Social Psychiatry and Psychiatric Epidemiology

, Volume 44, Issue 8, pp 675–684 | Cite as

Help-seeking for mental health problems among Chinese

The application and extension of the theory of planned behavior
  • Phoenix K. H. Mo
  • Winnie W. S. Mak


The underutilization of professional care is a perennial problem among Chinese populations. To examine the social-cognitive factors that may affect help-seeking intentions, the present study applied and extended Ajzen’s theory of planned behavior (TPB) to understand the intention to seek help from mental health professionals among Chinese. The effect of mental health and perceived barriers to help-seeking were also examined. Nine hundred and forty-one Chinese were recruited using a randomized household design in Hong Kong. Results from structural equation modeling showed that attitude, subjective norm, perceived behavioral control, and perceived barriers significantly predicted help-seeking intention. Mental health showed no significant effect on help-seeking intention. In addition, subjective norm indirectly predicted intention to seek help from mental health professionals through influencing attitude and perceived behavioral control. Results from multi-group analyses revealed that all path coefficients were invariant across gender. Results supported the utilization of TPB in understanding help-seeking intentions and highlighted the importance of subjective norm among Chinese. Implications on the enhancement of mental health awareness and the promotion of mental health services through a social-cognitive approach were highlighted.


Hong Kong Chinese theory of planned behavior help-seeking mental health 


  1. 1.
    Addis ME, Mahalik JR (2003) Men, masculinity, and the contexts of help seeking. Am Psychol 58(1):5–14PubMedCrossRefGoogle Scholar
  2. 2.
    Ajzen I (1985) From intentions to actions: a theory of planned behavior. In: Kuhl J, Beckman J (eds) Action control: from cognition to behavior. Springer, New York, pp 11–39Google Scholar
  3. 3.
    Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50(2):179–211CrossRefGoogle Scholar
  4. 4.
    Ajzen I (2002) Constructing a TPB questionnaire: conceptual and methodological considerations. In: Storrs CT (ed) University of Connecticut.
  5. 5.
    Albarracin D, Johnson BT, Fishbein M, Muellerleile PA (2001) Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull 127(1):142–161PubMedCrossRefGoogle Scholar
  6. 6.
    Anderson JC, Gerbing DW (1988) Structural equation modeling in practice: a review and recommended two-step approach. Psychol Bull 103(3):411–423CrossRefGoogle Scholar
  7. 7.
    Armitage CJ, Conner M (2001) Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol 40(4): 471–499PubMedCrossRefGoogle Scholar
  8. 8.
    Bagozzi RP, Lee K-H, Van Loo M (2001) Decisions to donate bone marrow: the role of attitudes and subjective norms across cultures. Psychol Health 16(1):29–56CrossRefGoogle Scholar
  9. 9.
    Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Upper Saddle RiverGoogle Scholar
  10. 10.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. J Pers Soc Psychol 51(6): 1173–1192PubMedCrossRefGoogle Scholar
  11. 11.
    Bayer JK, Peay MY (1997) Predicting intentions to seek help from professional mental health services. Aust N Z J Psychiatry 31(4):504–513PubMedCrossRefGoogle Scholar
  12. 12.
    Bentler PM, Bonett DG (1980) Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 88:588–606CrossRefGoogle Scholar
  13. 13.
    Bish A, Ramirez A, Burgess C, Hunter M (2005) Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res 58(4):321–326PubMedCrossRefGoogle Scholar
  14. 14.
    Boey KW (1999) Help-seeking preference of college students in urban China after the implementation of the “open-door” policy. Int J Soc Psychiatry 45(2):104–116PubMedCrossRefGoogle Scholar
  15. 15.
    Browne MW, Cudeck R (1993) Alternative ways of assessing model fit. In: Bollen K, Long JS (eds) Testing structural equation models. Sage, Newbury Park, pp 136–162Google Scholar
  16. 16.
    Burgess C, Potts H, Hamed H, Bish A, Hunter M, Richards M et al (2006) Why do older women delay presentation with breast cancer symptoms? Psychooncology 15(11):962–968PubMedCrossRefGoogle Scholar
  17. 17.
    Byrne BM (2001) Structural equation modeling with AMOS: basic concepts, applications, and programming. Lawrence Erlbaum, MahwahGoogle Scholar
  18. 18.
    Chan B, Parker G (2004) Some recommendations to assess depression in Chinese people in Australasia. Aust N Z J Psychiatry 38(3):141–147PubMedCrossRefGoogle Scholar
  19. 19.
    Chang DF, Tong H, Shi Q, Zeng Q (2005) Letting a hundred flowers bloom: counseling and psychotherapy in the People’s Republic of China. J Ment Health Couns 27:104–116Google Scholar
  20. 20.
    Cheung FM, Leung K, Zhang J, Sun H, Gan Y, Song W, Xie D (2001) Indigenous Chinese personality constructs: is the five-factor model complete? J Cross Cult Psychol 22:407–433CrossRefGoogle Scholar
  21. 21.
    Chiu MYL (2002) Help-seeking of Chinese families in a Hong Kong new town. J Soc Policy Soc work 6:221–240Google Scholar
  22. 22.
    Chiu MYL (2004) Why Chinese women do not seek help: a cultural perspective on the psychology of women. Couns Psychol Q 17:155–166CrossRefGoogle Scholar
  23. 23.
    Christodoulou GN, Christodoulou N (2007) Early intervention in psychiatry. Early Interv Psychiatry 1:7–8CrossRefGoogle Scholar
  24. 24.
    Codd R, Cohen BN (2003) Predicting college student intention to seek help for alcohol abuse. J Soc Clin Psychol 22(2): 168–191CrossRefGoogle Scholar
  25. 25.
    Deane FP, Skogstad P, Williams MWM (1999) Effects of attitudes, ethnicity and quality of prior therapy on male prisoners’ intention to seek professional psychological help. J Adv Couns 21:55–67CrossRefGoogle Scholar
  26. 26.
    Hagger MS, Chatzisarantis NL, Barkoukis V, Wang JC, Hein V, Pihu M et al (2007) Cross-cultural generalizability of the theory of planned behavior among young people in a physical activity context. J Sport Exerc Psychol 29(1):1–20Google Scholar
  27. 27.
    Hanson MJS (1997) The theory of planned behavior applied to cigarette smoking in African–American, Puerto Rican, and non-Hispanic White teenage females. Nurs Res 46(3):155–162PubMedCrossRefGoogle Scholar
  28. 28.
    Higgins A, Conner M (2003) Understanding adolescent smoking: the role of the theory of planned behavior and implementation intentions. Psychol Health Med 8(2):173–186CrossRefGoogle Scholar
  29. 29.
    Hong Kong Health and Welfare Bureau (2001) Services for mentally ill persons. Towards a new rehabilitation era: Hong Kong rehabilitation programme plan (1998–1999 to 2002–2003). Government Secretariat, Hong KongGoogle Scholar
  30. 30.
    Hong Kong Government Information Centre (2001) Provision of psychiatric services and counseling servicesGoogle Scholar
  31. 31.
    Hong Kong Census and Statistics Department (2005) Main tables of the 2001 population censusGoogle Scholar
  32. 32.
    Hunter MS, Grunfeld EA, Ramirez AJ (2003) Help-seeking intentions for breast-cancer symptoms: a comparison of the self-regulation model and the theory of planned behaviour. Br J Health Psychol 8(3):319–333PubMedCrossRefGoogle Scholar
  33. 33.
    Jiang GR, Wang M (2003) A study on help-seeking propensity of Chinese undergraduates. Chin J Clin Psychol 11:180–184Google Scholar
  34. 34.
    Jorm A, Griffiths K, Christensen H, Parslow R, Rogers B (2004) Actions taken to cope with depression at different levels of severity: a community survey. Psychol Med 34(2):293–299PubMedCrossRefGoogle Scholar
  35. 35.
    Kung WV (2004) Cultural and practical barriers to seeking mental health treatment for Chinese Americans. J Community Psychol 32(1):27–43CrossRefGoogle Scholar
  36. 36.
    Leong FT (1986) Counseling and psychotherapy with Asian–Americans: review of the literature. J Couns Psychol 33(2):196–206CrossRefGoogle Scholar
  37. 37.
    Levant RF, Wu R, Fischer J (1996) Masculinity ideology: a comparison between U.S. and Chinese young men and women. J Gend Cult Health 1:217–220Google Scholar
  38. 38.
    Lin Y-N (2002) Taiwanese university students’ perspectives on helping. Couns Psychol Q 15(1):47–58CrossRefGoogle Scholar
  39. 39.
    Maj M, López-Iboz JJ, Sartorius N, Sato M, Okasha A (2005) Preface. In: Maj M, López-Iboz JJ, Sartorius N, Sato M, Okasha A (eds) An early detection and management of mental disorders. Wiley, Chichester, pp ix–xGoogle Scholar
  40. 40.
    Marsh HW, Balla JR, McDonald RP (1998) Goodness-of-fit indices in confirmatory factor analysis: the effect of sample size. Psychol Bull 102:391–410Google Scholar
  41. 41.
    Mo PKH, Mak WWS, Kwan CSK (2007) Cultural change and Chinese immigrants’ distress and help-seeking in Hong Kong. J Ethnic Cult Divers Soc Work 15(3–4):129–151CrossRefGoogle Scholar
  42. 42.
    Montano DE, Kasprzyk D (2002) The theory of reasoned action and the theory of planned behavior. In: Glanz K, Rimer BK, Lewis FM (eds) Health behavior and health education: theory, research, and practice, 3rd edn. Wiley, San Francisco, pp 67–98Google Scholar
  43. 43.
    Morgan R, Ness D, Robinson M (2003) Students’ help-seeking behaviors by gender, racial background, and student status. Can J Couns 37:151–166Google Scholar
  44. 44.
    Ng RM (2000) The influence of confucianism on Chinese conceptions of power, authority, and the rule of law. In: Heisey DR (ed) Chinese perspective in rhetoric and communication. Greenwood, New York, pp 45–56Google Scholar
  45. 45.
    Nooijer Jd, Lechner L, Vries Hd (2003) Social psychological correlates of paying attention to cancer symptoms and seeking medical help. Soc Sci Med 56(5):915–920PubMedCrossRefGoogle Scholar
  46. 46.
    Norman P, Conner M, Bell R (1999) The theory of planned behavior and smoking cessation. Health Psychol 18(1):89–94PubMedCrossRefGoogle Scholar
  47. 47.
    Outram S, Murphy B, Cockburn J (2004) Factors associated with accessing professional help for psychological distress in midlife Australian women. J Ment Health 13(2):185–195CrossRefGoogle Scholar
  48. 48.
    Ow R, Katz D (1999) Family secrets and the disclosure of distressful information in Chinese families. Fam Soc 80(6):620–628Google Scholar
  49. 49.
    Oyserman D, Coon HM, Kemmelmeier M (2002) Rethinking individualism and collectivism: evaluation of theoretical assumptions and meta-analyses. Psychol Bull 128(1):3–72PubMedCrossRefGoogle Scholar
  50. 50.
    Pavuluri MN, Luk S-L, McGee R (1996) Help-seeking for behavior problems by parents of preschool children: a community study. J Am Acad Child Adolesc Psychiatry 35(2):215–222PubMedCrossRefGoogle Scholar
  51. 51.
    Pearson V (1993) Families in China: an undervalued resource for mental health? J Fam Ther 15(2):163–185CrossRefGoogle Scholar
  52. 52.
    Rogler LH, Cortes DE (1993) Help-seeking pathways: a unifying concept in mental health care. Am J Psychiatry 150(4): 554–561PubMedGoogle Scholar
  53. 53.
    Rudowicz E, Au E (2001) Help-seeking experiences of Hong Kong social work students: implications for professional training. Int Soc Work 44(1):75–91CrossRefGoogle Scholar
  54. 54.
    Rumpf H, Meyer C, Hapke U, John U (2001) Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res 105(3): 243–253PubMedCrossRefGoogle Scholar
  55. 55.
    Shek DTL (1992) Reliance on self or seeking help from others: gender differences in the locus of coping in Chinese working parents. J Psychol 126(6):671–678Google Scholar
  56. 56.
    Shek DTL (1993) Coping responses of Chinese parents with preschool mentally handicapped children. Soc Behav Pers 21(4):303–312CrossRefGoogle Scholar
  57. 57.
    Skogstad P, Deane FP, Spicer J (2006) Social-cognitive determinants of help-seeking for mental health problems among prison inmates. Crim Behav Ment Health 16(1–2):43–59PubMedCrossRefGoogle Scholar
  58. 58.
    Sutton S (2002) Using social cognition models to develop health behavior interventions: problems and assumptions. In: Rutter D, Quine L (eds) Changing health behavior: intervention and research with social cognition models. Open University Press, Buckingham, pp 193–208Google Scholar
  59. 59.
    Tabora BL, Flaskerud JH (1997) Mental health beliefs, practices, and knowledge of Chinese American immigrant women. Issues Ment Health Nurs 18(3):173–189PubMedCrossRefGoogle Scholar
  60. 60.
    The W.H.O. World Mental Health Survey Consortium (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291(21):2581–2590CrossRefGoogle Scholar
  61. 61.
    Thompson A, Hunt C, Issakidis C (2004) Why wait? Reasons for delays and prompts to seek help for mental health problems in an Australian clinical sample. Soc Psychiatry Psychiatr Epidemiol 39(10):810–817PubMedGoogle Scholar
  62. 62.
    Triandis HC, Bontempo R, Betancourt H, Bond M et al (1986) The measurement of the etic aspects of individualism and collectivism across cultures. Aust J Psychol 38(3):257–267CrossRefGoogle Scholar
  63. 63.
    Veit CT, Ware JE (1983) The structure of psychological distress and well-being in general populations. J Consult Clin Psychol 51(5):730–742PubMedCrossRefGoogle Scholar
  64. 64.
    Vogel DL, Wei M (2005) Adult attachment and help-seeking intent: the mediating roles of psychological distress and perceived social support. J Couns Psychol 52(3):347–357CrossRefGoogle Scholar
  65. 65.
    Walker GJ, Courneya KS, Deng J (2006) Ethnicity, gender, and the theory of planned behavior: the case of playing the lottery. J Leis Res 38(2):224–248Google Scholar
  66. 66.
    Wang P, Aguilar-Gaxiola S, Alonso J, Angermeyer M, Borges G, Bromet E et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850PubMedCrossRefGoogle Scholar
  67. 67.
    Wu R, Levant RF, Sellers A (2001) The influence of sex and social development on masculinity ideology of Chinese undergraduate students. Psychol Sci 24(3):365–366Google Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2009

Authors and Affiliations

  1. 1.Institute of Work, Health and OrganisationsUniversity of NottinghamNottinghamUK
  2. 2.Dept. of PsychologyThe Chinese University of Hong KongShatin, New TerritoriesHong Kong (SAR), China

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