Stigma, Theory of Planned Behavior Constructs and Professional Help-Seeking among Chinese University Students with Depressive Symptoms: The Mediating Role of Help-Seeking Intention

Adams, C., Gringart, E., & Strobel, N. (2022). Explaining adults' mental health help-seeking through the lens of the theory of planned behavior: A scoping review. Systematic Reviews, 11(1), Article 160. https://doi.org/10.1186/s13643-022-02034-y
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation.
Bohon, L. M., Cotter, K. A., Kravitz, R. L., Cello, P. C., Jr., & Fernandez y Garcia, E. (2016). The theory of planned behavior as it predicts potential intention to seek mental health services for depression among college students. Journal of American College Health, 64(8), 593–603. https://doi.org/10.1080/07448481.2016.1207646
Chen, W., & Dang, J. (2026). Mental health malleability beliefs and help-seeking intentions among Chinese college students: The mediating role of help-seeking self-stigma and the moderating role of depression. Frontiers in Psychology, 16, Article 1736421. https://doi.org/10.3389/fpsyg.2025.1736421
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
Corrigan, P. W. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066X.59.7.614
Crockett, M. A., Núñez, D., Martínez, P., Borghero, F., Campos, S., Langer, Á. I., Carrasco, J., & Martínez, V. (2025). Interventions to reduce mental health stigma in young people: A systematic review and meta-analysis. JAMA Network Open, 8(1), Article e2454730. https://doi.org/10.1001/jamanetworkopen.2024.54730
Dere, J., Watters, C. A., Yu, S. C.-M., Bagby, R. M., Ryder, A. G., & Harkness, K. L. (2015). Cross-cultural examination of measurement invariance of the Beck Depression Inventory–II. Psychological Assessment, 27(1), 68–81. https://doi.org/10.1037/pas0000026
Doll, C. M., Michel, C., Rosen, M., Osman, N., Schimmelmann, B. G., & Schultze-Lutter, F. (2021). Predictors of help-seeking behaviour in people with mental health problems: A 3-year prospective community study. BMC Psychiatry, 21, Article 432. https://doi.org/10.1186/s12888-021-03435-4
Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522–541. https://doi.org/10.1177/1077558709335173
Fang, S., Wang, X. Q., Yang, B. X., Liu, X. J., Morris, D. L., & Yu, S. H. (2019). Survey of Chinese persons managing depressive symptoms: Help-seeking behaviours and their influencing factors. Comprehensive Psychiatry, 95, Article 152127. https://doi.org/10.1016/j.comppsych.2019.152127
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.1177/002224378101800104
Gaiha, S. M., Salisbury, T. T., Usmani, S., Koschorke, M., Raman, U., & Petticrew, M. (2021). Effectiveness of arts interventions to reduce mental-health-related stigma among youth: A systematic review and meta-analysis. BMC Psychiatry, 21, Article 364. https://doi.org/10.1186/s12888-021-03350-8
Hagger, M. S., Polet, J., & Lintunen, T. (2018). The reasoned action approach applied to health behavior: Role of past behavior and tests of some key moderators using meta-analytic structural equation modeling. Social Science & Medicine, 213, 85–94. https://doi.org/10.1016/j.socscimed.2018.07.038
Hammer, J. H., Vogel, D. L., Grzanka, P. R., Kim, N., Keum, B. T., Adams, C., & Wilson, S. A. (2024). The integrated behavioral model of mental health help seeking (IBM-HS): A health services utilization theory of planned behavior for accessing care. Journal of Counseling Psychology, 71(5), 315–327. https://doi.org/10.1037/cou0000754
Hao, Z., & Liang, B. Y. (2011). Revision of questionnaire of stigma for seeking professional psychological help in college students [in Chinese]. Chinese Mental Health Journal, 25(9), 646–649. https://doi.org/10.3969/j.issn.1000-6729.2011.09.002
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Press.
Hilliard, R. C., Watson, J. C., & Zizzi, S. J. (2022). Stigma, attitudes, and intentions to seek mental health services in college student-athletes. Journal of American College Health, 70(5), 1476–1485. https://doi.org/10.1080/07448481.2020.1806851
IBM Corp. (2020). IBM SPSS Statistics (Version 27.0) [Computer software]. IBM Corp.
Jin, X., & Lian, F. (2026). It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China. BMC Psychology, 14(1), Article 1201. https://doi.org/10.1186/s40359-026-04838-2
Kalny, C., Walter, N., Lapinski, M., Shulman, H., & Demetriades, S. (2026). Descriptive norms ? injunctive norms: A meta-analytic review across four health contexts. Health Communication. Advance online publication. https://doi.org/10.1080/10410236.2026.2678927
Krejcie, R. V., & Morgan, D. W. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30(3), 607–610. https://doi.org/10.1177/001316447003000308
Lannin, D. G., Vogel, D. L., Brenner, R. E., Abraham, W. T., & Heath, P. J. (2016). Does self-stigma reduce the probability of seeking mental health information? Journal of Counseling Psychology, 63(3), 351–358. https://doi.org/10.1037/cou0000108
Li, W., Denson, L. A., & Dorstyn, D. S. (2017). Help-seeking intentions and behaviors among mainland Chinese college students: Integrating the theory of planned behavior and behavioral model of health services use. International Journal for the Advancement of Counselling, 39(2), 125–148. https://doi.org/10.1007/s10447-017-9287-x
Lin, Z. Z., Cai, H. W., Huang, Y. F., Zhou, L. L., Yuan, Z. Y., He, L. P., & Li, J. (2025). Prevalence of depression among university students in China: A systematic review and meta-analysis. BMC Psychology, 13(1), Article 373. https://doi.org/10.1186/s40359-025-02688-y
Liu, D., Li, B., Hao, F., Liu, N., Su, Z., Zhu, J., Tang, Y., Wang, B., Wang, J., & Liu, Y. (2022). The prevalence and incidence of major depressive disorder in 8079 Chinese university freshmen before and during COVID-19. Journal of Affective Disorders, 307, 62–68. https://doi.org/10.1016/j.jad.2022.03.022
Lui, J. C., Sagar-Ouriaghli, I., & Brown, J. S. L. (2024). Barriers and facilitators to help-seeking for common mental disorders among university students: A systematic review. Journal of American College Health, 72(8), 2605–2613. https://doi.org/10.1080/07448481.2022.2119859
McLaren, T., Peter, L.-J., Tomczyk, S., Muehlan, H., Schomerus, G., & Schmidt, S. (2023). The Seeking Mental Health Care model: Prediction of help-seeking for depressive symptoms by stigma and mental illness representations. BMC Public Health, 23(1), Article 69. https://doi.org/10.1186/s12889-022-14937-5
Ministry of Education of the People's Republic of China, Supreme People's Procuratorate, Publicity Department of the CPC Central Committee, Cyberspace Administration of China, Ministry of Science and Technology, Ministry of Public Security, Ministry of Civil Affairs, Ministry of Finance, National Health Commission, National Radio and Television Administration, General Administration of Sport, Chinese Academy of Sciences, Office of the National Working Committee on Children and Women, Central Committee of the Communist Youth League, All-China Women's Federation, China National Committee for the Care of the Next Generation, & China Association for Science and Technology. (2023). Special action plan for comprehensively strengthening and improving student mental health work in the new era (2023–2025) [in Chinese] (Jiao Ti Yi [2023] No. 1). https://www.gov.cn/zhengce/zhengceku/202305/content_6857361.htm
Mo, P. K. H., & Mak, W. W. S. (2009). Help-seeking for mental health problems among Chinese: The application and extension of the theory of planned behavior. Social Psychiatry and Psychiatric Epidemiology, 44(8), 675–684. https://doi.org/10.1007/s00127-008-0484-0
Ning, X., Huang, S., Hilario, C., Yamanda, J., Vahabi, M., Poon, M. L., Yao, Z., Fung, K. P., Cheng, S., Gao, J., Jia, C., Li, A. T., & Wong, J. P. (2024). Chinese university students' help-seeking behaviors when faced with mental health challenges. Journal of Mental Health, 33(3), 386–393. https://doi.org/10.1080/09638237.2024.2361259
Ning, X., Wong, J. P.-H., Huang, S., Fu, Y., Gong, X., Zhang, L., Hilario, C., Fung, K. P.-L., Yu, M., Poon, M. K.-L., Cheng, S., Gao, J., & Jia, C.-X. (2022). Chinese university students' perspectives on help-seeking and mental health counseling. International Journal of Environmental Research and Public Health, 19(14), Article 8259. https://doi.org/10.3390/ijerph19148259
Pan, Q., & Hao, Z. (2022). Reliability and validity of the theory of planned behavior psychological help-seeking scale in Chinese adults [in Chinese]. Chinese Journal of Behavioral Medicine and Brain Science, 31(12), 1126–1130.
Pan, Q., & Hao, Z. (2023). Chinese college students' help-seeking behavior: An application of the modified theory of planned behavior. PsyCh Journal, 12(1), 119–127. https://doi.org/10.1002/pchj.605
Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879
Rickwood, D. J., & Braithwaite, V. A. (1994). Social-psychological factors affecting help-seeking for emotional problems. Social Science & Medicine, 39(4), 563–572. https://doi.org/10.1016/0277-9536(94)90099-X
Schnyder, N., Panczak, R., Groth, N., & Schultze-Lutter, F. (2017). Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. British Journal of Psychiatry, 210(4), 261–268. https://doi.org/10.1192/bjp.bp.116.189464
Sheeran, P., & Webb, T. L. (2016). The intention–behavior gap. Social and Personality Psychology Compass, 10(9), 503–518. https://doi.org/10.1111/spc3.12265
Shi, W., & Hall, B. J. (2021). Help-seeking intention among Chinese college students exposed to a natural disaster: An application of an extended theory of planned behavior (E-TPB). Social Psychiatry and Psychiatric Epidemiology, 56(7), 1273–1282. https://doi.org/10.1007/s00127-020-01993-8
Tomczyk, S., Schomerus, G., Stolzenburg, S., Muehlan, H., & Schmidt, S. (2020). Ready, willing and able? An investigation of the theory of planned behaviour in help-seeking for a community sample with current untreated depressive symptoms. Prevention Science, 21(6), 749–760. https://doi.org/10.1007/s11121-020-01099-2
Vogel, D. L., Bitman, R. L., Hammer, J. H., & Wade, N. G. (2013). Is stigma internalized? The longitudinal impact of public stigma on self-stigma. Journal of Counseling Psychology, 60(2), 311–316. https://doi.org/10.1037/a0031889
Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53(3), 325–337. https://doi.org/10.1037/0022-0167.53.3.325
Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40–50. https://doi.org/10.1037/0022-0167.54.1.40
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
Wang, X., Weng, W., Li, M., Xue, J., & Chen, S. (2024). Understanding the intention and behavior of psychological help-seeking among Chinese college students using theory of planned behavior: A three-month follow-up study. Psychology, Health & Medicine, 29(4), 765–777. https://doi.org/10.1080/13548506.2023.2217379
Wang, Z., Yuan, C. M., Huang, J., Li, Z. Z., Chen, J., Zhang, H. Y., Fang, Y. R., & Xiao, Z. P. (2011). Reliability and validity of the Chinese version of Beck Depression Inventory-II among depression patients [in Chinese]. Chinese Mental Health Journal, 25(6), 476–480. https://doi.org/10.3969/j.issn.1000-6729.2011.06.014
Ward, M. K., & Meade, A. W. (2023). Dealing with careless responding in survey data: Prevention, identification, and recommended best practices. Annual Review of Psychology, 74, 577–596. https://doi.org/10.1146/annurev-psych-040422-045007
Weng, W., Hammer, J. H., Kim, N., McDermott, R. C., Li, M., Wang, F., & Shi, X. (2026). Understanding Chinese college students' professional help-seeking intention: A moderated integrated behavioral model. The Counseling Psychologist. Advance online publication. https://doi.org/10.1177/00110000261458370
Weng, W., Hammer, J. H., Sadek, S. M., Aspiranti, K. B., Miller, M. E., & Stanley, A. A. (2026). Relationship between mental health help-seeking intention and prospective help-seeking behavior: A meta-analysis with moderation testing. Social Science & Medicine, 403, Article 119427. https://doi.org/10.1016/j.socscimed.2026.119427
Wilson, C. J., Deane, F. P., Ciarrochi, J., & Rickwood, D. (2005). Measuring help-seeking intentions: Properties of the General Help-Seeking Questionnaire. Canadian Journal of Counselling, 39(1), 15–28.
Yang, W. H., Liu, S. L., Zhou, T., Peng, F., Liu, X. M., Li, L., Yang, Z. M., Liu, H. H., & Yi, J. Y. (2014). Reliability and validity of Chinese version of the Beck Depression Inventory-II in Chinese adolescents [in Chinese]. Chinese Journal of Clinical Psychology, 22(2), 240–245. https://doi.org/10.16128/j.cnki.1005-3611.2014.02.018
Yang, W. H., & Xiong, G. (2016). Screening for adolescent depression: Validity and cut-off scores of commonly used self-report scales [in Chinese]. Chinese Journal of Clinical Psychology, 24(6), 1010–1015. https://doi.org/10.16128/j.cnki.1005-3611.2016.06.011
Yang, X., Hu, J., Zhang, B., Ding, H., Hu, D., & Li, H. (2024). The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: Mediating roles of perceived social support and psychological help-seeking stigma. Frontiers in Psychology, 15, Article 1356435. https://doi.org/10.3389/fpsyg.2024.1356435
Yu, B. C. L., Chio, F. H. N., Cheung, R. Y. M., Kakani, K., & Mak, W. W. S. (2026). How does family face relate to intention to seek therapist-guided and digital self-guided psychological interventions? Mediating effects of interdependent stigma and help-seeking attitudes. Social Psychiatry and Psychiatric Epidemiology, 61(5), 803–817. https://doi.org/10.1007/s00127-025-02990-5
Yun, Y., Yang, H., Wu, C., Chen, Y., Li, J., Zong, Z., & Chen, N. (2026). Identifying subgroups of college students at risk of suicide: The impact of Andersen's model on help-seeking intentions and the role of others' positive help-seeking experiences. BMC Psychiatry, 26(1), Article 155. https://doi.org/10.1186/s12888-025-07771-7
Zhao, R., Amanvermez, Y., Pei, J., Castro-Ramirez, F., Rapsey, C., Garcia, C., Ebert, D. D., Haro, J. M., Fodor, L. A., David, O. A., Rankin, O., Chua, S. N., Martínez, V., Bruffaerts, R., Kessler, R. C., & Cuijpers, P. (2025). Research review: Help-seeking intentions, behaviors, and barriers in college students – a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 66(10), 1593–1605. https://doi.org/10.1111/jcpp.14145

Long, L., & Ahmad, N. S. (2026). Stigma, Theory of Planned Behavior Constructs and Professional Help-Seeking among Chinese University Students with Depressive Symptoms: The Mediating Role of Help-Seeking Intention. International Journal of Academic Research in Business and Social Sciences, 16(11), 391-.

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