Seeking professional psychological help in international undergraduate nursing students based on gender: An experimental study.

BACKGROUND: The acceleration in the number of undergraduate students experiencing mental illness necessitates action to prevent negative prognosis. AIM: This study aims to examine the impact of gender on the attitude of undergraduate nursing students toward seeking professional psychological help.
METHOD: The study used a pretest-posttest design in nursing school in Hashemite University. Students were followed up approximately 4 months after completing a psychiatric course to determine whether their attitude toward seeking professional psychological help had changed.
RESULTS: There were significant differences among females in respect of seeking help from professionals between pretest and posttest for overall score of seeking help from professionals, confidence in helper, recognition of need for help, and openness with professional. CONCLUSION/IMPLICATIONS FOR FUTURE STUDIES: The findings offer strong evidence on the importance of including a psychiatric course in nursing degree programs to enhance the attitude of undergraduate nursing students toward professional psychological help and overall health and well-being. The findings of this study regarding the impact of an educational psychiatric program provide future healthcare providers with an evidence-based intervention. This intervention can be implemented in all healthcare facilities and may lead to a significant change in mental health practices in Jordan, which is the inclusion of the education within routine care.

Introduction

Mental health problems are not uncommon in undergraduate students. The most common problems are anxiety and depression [1]. Moreover, the increasing number of undergraduate students suffering from these problems is alarming. Unfortunately, most of these students do not seek the appropriate psychological help [2]. Many studies have found that less than 30% seek help from professional healthcare providers [3]. The acceleration in the number of undergraduate students experiencing mental illness necessitates action to prevent negative prognosis [2]. Mental illnesses have an impact on physical, social, and personal functioning, especially among individuals of young age, such as undergraduate students [4]. However, it has been argued that early identification and treatment would prevent the progression of these diseases [1].

As regards this issue in relation to gender, many studies have found that more women seek treatment for mental illnesses than men. Most women are open to seeking help for emotional problems and they have a more positive view of counseling compared to men [5]. Studies have also found that many men are reluctant to seek treatment for mental illnesses, especially if they are undergraduate students [6]. Furthermore, it has been shown that the barriers preventing men of asking help in different nationalities, ethnicities, cultures, ages and racial backgrounds form asking for help are related to culture and the construction of masculinity [6,7]. Masculinity means, in many cultures, suppression of emotion and power to control all life situations without relying on others. These cultural pictures mean that men ignore treatment and do not seek help from professionals [7]. Moreover, it has been found that young adults (undergraduate students) are less likely to ask for help than older adults [8]. To help change this situation for the better, a good place to start would be to work with students studying to become healthcare professionals, and one of the key professions in healthcare is the nursing profession. It has previously been argued that it is especially important to understand the perceptions and attitudes among nursing students toward seeking professional help for themselves and for mentally ill patients early on, i.e., before they become fully-fledged nurses, in order to assist them in developing an understanding of how best to deal with this sensitive issue such as mental health issues [6]. Moreover, an understanding of the attitudes of undergraduate nursing students and their perceptions toward seeking help will enable instructors and future researchers to develop appropriate training modules aimed at teaching undergraduate nursing students how to seek help and how to help mentally ill patients seek help. This knowledge can be used to assist the next generation of nurses and healthcare providers by increasing their awareness of the importance of seeking professional help for mental illnesses for themselves, their families, and their future patients.

Aims of the study

Considering the above, the study sought to test the following hypotheses:

Gender has an impact on the attitude of undergraduate nursing students toward seeking help from professionals before attending an undergraduate nursing psychiatric course.

Attending an undergraduate nursing psychiatric course has a positive impact on the attitude of undergraduate nursing students toward seeking professional psychological help.

Methods

Design

The study used a pre-post design in which students were followed up approximately 4 months after finishing their psychiatric course to determine whether their attitude toward seeking psychological help had changed. This design is the preferred way of measuring the degree of change because of a specific intervention or a change in the behavior of the same population group.

Participant and setting

The participants in this study consisted of undergraduate nursing students who were recruited in their classrooms and volunteered to be part of the study. Participants received a consent form, and those who consented were asked to fill out a demographic questionnaire as well as the ATSPPH scale [9]. The participants were assured that all of their responses would remain anonymous. The study was conducted in a government nursing school in Hashemite University. Xxxx is a Jordanian state-run university that is located in Zarqa city. There are 26,000 students at Hashemite University, which offers 53 undergraduate programs and 27 graduate programs. The sample of the study were all nursing students who were attending an undergraduate nursing psychiatric course at the time of the study in the nursing school during the spring semester of 2017. A sample of 205 students met the inclusion criteria based on Cohen [10]. Information was collected from January 2017 to May 2017.

Instrument and data collection

After completing the study instruments, the students attended a psychiatric course designed for nursing undergraduates that consisted of theoretical and clinical classes about psychiatric illnesses and treatment. The mental illnesses covered included psychosis, uptake disorders, neurotic disorder, depression, combat-related post-traumatic stress disorder, mental disorder, and alcohol dependence. The theoretical and clinical classes were held during the same semester: The theoretical part of the course lasted for 16 weeks and consisted of a 1-h lecture on three days each week (48 hours), and the clinical part of the course also lasted for 16 weeks and consisted of a 3-h session on three days each week (144 clinical hours). At the end of the semester, participants were asked to complete the ATSPPH scale again.

A questionnaire was used to collect the demographic data collected from participants consisted of age, gender, legal status, employment, and income. The participants were asked if they had suffered from psychological problems and whether they had ever sought help from professionals for those problems. The ATSPPH scale [9] was used to evaluate the participants' attitude toward seeking skilled help for psychological issues. This scale consists of 29-items divided into four subscales: recognition of personal need for psychological help; stigma tolerance related to psychological facilitates; social openness relating to one's issues, and confidence in professionals. Every subscale is measured by a four-point Likert scale. The lowest total score is 0 and the highest is 87. A greater score denotes a more positive attitude toward psychological help seeking. The Cronbach's alpha for the whole instrument ranges from .83 to .73. Also, provide evidence to support the construct validity of the dimensions.

Statistical analysis

In this study, descriptive statistics were used to describe age, gender, social status, employment, and income and a multivariate regression was run to assess whether gender could impact the degree of seeking help from professionals for mental illnesses. Additionally, a paired t-test was conducted to identify whether there were any differences between the two genders in seeking help from professionals for mental illnesses.

Ethical statement

Permission to conduct the study was obtained in advance from the Institution Review Board (IRB) in Hashemite University in Jordan (IRB number 4/9/2015/2016). The researchers explained the needs, benefits, and risks of the study to every participant. Participation in the study was voluntary and the confidentiality of participants was assured. Written permission was obtained from every participant and they each signed an informed consent form. The researchers provided their mobile number and email addresses so that the participants could contact them directly if they had any queries. Researchregestiry:6691 https://www.researchregistry.com/browse-the-registry#home/registrationdetails/605b9e5f37f94a001bd8ada1.

Results

The overall sample of this study consisted of 205 Jordanian undergraduate nursing students (151 female, 54 male) ranging in age between 21 and 27 years, mean 21.8, (SD = 0.829). The income of the undergraduate students ranged from 180 to 1895 Jordanian dinar with a mean of 577 (SD = 297). Those who suffered from psychological problems (N = 106, 51.7%). The demographic characteristics of the participants are summarized in Table 1.

Table 1

Descriptive characteristics of participants (N = 205).

Variable	Mean	SD
Age (Range 20–26)	21.27	0.829
Income level/month (JD) (Range 110–1850)	577.4	294.8
	Frequencies	Percentages
Gender
Male	54	26.3
Female	151	73.7
Marital status
Married	14	6.8
Single	191	93.2
Working status
Working	27	13.2
Not working	178	86.8
Complaints of psychological problems
Yes	99	48.3
No	106	51.7

Gender has an impact on the attitude of undergraduate nursing students toward seeking help from professionals before attending an undergraduate nursing psychiatric course.

Logistic regression was used to investigate whether gender might moderate self-reported help seeking in the past, present and future. The results indicated that gender was a statistically significant moderator in help seeking (b = .095, SE = .047, p = .043). Thus, identifying as either male or female could have a significant effect on mental health help seeking, see Table 2.

Table 2

Multiple Regression for Factors Affecting Mental illnesses (N = 205).

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.	95.0% Confidence Interval for B
		B	Std. Error	Beta			Lower Bound	Upper Bound
1	(Constant)	-.347	.500		-.693	.489	−1.334	.640
	age	.095	.024	.273	4.046	.000	.049	.141
2	(Constant)	-.880	.561		−1.568	.119	−1.986	.227
	age	.112	.025	.323	4.529	.000	.063	.161
	gender	.095	.047	.145	2.039	.043	.003	.187

Attending an undergraduate nursing psychiatric course has a positive impact on the attitude of undergraduate nursing students toward seeking professional psychological help, as measured by self-report and the ATSPPH scale [9].

Paired t-tests were conducted to examine whether attending an undergraduate nursing psychiatric course on mental illness and treatment would positively predict help seeking in the future and whether there was a significant difference in the scores on the ATSPPH scale between pretest to posttest. The results indicated that attending the psychiatric undergraduate course produced significant differences in the attitude toward seeking help from professionals. For males, the difference in attitude toward seeking professional psychological help in the posttest was −3.74 (SD = 12.28) for confidence in helper it was -.13 (SD = .56), for stigma tolerance -.081 (SD = .64) for recognition of need for help -.19 (SD = .54), and for interpersonal openness -.098 (SD = .76). The most significant differences in seeking help from professionals in males between the pretest and posttest were observed in the overall score of seeking help from professionals (p = .001) and recognition of need for help (p = .01). For females, the difference in attitude toward seeking professional psychological help in the posttest was .82119 (SD = 13.22), for confidence in helper it was 0.16 (SD = .53), for stigma tolerance 0.02 (SD = .65), for recognition of need for help .32 (SD = .50), and for interpersonal openness .13 (SD = .73). The most significant differences were seen in seeking help from professionals for females between pretest and posttest were in the overall score of seeking help from professionals (p = .001), confidence in helper (p = .001) recognition of need for help (p= .001), and openness with professional (p = .02). This means females showed an overall increase in all dimensions of help seeking from professionals compared to males who showed only a difference in recognition of helper after attending the undergraduate nursing psychiatric course, see Table 3.

Table 3

Paired Samples Test for Seeking Professional Psychological Help from Professionals (N = 205) based on gender.

Gender		Paired Differences				T	df	Sig. (2-tailed)
		Mean	Std. Deviation	95% Confidence Interval of the Difference
				Lower	Upper
Male	a - b	−3.74074	12.28158	−7.09297	-.38852	−2.238	53	.029
	aconfavg - bconfavg	-.12757	.56467	-.28170	.02655	−1.660	53	.103
	astigavg - bstigavg	-.08148	.63901	-.25590	.09293	-.937	53	.353
	arecogavg - brecogavg	-.18750	.53901	-.33462	-.04038	−2.556	53	.013
	aopenavg – bopen avg	-.09788	.76092	-.30557	.10981	-.945	53	.349
Female	a - b	−4.82119	13.22880	−6.94834	−2.69404	−4.478	150	.000
	aconfavg - bconfavg	-.15747	.53215	-.24304	-.07190	−3.636	150	.000
	astigavg - bstigavg	.02252	.64974	-.08196	.12699	.426	150	.671
	arecogavg - brecogavg	-.32202	.50217	-.40277	-.24127	−7.880	150	.000
	aopeneavg - bopenesavg	-.13434	.72604	-.25109	-.01760	−2.274	150	.024

A = Pretest-attitude to seek help from professional.

B= Posttest-attitude to seek help from professional.

Aconfavg = pretest -confidence in professional average arecogavg = pretest –recognition of professional.

Bconfavg = posttest -confidence in professional average brecogavg = posttest –recognition of professional.

Astigavg = pretest –stigma toward mental illnesses average aopenavg = pretest –openness with professional.

Bstigavg = posttest –stigma toward mental illnesses average bopen.

Discussion

This study sought to examine the relationship between attitude toward seeking mental health help and gender in a sample of undergraduate nursing students. The study utilized a pre-post research design. Self-report questionnaires based on the ATSPPH scale were collected and analyzed to obtain the necessary data. There are many articles that focus on help seeking for mental health issues among a range of populations [3,11,12]. In the case of undergraduate students, it has been found that they do not seek help due to a lack of knowledge of mental illnesses and for cultural reasons [6,13]. Past research has also found that, compared to females, males do not seek mental health help as much.

Therefore, this study investigated whether gender would moderate help seeking for mental illnesses among undergraduate nursing students, and it was surmised that those who identify as female would seek help more often than males. The results revealed that mental health help seeking is influenced by gender. This finding is congruent with those of past research that indicate that females seek help for mental illnesses more as compared to males [14] A lack of gender balance in this study compromised the comparison of the two genders as a much larger proportion of the sample identified with the female gender role than with the male gender role, thus decreasing the power of any such comparison [15].It was also hypothesized that the undergraduate nursing students who gained knowledge of mental illnesses and treatment through attending a psychiatric course would be more inclined to seek mental health help for them in the future. Previous literature suggests that knowledge may be helpful (141) in this respect in dealing with mental health issues. So, perhaps the removal of the barrier of lack of knowledge regarding psychiatric diseases and mental health services would be sufficient if combined with other factors that have a positive effect on help seeking in significantly changing behavior with respect to seeking mental health help. Given the previous research, the statistically significant results reported herein are not surprising. The results confirm that, overall, undergraduate nursing students are more likely to seek professional help after attending a psychiatric course. Furthermore, significant differences in seeking help from professionals between the pretest and posttest were observed among the female participants for the overall score of seeking help from professionals, confidence in helper, recognition of need for help and openness with professional. The female participants also showed an overall increase in all the dimensions of help seeking from professionals compared to their male counterparts who only showed a significant difference in recognition of need for help after attending the psychiatric course.

Implication

The findings of this study regarding the impact of an educational psychiatric program provide future healthcare providers with an evidence-based intervention. This intervention can be implemented in all healthcare facilities and may lead to a significant change in mental health practices in Jordan, which is the inclusion of the education within routine care. Moreover, the significant positive psychological and physical effects of the course implemented in this study might help healthcare stakeholders and decision makers in developing an interventional strategy to facilitate the provision and monitoring of educational psychiatric classes at the university level. Furthermore, the results suggest that policy makers may need to encourage care providers to improve their own educational skills to achieve the needed positive outcomes of this type of educational program [16,17].

Limitations

This study has several limitations. One is the use of a self-reporting tool. This is because social desirability plays a major role in how a participant responds to a question in a self-report instrument [18]. Usually, when using self-reporting measures, there is both underreporting and overreporting of the response (19). However, in this study, the data were anonymized, which may have helped in reducing the influence of social desirability. A second limitation is that it was not possible to obtain objective data on help seeking from the students at Hashemite University. Therefore, it is recommended that an objective data approach is used in future research to enhance the accuracy of the data. Also, the participants in the study were from a single university. Thus, the generalizability of results to other students and other specialties is very limited. Furthermore, the sample of nursing students investigated in this study was homogenous as it consisted of Caucasians only and contained a disproportionate number of female students, thereby limiting the external validity of the data as well. Future research studies may therefore wish to use a more heterogeneous sample that consists of different ethnicities and specialties, genders, and ages in order to enhance the generalizability of the findings.

Conclusion

It is important to investigate whether increasing the knowledge of undergraduate nursing students about mental illnesses in both gender and the treatment available would enhance their attitude toward the seeking of professional help for themselves and for patients. The results revealed statistically significant results in terms of seeking given knowledge about mental illnesses and treatment after attending psychiatric course. The results of this study are therefore consistent with previous research.

Ethical aprroval

This study was got approval from the Hashemite University IRB.

Source of funding

No funding was provided.

Author contribution

All authors should have made substantial contributions to all of the following [1]: the conception and design of the study, or acquisition of data, or analysis and interpretation of data [2], drafting the article or revising it critically for important intellectual content [3], final approval of the version to be submitted.

Consent

Confirm consent was gotten from all students.

Registration of research studies

Name of the registry: Researchregestiry.

Unique Identifying number or registration ID: researchregistry6691.

Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.researchregistry.com/browse-the-registry#home/registrationdetails/605b9e5f37f94a001bd8ada1/

Guarantor

Sawsan Abuhammad.

Declaration of competing interest

No conflict of interest of any author.