Help-seeking attitudes among AfricanAmerican college students

College Student Journal, Dec, 2005 by Dominicus W. So, Stefanie Gilbert, Sergio Romero

Traditionally, African American students display a low-rate of seeking mental health treatment. Issues such as mistrust of White therapists, attitudes toward mental health problems, and African American spirituality affect their help-seeking behavior. The present study examined a sample of 134 African American students at a Historically Black College/University. Using the Attitude Toward Seeking Professional Psychological Help Scale, the present study explored the relationships between students' year in school, and number of college credits in predicting help-seeking attitudes. Results indicated that the greater the number of course credits students had received, the more confidence in the mental health profession they reported.

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Previous studies of the general population's attitudes and behaviors toward seeking help for mental health problems (e.g. Kushner & Sher, 1991) have documented a general underutilization of mental health services. Factors contributing to such underutilization include limited access to mental health services (Leaf, Bruce, Tischler, & Holzer, 1987), inadequate recognition or acknowledgment of problems (Yokopenic, Clark, & Aneshensel, 1983), fears (Kushner & Sher, 1991), and submissive authoritarianism (Furr, Usui, & Hines-Martin, 2003). Although attitudes toward seeking psychological help have been studied generally, relatively little is known about African American college students' attitudes towards seeking help for psychological difficulties. Specifically, an examination of the literature addressing help-seeking attitudes revealed that African Americans are underrepresented in this area of research. The lack of knowledge about African American help-seeking attitudes is significant given the contention that ethnic minorities are embedded within unique and different cultural experiences.

The limited extant research in this area suggests that, compared to Whites, Blacks are less willing to visit mental health clinics (e.g. Temkin-Greener & Clark, 1988). Black college students, in particular, (e.g. Gibbs, 1975) report unwillingness to seek help for psychological difficulties and more negative help-seeking attitudes, relative to their White same-aged peers (Gloria, Hird, & Navarro, 2001). Much is unknown about the reasons why many African American college students are reluctant to seek help from mental health professionals. Regardless of socio-economic level and mental health needs, African Americans in general are less likely than Whites to receive mental health services (Robins & Regier, 1991; Swartz, Wagner, Swanson, Burns, George, & Padgett, 1998). Instead, they are more likely to seek treatment in primary care setting (Pingitore, Snowden, Sansome, & Klinkman, 2001), emergency facilities (Hu, Snowden, Jerrell, & Nguyen, 1991), or only under coercion or to meet legal obligations (Takeuchi & Cheung, 1998). African Americans in need of mental health services are also more likely than Whites to terminate mental health treatment prematurely (Sue, Zane, & Young, 1994).

To account for people of color's limited use of mental health services, researchers have suggested that culture may play an important role in contributing to help-seeking attitudes and behaviors. Through socialization, one's culture sets the subjective standards for determining the levels of tolerance for, and reporting of negative affect and symptoms (Kleinman, 1980). Culture also influences help-seeking through people's communication patterns, interpersonal relationships, and reaction to the environment (Watanabe, 1973). Using Bronfenbrenner's (1979) ecological model, Cauce et al. (2002) argued that the ethnic minority pathway into mental health services is itself affected by cultural and contextual influences.

Using a racial identity paradigm, some researchers (e.g., Parham & Helms, 1981) have found that differences in Black racial identity correlated with preferences for Black counselors and that differences in cultural commitment among Blacks and the availability of culturally similar counselors together affects counseling service utilization (e.g., Atkinson, Jennings, & Liongson, 1990). Similarly, Blacks' cultural mistrust of Whites predicts Blacks' premature termination from counseling (Terrell & Terrell, 1984) and negative help-seeking attitudes (Nickerson, Helms, & Terrell, 1994). Similarly, a pro-Black orientation tends to relate to more negative attitudes toward professional psychological services (Delphin & Rollock, 1995).

Culture-specific stigma of mental illness also reduces African Americans' willingness to seek mental health services. African Americans have been found to be less kind toward mental patients, and more likely to reject them and think they are inferior (Silva De Crane & Spielberger, 1981). African Americans are also less likely than Whites to find psychotherapy efficacious (Hall & Tucker, 1985). They are also more likely than Whites to seek help for psychological problems from family members or community or spiritual leaders (e.g. Miller & Weisz, 1996). Cauce et al. (2002) argued that culture might influence behavioral definitions and patterns of acceptance. For instance, supernatural, spiritual, and religious theories of behavior and emotions have been found to be particularly prominent among African American families with strong ethnic affiliations (Cheung & Snowden, 1990). Consequently, prayer and spirituality are used by members of many ethnic minority cultures as coping resources in lieu of counseling or psychotherapy.