CHAPTER 1

INTRODUCTION

Rationale

Mental health problems among college students impede academic performance and program

completion (Gere, et al., 2019). The mental health of university students is becoming a growing problem

throughout the world. According to Siddique et al. (2022) after graduating from higher secondary school

(high school in some developed countries), students may encounter a variety of issues such as dormitory

life, study stress, lack of time management, unhealthy eating habits, sleeping disorders, smoking,

problematic internet usage, and sedentary behavior in their new academic setting. During this period of

transition, students struggle to deal with the intellectual and social obstacles of university studies, which

is vital for their preparation for professional jobs through the development of professional knowledge

and experience.

The Department of Health (DOH) reported at least 3.6 million Filipinos suffering from mental

health problems as the Philippines continues to struggle with the COVID-19 pandemic. In a report

written by Domingo (2021), in reference to Regional Resource Mapping 2019-2020 conducted by the

Department of Health Philippines, depressive disorder is the most prevalent disorder with a rate of

1.10%, followed by alcohol use disorders of 0.90% prevalence, drug use disorders with 0.70%, epilepsy

with 0.30%, and bipolar disorder and schizophrenia with 0.20%. Moreover, it was also reported that

there is a 5.4% rate of suicide deaths per year. Additionally, among the 1,879 Filipinos, specifically,

adults surveyed, 25% said they have moderate to severe anxiety, and 16.67% said they have moderate

to severe depression and psychological impact. Filipinos who are in adulthood become vulnerable and

have a higher risk of being infected with the coronavirus as postulated by the Department of Health

(2020); World Health Organization, 2020; and Buenaventura R., Ho J. B., &Lapid M. I. (2020).
 Visiting the guidance office has not been a habit among students in the Philippines largely

because of stigma (Hontucan, 2022). As of AY 2022-2023, 73 students sought guidance counseling from

Davao del Norte State College Guidance Office — 34 were referred while 15 were self-referred, then 6

students were call in (Nogan, 2023). This shows that mental health difficulties in the said school is

evident.

Also, Davao del Norte State College Guidance Office has programs for mental health to indicate

the literacy of the students which are — 3K Session (Kumustahan, Kwentuhan, Kahalagahan) and Mental

Health Webinar/Seminar such as Bullyproof, Prevention Against Suicide and Mental Wellness (Nogan,

2023).

However, age, gender, education, culture, and personality are all influences on mental health

literacy. Gender has a big impact on mental health knowledge and attitudes. Men and women differ in

early intervention, attitudes, and knowledge, which is indicated by the lower levels of mental health

literacy among men (Ryandra, 2019).

According to Metz (2023), college students who do not study mental health-related topics are a

population that is particularly susceptible to mental health problems due to the stress of higher

education and the potential lack of mental health literacy. If this population has low levels of mental

health literacy, they may not recognize a need to seek help and may be influenced against seeking help

due to perceived negative stigma.

In the Philippines, most people with mental issues and illness are often stigmatized and called

derogatory names such as sintu-sinto, papansin, may tililing, baliw, taong-grasa, regardless of age

differences, which entails the simplistic views and attitudes of Filipinos towards mental health, that

further calls for mental health literacy (Rey, 2022).

 Pretorious, et al. (2022) state, that despite high rates of incidence of mental health, few young

people pursue formal help-seeking. Low levels of mental health literacy have been identified as a

contributing factor to the notable lack of formal help-seeking by young people.

A qualitative study by Debate et al. (2022), explored mental health literacy and help-seeking

behaviors among undergraduate college men. Nevertheless, to the best of the researcher's knowledge,

no previous study concerning mental health literacy and help-seeking behaviors among male and female

undergraduates in Davao del Norte State College.

For this reason, it aims to investigate the relationship between the variables which is to identify

the level of mental health literacy and its influence on help-seeking behaviors.

Statement of the Problem

1. What is the level of mental health literacy of undergraduate students in terms of:

a. Mental health recognition

b. Knowledge and beliefs about self-help interventions

c. Attitudes that facilitate recognition and appropriate help-seeking

d. Knowledge on mental health influences

e. Knowledge and risk factors and causes

2. What is the level of students' help-seeking behavior in terms of:

a. Personal or emotional problems

b. Suicidal ideation
3. Is there a significant relationship between the Level of Mental Health Literacy and Help-seeking

Behaviors of the students in Davao del Norte Sate College?

Objectives of the Study

The objective of this study discussed the purpose and aimed to assess the results gathered in this study.

These are the following objectives:

1. To determine the level of mental health literacy of undergraduate students in Davao del Norte State

College.

a. Mental health recognition

b. Knowledge and beliefs about self-help interventions

c. Attitudes that facilitate recognition and appropriate help-seeking

d. Knowledge on mental health influences

e. Knowledge and risk factors and causes

2. To determine the level of help-seeking behaviors.

a. Personal or emotional problems

b. Suicidal ideation

3. To find out the significant relationship between the Level of Mental Health Literacy and Help-seeking

Behaviors.

Hypotheses of the Study

 Hi: There is a significant relationship between the Level of Mental Health Literacy and Help-

seeking Behaviors among undergraduates in Davao del Norte State College.

Ho: There is no significant relationship between the Level of Mental Health Literacy and Help-

seeking Behaviors among undergraduates in Davao del Norte State College.

Significance of the Study

Students. The findings of this study can enhance the understanding of students’ mental health literacy

levels and help-seeking behaviors. This can empower them to make informed decisions about their

mental well-being and seek appropriate support.

Department of Health's (DOH) impact on mental health literacy and help-seeking behaviors is of

significant importance as it allows us to assess the effectiveness of their initiatives in improving public

knowledge about mental health and promoting access to appropriate support services. By examining the

DOH's efforts, we can gain insights into the potential impact on reducing stigma, encouraging early

intervention, and enhancing mental health outcomes.

Educational Institutions. The study can provide valuable insights into the impact of mental health

literacy and help-seeking behaviors among undergraduates. This can guide the development of

educational programs and initiatives to promote mental health awareness and support within academic

settings.

Future Researchers. The result of the study will serve as a reference that will benefit future researchers

whose aim is to conduct research similar to this study.

Scope and Delimitations

 The study intends to focus on the level of mental health literacy and help-seeking behaviors in

Panabo, Davao del Norte. This is subjected to the students in the following criteria: (a) an undergraduate

student currently enrolled in the AY 2023-2024; (b) aged 18-27 years old. According to Miles et al.

(2020), in challenging the findings that age, in general, relates to better mental health literacy, no

differences were found between those in the 18–24 age group and those in the 25–64 age group in

terms of general knowledge of mental health.

The study is delimited to determine the level of mental health literacy and the level of help-

seeking behaviors about the mental health of college students in Davao del Norte State College.

Furthermore, this study ought to be to get the perspective of 388 respondents of college students in

Davao del Norte State College.

Chapter 2

REVIEW OF RELATED LITERATURE

 The pertinent research and studies that were chosen to support the overall objective and topic

of the study are presented and discussed in this chapter. The researcher carefully examined and grasped

the study. Certainly, the literature is pertinent to the study's overall concept, which is the Level of

Mental Health Literacy and Help-seeking Behaviors among Undergraduates in Davao del Norte State

College.

Mental Health of College Students in the Philippines

Mental health is a state of mental well-being that enables people to cope with the stresses of

life, realize their abilities, learn well and work well, and contribute to their community (World Health

Organization, 2022).

Over half (51%) of the 1,000 undergraduate college students surveyed in the College Student

Mental Health Report said their mental health worsened during college. Other survey research also finds

high levels of mental health conditions in students. In 2022, over three-quarters of college students

(77%) experienced moderate to serious psychological distress. 35% of students were diagnosed with

anxiety; 27% had depression. Trauma, eating disorders, obsessive-compulsive disorders, bipolar

disorders, and substance use disorders are other mental health conditions affecting college students.

Almost 9 in 10 students (89%) who face academic challenges say they affect their mental health. In

2021, 28% of student said they often feel isolated from others. Trans/gender nonconforming and

LGBTQIA+ students report higher levels of mental health challenges than their cis and straight peers.

College athletes, especially in women's sports, experience heightened levels of negative mental health

symptoms like anxiety, trouble sleeping, mental exhaustion, and feeling overwhelmed. Just 40% of

students think their school is doing enough to support student mental health (Bryant & Welding, 2023)

According to Krish et al. (2015), student mental health has gained attention due to the

increasing number of students experiencing distress. Universities reported a rising number of students
obtaining psychological services and a rising severity of students' symptoms (Castillo & Schwartz, 2013;

Lipson et al., 2016). University students reported receiving treatment and diagnosis for anxiety

disorders, depression, eating disorders, learning disabilities, and other psychotic disorders (Nami et al.,

2014). Community college students reported bipolar disorder, schizophrenia, substance abuse or

addictions, and other more severe mental health concerns.

Further to that, the Global School-based Student Health Survey (WHO, 2015) showed that

Filipino adolescents commonly experience anxiety disorders, depression and other mood disorders, and

behavioral cognitive disorders. Moreover, Department of Education (2023), 404 students died by suicide

during the 2021-2022 school year, with a staggering 2, 147 attempting suicide during the same period.

Mental Health Literacy of College Students

Press & Almanasef (2020), Mental Health Literacy (MHL) involves understanding and managing

mental health, but university students lack the skills to recognize and seek help. Due to that, university

students experience immense vulnerability associated with mental health problems. These difficulties

could interfere with everyday life and range on the spectrum from minor concerns, such as stress and

worry, to serious long-term mental health conditions, such as anxiety and depression.

Mental health literacy (MHL) plays an important role in both the recognition of mental health

problems and help-seeking for those problems. MHL refers to the knowledge and beliefs about mental

health disorders which aid in their recognition, management, or prevention. Research findings provide

support for a relationship between MHL and mental health services use. College students with low MHL

are less likely to seek help and receive treatment than students with high MHL. Kim, Yu, and Kim

reported that MHL had a direct effect on attitudes toward help-seeking and help-seeking intentions

through stigma (Cormier, et al., 2022).

 On the other hand, gender significantly impacts an individual's mental health knowledge and

attitude. Studies show men have lower mental health literacy levels compared to women. This results in

differences in early intervention, attitudes, and knowledge. Both men and women have risks of

developing mental health problems, and gender construction influences mental health problems.

Women are more prone to mental health issues due to gender expectations and lower resources, while

men are often overlooked. This highlights the need for gender equality in mental health literacy

programs and calls for further research (Ryandra, 2019).

Furthermore, mental health education interventions are effective in reducing stigma and

discrimination and provide opportunities to expand public awareness of mental illness and promote

inclusion of those who experience a mental illness (Chisholm et al., 2016; Wong et al., 2016; WHO,

2018). Mental health education provides the learner with information not only valuable for their

knowing how to care for their mental health but also holds the implication of using this knowledge for

the benefit of friends and family who may be affected by mental illness (Jorm, 2012; Wong et al., 2016).

Meanwhile, universities have tried to raise awareness of mental health and in response to the

increased prevalence of poor mental health have, where possible, expanded mental health professional

services (Gorczynski & Sims-Schouten, 2022) and resources to students. Researchers have suggested

that target strategies, perhaps those rooted in mental health literacy, are needed to provide students

with information about mental symptoms and disorders, facilitate self-compassion and self-care,

address the negative perceptions and attitudes toward poor mental health, and provide clear pathways

about how to access mental services when needed.

According to Mahfouz et al. (2016), the majority of students in Saudi (90.3%) have intermediate

mental health literacy. Regarding the etiology of mental illness, students agreed that genetic inheritance

(45.8%), poor quality of life (65%), and social relationship weakness (73.1%) are the main causes of
mental illness. The majority thought that mentally ill people are not capable of true friendships (52.5%)

and that anyone can suffer from a mental illness (49.4%). Students' attitudes towards psychiatric

patients were mixed, with 68.7% reporting that they could maintain a friendship with a mentally ill

person and that people with mental illness should have the same rights as anyone else (82.5%). Mental

health literacy among university students was intermediate. There is an urgent need for health

educational programs to change the attitudes of students regarding this important health issue

(Mahfouz, et al., 2016). Moreover, Filipino college students have still quite insufficient knowledge in

terms of the causes of depression, referring mostly to triggers and predisposing factors rather than

biomedical causes of depression (Ines, 2019).

Gorczynski et al. (2020) conducted a country-wide study on evaluating mental health literacy

and help-seeking behavior in UK university students. Overall, 78 percent of participants indicated mild or

more severe symptoms of distress. Students reported lower levels of mental health literacy when

compared to students in other nations. Women, bisexuals, and those with a history of mental disorders

indicated high levels of mental health literacy. Participants indicated they were most likely to seek

support from intimate partners and least likely to seek support from religious leaders. No significant

correlations were found between mental health literacy and help-seeking behaviors. Mental health

literacy was not correlated with distress, mental well-being, or self-compassion

Additionally, Hill, et al. (2017) states that, university students often lack mental health literacy

skills, which are essential for recognizing and seeking professional help when needed. Women have

significantly higher mental health literacy ratings than men. According again to Hill, et al. (2017), mental

health literacy scores increase with education year, and those with a previous mental health problem

score significantly higher than those without. No significant differences were found between

heterosexual, bisexual, gay, lesbian, or other participants.

 Aldridge & McChesney (2018), some Filipinos think that the symptoms of mental illness are

caused by a curse or possession by spirits, a loss of balance and excessive worrying, a soft personality,

and a lack of social support.

Moreover, a poor understanding of mental health conditions is associated with public fear and

the perception that people experiencing mental health problems are dangerous (Robinson, et al., 2018)

Mental Health Recognition

A study by Furnham and Hadjimina in 2017 found that age and gender influence mental health

literacy of anxiety disorders among European participants. The study found that general anxiety is a

significant problem, leading to higher recognition rates among Filipino adult respondents. Mass media

representation of mental health also contributed to this perception. Also, it found that media is the

most common information source on mental health awareness, with 64.2% dependency on recognizing

common mental disorders.

Meanwhile, educational attainment significantly influences the mental illness recognition of

Filipino adults. Studies show that Filipinos aged 18-65 are generally knowledgeable about mental health

illnesses, with a less stigmatizing attitude. They are relatively high in recognizing depression, stress,

bipolar disorder, and drug addiction as mental illnesses. College students at De La Salle University can

recognize symptoms of depression using the correct label and seek help, possibly due to higher

education (Rey et al., 2022).

Furthermore, in the Philippines, most people with mental issues and illness are often faced

stigmatized and called derogatory names such as sintu-sinto, papansin, may tililing, baliw, taong-grasa,

regardless of age differences, which entails the simplistic views and attitudes of Filipinos towards mental

health (Rivera & Antonio, 2017), that further calls for mental health education among adults to an older
generation before us. One of the common misconceptions and often stigmatized among Filipinos is that

depression and anxiety don't exist and that mental illnesses are something to be ashamed of.

On the other hand, Martinez et al.'s systematic review found that financial constraints and

psycho-social barriers hinder access to mental health services and support, rather than recognizing

mental health problems. Rey et al. (2022), religion did not significantly differ in recognizing mental

illness, finding that Filipinos attribute psychological illnesses to religious beliefs. Marital status also did

not significantly differ in recognizing mental illness, possibly due to married couples viewing mental

health conditions as unique and tolerant, rather than correct labeling.

Knowledge And Beliefs About Self-Help Interventions

To define self-help interventions, it involve individuals using therapeutic materials on their own

or with minimal guidance from a therapist, often delivered through various methods. Traditionally,

these interventions aim to improve access to psychological services and reduce health disparities,

targeting mild-to-moderate distress patients, with more complex needs requiring more time- and

resource-intensive services (Greenwell, et al., 2015).

A study in Queensland found that Filipinos have a high tolerance for dealing with mental health

struggles independently and value self-sufficiency. They believe mental health is a temporary state and

does not require professional help. Traditional healing techniques include massage, acupressure, and

magnetic healing. Bonesetters (manghihilot), and arbolarios use herbal medications and massage to

treat pain, reduce anxiety, and improve mental health. These traditional and complementary medicine

methods combine indigenous methods from Spanish colonization and Ayurvedic and Chinese traditions

(Rey et al., 2022).

 Furthermore, A systematic review by Greenwell et al. (2015) states that self-help interventions

have shown positive effects on mental health, chronic pain, and insomnia. They offer advantages over

traditional therapeutic services, as they can be completed at home, revisited, and can be accessed at a

pace, making them an alternative for those hesitant to seek traditional psychotherapy.

Attitudes That Facilitate Recognition And Appropriate Help-Seeking

In the study of Gong, Gage, and Tacata (2003), conducted interviews with Filipino Americans

who are Bilingual and live in San Francisco, California, or Honolulu, Hawaii. They also split mental health

care systems into four groups (lay, mental health specialty, general practitioner, and folk systems) to

better understand Filipino Americans' help-seeking behavior. In comparison to the professional and folk

domains, the lay system (asking a friend or relative for aid) is the most common source of care for

Filipino Americans. Additionally, Straiton, Ledesma, and Donnelly (2018) studied 14 Filipino informants

(particularly Filipinas) between the ages of 18 and 49 who lived in Norwegian for one to six years.

According to the findings, Filipino women generally view their mental health issues as temporary and

situational and hence do not require professional help. The women's willingness to seek professional aid

did not appear to be related to their level of emotional distress. Furthermore, the majority of Filipina

informants who had suffered mental health problems drew strength from their strong support networks

and their religious beliefs to help them get through their troubles. Furthermore, twenty-five of the thirty

women migrant live-in caregivers studied by Vahabi, and Wong (2017) were Filipina. According to the

results, many migrant caregivers have limited access to social support.

Additionally, the majority of participants said their primary sources of social support were their

family back home, new acquaintances in Canada, and church groups. They also recognized trust as a

crucial element in deciding who they would seek help from or believe in. Moreover, professional help is

needed primarily in the absence of social support; therefore, the availability of sympathetic, reliable,
and trusted family and friends is harmful to formal help-seeking. This is due to the prevailing cultural

beliefs that regulate Filipino interpersonal connections, known as kapwa (shared identity), in which

trustworthy family and friends are regarded as "hindi-ibang-tao" (one-of us/insider), whereas doctors

and professionals are regarded as "ibang-tao" (outsider). Filipinos are more likely to disclose and be

open and honest about their mental illness to individuals they consider to be "hindi ibang-tao" (insiders)

rather than "ibang-tao" (outsiders), resulting in a preference for family and close friends as informal aid

sources. It is difficult for Filipinos to trust a mental health practitioner who is not a family member (Rey

et al., 2022).

Knowledge On Mental Health Influences

The World Health Organization (2008), stated that stigma is also considered one of the

significant determinants of social exclusion. In the recent systematic review of the relationship between

mental health and social exclusion, they identified that inadequate knowledge of mental health can

result in discrimination against people suffering or who have a mental illness. It is rampant in every

aspect like economic, political, and social exclusion (Curran et al., 2007). In the American Psychiatric

Association (2021) article, people with mental illness are marginalized and discriminated against. They

emphasized the three types of stigmas which are public stigma, self-stigma, and institutional stigma. In

public stigma, it refers to the negative or discriminatory attitude of others towards mental illness. Self-

stigma involves the negative attitude that a person with a mental illness has about their condition,

including internal shame.

Meanwhile, the institutional stigma, where they labeled it as more systematic because it

involves an involvement of policies from both government and private organizations that intentionally

or unintentionally limit opportunities for people with mental illness (American Psychiatric Association,

2021). Furthermore, in a study conducted by Tanaka's et al. in 2018, they documented the rampant
stigmatization experienced by Filipinos with mental health problems with epilepsy conditions in the

Philippines. It highlighted the factor of culturally and socio-economically specific situations that could

result in influential modifiers of the stigmatized experience. In their study, participants faced a stigma

due to cultural characteristics such as the perception of mental health problems as a family illness.

Abdullah and Brown highlighted that stigma is inextricably bound to culture. Culture influences

behaviors and beliefs, and sets the standard for what is considered normal and acceptable to a society.

Beliefs about mental health and illness are, therefore, also culturally bound. In the Filipino culture,

having a mental illness is viewed as a family's mental illness. In a study, private stigma (self-stigma) is

said to mediate the relationship between public stigma and attitudes toward seeking professional help;

private stigma also has a negative correlation with intentions to seek professional help; while another

study found that loss of face is directly associated with perceived stigma for both seeking and receiving

psychological help among Filipinos (Rivera & Antonio, 2020).

Hence, news coverage is sensationalized and creates the perception that the mentally ill are

dangerous, unintelligent, and dysfunctional. Most news reports involving the discussion of mental illness

are reports on gun violence or mass shootings which creates in viewers’ minds a correlation between

mental illness and violence. Depictions in news coverage of the mentally ill involved in violent crimes

most often involve suspects being presented with some form of psychosis, primarily schizophrenia (Klin

and Lemish 2008). With news coverage like this, the stereotypes and the violent stigma of those with a

mental illness are further perpetuated. Media presents severe psychotic disorders most often while

depicting the persons displaying them as unlikeable, dangerous, and unemployable (Stout, Villegas, and

Jennings 2004). There is a gap in the media presentation of mental illness because of the lack of

empirical evidence that serves as a link between mental illness, knowledge, attitudes, and behaviors that
can affect stigma (Stout et al. 2004). Attention has been given to the fact that media sources need to

display more accurate information to the public to reduce the stigma surrounding mental illness.

Furthermore, Stout et al. (2004), if news media displayed more accurate information and

involved more educated screenwriters and news reporters, there could be increased knowledge and

positive attitudes regarding mental illness among viewers, as well as having experts such as psychiatrists

for sources of information to aid in the presentation. A correlation has been previously found between

the display of mental health histories and the perceived dangerousness of the mentally ill, and articles

that discuss accurate information were associated with less positive attitudes about the dangerousness

of mentally ill persons (Wilson, Ballman, and Buczek 2015). When viewers are given more background

information on the subjects and the mental illnesses involved, they are less likely to stereotype them as

being dangerous.

Knowledge And Risk Factors and Causes

In the Philippines, people with mental illness were widely transpired because of the power of

the media to influence and shape one's beliefs. The media usually portrays people with mental illness as

someone dangerous and treated comically. People who are suffering from substance addiction were

portrayed as criminals, murderers, rapists, and sexual deviants in Filipino tabloids and broadsheets.

Hence, it was also found that stigma continues to be the most significant impediment to the

development of the mental health system in the Philippines. The conceptualization of Filipinos on causes

of mental illness was emphasized on personal responsibility. Severe mental problems are believed to be

caused by the softness of character and specific traits. Thus, the ability to deal with one's emotional

concerns is valued and also considered as a personal responsibility. Additionally, some psychological and

physical illnesses are said to be caused or caused by evil activities. It also discusses various Filipino

beliefs that physical and psychological problems are caused by sumpa (curse) brought on by a violation
of traditional family values, or by gaba, a divine curse or punishment. Finally, when it comes to

recognizing dissociative disorders, Filipinos were more likely to define symptoms as a result of spirit

possession than as a result of a psychiatric condition (Rey et al., 2022). Moreover, it was found in the

study of Picco et al. 2019 that stigma is thought to be the result of a combination of three issues: a lack

of understanding (ignorance), bad attitudes (prejudice), and exclusion or avoidance of actions

(discrimination).

Furthermore, entertainment media seems to hold on to and portray the most sensitive

stereotypes of mentally ill individuals. Crime dramas often make the mentally ill characters the

perpetrators of violent crimes, while the mentally ill are more often victims of crimes and violence in

real life. In reviewing previous literature, several studies look at depictions of the mentally ill in the

media, focusing on TV programs and movies. Negative media images of mentally ill characters help to

perpetuate stigma (Stuart 2006). Parrott and Parrott (2015) found that one in two characters with a

mental illness committed a crime, which is compared to one in five in the general population. About 60%

of the mentally ill characters in crime dramas are the perpetrators of crimes when compared to only

19% in the general population (Parrott and Parrott 2015). The mentally ill characters in crime dramas

lead to the overall public perception that the mentally ill are dangerous (Parrott and Parrott 2015). By

using mentally ill characters, TV programs, and movies emphasize that the seriously mentally ill are

dangerous or violent, which gets generalized to the whole umbrella term of “mental illness.” But these

few violent events committed by the seriously mentally ill are not common to all but result in the

targeting and stigmatizing of the entire group.

Help-Seeking

The definition of help-seeking according to Kauer, Mangan & and Sanci (2014), is a coping

process whereby a person attempts to seek external assistance for a problem. It can be further
characterized by the various sources from which a young person can seek help. These may be formal

sources of help (e.g. a professional counselor), informal sources (a friend or family member), or an

online help source.

Most university and college campus settings in the United States offer emotional and mental

health care services, however, not many students seek help or make actual contact with professionals

on the campus (Blanco et al., 2008). National policymakers have identified the stigma surrounding

mental health and mental illness as an important barrier for college students who are seeking mental

health care (Clement, 2015; Drum et al., 2009; Gulliver, Griffiths, & Christensen, 2010). Gender and age

also have been reported as influencing intentions to seek professional mental health help. Findings

show that women are more likely to exhibit positive attitudes toward seeking mental health

professionals than men and older adults exhibited more favorable intentions to seek help from primary

care physicians than younger adults (Berger, Levant, McMillan, Kelleher, & Sellers, 2005; Mackenzie,

Gekoski, & Knox, 2006). Furthermore, students with no history of mental health issues scored

significantly higher in help-seeking behaviors from informal sources (Almanasef, 2020).

In addition, despite the prevalence of mental health challenges experienced by college students,

research indicates that students who have mental health problems experience stigma and do not usually

seek or receive help (Martin, 2010). For example, in one college study, only 37.5% of women and 16% of

men received professional help for their MH (Hubbard et al., 2018). Students who do not seek help

usually experience lower levels of academic success and higher dropout rates (National Council on

Disability, 2017).

Personal Or Emotional Problems

Psychological problems are an integral part of an individual’s life. Individuals usually experience

psychological problems in their work, maintaining relationships, health problems, and when they feel
overwhelmed due to certain factors, such as workload, unable to obtain adequate sleep, nutrition, and

so forth. When psychological problems, experienced by individuals are affecting them to a major extent,

then they need to seek solutions. The various kinds of psychological problems that are experienced by

individuals are depression, stress, and anxiety. In educational institutions at all levels, students do

experience psychological problems. A student’s life is subjected to various aspects that cause

psychological problems. The major ones include the pressure of academics with the obligation of

success, an uncertain future and difficulties, envisaged for integration into the system, learning

disabilities, difficulties in understanding academic concepts, financial problems, health problems, exam

stress, and experiencing discriminatory treatment or any form of violent and criminal acts within

educational institutions (Kapur, 2019).

Mathew (2017), the abilities of the students vary in terms of coping with psychological

problems. The psychological problems of the students are also influenced by social, physical, emotional,

and family problems, which affect their learning abilities and academic performance. Some of the

students find it difficult to cope with psychological problems and experience setbacks. Whereas, some

take it as a challenge and work diligently. Usually, when students experience psychological problems and

feel that they are becoming impediments within the course of achievement of desired academic goals,

they seek solutions from professional counselors. Psychological problems can cause disruptions in both

physical and mental health.

Research shows that mental health problems are highly prevalent among college students

(Auerbach et al., 2016; Eisenberg, Downs, Golberstein, & Zivin, 2009; Selkie, Kota, Chan, & Moreno,

2015). These mental health problems consequently affect students’ academic success as well as their

relationships with family and friends (Hunt & Eisenberg, 2010, Kadison, & DiGeronimo, 2004, Kessler et

al., 2005, Silverman, Meyer, Sloane, Raffel, & Pratt, 1997).

 According to several research findings, factors such as interpersonal relationships, sexuality,

identity development, academic pressures, extracurricular demands, roommate problems, parental

expectations, and racial and cultural differences are the most commonplace stress factors among

college students (Beiter et al., 2015; Kadison & DiGeronimo, 2004, Mahmoud, Staten, Lennie, & Hall,

2015).

Suicidal Ideation

World Health Organization (2019), self-harm is when somebody injures or harms themselves to

cope with or express extreme emotional distress and internal turmoil. They do not generally intend to

kill themselves, but the results can be fatal. Examples of self-harm include trying to poison oneself by

taking too many tablets (medicines or something harmful), cutting or burning, banging your head

against objects, and punching or hitting yourself against something hard. Usually, people who self-harm

do not intend to kill themselves.

On the other hand, suicide is the act of intentionally acting to kill oneself. Every year nearly

800,000 people commit suicide, which equates to one person every 40 seconds, and many more people

attempt suicide. Every suicide is a tragedy that affects families, communities, and entire countries and

has long-lasting effects on the people left behind. Suicide can occur at any age, from young adolescence

to old age. It was the second most common cause of death among 15 to 29-year-olds around the world

in 2016 (World Health Organization, 2019).

According to the statistics in 2013, more than 574,000 or 3% of Filipino youth tried ending their

life. In 2021, the percentage rose to 7.5%, equivalent to almost 1.5 million youth with such experience

(Pinoy Youth in Worse Mental Shape Today, Nationwide Survey Indicates | UP Population Institute,

2022)
 While based on Domingo (2021), the Philippine Statistics Authority stated that in 2020 the

number of deaths due to suicide rose to 3,529 (25.7%), which is higher compared to 2019, where 2,808

deaths due to self-harm (Rey, et al., 2022).

Unfortunately, six in 10 of those who ever thought of committing suicide did not reach out to

anyone about it. The few who did so mostly sought help from close friends or peers (25% of suicide

ideators), followed by parents/guardians (7%) and other relatives (5%). Even among those who acted on

their suicidal thought, seeking professional help was highly unpopular (4%). In every 10 young adults,

only one is aware of any suicide prevention program or service (Pinoy Youth in Worse Mental Shape

Today, Nationwide Survey Indicates | UP Population Institute,

Theoretical Framework

In this study, two (2) communication theories will be used namely: Social Cognitive Theory and

Social Penetration Theory

According to Baranowski et al. (2002), Social cognitive theory (SCT) is one of the most frequently

applied theories of health behavior. Bandura (1977, 1986, 2001), SCT posits a reciprocal deterministic

relationship between the individual, his or her environment, and behavior; all three elements

dynamically and reciprocally interact with and upon one another to form the basis for behavior, as well

as potential interventions to change behaviors.

Social Cognitive Theory underscores the significance of social interactions and interpersonal

relationships in the dissemination of information. Individuals can learn about mental health through

direct interactions with family members, friends, colleagues, and peers who may share their own

experiences, knowledge, or attitudes related to mental health. For example, a supportive and
understanding friend can have a positive impact by providing information and encouragement to seek

help when facing mental health challenges.

Furthermore, this theory highlights the role of role models and mentors in mental health

literacy. Individuals who have successfully navigated their own mental health journeys and openly share

their experiences can serve as powerful role models. Observing others' resilience, recovery, and coping

strategies can inspire hope and encourage individuals to seek help, develop coping skills, and enhance

their understanding of mental health issues.

Meanwhile, it also underscores the importance of self-efficacy in mental health literacy. Self-

efficacy refers to an individual's belief in their ability to take specific actions to achieve desired

outcomes. In the context of mental health, individuals with higher self-efficacy are more likely to seek

information, adopt healthy coping strategies, and engage in help-seeking behaviors. Mental health

literacy programs can focus on building self-efficacy by providing practical tools, resources, and support

to empower individuals to take an active role in managing their mental well-being.

Moreover, the theory highlights the concept of modeling, where individuals observe and learn

from the behaviors and attitudes of others. In mental health literacy, positive modeling involves

showcasing individuals who have successfully sought help, managed mental health challenges, and

reduced stigma. These role models can serve as examples of resilience and recovery, encouraging others

to take similar steps toward mental health improvement.

On the other hand, social penetration theory was developed to explain how information

exchange functions in the development and dissolution of interpersonal relationships. Social penetration

describes the process of bonding that moves a relationship from superficial to more intimate (Altman &

Taylor, 1973). Social penetration is specifically accomplished through self‐disclosure, the purposeful

process of revealing information about oneself (Derlega, Metts, Petronio, & Margulis, 1993). Self‐
disclosure increases intimacy in relationships to a certain point. Social penetration can occur in different

contexts including romantic relationships (e.g., Taylor & Altman, 1975, 1987), friendships, social groups

(for example, religious groups or soccer clubs), and work relationships. The theory has also been applied

in computer‐mediated communication contexts such as online dating and virtual teams.

Furthermore, Social Penetration Theory provides a lens through which we can understand help-

seeking behaviors in the context of interpersonal relationships and mental health. This theory posits

that as individuals interact over time, their communication and disclosure levels deepen, leading to a

more intimate and meaningful relationship. Applying this theory to help-seeking, we can examine how

individuals gradually reveal their mental health concerns and seek assistance within their social

networks.

In the initial stages of help-seeking, individuals may disclose only superficial information about

their mental health issues to acquaintances or friends, known as peripheral layers. This disclosure may

take the form of casual conversations or hints about their struggles. As individuals perceive empathy and

non-judgmental support, they are more likely to penetrate deeper into their feelings and thoughts,

gradually revealing more personal and sensitive aspects of their mental health.

As the relationship between the person seeking help and their confidant deepens, they move

into the intermediate layers of disclosure, sharing more in-depth information about their mental health

challenges. This may include discussing specific symptoms, concerns, or experiences. The social

penetration process in help-seeking involves building trust and reciprocity, which encourages the person

seeking help to feel comfortable and understood by their confidant.

Ultimately, in the innermost layers of social penetration, individuals seeking help are likely to

share their most intimate thoughts, emotions, and experiences related to their mental health. This level

of disclosure often signifies a high level of trust and emotional connection within the relationship. It is at
this point that individuals may seek advice, support, or guidance on how to address their mental health

challenges effectively.

In summary, Social Penetration Theory helps us understand how help-seeking behaviors evolve

within interpersonal relationships. By recognizing the gradual process of disclosure and trust-building,

mental health professionals, friends, and family members can provide a supportive environment for

individuals seeking help, enabling them to open up about their mental health concerns and receive the

assistance they need.

Conceptual Framework

The concept behind this research is to identify the level of mental health literacy and help-

seeking behaviors.