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356 Canadian Journal of Counselling and Psychotherapy /
Revue canadienne de counseling et de psychothérapie
ISSN 0826-3893 Vol. 48 No. 3 © 2014 Pages 356–374
Postsecondary Students’ Information Needs and Pathways
for Help with Stress, Anxiety, and Depression
Les besoins d’information des étudiants postsecondaires
et les parcours conçus pour réduire le stress, l’anxiété, et la
dépression
Donald W. Stewart
John R. Walker
Brooke Beatie
Kristin A. Reynolds
Ken Hahlweg
Mark Leonhart
Alexandria Tulloch
University of Manitoba
e Mobilizing Minds Research Group
Toronto, Ontario
Surveys indicate that prevalence rates of depression, anxiety, and other disorders in post-
secondary students are equal to or higher than those in the general population; however,
students often do not access help for these problems. Moreover, those who do seek help
are confronted by a range of choices involving psychological, pharmacological, or com-
bined treatment, along with multiple sources of information regarding treatment options.
In an eort to identify the information needs and preferences of Canadian university
students, we conducted a survey of students seeking counselling or medical services on
campus. Results indicated that students were more likely to initially seek advice from
romantic partners or friends rather than counsellors or health care providers. When asked
to consider what information is important when seeking help, students reported that
treatment eectiveness, advantages/disadvantages of treatment, side eects, and what
happens when treatment is stopped were all very important. Training and experience of
service providers were seen as more important than providers’ recommendations for type
of treatment. Meetings with a counsellor were preferred over medication as a treatment
modality. Preferred sources of information included health care providers, information
sheets, and the Internet. Implications of the survey for postsecondary mental health
service delivery are discussed.
R
Selon les sondages, les taux de prévalence de la dépression, de l’anxiété, et d’autres troubles
chez les étudiants postsecondaires sont équivalents ou plus élevés que dans la population
en général, et pourtant, dans bien des cas, ces jeunes n’ont pas recours à de l’aide pour
ces problèmes. De plus, ceux et celles qui se décident à chercher de l’aide doivent choisir
parmi une gamme de services qui va du traitement psychologique, en passant par la
Postsecondary Students’ Information Needs and Pathways 357
pharmacologie ou une combinaison des deux, ainsi que de multiples sources de rensei-
gnements au sujet des options de traitement. An de dénir les besoins et préférences
des étudiants postsecondaires canadiens en matière d’information, nous avons mené un
sondage auprès d’étudiants à la recherche de services de counseling ou médicaux sur le
campus. Les résultats indiquent que les étudiants sont plus susceptibles de rechercher, dans
un premier temps, l’avis de partenaires de cœur ou d’amis plutôt qu’auprès d’un conseiller
ou d’un fournisseur de soins de santé. Lorsqu’on leur a demandé de rééchir au type de
renseignements qu’ils jugeaient importants dans leur recherche d’aide, les étudiants ont
répondu que l’ecacité du traitement, les avantages et inconvénients qu’il comporte, ses
eets secondaires, et ce qui advient à la n du traitement sont tous des aspects très impor-
tants. Ils considéraient aussi la formation et l’expérience des fournisseurs de services des
facteurs plus importants que les recommandations de ces fournisseurs concernant le type
de traitement. Comme mode de traitement, les étudiants ont dit préférer les rencontres
avec un conseiller plutôt que la médication. Parmi les sources de renseignements privi-
légiées sont les fournisseurs de soins de santé, les ches de renseignements, et Internet.
L’article présente une discussion des implications du sondage pour la prestation de services
de soins de santé mentale chez les clients au niveau postsecondaire.
Mental disorders are common among young adults, with the prevalence of the
most common disorders, such as anxiety and depression, reaching a peak between
ages 18 and 24 (Kessler, 2007). When considering postsecondary students more
specically—where academic, nancial, and interpersonal stressors compound the
age-related risk factors—the prevalence of mental disorders may be even higher
(Cooke, Bewick, Barkham, Bradley, & Audin, 2006). One national U.S. survey
found that almost half of the students sampled met the DSM-IV criteria for at
least one mental disorder in the previous year, including 12% for an anxiety dis-
order and 18% for a mood disorder (Blanco et al., 2008). More recently, a North
American survey of students indicated that more than 80% of respondents felt
exhausted and overwhelmed, with nearly half reporting that they felt hopeless
at some point in the past academic year (American College Health Association,
2013). In line with these ndings, rates of suicidality are also high among postsec-
ondary students, with one U.S. national survey indicating that more than half of
students surveyed had considered suicide at some point in their lives, including an
alarming 8% of undergraduates who reported at least one suicide attempt (Drum,
Brownson, Burton Denmark, & Smith, 2009).
Given the high levels of mental health concerns among postsecondary students,
one might expect that mental health service utilization would be similarly high;
however, this is not the case (Kiley, 2013). A national U.S. survey showed that
fewer than half the students screening positive for mood or anxiety disorders re-
ported receiving any mental health services during the preceding year (Eisenberg,
Golberstein, & Gollust, 2007). Although there have been apparent increases in
the willingness of postsecondary students to access campus mental health services
(Hunt & Eisenberg, 2010), young adults are among the age cohorts least likely
to seek help for their mental health problems (Statistics Canada, 2011; Wang et
al., 2005). In addition, when young adults do seek treatment, they may not be
basing their decisions on complete information or seeking this information from
358 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
reliable sources. As such, it is worthwhile to explore the ways in which mental
health information and treatment resources can be made more accessible for this
vulnerable cohort.
Much of the information that young adults want or need about mental health
problems and treatment options can be understood within the framework of
mental health literacy, which may be dened as the extent to which individuals in
need of treatment are able to recognize and identify their symptoms as a condition
requiring access to mental health resources (Coles & Coleman, 2010). e role of
mental health literacy in service accessibility is highlighted by a recent Australian
study that found only 26% of students would seek help from a general practitioner
and only 10% from a student counsellor should they experience a mental health
problem (Reavley, McCann, & Jorm, 2012). Results from a U.K. survey of 3,000
young people aged 16–24 showed similar results (Klineberg, Biddle, Donovan, &
Gunnell, 2011). In this study, participants were asked to identify if characters from
a vignette had depression, and what they thought the characters would do in terms
of seeking help. Interestingly, about one third of the participants who recognized
severe mental health symptoms in the vignettes thought that the characters would
do nothing about their mental health problems (Klineberg et al., 2011).
In addition to low rates of mental health literacy, previous research has identied
a number of psychological factors that are related to reduced rates of help-seeking,
including lack of emotional openness (Hunt & Eisenberg, 2010), degree of
symptom severity (Leahy et al., 2010; Wilson, 2010), and self-stigma (Eisenberg,
Downs, Golberstein, & Zivin, 2009). Of these factors, self-stigma is of particular
concern because of its pervasive nature and impact. For example, in a study by
Vogel, Wade, and Haake (2006), self-stigma, above all other factors measured,
uniquely predicted participants’ willingness to seek counselling and other forms
of help. Self-stigma is likely to have such a high degree of impact because it in-
volves a perception that one is socially unacceptable (Vogel et al., 2006), which
may lead people experiencing psychologically distressing symptoms to forego
seeking treatment in order to maintain a positive self-image (Miller, 1985; Vogel
et al., 2006; Vogel, Wade, & Hackler, 2007). In an eort to address this concern,
Romer and Bock (2008) looked at whether improved provision of treatment
information would help to reduce self-stigma among people who had previously
faced troubling mental health symptoms and those who had not. ey found that
providing counterstereotype information and information on treatment eective-
ness was helpful in reducing stigma in both groups. ese ndings underscore the
importance of ensuring that young adults have sucient information to increase
their knowledge regarding symptoms and treatment options and also to decrease
the risks associated with self-stigmatization.
In working with young adults, however, it is also important to recognize the
signicant role that relationships play in help-seeking (O’Callaghan et al., 2010).
For most, the rst act of help-seeking is made to friends and family (Klineberg
et al., 2011). Although friends and family may not be the best source to provide
accurate mental health information, a study by O’Callaghan et al. (2010) found
Postsecondary Students’ Information Needs and Pathways 359
that having a family member involved in the help-seeking process was associated
with shorter help-seeking delays. erefore, families may play a vital role in initiat-
ing treatment and increasing service utilization among individuals experiencing
problems. However, it is also possible that family inuence may result in a nega-
tive outcome. For example, depending on their experiences, people with a family
history of mental health problems may be less likely to seek help due to a lack
of condence in the ability of available health services to successfully address the
problem (Chen et al., 2005). erefore, receiving unbiased and reliable informa-
tion is important in promoting help-seeking behaviour.
Overall, untreated mental health problems are of great concern for postsec-
ondary students who are expected to function at peak levels of psychological
and intellectual performance. In addition to complicating their adjustment to
postsecondary education, mental health problems can adversely aect students’
physical health, personal development, academic achievement, and quality of life
(Bayram & Bilgel, 2008). For these reasons, insight regarding the preferred ways
in which students would like to receive information about mental health problems,
treatment options, and means of accessing help would be valuable in identifying
ways to meet their needs more eectively.
e aim of the present study was to explore the opinions of university students
regarding their information needs and pathways for help with common mental
health problems. More specically, our research asked: If a young adult were to
experience a signicant problem with stress, anxiety, or depression,
1. Who would they likely turn to for advice?
2. What information would be important to them in considering the types of
help available?
3. What types of assistance would they see as being helpful to them?
4. How would they prefer to receive information?
5. How much information would they prefer to receive?
Participants
All participants were students at the University of X, an intermediate-sized
comprehensive Canadian university with a student population of approximately
29,000. Participants were solicited from the waiting rooms at the university’s
separate student counselling and health centres. Participants were 187 students
(122 females, 60 males, and 5 unspecied) between the ages of 18 and 25 (see
Table 1 for details).
e counselling and health centres are both dedicated to providing services
to students, and each serves a large number of students seeking help for mental
health concerns. All counselling services are provided free of charge; costs for medi-
cal services are covered through the provincial health services plan for Canadian
citizens or through mandatory private insurance for international students. e
counselling centre is a multidisciplinary unit with psychologists, counsellors, social
360 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
workers, and career specialists on sta. According to annual utilization statistics,
the primary presenting issues at the counselling centre are stress, anxiety, depres-
sion, and relationship concerns. More than 1,000 students access counselling
services at the counselling centre each year. e university health centre is a family
practice-style medical clinic providing a full range of medical services, including
care for acute and minor health problems, check-ups, prenatal care, health and
travel counselling, immunizations, and health promotion programming. According
to the clinic administrator, depression and anxiety are among the top ve concerns
for students seeking health services, with approximately 30% of physician time
devoted to student mental health problems.
Table 1
Sociodemographic Characteristics of Respondents
Mean age (SD) 23.1 years (4.78)
Female/male proportion 72%/28%
Racial origin
Caucasian 54%
Asian 23%
Aboriginal/First Nations 9%
Black 7%
Other 7%
Born in Canada 73%
Marital status
Married & living together 16%
Never married & never lived with someone in a marital-like relationship 73%
Divorced/separated 10%
Participants’ mean years of education (SD) 16.0 years (8.37)
Mothers’ mean year of education (SD) 15.0 years (8.76)
Fathers’ mean year of education (SD) 14.8 years (3.94)
Program working toward
Bachelor’s degree/diploma 80%
Graduate degree 14%
Professional degree 6%
Recruitment location
University Health Services 15%
Student Counselling and Career Centre 85%
Main activity in the last 12 months
School 54%
Working (full-time) 12%
Working (part-time) 4%
Work part-time/school part-time 25%
Other 5%
Depression Anxiety Stress Scale-21
Depression mean score (SD) 7.5 (6.17)
Anxiety mean score (SD) 5.9 (4.99)
Stress mean score (SD) 8.1 (5.03)
K10 distress scale mean score (SD) 14.9 (8.49)
Have received professional help for stress, anxiety, or depression (% yes) 50%
Was there a time when professional help for stress, anxiety, or depression would
have been helpful? (% yes)
63%
Note. N = 187.
Postsecondary Students’ Information Needs and Pathways 361
Procedure
is study was approved by the University of X Research Ethics Board. When
recruiting participants, a research assistant approached students who appeared to
be between the ages of 18 and 25 in the waiting rooms of the separate counselling
and health centres. Students who provided written informed consent were invited
to complete the questionnaire while waiting for an appointment and to return it
in a sealed envelope. Students were given a survey package that was gender-typed
for their gender. If students were called for their appointment before they had
completed the survey, they had the opportunity to complete the survey after their
appointment or to take the survey home with them and return it later. When
surveys were returned to the research assistant or to reception sta, participants
received a $10 gift card for campus food services. e survey took approximately
30 minutes for participants to complete. Of those approached about the study,
71% agreed to participate, and 84% of those who agreed to participate returned
completed surveys.
Measures
Sociodemographic information. Participants provided information regarding their
age, gender, racial/ethnic background, education, occupation, parents’ education,
and living situation.
Emotional distress. Emotional distress was measured using the Depression Anxi-
ety Stress Scale (DASS-21; Lovibond & Lovibond, 1995). e DASS-21 assesses
symptoms over the previous week on depression, anxiety, and stress subscales. Items
are rated on a 4-point severity/frequency scale ranging from 0 (Did not apply to me
at all) to 3 (Applied to me very much, or most of the time). Additional information
on participants’ emotional distress was obtained using the Kessler Psychological
Distress Scale (K10; Kessler et al., 2003), which measures past-month symptoms
of anxiety and depression. e 10-item survey contained questions such as “In
the past 4 weeks, about how often did you feel tired out for no good reason?”
Items were rated on a 5-point Likert scale ranging from 1 (none of the time) to 5
(all of the time), with total scores of distress ranging from a category of likely to
be well (score of 10–19) or likely to have a mild (score of 20–24), moderate (score
of 25–29), or severe (score of 30–50) mental disorder (Andrews & Slade, 2001).
Previous psychometric analyses indicated excellent internal reliability for the
DASS-21, with a Cronbach’s alpha of .93 for the total score and individual subscale
coecients of .88 for depression, .82 for anxiety, and .90 for stress (Lovibond &
Lovibond, 1995). e DASS-21 has been shown to possess adequate construct
validity in measuring general psychological distress and shows good convergent
and discriminant validity when compared with other valid measures of depression
and anxiety (Antony, Bieling, Cox, Enns, & Swinson, 1998; Clara, Cox, & Enns,
2001; Henry & Crawford, 2005).
In comparison to the 42-item DASS, Antony et al. (1998) reported lower
intercorrelations of factors, higher mean loadings, and fewer cross-loading items
362 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
in the shorter DASS-21 version. A study by Henry and Crawford (2005) further
examined the validity of the subscales and concluded that the DASS-21 subscales
can validly be used to measure depression, anxiety, and stress. Additionally, the
K10 was shown to produce high discrimination scores between community and
noncommunity cases of DSM-IV-dened psychiatric disorders, including anxi-
ety, mood, and nonaective disorders (Kessler et al., 2003). Similarly, previous
psychometric analyses indicated excellent internal reliability for the K10, with a
Cronbach’s alpha of .93 (Kessler et al., 2003).
Information preferences. With the purpose of providing context for the survey
questions, respondents were asked to read brief vignettes describing two young
adults of the same gender as the respondent (male or female). e rst vignette
described experiences of signicant distress and impairment from symptoms
of panic disorder, and the other described symptoms of depression. In the rst
question in the information preferences section, respondents rated how familiar
they were with dierent types of help available to people experiencing mental
health problems on a 9-point scale ranging from 0 (not familiar at all) through
4 (moderately familiar) to 8 (very familiar). In answering subsequent questions,
respondents were asked to consider that at some time in their lives, they, a close
friend, or a close family member might have a problem similar to those described
in the vignettes. From this perspective, they were then asked to answer questions
concerning their preferences for information, including amount of content, mode
of delivery, and whom they would likely turn to for advice concerning problems
with stress, anxiety, or depression.
A series of questions also asked for participants’ views concerning the helpful-
ness of various forms of assistance for these problems. In developing questions
about the information content that might be important to young adults, we
considered the logical sequence of events in treatment and also ndings from
qualitative research (individual interviews and focus groups) with young adults
(Ryan-Nicholls, Furer, Walker, Reynolds, & e Mobilizing Minds Research
Group, 2009). When weighing treatment options, a person might want to consider
the available treatment choices, what is involved in the treatment (what you do),
cost of treatment, eectiveness of treatment, how long it takes for treatment to
work, how long treatment continues, what happens when treatment stops, and
risks and benets of treatment.
We also included two questions about their own experience. e rst question
stated, “When thinking about your own past experiences, was there a time when
you received help from a professional (such as a counsellor, therapist, or doctor)
for problems with stress, anxiety, or depression?” A second question asked if there
was a time when they would have beneted from professional help but did not
receive it.
Table 1 shows the demographic information and characteristics of the sample.
Sixty-ve percent of the participants identied themselves as female, 32% as male,
Postsecondary Students’ Information Needs and Pathways 363
and 3% reported no gender. e apparent overrepresentation of female partici-
pants is characteristic of the proles of service utilization at the centres where
students were recruited. Overall, 73% of participants were born in Canada. On
average, respondents had completed four or more years of education after high
school and their parents had completed an average of three years after high school.
Most respondents (80%) were working toward an undergraduate degree, with the
remainder working toward graduate or professional qualications.
e majority of participants were solicited from the waiting room at the
counselling centre (85%), with a much smaller proportion (15%) obtained from
students attending the health centre. Dierential rates of participation were ob-
tained at the two sites in part because the reception sta at the counselling centre
notied students about the study during times when the research assistant was
not on site, whereas the health centre receptionists were unable to assist with this
aspect. Respondents from both locations were compared using chi-square analy-
ses to assess for dierences regarding demographic information, mental health
service use, and levels of depression, anxiety, and stress. No signicant dierences
were found between the two samples based on these variables, with the exception
of depression. Participants from the counselling centre reported signicantly
higher levels of depression symptoms than participants at the health centre.
Considering that depression is one of the major pressing issues at the counselling
centre, this result was not surprising. Because there were no other dierences
identied between the two samples, a decision was made to combine participants
from both locations into a single dataset for further analyses. As might be ex-
pected among participants from general counselling and health service settings,
levels of symptoms of distress were low to moderate. Participants’ mean levels of
depression, anxiety, and stress on the DASS-21 were higher than those reported
for nonclinical community samples, but lower than those reported for samples
of people with clinical levels of distress (Henry & Crawford, 2005). Similarly,
the average score on the K10 distress scale was consistent with levels reported in
community samples (Andrews & Slade, 2001). As might be expected with the
population we sampled, a high percentage of participants (50%) reported receiv-
ing professional help at some time for problems with stress, anxiety, or depres-
sion. Additionally, a high percentage of participants (63%) reported that there
was a time when professional help with stress, anxiety, or depression would have
been helpful, but they did not receive it.
Preferred Sources of Information
Table 2 contains information on how likely participants would be to talk
to various people if they were having a serious problem with stress, anxiety, or
depression. e largest proportion of respondents indicated that they would be
very likely to talk to a romantic partner (65%), a close friend (63%), a counsellor
at university (52%), a parent (51%), or a family doctor (51%). A lower percent-
age indicated that they would be very likely to speak to an instructor (19%) or a
phone-in counselling or health line (16%).
364 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
Table 2
Preferred Sources of Information
How likely would you be to talk to one of the following people for advice if you were having a serious
problem with stress, anxiety, or depression?
Source of advice
Not
likely (%)
Moderately
likely (%)
Very
likely (%)
Mean rating (95%
condence interval)
Parent 14 35 51 4.9 (4.52–5.31)
Brother or sister 23 35 42 4.2 (3.79–4.62)
Close friend 7 30 63 5.8 (5.44–6.07)
Romantic partner 5 30 65 5.7 (5.33–6.07)
Teacher or instructor 34 47 19 2.4 (2.02–2.69)
Counsellor at school 15 33 52 4.7 (4.27–5.03)
Phone-in counselling
or health line 39 45 16 2.4 (2.02–2.72)
Family doctor 12 37 51 4.6 (4.24–5.01)
Note. N = 187. Each source was rated on a 9-point rating scale with the anchors 0–2 (not likely), 3–5
(moderately likely), and 6–8 (very likely).
Important Information Content when Considering Help
Tables 3 and 4 summarize participants’ ratings on the importance of various
topics concerning help for mental health problems. Table 3 describes ratings of
importance regarding information about dierent aspects of the treatment proc-
ess and dierent treatment options. Information about the cost of the treatment
to the recipient was rated as more important (60% very important) than the cost
of treatment to the health care system (37% very important). More participants
thought it was highly important to receive information about counselling/psy-
chological treatment (78% very important) than medication treatments (44%
very important).
Table 4 summarizes participants’ ratings of the importance of information about
the administrative and logistical aspects of treatment. e treatment provider’s
training (80% very important) and experience (81%) were seen as more important
than rationale for the recommended treatment (74%) or latency to begin treat-
ment (66%). Logistical aspects of treatment, such as information about where it
would take place (48% very important) and the time of day when appointments
were scheduled (48%) were seen as less important, even though nearly half of the
respondents thought these aspects were very important.
Helpfulness of Various Forms of Assistance
Table 5 provides a summary of opinions about the helpfulness of dierent
types of services that respondents might consider if they were having a problem
with stress, anxiety, or depression at some point in their life. e highest rating
was for an in-person meeting with a counsellor (72% very helpful). A range of
Postsecondary Students’ Information Needs and Pathways 365
Table 3
Importance of Information on Treatment Options
What information would be important to you if you were considering help (for yourself, a close
friend, or a close family member?)
Information type
Not
important
(%)
Moderately
important
(%)
Very
important
(%)
Mean rating
(95% condence
interval)
Available treatments 7 26 67 6.0 (5.75–6.30)
Available medication treatments 11 45 44 4.9 (4.56–5.17)
Available counselling or psychological
treatments
2 20 78 6.5 (6.29–6.79)
What you have to do as part of the
treatment
1 19 80 6.4 (6.16–6.67)
Cost of treatment to you 10 30 60 5.5 (5.14–5.79)
Cost of treatment to healthcare system 21 42 37 3.6 (3.18–3.95)
Eectiveness of treatment 0 10 90 7.1 (6.89–7.28)
How treatment works 1 16 83 6.9 (6.65–7.05)
Goal or outcome of treatment 0 10 90 7.2 (7.01–7.35)
How long it takes for treatment to
produce results
0 22 78 6.5 (6.27–6.69)
How long treatment continues 1 24 75 6.4 (6.14–6.58)
What happens when treatment stops 1 18 81 6.6 (6.40–6.87)
Common side eects of treatment 1 15 84 6.9 (6.69–7.11)
Uncommon but serious side eects of
treatment
3 24 73 6.4 (6.14–6.64)
Advantages and disadvantages of
treatment
0 12 88 6.9 (6.65–7.05)
Note. N = 187. Each information area was rated on a 9-point rating scale with the anchors 0–2 (not
important), 3–5 (moderately important), and 6–8 (very important).
Table 4
Importance of Information on Administrative Aspects of Treatment
What information would be important to you if you were considering help (for yourself, a close
friend, or a close family member?)
Information type
Not
important
(%)
Moderately
important
(%)
Very
important
(%)
Mean rating
(95% condence
interval)
Training of person providing treatment 1 20 80 6.7 (6.48–6.90)
Health care provider’s experience in
treating these problems
2 17 81 6.6 (6.41–6.86)
Waiting period before starting treatment 3 31 66 6.0 (65.70–6.23)
Where treatment will take place 7 45 48 5.2 (4.89–5.46)
Amount of time required to take
treatment
4 37 59 5.7 (5.49–5.99)
Time of day appointment is scheduled 11 41 48 5.1 (4.78–5.41)
Treatment option health care provider
recommends and reasons why
2 24 74 6.4 (6.13–6.59)
Note. N = 187. Each information area was rated on a 9-point rating scale with the anchors 0–2 (not
important), 3–5 (moderately important), and 6–8 (very important).
366 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
other options were considered likely to be very helpful by a smaller number of
respondents, including a recommended self-help book (47%), a recommended
self-help website (48%), medication recommended by their family doctor
(41%), and medication recommended by a psychiatrist (45%). Other service
options (e.g., Internet discussion group, educational workshop) were rated as
less helpful, with only 22–27% of respondents rating these options as likely to
be very helpful.
Table 5
Helpfulness of Various Forms of Assistance
How helpful would the following types of assistance be if you were having a problem with stress, anxiety, or
depression?
Type of assistance
Not
helpful
(%)
Moderately
helpful
(%)
Very
helpful
(%)
Mean rating
(95% condence
interval)
Recommended self-help book 11 42 47 4.6 (4.23–4.89)
Recommended self-help website 12 40 48 4.9 (4.56–5.18)
Telephone meetings with a counsellor 22 51 27 3.6 (3.24–3.88)
In-person meetings with a counsellor 5 23 72 6.2 (5.88–6.45)
Educational meeting (about 2 hours
with 20–30 people)
36 42 22 3.6 (3.25–4.01)
Educational workshop (about 6 hours
with 20–30 people)
11 41 24 3.3 (2.99–3.66)
Internet discussion group led by a
professional
31 43 26 3.3 (3.00–3.68)
Internet discussion group led by a
person who has coped with the
problem themselves
26 51 23 3.5 (3.21–3.87)
Medication recommended by your
family doctor
21 38 41 4.4 (4.04–4.71)
Medication recommended by a specialist
in psychiatry
17 38 45 4.7 (4.35–5.04)
Note. N = 187. Each source was rated on a 9-point rating scale with the anchors 0–2 (not helpful), 3–5
(moderately helpful), and 6–8 (very helpful).
Preferred Source and Amount of Information
Information about help for common mental health problems may be obtained
from a variety of sources. We asked participants how they would prefer to receive
information about various services. As described in Table 6, the preferred methods
to receive information about services were discussion with a health care provider
(67% highly preferred), information in a written form (brochure or booklet, 60%
highly preferred), and information on a recommended website accessed from
home (60% highly preferred). Less preferred methods of obtaining information
were a website accessed in a health care provider’s oce (44% highly preferred)
and video or DVD (29%).
Postsecondary Students’ Information Needs and Pathways 367
Table 6
Preferred Method for Receiving Information About Services
Preferred method
Not at all
preferred
(%)
Moderately
preferred
(%)
Highly
preferred
(%)
Mean rating
(95% condence
interval)
Written form (information sheet) 11 29 60 5.6 (5.28–5.88)
Discussion with health care provider 3 30 67 6.1 (5.85–6.36)
Video or DVD 19 52 29 3.7 (3.40–4.08)
Recommended website accessed from home 8 32 60 5.5 (5.24–5.85)
Website accessed in health-care provider’s
oce
13 43 44 4.8 (4.46–5.09)
Note. N = 187. Each method was rated on a 9-point rating scale with the anchors 0–2 (not at all
preferred), 3–5 (moderately preferred), and 6–8 (very much preferred).
Participants were also asked about the amount of information they would
prefer concerning various types of help. Table 7 shows participants’ ratings of the
amount of information they would prefer to receive (in pages) concerning medica-
tion treatment, counselling or psychological treatment, and self-help approaches.
Most participants (75–87%) indicated an interest in receiving two to six pages of
information about each of these forms of treatment.
Table 7
Preferred Amount of Information About Treatment Options
Treatment option Number of pages
Mean rating
(95% condence
interval)
0 (%) 2 (%) 4 (%) 6 (%) 8 (%) 10+ (%)
Medication treatment 2 30 37 20 3 8 2.2 (1.99–2.33)
Counselling or psychological
treatment
1 22 36 26 8 7 2.4 (2.26–2.59)
Self-help approaches 4 29 28 18 7 14 2.4 (2.15–2.57)
Note. N = 187. Amount of information area was rated on a 6-point rating scale with the anchors 0 (0
pages), 1 (2 pages), 2 (4 pages), 3 (6 pages), 4 (8 pages), and 5 (10 pages or more).
Students accessing a university counselling or health centre were surveyed to
identify their mental health information needs and pathways for help. Students
were asked, “If you were to experience a signicant problem with stress, anxiety,
or depression: Who would you likely turn to for advice? What information would
be important in considering the types of help available? What types of assistance
would you see as helpful? How would you prefer to receive information? How
much information would you prefer to receive?”
368 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
Preferred Sources of Information
e survey participants indicated that they would be likely to rst turn to
members of their personal support network when seeking advice about dealing
with common mental health problems such as stress, anxiety, and depression.
is nding about the importance of friends and family is consistent with other
research on help-seeking for mental health problems (e.g., Reavley, Yap, Wright,
& Jorm, 2011). In order to reach those who would benet from help for these
problems, it is important to reach out to students’ friends and family members to
inform them about the availability of information and help for common mental
health problems. Beyond their personal support network, students are also likely
to turn to available counselling sta and health resources such as a family doctor.
is suggests that in disseminating information to students it will be important
to ensure that high quality educational resources are available to friends and fam-
ily as well as to counselling and health professionals who are likely to come into
contact with them.
Although students overall seem less likely to use phone-in lines than friends,
family, or health care professionals as a source of advice, about 60% of our respond-
ents indicated that they would be moderately to very likely to use phone-in lines
as a source of information. ere are times when sources of information like this
may be especially helpful, such as when other sources of assistance are not available,
after regular oce hours, or in the middle of the night. Approaches such as the use
of phone lines may also have advantages in terms of cost and ease of accessibility.
In addition, other technology-based approaches could also be considered to assist
with mental health support, such as social media sites (e.g., Gowen, Deschaine,
Gruttadara, & Markey, 2012) and mobile applications that are always accessible
by students (e.g., Samson, 2014).
Important Information Content when Considering Help
Survey questions on the preferred information content revealed that par-
ticipants judged information on a wide range of topics to be highly important,
including treatment eectiveness, advantages/disadvantages of treatment, side
eects, and what happens when treatment is stopped. Previous research with
young adults suggests that information on a small number of these topics (pri-
marily descriptions of common mental health problems and the types of treat-
ment available) is accessible on the Internet and in brochure format (Walsh,
Walker, Reynolds, & the Mobilizing Minds Research Group, 2010). However,
very little information is available to the public on other topics important to
making informed choices (e.g., eectiveness of various treatments, advantages
and disadvantages of treatment, common side eects of treatments). Moreover,
where it is available, some of this information is focused on marketing specic
medications or products. As such, evidence-based information on some impor-
tant topics, such as what happens when treatment stops, is not easily accessible
to either the public or health care professionals. Developing accessible, reliable
Postsecondary Students’ Information Needs and Pathways 369
sources of such information would be very helpful for students, health care pro-
viders, and other stakeholders.
Helpfulness of Various Forms of Assistance
Participants indicated that in-person meetings with a counsellor were the
most highly preferred source of direct help, followed by a range of other services
including self-help books or websites and medication treatment recommended by
a family doctor or a psychiatrist. Respondents were quite positive about self-help
resources, which have advantages in terms of low cost and potentially wide avail-
ability. Self-help resources may also be integrated with other sources of help, such
as contact with a counsellor or a physician. Medication was also considered to be
a helpful form of treatment. Potentially lower-cost alternatives, such as telephone
meetings with a counsellor, educational meetings, and educational workshops,
were considered to be very helpful by a lower proportion of respondents. However,
considering both very helpful and moderately helpful ratings, almost two thirds of
respondents considered these resources to be potentially helpful. As such, these
low-cost alternatives may be methods of meeting the needs of students when one-
on-one counselling resources are limited.
Preferred Source and Amount of Information
About two thirds of the survey respondents indicated that they preferred to
receive information about mental health services through in-person discussion
with a health care provider. However, a signicant challenge for health care pro-
fessionals in providing information to students is the limited time that they have
available in each consultation. For most patients, a physician visit typically lasts
for 15 minutes or less. Visits with a counsellor are usually limited to a 50-minute
session, during which it is often necessary to accomplish a number of goals in
addition to exchanging information. ere are also limits to the availability and
accessibility of these service providers, who are only available at particular times
and at specic locations. is suggests that other methods of delivering informa-
tion would be helpful as alternatives to directly seeking out professionals for advice.
Given these issues with accessibility to information meetings with a service
provider, it is helpful to note that 60% of respondents also expressed preferences
for receiving information in written form (brochure or booklet) or through a
recommended website accessed from home. ese latter ndings are consistent
with a recent study (Cunningham et al., 2013) carried out in primary care medical
clinics, where more than 1,000 young adults from a wide range of educational
backgrounds responded to a consumer-preference modelling survey concerning
how they would like to obtain information about problems with anxiety or depres-
sion. ese researchers identied two segments of young adults—one segment
that was particularly interested in receiving information through the Internet, and
another segment interested in receiving information through more traditional
written materials such as brochures. When these ndings are considered along
with our survey results, it would seem helpful to develop resources that can be
370 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
accessed online and also downloaded in hard-copy format, as well as printed for
distribution in conventional brochure formats of two to six pages, as found in
many health service settings.
Limitations
is study has a number of limitations that should be considered when inter-
preting the results and considering their application to other samples of students
or young adults. Although the levels of symptoms and distress were fairly low, the
majority of respondents were seeking some form of help, which was corroborated
by the observation that a relatively high proportion had reportedly received help
for problems with stress, anxiety, or depression in the past. e opinions of stu-
dents who have never attended a counselling centre may be dierent, as may be
the opinions of students who did not volunteer to complete the survey. It would
be helpful in future research to obtain the opinions of students who are recruited
in other settings, such as public areas of the university campus, and from more
than one institution. In addition, the respondents had, on average, four years of
education after the completion of high school, and it would be helpful to obtain
information from young adults with lower levels of education and from families
with lower levels of parental education. Although the proportion of respondents
born outside of Canada and from dierent racial/ethnic groups suggests that
respondents came from diverse backgrounds, it is possible that young adults with
dierent characteristics (e.g., from other specic cultural groups or from lower-
income families) would have dierent opinions than participants in this survey.
Such considerations should be explored in future studies to ensure that adequately
generalizable results are obtained regarding information pathways for students
seeking help for their mental health problems.
Implications
In summary, the survey ndings indicated that students would rst turn to
people in their personal support network and then to health care providers for in-
formation, advice, and assistance with common mental health concerns. However,
given limitations on the level of mental health literacy among partners, peers, and
parents, along with limited access to counsellors and physicians, alternative sources
of information about mental health conditions and various treatment aspects are
needed. As most students have relatively easy access to the Internet and are famil-
iar with using it as a source of information, development of websites focusing on
accessible, balanced, and reliable information about their mental health-related
needs would be very helpful.
With respect to such websites, it may be especially eective to develop com-
bined sources of information that would enable students, family, friends, and
health care providers to access the required information online, which could also
be downloaded and printed as resource sheets if desired. In addition, while video
content was not highly rated as a primary method of receiving information in
the survey, such narrative information may be particularly useful in encouraging
Postsecondary Students’ Information Needs and Pathways 371
positive health behaviours (Fix et al., 2012). With broadband access now widely
available, it is not dicult to include video content on information websites.
For example, e Mobilizing Minds Research Group has recently developed
a website to specically address the documented information needs of young
adults concerning treatment choices for depression (http://depression.informed-
choices.ca), which serves to illustrate how evidence-based sites can be used to
increase mental health literacy for students and those to whom they are likely to
turn for support, such as friends and families. Professionals can also download
materials from this site, in both French and English, through its Creative Com-
mons licence.
Web-based resources are also useful as a way for student groups to enhance
mental health literacy among their peers. For example, the McMaster University
Students Union has partnered with the Canadian Mood Disorders Association
to develop the COPE: Student Mental Health Initiative (http://copex.weebly.
com/) that consists of both web-based materials and peer-led workshops to
increase awareness of depression and available treatment resources on campus.
From a faculty and sta perspective, web-based resources can also be helpful to
both increase mental health literacy and provide basic information on how to
identify and refer students at risk, such as the Mental Health Awareness Program
developed for those who work closely with students at the University of Guelph
(https://www.uoguelph.ca/counselling/awareness/).
In addition to web resources, campus events (e.g., speakers, workshops, panel
presentations, information booths, and displays) during national campaigns
such as the Canadian Mental Health Association’s Mental Health Week (http://
mentalhealthweek.cmha.ca/) provide high-prole opportunities to increase men-
tal health literacy and provide helpful information about treatment resources
available on campus. Similar programming can also be introduced at orientation
events for students and their parents. And, on an even broader scale, national
initiatives such as the Canadian Association of College & University Student
Services and Canadian Mental Health Association (2013) joint project to de-
velop a comprehensive guide for postsecondary mental health hold promise of
changing the entire landscape of mental health awareness and service delivery on
campuses across Canada.
We hope that the results of our survey of postsecondary students’ information
needs and pathways for treatment can assist in the continued development of
evidence-based resources that can be delivered online, made available in printed
format, and used to inform programming and policy development designed to
address the mental health-related issues aecting postsecondary students across
Canada.
Acknowledgements
is project was supported by a Knowledge Translation Team Grant from
the Canadian Institutes of Health Research and Mental Health Commission of
Canada (TMF 88666).
372 Stewart, Walker, Beatie, Reynolds, Hahlweg, Leonhart, Tulloch, & Mobilizing Minds
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About the Authors
Donald W. Stewart is a clinical psychologist, associate professor, and academic administrator in
Student Support at the University of Manitoba who conducts research in young adult mental health.
John R. Walker is a professor of clinical health psychology at the University of Manitoba with
interests in anxiety and mood disorders in adults and youth and knowledge translation.
Brooke Beatie is a MA student in clinical psychology at the University of Manitoba with interests
in mental health help-seeking and service utilization.
Kristin A. Reynolds is a PhD candidate in the Department of Psychology at the University of
Manitoba with research interests in the knowledge translation of health information, website
evaluation, and aging and mental health.
Ken Halhlweg is an academic family physician in the Department of Family Medicine at the
University of Manitoba with a special interest in mental health and was formerly the Director of
the University Health Service.
Mark Leonhart is currently in the MA clinical psychology program at Concordia University, focus-
ing on anxiety disorders in adults.
Alexandria Tulloch currently works as an autism senior tutor for the St. Amant Autism Program
in Winnipeg, MB.
Members of e Mobilizing Mind Research Group include the following (in alphabetical order):
Young adult partners: Chris Amini, Amanda Aziz, Meagan DeJong, Pauline Fogarty, Mark Le-
onhart, Alicia Raimundo, Kristin Reynolds, Allan Sielski, Tarannum Syed, and Alexandria Tul-
loch; community partners: Maria Luisa Contursi and Christine Garinger from mindyourmind
(mindyourmind.ca); research partners: Lynne Angus, Chuck Cunningham, John D. Eastwood,
Jack Ferrari, Patricia Furer, Madalyn Marcus, Jennifer McPhee, David Phipps, Linda Rose-Krasnor,
Kim Ryan-Nicholls, Richard Swinson, John Walker, and Henny Westra; and research associates:
Jennifer Volk and Brad Zacharias.
Address correspondence to Donald W. Stewart, Student Support, 519 University Centre, University
of Manitoba, Winnipeg, MB, R3T 2N2, Canada; e-mail <don_stewart@umanitoba.ca>
