Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
Toward sustainable well-being in higher education:
mental health status, attitudes, social support, and
service utilization among college students
Rica Rose May Rubio, Sandra Covarrubias, Lorna Carpio, Jocelyn Orquia, Maria Fatima Tan
Western Mindanao State University, Zamboanga City, Philippines
Abstract
Introduction: College students worldwide face increa
sing mental health challenges. In the
Philippines, there is limited understanding of how mental health status, attitudes toward mental
health services, and perceived social support influence service utilization in higher education
settings.
Purpose: This study examined the mental health status, attitudes toward mental health services,
levels of social support, and actual utilization and barriers to service use among college
students at a university in Zamboanga City, Philippines. It also explored whether mental health
status, attitudes, and social support were associated with service utilization.
Methodology: An institution-based, cross-sectional survey was conducted among 332 randomly
selected students using stratified sampling. Data were collected from July to November 2024
using validated tools: the Depression Anxiety Stress Scales (DASS-
21), Attitudes Toward Mental
Health Services Scale (ATMHSS), Perceived Social Support Scale (PSSS), and questions on service
utilization. Data were analysed using descriptive statistics, chi-square tests, ANOVA, Spearman
correlation and logistic regression via SPSS.
Results: A high prevalence of mental health concerns was found: 86% of respondents reported
symptoms of depression, 80% anxiety, and 35% stress. However, only 12% accessed campus-
based mental health services, and 9% sought external support. While most students expressed
moderately positive attitudes toward seeking help and showed low concern for stigma, only
10% reported strong social support. Notably, social support significantly predicted service use,
especially in reducing stigma and enhancing help-seeking attitudes. Major barriers to service
use included reluctance and uncertainty about where to seek help.
Conclusion: Despite widespread mental health concerns, service utilization remains low. Social
support plays a critical role in promoting help-seeking behaviour. Higher education institutions
should strengthen support systems, improve mental health awareness, train faculty to respond to
student needs, and engage families and communities to build a more supportive mental health
environment.
Keywords
Mental Health, Higher Education, Psychological Assistance, Social Support, Health Service,
Sustainable Development
Address for correspondence:
Rica Rose May A. Rubio, DNS, RN.
Western Mindanao State University, Normal Road,
Baliwasan, 7000 Zamboanga City, Philippines
E-mail: rica.rubio@wmsu.edu.ph
This work is licensed under a Creative Commons Attribution- 4.0 International License (CC
BY 4.0).
©Copyright: Rubio et al., 2025
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v8i1.269
Submitted for publication:
14 May 2025
Revised: 08 July 2025
Accepted for publication:
25 July 2025
13
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Introduction
The mental health of college students has
gained increasing attention in recent years. They
frequently encounter significant anxiety and
depression, as confirmed by multiple studies
(Aruta et al., 2022; Cao et al., 2020; Khan et al.,
2020). The World Health Organization (2018)
identified suicide and depression as the second
and third leading causes of death among
individuals of this age, with numerous studies
reporting that some students consider dropping
out or exhibit suicidal tendencies (Alejandria et
al., 2023; Bangalan et al., 2023; Grasdalsmoen
et al., 2020; Sivertsen et al., 2022). The COVID-19
pandemic has exacerbated these challenges,
disrupted traditional learning, and affected
student well-being (Barrot et al., 2021; Waseem et
al., 2020).
Mental health is recognized as a fundamental
human right and a pillar of sustainable
development (WHO, 2022). The United Nations
reinforces this through Sustainable Development
Goal (SDG) 3, which promotes good health and
well-being, and SDG 4, which emphasizes
inclusive and equitable quality education.
Achieving these goals requires educational
institutions to support both academic success
and student mental well-being.
Despite these global commitments, there is
limited research on how Filipino college students
actually use mental health services. National and
regional data show high rates of anxiety and
depression among youth (Acob et al., 2021;
Alibudbud, 2021; Billote et al., 2022), including
13.6% in the Zamboanga Peninsula who have
considered suicide (UP Population Institute, 2023).
Yet, university records indicate that while more
than half of reported mental health concerns
involve depression, actual service use remains
low.
Attitudes toward mental health services are
known to influence utilization, but positive
perceptions do not always lead to help-seeking
behavior (Kukoyi et al., 2022), suggesting that
other barriers exist. Social support, a well-
established protective factor, is often overlooked
in mental health programs. Strong support
systems—whether from family, peers, or even
pets—can facilitate help-seeking, while social
isolation often exacerbates mental health
challenges (Acoba, 2024; Corrigan et al., 2014).
However, few studies in the Philippine higher
education context have examined social support
as a predictive factor in service utilization.
By addressing both mental health outcomes
and access to services, this study supports SDG 3
by identifying barriers to care and promoting
student well-being. It also supports SDG 4 by
highlighting the importance of emotionally
supportive learning environments. The findings
aim to inform evidence-based policies that
strengthen integrated support systems and
highlight the critical role of social networks in
mental health care.
Moreover, this study adds to existing literature
by integrating mental health status, attitudes, and
social support as predictors of service utilization in
a Philippine university context—an area previously
underexplored. Ultimately, this study provides
insights into how universities can foster enabling
environments that promote both mental health
and educational success, ensuring that no
student is left behind in the pursuit of health and
quality education.
Purpose
This study aimed to examine the mental
health status, attitudes toward mental health
services, levels of social support, and actual
utilization and its barriers to mental health services
among college students at a university in
Zamboanga City, Philippines. Additionally, it
purports to see whether mental health status,
attitudes, and social support are associated with
service utilization.
Methodology
Study design
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
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
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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.
Table 1. DASS-21 Severity Ratings
Depression levels
Anxiety levels
Stress level
normal
0–9
0–7
0–14
mild
10–13
8–9
15–18
moderate
14–20
10–14
19–25
severe
21–27
15–19
26–33
extremely severe
28 and more
20 and above
34 and above
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.
Ethical considerations
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.
Results
Demographic profile
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.
Mental health status of college students
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-
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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 2. Demographic profile of students
Frequency
Percent
Gender
164
49.4
168
50.6
Age Group
121
36.45
194
58.43
17
5.12
Civil Status
302
90.96
30
9.04
Religion
207
62.35
87
26.2
12
3.61
26
7.83
Ethnicity
162
48.8
73
21.99
5
1.51
8
2.41
84
25.3
Family Structure
221
66.57
40
12.05
52
15.66
7
2.11
8
2.41
4
1.2
Family Monthly
Income
118
35.54
94
28.31
62
18.67
31
9.34
16
4.82
7
2.11
4
1.2
Year Level
1
87
26.2
2
83
25
3
80
24.1
4
76
22.89
5
6
1.81
Total
332
100
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Table 3. Levels of Mental Health Status (DASS-21) of College Students.
Levels
Depression
Anxiety
Stress
Freq.
Percent
Freq.
Percent
Freq.
Percent
Normal
47
14.16
40
12.05
156
46.99
Mild
69
20.78
27
8.13
60
18.07
Moderate
119
35.84
97
29.22
78
23.49
Severe
68
20.48
72
21.69
31
9.34
Extremely Severe
29
8.73
96
28.92
7
2.11
Mean Score (SD=7)
16.91
15.47
15.98
Total
332
100
332
100
332
100
DASS Scores Interpretation:
Depression = 0-9 Normal, 10-13 Mild, 14-20 Moderate, 21-27 Severe, 28+ Extremely Severe
Anxiety = 0-7 Normal, 8-9 Mild, 10-14 Moderate, 15-19 Severe, 20+ Extremely Severe
Stress = 0-14 Normal, 15-18 Mild, 19-25 Moderate, 26-33 Severe, 34+ Extremely Severe
Attitude towards utilization of mental health
services
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 4. Descriptive Statistics for Attitude Toward Utilization of Mental Health Services
Total Score
ATMHSS_12
Help-Seeking
Propensity
Indifference To
Stigma
Psychological
Openness
Mean
32.14
10.70
14.47
6.95
SD
5.00
2.31
3.33
1.91
Median
32
11
15
7
Total Items
12
4
5
3
Maximum Total
48
16
20
12
Middle Point
24
8
10
6
Social support towards mental health service
utilization
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.
Table 5. Levels of Social Support to Mental Health Services Utilization
Levels of Social Support
Score Range
Freq.
Percent
Poor
8-18
140
42.17
Moderate
19-25
158
47.59
Strong
26-32
34
10.24
Association of Attitude and Social Support
with Mental Health Service Utilization
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.
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.
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Figure 1. Comparative Assessment of Attitude and Level of Social Support on Mental Health Services Utilization
Table 6. Mean Scores of Help-Seeking Propensity Across Levels of Social Support.
Poor
Moderate
Strong
Mean
10.04
10.97
12.15
SD
2.16
2.20
2.52
Median
10
11
13
Further, 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.
Predictors to Mental Health Services
Utilization
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 7. Logistic Regression for Service Utilization In School and Mental Health Status, Attitude, and Social
Support.
Variables
Odds Ratio
Std. Err.
t-value
p-value
95% CI
Lower
95% CI
Upper
Intercept
0.035
0.056
-2.12
0.034
0.002
0.777
Depression
1.069
0.316
0.23
0.821
0.599
1.910
Anxiety
0.993
0.244
-0.03
0.978
0.613
1.609
Stress
1.143
0.319
0.48
0.633
0.660
1.978
Attitude in
Utilization
0.991
0.039
-0.23
0.817
0.916
1.071
Social
Support for
Utilization
1.940
0.539
2.39
0.017*
1.125
3.343
Log likelihood = -116.73301
LR chi-squared (5) = 6.55
p-value = 0.2560
Pseudo R-squared = 0.0273
*Significant at p ≤ 0.05
Table 8. Logistic Regression for Service Utilization Outside School and Mental Health Status, Attitude, and
Social Support
Variables
Odds
Ratio
Std. Err.
t-value
p-value
95% CI
Lower
95% CI
Upper
Intercept
0.000
0.000
-4.27
0.000
4.70E
0.011
Depression
1.553
0.533
1.28
0.199
0.793
3.043
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Anxiety
0.944
0.273
-0.2
0.842
0.536
1.663
Stress
1.449
0.456
1.18
0.238
0.782
2.687
Attitude in Utilization
1.085
0.049
1.79
0.073
0.992
1.187
Social Support for
Utilization
2.264
0.713
2.6
0.009*
1.221
4.197
Log likelihood = -92.465
LR chi-squared (5) = 20.90
p-value = 0.0008
Pseudo R-squared = 0.1015
*Significant at p ≤ 0.05
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.
Actual utilization of mental health services
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.
Table 9. Mental Health Services Utilization inSchool
Frequency
Percent
Services Utilized
One-time meeting with Guidance Counselor or
Coordinator
26
66.67
Group Counseling
6
15.38
Online consultation with a specialist or psychiatrist
4
10.26
Regular Individual Counseling
3
7.69
Total
39
100
Reasons for availing services
Difficulty in controlling emotions
7
19.44
Feeling sad or depressed
7
19.44
Having negative thoughts
7
19.44
Difficulty with a course or subject
5
13.89
Teacher-related issues
3
8.33
Conflict with family
3
8.33
Anxious about something
2
5.56
Conflict with friends
1
2.78
Others
1
2.78
Total
36
100
Table 10. Mental Health Services Utilization Outside School
Frequency
Percent
Sought out for mental health support
Psychiatrist
8
25.81
Religious Leader
7
22.58
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Counsellor
6
19.35
Psychologist
4
12.90
Family therapist
3
9.68
Barangay/ Community Leader
2
6.45
Coach
1
3.23
Total
31
100
Reasons for availing mental health support
Overthinking
5
22.73
Having negative thoughts
5
22.73
Feeling sad or depressed
3
13.64
Difficulty in controlling emotions
2
9.09
Anxious about something
2
9.09
Difficulty with a course or subject
1
4.55
Difficulty with working on a project
1
4.55
Conflict with family
1
4.55
Conflict with friends
1
4.55
Thinking of suicide
1
4.55
Total
22
100
Table 11. Reasons for Not Utilizing Mental Health Services
Reasons for not availing of mental health
services
Did Not Avail School
Services
Did Not Avail External Services
Freq.
Percent
Freq.
Percent
I don’t want to
130
44.67
105
34.88
Unsure where to go
70
24.05
88
29.24
Unsure who to see
21
7.22
15
4.98
Unsure if they can help
20
6.87
12
3.99
Have not heard about them/not aware of
them
21
7.22
14
4.65
It is expensive
5
1.72
33
10.96
Not accessible
7
2.41
16
5.32
Others
17
5.84
18
5.98
Total
291
100
301
100
Discussion
The findings of this study indicate that a
significant proportion of students at this university
experience mental health concerns, reflecting a
global trend of rising psychological issues among
university students (Alibudbud, 2021; Cleofas,
2020; Dessauvagie et al., 2022; Kabir et al.,
2024; Li et al., 2022; Lipson et al., 2019). These
concerns pose serious implications at both the
individual and institutional levels. Individually,
students may experience poor academic
performance, absenteeism, and psychological
distress. Institutionally, the university may face
declining retention rates and increased demand
for psychological services.
However, despite these alarming trends,
mental health service utilization remains low. Only
9% to 12% of students reported accessing
mental health services, either within the university
or through external sources. A vast majority—
ranging from 88% to 91%—have never sought
formal support. The most frequently reported
barrier was the response, “I don’t want to,” which
may reflect reluctance rooted in self-reliance or
the perceived ability to handle problems alone,
fear of judgment or stigma, or lack of awareness
(Muhorakeye & Biracyaza, 2021; Patte et al.,
2024; Stanley-Clarke et al., 2024).
Nevertheless, the study directly addresses the
research aim of predicting mental health service
utilization by demonstrating that social support
significantly influences students' attitudes toward
mental health services, which, in turn, can shape
their likelihood of seeking help. Specifically,
analysis of variance shows that students with
higher levels of social support exhibit significantly
more favorable overall attitudes toward mental
health services (F(2, 328) = 18.05, p < .0001).
This trend is particularly evident in the subdomains
of help-seeking propensity and indifference to
stigma, suggesting that students who feel well-
supported are more likely to seek help and are
less concerned about stigma. This finding is
consistent with a study among Turkish university
students, which reported that positive help-
seeking attitudes were associated with perceived
support from parents and friends (Koydemir-
Özden, 2010).
Moreover, the mean scores in Table 6
reinforces these findings, revealing that students
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with strong social support had the highest attitude
scores (mean = 12.15), compared to those with
poor support (mean = 10.04). Further, social
support significantly predicted actual service
use—both for school-based (p = 0.017) and
external (p = 0.009) mental health services. These
results are similar with findings from other cultural
contexts. In the United States, students with
stronger perceived social support were
significantly more likely to access professional
services (Eisenberg et al., 2013). In China,
improving mental health literacy and perceived
social support while reducing stigma can
increase the likelihood of Chinese college
students seeking professional psychological
assistance (Yang et al., 2024).
Furthermore, a systematic review which
examined studies from ten countries—including
Australia, Canada, China, Indonesia, and the
United States—found that social support
mitigated symptoms of depression, anxiety,
suicide, and psychological distress among 3,669
university students (Vicary et al., 2024). Although
the review did not explicitly examine service
utilization, it emphasized the foundational role of
social support in promoting student mental
health.
Interestingly, the study’s logistic regression
analysis revealed that mental health status—
specifically symptoms of depression, anxiety, and
stress—did not significantly predict service
utilization. This finding contrasts with the results of
Lipson et al. (2019), who reported a strong link
between psychological distress and help-seeking
behavior. One possible explanation is that
students experiencing high levels of distress may
view available services as inadequate,
inaccessible, or unhelpful. As a result, they may
turn to alternative coping strategies such as peer
support, self-help methods, or avoidance
(Ravisankar, 2024). These tendencies may help
explain the most frequently reported barrier: “I
don’t want to.”
Additionally, while attitude alone did not
significantly predict service use, findings suggest
that attitudes can be positively influenced by
social support. Students who feel supported tend
to adopt more favorable views toward help-
seeking and show reduced stigma. This aligns
with the study involving college students in
Pampanga, Philippines, which found that greater
perceived social support lessens the impact of
self-stigma on help-seeking attitudes (Punla et al.,
2022). Thus, enhancing social support systems
within and around the university can serve as an
effective and culturally appropriate strategy to
improve mental health service utilization among
students in higher education.
Strengths and Limitations of the study
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.
Practical Value
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.
Conclusions
Despite the prevalence of depression, anxiety,
and stress among students, actual use of mental
health services remains disproportionately low
among college students in a university in
Zamboanga City, Philippines. These findings must
be interpreted within the study’s limitations,
including its cross-sectional design, limited
geographic scope, and exclusion of qualitative
insights.
Importantly, the study advances existing
literature by integrating mental health status,
attitudes, and social support as predictors of
service use within a localized sociocultural
framework of an educational institution. While
mental health status and attitudes alone did not
significantly predict utilization, social support
emerged as a robust and consistent facilitator,
indirectly enhancing attitudes by reducing stigma
136
Mental Health: Global Challenges Journal
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ISSN 2612-2138
and increasing openness to professional
assistance.
Moreover, the findings highlight the
importance of strengthening social support
systems within the university to bridge the gap
between students’ mental health needs and their
actual use of services. The first initiative that the
university can implement is using communication
tools such as infographics, short videos, student
testimonials, and printed materials with QR codes
linking directly to university mental health
resources. These should be displayed prominently
across campus and shared via official online
platforms. Second, actively involve faculty, staff,
and students in mental health promotion efforts.
Faculty members should receive regular training
on how to identify students in distress and how to
respond appropriately. They can also include
mental health topics into their coursework or
discussions to help normalize conversations
around mental well-being. Third, strengthen
external sources of support by involving families
and religious or community organizations in
mental health education. For instance, the
university can host workshops for parents on
adolescent mental health or collaborate with
faith-based groups to promote supportive
messaging around mental health.
Acknowledgments
The authors extend their sincere gratitude to
Western Mindanao State University for the
research grant that made this study possible,
under the leadership of its President, Dr. Ma.
Carla A. Ochotorena. Special appreciation is
given to Dr. Fini Joy P. Buenafe, Dr. Jennifer T.
Composa and Mr. Gerald James Y. Ebal for their
invaluable insights and contributions. The authors
also acknowledge Ere Lee Q. Salang for her
statistical support, Mary Anthonette G. Del
Rosario, Jinky Rose V. Tubog, and Deutro James
P. Epe for their technical support. Finally, heartfelt
thanks go to all the student respondents and
individuals who generously provided essential
data and insights, contributing to the success of
this research.
Funding statement
This study was funded by Western Mindanao
State University, Zamboanga City, Philippines. The
funders had no role in study design, data
collection and analysis, decision to publish, or
manuscript preparation.
Conflict of interest
The authors declare no conflict of interests.
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