procidano & Heller, 1983; Umberson & Montez, 2010; Zimet et al., 1988). Social support from friends or family can provide emotional, informative and /or instrumental assistance to students (Hefner & Eisenberg, 2009). Although previous literature has reported a close association between social support and mental health, empirical studies of the mechanisms by which social support relates to other important factors (e.g., perceived stigma surrounding mental health issues) and ultimately influences students' attitudes to seeking help are still lacking.
An essential initial step in seeking professional help involves seeking information on professional or alternative treatment options. Studies have suggested that young adults are reluctant to take this first step because they feel threatened and fearful due to public stigma (Cheng et al., 2018; Jennings et al., 2015; Lannin et al., 2016; Rafal et al., 2018). Here, public stigma is defined as the stigmatizing perception, negative stereotypes, and prejudice held by the general public that those seeking mental health services are undesirable or socially unacceptable (Corrigan, 2004; Vogel et al., 2013). The public stigma can often be learned and internalized by students, playing a negative role in whether to seek help. This cascading stigma induced by public stigma is called self-stigma, and is defined as the negative perception that getting help for mental health is a threat to self-values (Cheng et al., 2018).
It is therefore essential to develop effective interventions to address college students' mental health issues and to further the understanding of how social support can address some of the stigma-related problems among students. Indeed, many previous studies focusing on the association between social support and attitudes toward seeking health treatments have overlooked the possibility of using positive social support to reduce the stigma of seeking mental health services. Empirically demonstrating this connection can further our understanding of the role and importance of social support, and the underlying psychological mechanisms of social support on college students' mental health.
Based on the theoretical insights of social support theory (Cohen & Wills, 1985), this study aims to investigate how social support is associated with the perceived public and personal stigma surrounding mental health issues among college students and further explores its impact on attitudes toward seeking professional help. The study’s findings are expected to provide public health communicators, policymakers, and university personnel with empirical evidence to utilize while improving the development of their future programs and communications. Especially given the limitations on social interaction due to the COVID pandemic, professionals and scholars may need to investigate alternative possibilities in terms of creating social support, for instance through new media channels.
Literature Review
Social Support
Emerging adulthood, from one’s late teens to twenties, can be characterized by frequent change, transition, and exploration of one’s identity for the remainder of life (Arnett, 2000). Having left the dependency of adolescence, emerging adults often face uncertainty in life and need to explore various possibilities of life directions (Arnett, 2000). College students face a completely different environment after the transition to university. Most first-year college students no longer live with their parents and in their hometowns in which they have established social support and networks. Although college students may feel significantly greater freedom because they are no longer under the constant supervision of other adults (Lefkowitz, 2005), they frequently experience a greater sense of isolation, homesickness, and interpersonal conflicts than ever before (Buote et al., 2007). Students also feel pressure to obtain the level of training and education that can serve as a foundation for future occupational achievements. These various stressors negatively impact students’ mental well-being. It is thus important to understand the social context that college students face in order to have effective health communication and intervention programs (Hefner & Eisenberg, 2009). This study focuses on the role of social support, referring to “the emotionally sustaining qualities of relationships” (e.g., feeling loved and listened to by friends, family, significant others) (Umberson & Montez, 2010, p. 3).
Although there have been several theoretical views on the role of social support in relation to health given the vast social support literature, one perspective that has received much attention in recent years is the social support theory (Lakey & Cohen, 2000; Lakey & Orehek, 2011). Social support theory (Cohen & Wills, 1985) focuses on how social interactions and relationships (i.e., social support) influence an individual's mental and physical health through two mechanisms. First, social support serves as an effective buffer in stressful situations. Social support helps individuals to evaluate their situation more positively and reduce stress. Second, social support promotes people to adopt desirable coping strategies and has a positive effect on actual coping performance. Coping can include a wide range of deliberate cognitive and emotional thoughts and behaviors (e.g., problem solving, seeking or maintaining help). Support is a reliable and effective resource that individuals have to relieve stress and make healthier coping choices (Lakey & Orehek, 2011). Importantly, this social support includes not only actual supportive activities, but also perceived support, which refers to the psychological belief that support exists (Cohen & Wills, 1985; Lakey & Cohen, 2000). The two mechanisms are closely related to one of the most influential theories in mental health literature, a theory of stress and coping (Lazarus & Folkman, 1974). Based on these insights, Homberg's (2012) stress coping (mis)match hypothesis asserts that social support may be more effective in facilitating an individual to adopt desirable coping strategies when it is well aligned with the specific needs an individual requires to deal with a particular stress condition (e.g., appropriate support based on an understanding of the individual's situation). These theoretical insights provide an important basis for predicting the impact of social support on attitudes to seeking help as part of coping strategies for mental health problems.
Empirical research findings support this theoretical frame for a positive role of social support. Social support provides not only emotional assistance but is also instrumental and informational assistance (Hefner & Eisenberg, 2009). It has been recognized as an important coping resource for college students. Quality social support can improve an individual’s adjustment to a stressful environment, increase one’s self-esteem and self-efficacy (Thoits, 1995). Social support acts as an effective buffer, reducing the determinant impact of stressful life events on psychological well-being (Hefner & Eisenberg, 2009; Son et al., 2020; Zimet et al., 1988). Extensive literature has demonstrated that frequent and quality social support from friends and family tends to be associated with low levels of depression and anxiety (Hefner & Eisenberg, 2009; Zimet et al., 1988). Feelings of social isolation, diminished contact with friends, significant others or family members are correlated with more severe psychological distress (Caron, 2007). College students without quality social support tend to experience more mental health problems than college students with quality support (Hefner & Eisenberg, 2009).
The positive and direct impact of social support on students' mental well-being is likely to extend to their attitudes toward seeking professional help. “Despite the prevalence of mental health disorders and clinically significant symptoms, young adults are unlikely to seek mental health care for such concerns” (Pedersen & Paves, 2014, p. 2). However, as discussed above, social support functions as coping assistance that helps individuals mitigate the negative impact of stressful situations by providing emotional, instrumental, and information resources (e.g., Caron, 2007; Hefner & Eisenberg, 2009; Son et al., 2020; Thoits, 1995; Zimet et al., 1988). People can help an individual change their situation, view stressful situations from different perspectives, and or increase their sense of self-efficacy with respect to control over the environment.
Such coping assistance can be extended to supporting an individual to take the initial step of exploring information on mental health issues or mental health professionals. Indeed, previous studies propose that social support can be crucial in seeking mental health help (Gulliver et al., 2010; Vogel et al., 2007). Attitudes toward mental health help-seeking is a reliable indicator that leads to actual help-seeking behavior (Gulliver et al., 2010). Jung et al. (2017) argued that social support should be considered as an important variable that influences attitudes towards mental health help-seeking. Thus, the following hypothesis was derived:
H1: Perceived social support positively influences attitudes toward seeking professional help.
Impact of Social Support on Stigma
This study further proposes that quality social support can lead to stronger attitudes to seek help by reducing perceived public and self-stigma. There may be various factors associated with the development of public stigma or self-stigma. Examples include contact with people with a mental illness or reasoning or belief about the cause of a health problem (Calear et al., 2011; Oh et al., 2009). Mass media is also a major source of information on mental health, and can strengthen or reduce stigma (Wahl et al., 2002). Research shows that media often reinforces the public stigma by portraying people with mental health problems with certain stereotypes, which can further influence individual beliefs (Block, 2013; Stout et al., 2004). Social media is no exception, according to recent research (Budenz et al., 2020). While social media may contain support messages, it can also distribute messages that stigmatize mental health issues (Budenz et al., 2020). The study found that analyzed tweets had more stigmatizing content and fewer supportive messages for bipolar disorder (Budenz et al., 2020). As such, previous studies have focused on factors that may worsen public stigma. However, while identifying exacerbations can provide insight into prevention campaigns, there exists a need to identify factors that can help reduce public stigma to provide greater insight for health communication programs. “As a result, there is a clear mandate to better understand the factors involved in the development of stigma in order to improve interventions that decrease stigma and increase people’s willingness to seek help when experiencing psychological distress” (Vogel et al., 2013, p. 311).
This study argues that social support can be linked to lowering perceived public stigma. The theoretical insights of social support theory is useful in predicting the impact of social support on public stigma. Individuals facing stress situations make an initial appraisal of the situation (Cohen & Wills, 1985). Public stigma is likely to be perceived as a negative factor in these initial assessments and perceived as a threat to an appropriate response. However, social support is expected to help people feel less threatened by public stigma as they serve as an effective buffer in situational appraisals to further assist coping (Cohen & Wills, 1985; Lakey & Cohen, 2000; Lakey & Orehek, 2011). Perceived public stigma is about how others judge individuals with mental health issues. Helping individuals to utilize social support networks can be useful for combating such rather abstract fears. Birtel et al. (2017) suggested that social support may help reduce stigmatizing prejudice and shame about seeking help for mental well-being. “By talking about mental health concerns with at-risk students, peers may be able to normalize the behavior and mitigate perceptions of stigma” (Pace et al., 2018, p. 103). According to previous literature, the following hypothesis is suggested:
H2a-b: Perceived social support negatively influences perceived public stigma (a) and self-stigma (b).
Public Stigma, Self-Stigma and Attitudes toward Seeking Help
“Multiple logistical and attitudinal barriers prevent young adults from engaging in treatment, such as personal attitudes that seeking care will not be beneficial, belief one can handle problems on their own, concerns about cost, and lack of awareness of treatment options” (Pedersen & Paves, p. 144). Among those barriers, perceived public stigma is the most cited barrier that prevents young adults from seeking or accessing services (Pedersen & Paves, 2014). The role of perceived public stigma, as an obstacle in pursuing mental health care, is consistent with the previously proposed conceptual models of seeking help (e.g., Rosenstock, 1966). These models suggest that care-seeking should be viewed as a process that is highly influenced by social aspects. Recently, many scholars have recognized public stigma as an important social factor influencing the decision-making process of seeking help.
Studies have suggested that young adults are reluctant to seek help because they worry about and feel threatened by public stigma (Lannin et al., 2016). That is because not just having mental health issues but seeking help itself is often stigmatized (Rafal et al., 2018; Vogel et al., 2007). As an example, one out of five individuals drop out of treatment because of their fear of public stigma (Mojtabai et al., 2011). A study by Golberstein et al. (2008) found that perceived stigma negatively affected young people's perceptions of the need for mental health treatment. Perceived public stigma is a critical barrier to seeking treatment and can worsen depression, anxiety, and social isolation (DeBate et al., 2018; Jung et al., 2017; Keyes et al., 2010).
More problematic than perceived public stigma is self-stigma. While people seeking help must overcome various types of public stigma, self-stigma can play a much more direct and serious role in shaping attitudes or intentions to seek help (Cheng et al., 2018; Lannin et al., 2016; Vogel et al., 2007). Corrigan and Rao (2012) argue that various forms of stigma occur sequentially. When there is public stigma, individuals become aware of the public stigma, form personal attitudes toward the beliefs, and begin to internalize and apply the stigmatizing beliefs to themselves. The internalization of negative stereotypes can be accelerated, especially when individuals think they belong to a stigmatized group with mental health issues. In other words, the more exposed to negative stereotypes and prejudices against people with mental health problems (i.e., increased awareness of public stigma), the more individuals, regardless of their intentions, learn these as social notions or the ideas of many. “Self-stigma occurs when an individual identifies himself with the stigmatized group and applies corresponding stereotypes and prejudices to the self” (Eisenberg et al., 2009, p. 523). As a result, individuals may believe that seeking help is for people who are not emotionally stable, less socially acceptable, and have no control over emotional well-being, among other things (Ben-Porath, 2002; Cheng et al., 2018; Vogel et al., 2013; Vogel et al., 2007). Vogel et al. (2013) have shown that public stigma directly affects the development of self-stigma, but not vice versa. This linear effect of public stigma on self-stigma is consistent with the sequenced order suggested by Corrigan and Rao (2012).
Among college students, once a self-stigma is developed and internalized, those beliefs can have a determinant negative impact on their self-esteem, self-efficacy, and attitude toward seeking help (Corrigan, 2004; Komiya et al., 2000). The stigma of mental health problems not only prevents people from recognizing the need for treatment, it also acts as a barrier to seeking professional services for those who recognize that they need help (Corrigan, 2004; Lannin et al., 2016; Mojtabai et al., 2011). Birtel et al. (2017) found that internalized self-stigma resulting from public stigma mediates the effects of social support on mental health and well-being. Based on the discussion, the following hypotheses were proposed:
H3: Perceived public stigma of mental health issues is positively associated with self-stigma.
H4: Self-stigma is negatively associated with students’ attitudes toward seeking professional help.
Sex and Class Standing
Research has shown that there are significant gender differences in attitudes to seeking mental health help (Davies et al., 2016; DeBate et al., 2018; Eisenberg et al., 2012; Rafal et al., 2018). Females are nearly twice as likely to seek help with mental health concerns than males (Eisenberg et al., 2009). Conversely, it has been observed that male students are less likely to notice or acknowledge symptoms of psychological distress and are less likely to seek help with such problems than female students (Rafal et al., 2018). Male students also have a relatively lower attitude toward professional services with mental health issues (Lannin et al., 2016). Previous research has explained that some of the reasons for the prominent gender differences in mental health-related attitudes and behaviors may be psychological factors, such as perceptions of stigma and perceptions of social norms expected of men (Beatie et al., 2016; DeBate et al., 2018; Lannin et al., 2016; Rafal et al., 2018). Therefore, the impact of social support is likely to be gender specific. The focus of this study is to demonstrate the effects of social support on stigma and students' help-seeking attitudes; but to provide insights more precisely, it is necessary to explore how gender makes the difference.
Hefner and Eisenberg (2009) point out that the risk of social isolation can be much greater among certain groups of students, which means that the socio-demographic characteristics of students influence social support. In particular, first-year students may face difficulties during their transition to college life. Stress from transitioning to a new environment and anxiety of leaving existing social support behind can lead to negative mental health problems like depression (Dyson & Renk, 2006). Compared to first-year students, seniors may be slightly more mentally and emotionally stable as they may have already built new social support networks and developed appropriate coping strategies. However, at the same time, the stress related to graduation and life after graduation can lead to other mental health problems. Therefore, it is important to gain more in-depth insight by exploring how students' sociodemographic characteristics (gender and class rankings in this study) relate to social support, public stigma, and perceptions of self-stigma. Providing comparative analysis between gender and class rank is not the focus of this study. Presenting such factors as mediators require theorizing different pathways or different magnitudes of influence for each path by gender or class rank. However, the intention to explore potential differences by gender or class ranking in this study is to provide more useful insight into the interpretation of the relationship between social support, stigma, and attitudes toward seeking help. Accordingly, the research questions below rather than moderation hypotheses are suggested:
RQ1: What is the relationship between sex and perceived social support of students, the public and self-stigma, and attitudes toward seeking professional help?
RQ2: What is the relationship between class ranking and perceived social support?
The proposed conceptual relationships between concepts is shown in Figure 1.
Methods
Participants and Procedure
An online survey was conducted in February 2020 at a large southern university in the United States. A total of 10,000 students were randomly sampled using the bulk email service at the institution's registrar’s office. Email invitations were sent with a link to the survey. When students clicked on the link, the informed consent form was presented before participants decided to participate in the survey. After reviewing the informed consent, the students proceeded with the survey, which takes about 15 minutes to complete. The University Human Subjects Research Office approved the survey.
A total of 854 people participated. Out of 854, 172 (20.1%) reported as male and 682 (79.9%) as female. When asked their ethnicity, 719 (84.2%) reported as Caucasian, 42 (4.9%) reported as Asian, 32 (3.7%) reported as Black/African American, and 31 (3.6%) reported as Latino/Hispanic. In terms of their class standing, 569 (66.6%) were freshmen, 104 (12.2%) were sophomores, 99 (11.6%) were juniors, and 82 (9.6%) were senior students. The average age of the respondents was approximately 20 years old (SD=1.91).
Measurements
To measure perceived social support, this study used 12 items from the Multidimensional Scale of Recognized Social Support (MSPSS) (Hefner et al., 2009). Example items of the scale include: “My family really tries to help me,” “There is a special person who is around when I am in need,” and “I get the emotional help and support I need from my family.” Perceived public stigma was assessed using 12 items (Link et al., 2015). Example items of this widely used scale are: “Most people believe that entering a psychiatric hospital is a sign of personal failure” and “Most employers will not hire a person who has been hospitalized for mental illness.” Perceived self-stigma was measured using five items adopted from a previous study (Komiya et al., 2000). Example items of the scale are: “I believe that it is a sign of personal weakness or inadequacy to see a psychologist for emotional or interpersonal problems,” and “I believe that people tend to like less those who are receiving professional psychological help.” Attitudes toward seeking professional help were measured using 10 items (Fischer & Farina, 1995). Demographic information questions were also included. All items were adapted from previous studies and measured using a five-point Likert scale anchored by 1 = strongly disagree and 5 = strongly agree. Table 1 presents the measurement items and Cronbach’s α for all the variables. The measurement model was tested with CFA. The results revealed that the measurement model fits the data well (x2/df=1.61, CFI= .981, TLI =.977, NFI=.951, and RMSEA=.027, [.023, .030]). Convergent validity and discriminant validity and reliability were further tested using composite reliability (CA), average variance extracted (AVE), and maximum shared variance (MSV). According to the fit index criteria proposed by Hu and Bentler (1999), no concerns were found as shown in Table 2.
Results
A multi-group path analysis was employed to evaluate the hypothesized model. A moderation-mediation model which uses a categorical variable as a moderator (e.g., male and female) can be assessed by a multi-group path analysis as another method of moderation analysis. The multi-group path analysis is an analytical method to evaluate whether the proposed model appears to differ between categorical groups (Kline, 2015). The proposed model was tested via AMOS 26. When running the analysis, correlations between error terms or variables were not allowed. The results yielded excellent goodness-of-fit indexes, indicating that the hypothesized model fit the data (x2/df=3.53, CFI= .992, TLI =.955, NFI=.989, and RMSEA=.048, [.001, .095]). A comparison of nested models revealed statistically significant differences between males and females (p<.005). The path coefficients for each group can be found in Figure 2.
H1 suggested a direct positive effect of perceived social support on attitudes toward seeking professional help. A direct impact of perceived social support on attitudes toward seeking professional help was found, supporting H1. H2a-b hypothesized that social support has a positive impact on students' public and self-stigma. The perception of social support was positively associated with attitudes to seek professional help. Thus, H2a-b was supported. Significant path coefficients were found in both male and female students without significant differences between the two groups. H3 hypothesized that the public stigma of mental health problems has a positive effect on self-stigma. The results showed that the perceived public stigma had a statistically significant direct positive impact on self-stigma. Thus, H3 was supported. H4 suggested the negative impact of personal stigma on attitudes toward seeking professional help. Direct adverse effects have been found to support H4.
RQ1 examined the potential relationship between sex and perceived social support, the public and self-stigma, and attitudes toward seeking professional help. The proposed model, which focused on the relationship between key concepts (e.g., the impact of social support on public stigma), showed similar patterns in both groups as mentioned above. Although the overall model pathways were similar, a multi-group pathway analysis revealed significant gender differences in path coefficients between males and females. Subsequent analysis constrained each path and compared the difference in coefficient weights between groups to identify specific paths leading to differences in overall model fit between the two groups. Two paths showed significant differences. The path from perceived social support to a help-seeking attitude (.335 vs. .124, p<.001), and the path from perceived social support to self-stigma (-.321 vs. -.111, p<.001). This indicates that the positive effect of social support on the attitude toward seeking help was greater among male students than female students. Also, the negative effect of social support on self-stigma was greater for male students than female students. Multiple t-tests were performed to further investigate possible differences between men and women in terms of current status of social support, perceptions of stigma, and attitudes to seeking help. The level of perceived social support of female students was significantly higher than that of male students (M: 4.08 vs. 3.87; t= -.285, df=845, p<.005). No significant differences were found for public stigma between the two groups (M = 2.76 vs. 2.78, n.s.), but female students reported less severe self-stigma compared to male students (M: 2.43 vs. 2.55; t=2.09, df=852, p<.05). Lastly, female students reported greater attitudes toward seeking professional help than male students (M: 3.46 vs. 3.05; t=-8.06, df= 852, p<.001). RQ2 explored the relationship between class standing and perceived social support. An analysis of variance (ANOVA) test was performed. As can be seen in Figure 3, there were statistically significant differences between students according to class rank (F (1,853) = 10.50, p<.001, ηp2=.036). Interestingly, according to a Tukey post hoc test, the perceived social support of first-year students was significantly higher than that of sophomore and junior students, and the perceived social support of senior students was similarly high to that of first-year students.
Discussion
This study investigates how social support is linked to perceived public stigma and self-stigma as to mental health problems among college students, and further explores their impact on attitudes toward seeking professional help. An online survey with 854 students was conducted.
First, this study's findings suggest that perceived social support is positively related to college students' attitudes toward seeking professional help. Previous studies have empirically shown the link between perceived social support and students’ mental well-being. Social support functions as coping assistance that helps individuals mitigate the negative impact of stressful situations by providing emotional, instrumental, and information resources (e.g., Caron, 2007; Hefner & Eisenberg, 2009; Son et al., 2020; Thoits, 1995; Zimet et al., 1988). Yet, additional research on the positive role of social support at enhancing students’ attitudes toward seeking help was needed. This study meets this research need by showing that students who feel more socially supported are more receptive to the idea of seeking professional help when needed. Further, this study shows that perceived social support is not only directly related to attitudes toward seeking professional help, but also indirectly through stigma, which will be discussed a bit later.
Second, perceived public stigma had a direct impact on students’ self-stigma. The finding supports the arguments of previous literature that individuals can learn and internalize public stigma surrounding mental health problems and develop self-stigma (Corrigan & Rao, 2012). That is, as students recognize that the general population has stigmatizing perceptions, negative stereotypes, and prejudices toward people with poor mental health and those seeking professional help, students tend to internalize stigmatized thoughts. In addition, this study showed that self-stigma negatively affected students' attitudes toward seeking professional help. Attitude is a critical predictor of intent and behavior as conceptual models of seeking help proposed (e.g., Rosenstock, 1966). Given the importance of the role of attitudes, the formation of a weak attitude towards treatment seeking can potentially have a decisive negative impact on a student's mental well-being. Students at risk of mental health problems may not seek treatment or continue treatment due to self-stigma caused by public stigma. Therefore, breaking the link between perceived public stigma and self-stigma and reducing perceived public stigma could be two important points proposed in this study that would be useful for health communicators to develop effective health promotion messages and programs.
Third, this study shows that one effective way to reduce public and self-stigmatization is to increase perceived social support. It was found that students’ perception of social support negatively affects their perceptions of public and self-stigma, and therefore, students with stronger perceived social support have a better attitude toward seeking help. Little is known about how social support can relate to public stigma, although several studies have suggested its potential positive role in reducing stigma (e.g., Birtel et al., 2017; Vogel et al., 2013). This study fills the literature gap by providing empirical evidence. Social support from friends, family, and partners can be of great help to students by helping them overcome the abstract fears associated with public stigma and focus more on the psychological, emotional, and informational support around them. As such, previous studies have shown social support to be an important coping resource that improves students’ mental well-being. Especially given the limitations on social interaction due to the COVID pandemic, professionals and scholars may need to investigate alternative possibilities in terms of creating social support; for instance, a recent study claims that social media is an ideal channel to engage in advocating health communication to reduce stigma (e.g., Budenz et al., 2020).
Fourth, the results of this study also showed significant differences in perceived social support, self-stigma, and attitudes toward seeking help between male and female students. The perceived level of social support among female students was much higher than that of male students. The perceived public stigma has been reported to be similarly problematic in both groups. However, female students reported that they had less self-stigma and a more positive attitude toward seeking professional help than male students. This snapshot of the current state of students' perceived social support, stigma, and attitudes is intended to help researchers understand which student groups are more at risk for mental health problems. Current research suggests that male students tend to be at a relatively higher risk because they have low levels of social support, greater self-stigma, and weaker attitudes toward seeking professional help. That said, male students tend to feel more socially isolated, tend to internalize public stigma, and are more reluctant to seek professional help. Building on this understanding, there is a need to address these concerns through health promotion messages and programs tailored for male students.
Lastly, this study’s findings suggest that perceived social support among first-year students was significantly higher than that of sophomore and junior students, and perceived social support of senior students was similarly high as that of first-year students. This result is inconsistent with previous research claims that first-year students may face the most challenges during their transition to college life due to the anxiety and stress associated with an entirely new environment (e.g., Dyson & Renk, 2006). Perhaps students may experience more social isolation when the excitement of their first-year experience begins to fade in their second or third year of college life. Or, it is likely that university-led programs that help first-year students successfully transition to a new environment have been successful, at least in the university where the research was conducted. Further research is needed to explore the relationship between classroom location and student social support to help health communicators better understand groups of students at greater risk of social isolation.
Limitations and Directions for Future Research
Despite the useful implications of the study, there are limitations. The survey was conducted in February 2020 before the onset of the COVID-19 pandemic in the U.S., and therefore the results cannot be generalized to the current situation. Students face stress and anxiety associated with a variety of problems related to online distance learning, compared to when the study was conducted. The current pandemic has created a distorted learning environment on college campuses, and the findings should be interpreted carefully in the sense that they apply better to non-epidemic situations. It seems important to look for alternatives that can generate social support through new media channels (e.g., social media), especially given that social media use may be less affected by the current pandemic. Lastly, the survey was conducted at one university, which limited the generalization of the findings to the entire university system of the United States. Future research may consider a national survey.
Conclusion
Although the vast amount of research in the mental health literature has focused on the negative role of stigma on health-seeking attitudes or behaviors, few studies have sought to identify the various factors that may reduce public and self-stigma. By linking perceived social support to stigma, professional help-seeking attitudes, this study offers important practical implications. Building on social support theory, the proposed model of this study extends the use of the theory into the context of mental health among college students.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation
Print
