By Dr. Duke D. Biber, University of West Georgia & Dr. Daniel R. Czech, Georgia Southern University



The purpose of this study was to examine the attitudes towards seeking professional help of college students from a rural setting. The secondary purpose was to examine the relationship between mental health (e.g. self-compassion, stress, anxiety, depression) and attitudes towards seeking professional help. Participants included undergraduate students from two rural southeastern universities (n = 216). Participants completed the Attitudes toward Seeking Professional Help Scale (ATSPH), Self-Compassion scale (SCS-12), and the Depression, Anxiety, and Stress scale (DASS-21). There was a moderate to strong, negative correlation between self-compassion and depression, anxiety, and stress across gender, race, and school classification. Males had significantly stronger ATSPH (M = 68.67, SD = 9.67) than females (M = 62.17, SD = 9.71), F(2, 213) = 3.00, p = .05. Males also reported significantly greater levels of self-compassion than females, F(2, 213) = 12.49, p < .001. Overall, the present study provided information into the mental health of rural undergraduate students and the likelihood of seeking services on campus. Future research for improving attitudes toward seeking professional help is recommended through self-compassion training.

Rural College Students’ Attitudes toward Seeking Professional Help

The awareness of mental and behavioral health problems has received increased research attention over the past few decades, but only about 35% of individuals with mood disorders reported receiving mental health treatment and only 5% with substance abuse disorders received treatment (Eisenberg, Golberstein, & Gollust, 2007; Wu, Pilowsky, Schlenger, & Hasin, 2007). This is important because the current generation of college students is more overweight and sedentary, less spiritual, more depressed, anxious, and stressed, and more likely to attempt and commit suicide than previous generations (CDC, 2010; Collins, Hancock, & Weiss, 2018; Ogden, Curtin, Lamb, & Flegal, 2010; Smith et al., 2005; Twenge, 2017; Twenge et al., 2010; Weitzman, 2004). Specifically, the percentage of college students with mental health problems has risen in recent years (Gallagher, 2011).

Furthermore, the transition from high school to college is developmentally challenging and stressful (Hunt & Eisenberg, 2010). College is associated with high levels of depression, anxiety, and stress (Hishan et al., 2018). College students have to cope with academic standards, social expectations, and overall life transition, much of which can contribute to psychological issues (Crystal, Chen, Fuligni, Stevenson, Hsu, et al., 1994; Uehara, Takeuchi, Kubota, Oshimi, Ishikawa, et al., 2010). Previous generations were defined by the help-negation effect, or an inverse relationship between mental health symptom severity and the likelihood to seek mental health services (Barnes, Ikeda, & Kresnow, 2001; Dean, Wilson, & Ciarrochi, 2001; Rudd, Joiner, & Rajab, 1995; Wilson & Deane, 2010; Yakunina, Robers, Waehler, & Werth, 2010). It is necessary to understand perceptions towards seeking professional mental health treatment so that proper resources and treatment can be provided to students in need.

Differences in suicide ideation and acceptance, depression rates, and anxiety rates differ between cultures (Wong, 2013). Much research has also been conducted with affluent and high-income areas, with less attention given to rural and poor areas (Li & Phillips, 2010). For example, in a study with the previous generation of college students, students cited lack of time, desire for self-management and treatment, perception that treatment was not needed, and stigma as common barriers to seeking mental health services (Czyz, Horwitz, Eisenberg, Kramer, & King, 2013). However, the perceptions towards mental health and treatment has not been examined with the current generation of students nor in a rural population.

It is important to examine perceptions towards seeking professional mental health in areas with less resources, less access to care, and potentially less knowledge about the effects of college transition and psychological repercussions. That being said, the purpose of this study was to examine the attitudes towards seeking mental health services of rural, college students. The secondary purpose was to examine the relationship between mental health (e.g. self-compassion, stress, anxiety, depression) and attitudes towards seeking professional help.




Participants were undergraduate students from the universities in the southeast United States. Participants were emailed the consent form, demographic questionnaire, and other questionnaires via university email. Participants did receive any compensation for participation in the study. There was no harm that participants could incur from participating in this study.


Personal History Questionnaire. This measure solicited self-reported gender, race and/or ethnicity, and school grade classification.

Attitudes toward seeking professional help scale (ATSPHS). The ATSPHS consisted of 29 items. Items were scored on a 4-point scale from strongly disagree (1) to strongly agree (4). The ATSPHS distinguished mental health facilities users from nonusers and has a retest reliability of .83 (Fischer & Turner, 1970). The ATSPHS was adapted for a college-student population by substituting the words psychologist-counselor and counseling center for psychiatrist and mental health center. This adapted version has been used previously with Vietnamese-American and Asian-American college students (Atkinson & Gim, 1989; Atkinson et al., 1984). The ATSPHS had strong scale reliability (α = .82).

Depression, Anxiety and Stress Scale-21 (DASS-21). Depression, anxiety and stress were measured with the Depression, Anxiety and Stress Scale-21 (DASS-21; Antony et al., 1998). The scale has 21 items across three scales: depression (DASS-D), anxiety (DASS-A) and stress (DASS-S). The items are scored on a 4-point Likert-type scale of 0 to 3 (0 = not at all, 3 = most of the time), and the total scores for each scale are to be multiplied by the sum of 2. Possible range for each scale is from 0 to 42, with higher scores indicating more depression, anxiety and stress. Cronbach’s alphas for depression, anxiety and stress were found to be .82, .90 and .93, respectively (Henry and Crawford, 2005). The DASS-21 had strong scale reliability for stress (α = .87), anxiety (α = .85) and depression (α = .89).

Self-Compassion Scale (SCS-12). The 12-item scale measured several attitudes (e.g., self-kindness, self-judgment, mindfulness) that combine to represent self-compassion. With university samples, 3-week test-retest reliability was supported (r = .93), and internal consistency was α = .92. Concurrent validity was demonstrated by large correlations with indicators of depression, anxiety, and life satisfaction. The SCS had strong scale reliability (α = .77).


Upon IRB approval, undergraduate students were recruited from two rural universities in the southeast United States. Instructors were sent an email asking for student participation. If given approval, instructors sent an email to potential participants. The email included a link to electronic informed consent and if they choose to continue, electronic surveys including the personal history questionnaire, ATSPHS, DASS-21, and SCS-12 via Qualtrics survey software. Participants were not incentivized to participate in the study and were allowed to discontinue participation at any time without penalty.

Data Analysis

Descriptive statistics included the means, standard deviation, and ranges for gender, race, and school classification. Pearson’s r coefficient determined the correlation between SCS-12, the DASS-21 and ATSPHS. Correlations between .10-.29 were considered small, between .30-.49 were considered moderate, and .50 and greater were considered large (Cohen, 1988). ANOVA’s examined differences in ATSPHS, SCS-12, and the DASS-21 for gender, race, and school classification. Scale reliabilities (i.e., Cronbach’s alpha; α) were calculated for the SCS-SF, DASS-21, ATSPHS questionnaires. Alphas greater than or equal to .70 were classified as acceptable, .60-.69 were considered questionable, .50-.59 were classified as poor, and below .50 were considered unacceptable (George & Mallery, 2016).




Undergraduate students from a southwestern university participated in the study (n = 283). A total of 216 participants completed the entire survey and were included in analysis. Participant demographic information is provided in Table 1.

Table 1: Demographic Information


The data were normally distributed based on skewness and kurtosis values (i.e., skew < 3.00 and kurtosis < 10.00; Kline, 2010). Self-compassion, ATSPH, depression, anxiety, and stress were analyzed with means and standard deviations across gender, race, and school classification (See Table 2).

Table 2: Descriptive Statistics Across Outcome Variables for Race, Gender, and School Classification

Participant depression, anxiety, and stress was described based on severity of symptomatology (see Table 3).


Table 3: DASS-21 Severity

Pearson’s r correlations were used to examine the relationship between ATSPH, depression, anxiety, stress, and self-compassion and scale reliabilities were provided with alpha (See Table 4).


Table 4: Correlations between ATSPH, DASS-21, and SCS-12

*correlation is significant at 0.05 level (2-tailed).
**correlation is significant at 0.01 level (2-tailed).

Multiple one-way ANOVAs were conducted to determine whether there were differences between groups (i.e. gender, race, school classification) for ATSPH, depression, anxiety, stress, or self-compassion. There was a significant difference between genders for self-compassion, F(2, 213) = 2.99, p = .05, with males recording greater self-compassion (M = 3.11, SD = .50) when compared to females (M = 2.95, SD = .71). There was also only a significant difference between genders for ATSPH, F(2, 213) = 11.76, p < .001, with males recording greater ATSPH (M = 68.67, SD = 9.67) than females (M = 62.17, SD = 9.71). There was not a statistically significant difference between gender for depression (p = .20), anxiety (p = .40), or stress (p = .06). There was not a statistically significant difference between race or school classification for self-compassion, ATSPH, depression, anxiety, or stress.


The current study examined attitudes towards seeking professional help (ATSPH) as well as self-compassion, depression, anxiety, and stress in college students from rural universities. Overall, 42.13% of participants were classified with mild to severe depression, 56.02% with mild to severe anxiety, and 39.81% with mild to severe stress. This is consistent with previous research in which college students report greater anxiety than depression or stress (Hishan et al., 2018). Furthermore, the percentage of depression, anxiety, and stress in college students was higher than other studies with rural samples (Camacho, Cordero, & Perkins, 2016). While this study did not diagnose clinical disorders, the high prevalence of depression, anxiety, and stress is important to monitor.

There was a moderate to strong, negative correlation between self-compassion and depression, anxiety, and stress. A review of self-compassion has found consistent correlations between self-compassion and depression, stress, and anxiety (Barnard & Curry, 2011). Self-compassion is the ability to treat oneself with the same compassion and kindness that one would treat a best friend or loved one (Neff, 2003). The correlation between self-compassion and the DASS-21 replicates previous research (Raes, 2010; Van Dam, Sheppard, Forsyth, & Earleywine, 2011). However, ATSPH was not significantly correlated with self-compassion, which is contrary to other studies (Jones, 2017). Self-compassion interventions and compassionate mind training could be effective methods to promote positive ATSPH as self-compassion equips individuals to cope with difficulty and suffering (Neff, 2003). There are not many published studies examining self-compassion with rural students’ ATSPH, so interventions and programs could be tailored to this specific demographic (Camacho et al., 2016).

Furthermore, there was a significant negative correlation between ATSPH and both anxiety and stress. Previous research is inconsistent regarding significant correlations between attitudes to seek professional help and mood disorders (Mojtabai, Olfson, & Mechanic, 2002; Shaffer, Vogel, & Wei, 2006; Watson & Hunger, 2015). While replication is needed, the present results indicate that rural college students attitudes to seek help reduce as stress and anxiety become more severe, supporting the notion that individuals who are struggling with mental illness may be less likely to seek treatment (Baptista & Zanon, 2017). The negative relationship provides evidence for the need of self-compassion training in college to overcome depression, anxiety, and stress and promote positive attitudes toward professional health services (Barnard & Curry, 2011). It is necessary to educate college students on mental health literacy, importance of help-seeking, and available resources as such interventions have been proven effective (Gulliver, Griffiths, Christensen, & Brewer, 2012). Further research should examine professional health seeking habits to understand the impact of seeking help on the relationship between self-compassion, depression, anxiety, and stress.

There was a significant gender difference for both self-compassion and ATSPH. Males exhibited more positive attitudes toward seeking professional help, which is inconsistent with previous research (Shea & Yeh, 2008; Yousaf, Popat, & Hunter, 2015). However, a previous meta-analysis indicated that males, especially from diverse samples, were more self-compassionate than females (Yarnell et al., 2015). The higher level of self-compassion may indicate a likelihood to engage in self-care and resultant positive attitudes to seek professional help (Neff, 2012). The significant correlation with self-compassion supports the potential impact of self-compassion training as an effective way to reduce depression, anxiety, and stress symptomatology (Soysa & Wilcomb, 2015). Further research could examine contributing factors and social norms that contribute to preferences and beliefs of seeking professional help.

Overall, the present study provides information into the mental health of undergraduate students and the likelihood of seeking services on campus. The results furthered the research on the correlational relationship between self-compassion and depression, anxiety, and stress in rural university students. Further research should include access to and history of seeking professional help as a variable of interest. These results indicate the need to educate rural high school and college students on mental health, the importance of professional help, and how self-compassion may improve mental and emotional well-being.


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Author Duke Biber is the corresponding author and declares that he has no conflict of interest. Author Duke Biber is also the corresponding author for all inquiries.
Author Daniel Czech declares that he has no conflict of interest.