Toward sustainable well-being in higher education: mental health status, attitudes, social support, and service utilization among college students

This study utilized an institution-based descriptive cross-sectional design. The study population included 13,993 students enrolled during the first semester of the 2023–2024 academic year at a university in Zamboanga City, Philippines. This population comprised regular students, returnees, shifters, and transferees across eleven colleges and two external studies units of the university.

A stratified random sampling was employed based on shared characteristics such as gender and year level. From each stratum, students were randomly selected to form the final sample of 332, determined using a 5% margin of error, a 95% confidence level, and a 33% response distribution.

Data collection took place from July to November 2024 using a five-part questionnaire. Part 1 collected data on the socio-demographic characteristics and student-related information of the respondents. Parts 2 to 4 comprised of the following scales: Depression Anxiety Stress Scales - Short Form (DASS-21), Attitude Toward Mental Health Services Scale (ATMHSS), and Perceived Social Support Scale (PSSS).

DASS-21 assessed the mental health status of respondents. The scale has seven items each for depression, anxiety, and stress. Each of the 21 items is rated on a four-point Likert scale ranging from 0 to 3. 0 – did not apply to me at all, 1 – applied to me to some degree or some of the time, 2 – applied to me to a considerable degree or a good part of the time, 3 – applied to me very much or most of the time (Lovibond & Lovibond, 1995). The item scores on each scale are totaled and multiplied by 2 to obtain the three scale scores, as shown in Table 1.

DASS-21 is widely applicable and has been translated into 45 different languages. It was also widely investigated for its reliability and validity across different nations such as Australia, England, Canada, Malaysia, Brazil, China, Pakistan, Germany, USA, and UK. The scale has also been applied to diverse racial groups (Black, White, Latino, and Asian).

Studies had shown that the DASS-21 has good internal consistency reliability (Cronbach's alpha ranged between 0.74 and 0.93) in both clinical and non-clinical samples. It was tested for validilty and reliability to studies involving adolescents (Le et al., 2017; Naumova, 2022) and students (Wittayapun, 2023).

The ATMHSS examined the attitudes of the respondents toward mental health services provided in and outside of the university. It has 12 items, nine of which were adapted from the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) (Mackenzie et al., 2004). The IASMHS scale has already been validated in Ireland, Russia, France, Austria, Portugal, and the Philippines (Tuliao et al., 2019). For this study, the twelve items covered the three factors of IASMHS: psychological openness, help-seeking propensity, and indifference to stigma. The scale ranges from 1 (Strongly Disagree) to 4 (Strongly Agree).

The PSSS assessed the level of social support received by respondents in relation to their utilization of mental health services. The section comprised eight items adapted from the study of Kukoyi et al. (2022). Responses were measured using a 4-point Likert scale: Never (1), Rarely (2), Occasionally (3), and Always (4). The total scores were then categorized to reflect levels of social support: poor (8–18), moderate (19–25), and strong (26–32).

Part 5 focused on students' use of mental health services, evaluating mental health service utilization in and outside the university through single-choice questions.

The questionnaire for this study underwent expert validation. DASS-21 (0.91) had excellent internal consistency, and acceptable scores for attitude (0.71) and social support (0.73) scales. Descriptive statistics, chi-square tests, analysis of variance, Spearman correlation and logistic regression were used for analysis. The significance level was set at 0.05, and IBM SPSS software was used for processing.

The actual collection of data commenced after obtaining the ethics clearance from the Research Ethics Oversight Committee of Western Mindanao State University with reference number 2024-IF-0508 on June 28, 2024. Informed consent was obtained from all the participants and data were anonymized.

Table 2 shows that most students (58.43%) are aged 20–22, with a nearly equal gender distribution (49.4% male, 50.6% female). The majority are single (90.96%) and Roman Catholic (62.35%). Most students come from nuclear families (66.57%) and low-income households (63.85%). Year 1 students make up the largest group (26.2%), with fairly even representation across year levels 1 to 4.

Table 3 shows that the mental health status of college students predominantly reveals moderate levels of depression (36%), with moderate (29%) and extremely severe (29%) levels of anxiety, and normal levels of stress (47%). Overall, 86% of students experience mild to extremely severe depression, 80% exhibit moderate to extremely severe levels of anxiety, and 35% encounter moderate to extremely severe levels of stress. Only less than 15% of the students have normal levels of depression and anxiety.

Additionally, the data implies that the average scores for depression (16.91), anxiety (15.47), and stress (15.98) among the college students surveyed fall within the moderate range of DASS-21. The standard deviation (SD=7) suggests that while some students may have lower or higher levels of these mental health concerns, the majority experience moderate levels.

Table 4 presents the descriptive statistics for the Attitude Toward Mental Health Services. The overall mean score is 32.14, indicating a generally positive attitude toward accessing mental health services.

Help-seeking propensity. In the help-seeking propensity subscale, the mean score is 10.70 (SD=2.31) indicates a moderate to high willingness among students to seek professional help when needed.

Indifference to Stigma. The mean score of 14.47 suggests that students appear largely unconcerned about the social stigma associated with seeking mental health services. Although some variability in scores is observed (SD=3.33).

Psychological openness. This refers to the willingness to acknowledge and talk about mental health concerns. The mean score of 6.95 indicates a moderate level of openness. Notably, this subscale shows the least variability (SD=1.91), suggesting that respondents' views are relatively consistent.

Table 5 indicates that nearly half of the respondents (48%) reported receiving moderate support, while 42% indicated poor support. Only a small portion—about 10%—reported strong social support.

The 42% reporting poor support highlights a substantial group potentially lacking the necessary encouragement or guidance from family, peers, or the community. In contrast, the relatively small proportion of students with strong support indicates that only a few receive consistent and meaningful encouragement.

Figure 1 illustrates a clear trend indicating that higher levels of social support are strongly associated with more favorable attitudes (F (2, 328) = 18.05, p<.0001). This trend is consistent across two attitude subcategories: help-seeking propensity (F (2, 329) = 14.58, p <.0001) and indifference to stigma (F (2, 329) = 9.67, p<.0001). This suggests that stronger social support positively influences students' willingness to seek help and reduces concerns about stigma.

Figure 1.

Comparative Assessment of Attitude and Level of Social Support on Mental Health Services Utilization

In contrast, the subcategory psychological openness shows no significant differences (F (2, 328)=1.58, p =.2082) increase in scores across support levels. This indicates that psychological openness is less influenced by social support compared to the other two subcategories.

Further, Spearman correFurther, Spearman correlation supports the association between social support and utilization of mental health services in (ρ= 0.130, p=.0175) and outside (ρ= 0.128, p=0.0197) the university.

Table 6 further supports that students with strong social support have the highest mean (12.15), compared to 10.04 for those with poor support.

Table 7 shows that only social support (p=0.017) showed a statistically significant relationship with the utilization of school-based mental health services, indicating that stronger social support increases the likelihood of utilizing these services.

Table 8 indicates that social support (p=0.009) showed a statistically significant relationship with the likelihood of utilizing external services.

However, mental health status (i.e. depression, anxiety, and stress) did not significantly predict service utilization in and outside the university. Despite some indications that higher depression and stress scores might increase utilization, these relationships were not statistically significant.

Mental health service utilization among students remains low, with only 12% (39 students) accessing school-based services and 9% (31 students) seeking help outside. A vast majority—88% to 91%—have never accessed mental health support from either source.

Among those who used school services (Table 9), most (67%) saw the Guidance Counselor or Coordinator only once. The main reasons for seeking help were difficulty managing emotions (19%), feelings of sadness or depression (19%), and negative thoughts (19%). Fewer students sought help for academic difficulties, teacher-related issues, family conflicts, anxiety, or peer concerns.

Among the 31 students who accessed services outside the university (Table 10), the most consulted professionals were psychiatrists (27%), religious leaders (23%), and counselors (20%). Some sought help from psychologists, family therapists, barangay or community leaders, and one student from a coach. Common reasons included overthinking, sadness, anxiety, difficulty with emotions, and suicidal thoughts, alongside academic and interpersonal concerns.

Table 11 summarizes reasons for not accessing services. The most reported barrier was the statement “I don't want to”—45% for in-school and 35% for external services—followed by uncertainty about where to get help.

The use of validated instruments enhanced the reliability and consistency of the findings. A comprehensive five-month data collection period ensured broad representation across all year levels, enriching the depth of analysis. Moreover, the large sample size and application of stratified random sampling strengthened internal validity and minimized sampling bias.

Nevertheless, several limitations must be acknowledged. Response bias may have affected the accuracy of self-reported data, and the cross-sectional design limits the ability to draw causal inferences or observe changes over time. Important factors such as past trauma, academic workload, and family dynamics were not accounted for, potentially omitting key influences on mental health and service utilization. Additionally, students with severe mental health conditions or heightened stigma-related concerns may have been underrepresented. Cultural factors unique to Zamboanga Peninsula may also limit the generalizability of the findings to other student populations.

This study offers valuable insight for university administrators and mental health practitioners by identifying social support as a key factor influencing students' willingness to seek mental health services. While mental health concerns are widespread, service utilization remains low. Strengthening students' support networks—through peer programs, family engagement, and faculty training—can help reduce stigma, encourage help-seeking behavior, and improve student well-being and retention.