Research on college students' problems and needs has indicated that students are likely to encounter psychological problems during their college years for which they are in need of professional help (e.g., Al-Samadi & Al-Tahan, 1997; Heppner, Kivlighan, Good, Roehlke, Hills, & Ashby, 1994; Soliman, 1993). Moreover, these findings indicate that college students may or may not seek help and that those who do may precipitately terminate therapy. Reasons for such attitudes toward seeking professional help have been extensively studied (cf. Wills & DePaulo, 1991). Fear of emotions, perception of stigma, fear of treatment (Komiya, Good, & Sherrod, 2000; Kushner & Sher, 1991), and reluctance to self-disclose (Hinson & Swanson, 1993) are among the most salient factors affecting college students' negative attitudes toward seeking professional help. Among Arab students, reluctance to seek psychological help may be partially attributed to the fear that self-disclosure by the individual client may indicate betrayal of one's own family, or more troubling, self-disclosure might be seen as an unequivocal declaration of weakness (Sayed, 2002).

In the same vein, a number of studies have indicated that gender is the most salient variable that correlated significantly with attitudes toward seeking professional help (e.g., Al-Samadi, 1994; Fischer & Farina, 1995; Komiya et al., 2000). With the exception of two reported studies (Atkinson & Gim, 1989; Snyder, Hill, & Derksen, 1972), women, in general, have shown more positive help-seeking attitudes than have men. Gender difference in attitudes toward seeking psychological help is attributed to factors such as awareness and utilization of psychological services (Al-Samadi, 1994), cultural training and value differences (Fischer & Turner, 1970), and some personality traits (Rule & Gandy, 1994). According to Fischer and Cohen (1972) and Fischer and Farina (1995) more educated individuals - especially those majoring in social sciences - and some ethnic minorities are more likely to endorse positive help-seeking attitudes compared to those from other backgrounds.

Of studies examining the impact of the type of the problems students have, depression has received the most attention because it is considered a major psychological problem among college students for which they are expected to seek professional help. Nonetheless, findings are inconclusive (Good & Wood, 1995; Halgin, Weaver, Edell, & Spencer 1987; Padesky & Hammen, 1981). Similarly, self-esteem has been found to be related to willingness to seek professional help (Nadler, Maler, & Friedman, 1984; Tessler & Schwartz, 1972; Thoresen 1970). There is a paucity of documented studies dealing with attitudes toward seeking professional help in the Arab culture. An extensive literature review yielded only two studies which have used college students from two Arab countries. The first study was reported by Al-Samadi (1994) in Jordan and the other was conducted in Kuwait by Soliman (1993). The Jordanian study revealed that female college students tend to endorse more positive attitudes toward psychological help-seeking when compared to males; whereas the Kuwaiti study found college students to prefer seeking help from same-gender helpers for all problem areas studied with the exception of career-related problems for which they were likely to receive help from a male helper.

Generalizations regarding the behaviors of the individuals in the Arab culture can be misleading and problematic due to differing sociopolitical, historical, and ethnographic compositions of Arab countries (Sayed, 2002). Therefore, conclusions obtained from such studies may not be applicable to the UAE population in general; certain caveats need to be kept in mind.

In the UAE, rapid social and economic changes have taken place within the last 30 years. Internal changes manifested in the social and economic domains as well as the external influence of other cultures seem to impact on the values, attitudes, and roles of individuals. For people with less tolerance to change such shifts may lead to the experiencing of psychological difficulties. The stigma of mental-health problems and the cultural barriers to seeking psychological help may prevent some individuals from seeking professional help despite the availability of such services (Sayed, 2002).

College students at UAE University have been found to experience psychological issues such as distress, depression, and anxiety (e.g., Al-Darmaki & Alqaydi, 2002; Mahmood, Kamali, Sawqi, Al-Najar, & Al-Amiri, 2001). However, based on preliminary observations, only a small number of college students who were in need of counseling actually sought the services. Among those who did seek them, some expressed their initial reluctance to seek professional help. One explanation put forward for students' reluctance to come to therapy might be their attitudes toward seeking psychological help.

Personal attitudes toward psychological services are important determinants of a person's response toward seeking professional help for emotional and other problems or avoiding getting such help. Therefore, investigation of UAE university students' willingness to seek professional help would be of use to mental-health providers to design interventions pertinent to UAE culture. Additionally, the demographic variables examined in this study were chosen because of their possible impact on attitudes toward seeking professional help as indicated in the literature. Self-esteem and depression were chosen because of their relevance to attitudes toward seeking professional help (Good & Wood, 1995; Halgin et al., 1987; Nadler et al., 1984). Help-seeking is a self-relevant process. One would expect that self-information can affect the help-seeker's level of self-esteem and, therefore, that he/she may avoid seeking help to protect against negative feelings regarding the self. Whether either high self-esteem or low self-esteem would relate to help-seeking attitudes for college students from UAE is to be examined. Furthermore, individuals who experience negative emotional events such as depression are expected to seek help to alleviate such feelings and experience. Whether college students in this study would favor seeking professional help for their depression is worth investigating in order to better understand this population.

The purpose of this study was three-fold. First, to investigate the validity of the Arabic translated version of the Attitudes Toward Seeking Professional Psychological Help scale (ASPPH). Second, to explore the factor structure of the ASPPH scale in a UAE college sample and to compare it with the one derived from their American counterparts. Third, to examine help-seeking attitudes of UAE college students in relation to some demographic variables, self-esteem, and depression. It was hypothesized that attitudes toward professional help-seeking would be related to a number of demographic variables (gender, age, college major, and educational level). Finally, the study hypothesized that there would be a significant relationship between attitudes toward professional help-seeking as measured by the ASPPH and self-esteem as well as depression. Findings from this study may help in developing counseling programs designed to meet the needs and the expectations of UAE college students.

Method

Participants

Participants were 350 college students drawn from the UAE University. There were 273 females (78.0%), 53 males (15.1%), and 24 subjects did not specify their gender. Participants ranged in age from 18 to 33 years (Mean = 21.32; SD = 2.09). There were 8.0% freshmen, 12.3% sophomores, 16.6% juniors, 20.3% seniors, and 42.9% of the subjects did not report their educational levels. Forty- eight percent of the sample were from the College of Humanities and Social Sciences, 6.0% were from the College of Education, 16.3% were from the College of Shari'a and Law, 14.8% were from the College of Engineering, 2% were from the College of Agriculture, 1.7% were from the College of Medicine, and .9% and .6% were from the College of Science and College of Business and Economics, respectively. The majority of the sample studied (90.3%) did not receive psychological help.

Measures

Attitudes Toward Seeking Professional Psychological Help Scale The Attitudes Toward Seeking Professional Psychological Help Scale (ASPPH; Fischer & Turner, 1970) consists of 29 items designed to assess general attitudes toward seeking professional help for psychological problems and issues. Fischer and Turner found four factors for the ASPPH scale. These factors are: 1) Recognition of Personal Need for Psychological Help (8 items); 2) Stigma Tolerance Associated with Psychological Help (5 items); 3) Interpersonal Openness Regarding One's Problems (7 items); and 4) Confidence in Mental-Health Professionals (9 items). Items are rated using a 4-point Likert type scale ranging from (0) disagree to (3) agree. Eleven items are positively keyed so that agreement indicates positive attitudes, and 18 are negatively keyed so that disagreement with the item shows positive attitudes toward seeking psychological help. Total scores range from 0 to 87, with a higher score indicating positive attitudes toward psychological help-seeking.

Internal reliability estimates as measured by coefficient alpha for the entire scale range from .83 to .73 and for the four factors range from .74 to .62 and from .76 to .53 (Fischer & Turner, 1970; Good & Wood, 1995). Test-retest reliabilities of .89 (two weeks) to .84 (two months) were reported by Fischer and Turner who also provided support for the construct validity of the scale.

The ASPPH has been translated into Arabic by the author of this article. The scale was then back-translated to English to check the accuracy of the translation. Results showed that back-translation of the ASPPH was identical to the original ASPPH and was found to be relevant for the purpose of the study.

Self-Esteem Scale The Self-Esteem Scale (SES; Rosenberg, 1965; cited in Blascovich & Tomaka, 1991) consists of 10 items. Five items are keyed in the reverse direction. Scores on the SES range from 10 to 40 with lower scores representing higher self-esteem. Cronbach coefficient alpha of .77 and .88 and test- retest reliability of .82 (1 week) were reported for the SES. Some studies have found the SES to be a unidimensional measure. However, other studies have reported two highly correlated factors, one factor reflecting positively worded items and the other factor reflecting negatively worded items. Convergent and discriminant validity have been reported for the SES (cf. Blascovich & Tomaka). The SES has been translated into Arabic in a previous study (Al-Darmaki, 1998). Principal components analysis extraction with varimax rotation performed on the SES items resulted in two factors, Positive View of Self and Negative View of Self. Internal consistency coefficient alphas were .68 for Positive View of Self and .58 for Negative View of Self, respectively. Coefficient alpha found in the current study was .77.

Nine items were retained (item 3 was removed because it was considered a cross-loading item); thus, the scores ranged from 9-36. SES subscales were found to be moderately correlated with the Self-Esteem Inventory (SEI) as well as with the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression Scale (cf. Al-Darmaki, 1998).

Center for Epidemiologic Studies Depression Scale The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) was developed to measure depressive symptoms in the general population. The CES-D is a 20- item self-report inventory measuring symptoms selected from existing measures of depression. CES-D items reflect depressed mood, feelings of guilt and worthlessness, a feeling of helplessness, psychomotor retardation, loss of appetite, and sleep disturbance. Participants report the frequency of experiencing each symptom within the past week on a scale ranging from 1 (rarely or none of the time) to 4 (most or all of the time). Four of the items are worded in a positive direction in order to avoid response set and to assess positive affect or its absence. Depression scores are obtained by reversing the positively keyed items and summing item scores. The subjects' scores range from 20 to 80, with higher scores indicating higher frequency of depressive symptoms. The internal consistency estimates of the CES-D ranged from .85 to .90 using coefficient alpha.

Test-retest reliability was .67 (4 weeks). Evidence for construct validity and discriminant validity of the scale were reported (Radloff).

The CES-D has been translated into Arabic in a previous study by Al-Darmaki (1998) whose analysis led to the removal of items 2 (loaded below the cut of criteria) and 3 (a cross-loading item). Therefore, total scores range from 18-72. Her findings revealed three factors for the CES-D: the Apathy and Negative Affect subscale, the Positive Affect subscale, and the Somatic and Depressed Mood subscale. The reliability coefficient alphas for the three subscales and the total CES-D scale on a UAE sample were .83, .74, .62, and
.86 respectively. The reliability coefficients alpha for the scale found in the current study was .86. Al-Darmaki found CES-D subscales to be moderately significantly correlated with BDI, SES, and SEI.

Procedure

A packet of the measures was given to volunteer participants who were instructed to fill out the questionnaires in one sitting.

Analysis

The data of ASPPH were factor analyzed as a means of determining whether the factor structure of the scales with the UAE college sample replicated the factor structure of the scale reported by Fischer and Turner (1970) using American samples. Then, the internal reliability estimates of the subscales and the total ASPPH items were computed. Finally, correlation matrices for the demographic variables, ASPPH scale and subscales, SES, and CES-D scale were obtained to examine the relationship between the variables.

Results

Factor Analysis

The initial internal reliability estimate obtained for the total ASPPH scale items showed that seven items (4, 5, 13, 20, 24, 27, and 29) were correlated weakly (below r = .20) with the total scale; these items were therefore removed from all the analysis of the data. To test the effect of gender on the scores of the remaining 22 items of ASPPH a t-test procedure was run. Results showed no significant differences (t = -1.15; p = .252) between the mean scores of males (M = 34.46; SD = 8.79) and females (M = 36.12; SD = 9.68) on the ASPPH scale. Likewise, no significant differences were found between the mean scores of males (M = 18.99; SD = 4.83) and females (M = 19.14; SD = 29) on SES (t = -.22; p = .829) or the mean scores of males (M = 35.06; SD = 10.48) and females (M = 38.12; SD = 11.05) on CES-D scale (t = -1.86; p = 064). Therefore, a decision was made to run the analysis for the whole sample.

A principal components analysis extraction with Varimax rotation was conducted with the remaining 22 items. Three factors with eigenvalues greater thanone were extracted. The total variance accounted for by the three factors was 32.8%. The eigenvalues for the first, second, and third factors were 2.7, 2.5, and 1.97 which accounted for 12.39%, 11.46%, and 8.96% of the variance, respectively. Nine items loaded on Factor I (i.e., 2, 7, 11, 12, 16, 18, 23, 25, 28). This may be interpreted as Confidence in Professional Help Providers. Factor II consisted of nine items (i.e., 1, 3, 6, 8, 9, 14, 15, 17, 19) which assessed Stigma Tolerance. Four items loaded on factor III (i.e., 10, 21, 22, 26) and appeared to measure Interpersonal Openness. Five items (55.5%) of Factor I, which was labeled Confidence in Professional Help Providers, seemed to replicate the items of Factor IV (Confidence in Mental Health Practitioner) reported by Fischer and Turner (1970). Factor II in the present investigation (Stigma Tolerance) appeared to contain items from factors I, II, and III in the Fischer and Turner (1970) study. Only three items (75%) of Factor III, which was labeled Interpersonal Openness in this study, replicated 42.9% of Factor III in the findings of Fischer and Turner. The three factors found in this study were moderately internally consistent. Cronbach's alpha reliability coefficients were .70 for Factor I, Confidence in Professional Help Providers; .66 for Factor II; and .57 for Factor III. The reliability estimate for the overall ASPPH scale was .78, which was higher than the alpha (.73) reported by Good and Wood (1995).

The means for the three ASPPH factor scale were 16.57 (SD = 5.01; score range = 2-27), 15.60 (SD = 4.75; score range = 2-27), and 3.56 (SD = 2.65; score (SD = 9.42; score range = 10-59). To determine whether participants endorsed negative or positive attitudes toward professional help-seeking the median scores were used in the interpretation of the mean scores. The median scores for the ASPPH, Confidence in Professional Help Providers, Stigma Tolerance, and Interpersonal Openness were 36.00, 17.00, 16.00, 3.00 respectively. Accordingly, the mean for Interpersonal Openness suggests that the UAE sample endorsed negative attitudes toward interpersonal openness. However, the overall ASPPH mean and the means for Confidence in Psychological Help Providers and Stigma Tolerance subscales indicate that the UAE sample endorsed slightly positive attitudes toward seeking professional help. The mean score for CES-D was 37.65 (SD = 10.83; score range = 18-69), which suggests that the UAE sample reported fewer symptoms of depression. The mean for SES was 19.05 (SD = 4.38; score range = 9-36), indicating that the sample reported high self-esteem.

Correlation Coefficients

Table 1 shows small yet significant correlations between two of the demographic variables and the ASPPH total scale as well as two of the ASPPH subscales. Participants' college majors correlated with ASPPH (r = -.23), with Confidence in Psychological Help Providers (r = -.22), and with Stigma Tolerance (r = -17), p < .01. These findings would suggest that participants studying in Arts-related colleges endorsed more positive help-seeking attitudes as compared to students majoring in science-related fields. Subjects' educational level correlated (r = .21) with the ASPPH total scale and (r = .22) with Stigma Tolerance, p < .01, and (r = .17) with Confidence in Psychological Help Providers, p < .05. This may suggest that those who have more college education exhibited more positive attitudes toward seeking professional help as compared with those who have less college education.

The intercorrelations for the ASPPH subscales were moderately significant at p < .01. The Confidence in Psychological Help Providers subscale correlated with Stigma Tolerance (r = .42) and with Interpersonal Openness (r = .24). Stigma Tolerance correlated with Interpersonal Openness (r = .31). ASPPH correlated significantly at p < .01 with Confidence in Psychological Help Providers (r = .81), with Stigma Tolerance (r = .82), and with Interpersonal Openness (r = .56).

Results on the correlations between ASPPH subscales and the SES showed a small yet significant relationship between ASPPH and SES. The SES correlated significantly (p < .01) with ASPPH overall scores (r = -.18), with Confidence in Psychological Help Providers (r = -.16) and Stigma Tolerance (r = -.15). These findings would suggest that positive attitudes toward professional help providers and stigma tolerance were associated with high self-esteem. The correlations between SES and the ASPPH and its subscales provided partial support for the hypothesized relationship between attitudes toward professional help-seeking and self-esteem. Likewise, CES-D correlated significantly with the ASPPH scale as well as with two of its subscales. The CES-D correlated (r = -.14) with the ASPPH, (r = -.14) with Confidence in Psychological Help Providers, (r = -.14) with Stigma Tolerance, p < .01, indicating that positive attitudes toward seeking professional help were related to less depression. This result provided support for the hypothesized relationship between attitudes toward professional help-seeking and depression. The correlation found between CES-D and SES (r = .39; p < .01), suggests that higher numbers of depression symptoms were related to low self-esteem.

Discussion

The results indicated that attitudes toward seeking professional help may be culturally determined. In UAE culture, attitudes toward seeking psychological help may be influenced by factors such as education, family values, cultural beliefs regarding mental health and mental illness, and accessibility of mental-health services. Psychological services and psychotherapy are in fact products of Western culture (Marsella, 1998). Psychological services are widely spread and more accepted in the American culture, whereas mental health services are less available to individuals in the Emirates and not yet well accepted. Individuals from UAE society seem to rely more on traditional methods (family, friends, religious persons, Holy Qu'ran) for help with psychological problems. Seeking psychological help is still considered a sign of weakness or insanity in Arab culture. People may experience psychological problems in the form of physical complaints (Sayed, Collins, & Takahashi, 1998). It is more acceptable to seek help from a physician than from a psychological-help provider, therefore, troubled persons may prefer to get help from a medical doctor and a psychiatrist or a psychologist may be considered last.

Subjects in this study showed slight confidence in psychological-health providers and tolerance for stigma reflecting a trend that may make seeking psychological help services less stigmatized. This result is consistent with previous findings (Fischer & Turner, 1970; Good, Dell, & Mintz, 1989). Previous research has identified stigma as a key factor in avoiding counseling (Kushner & Sher, 1991; Sayed et al., 1998), yet college students in the current study seemed to be more accepting and more tolerant of stigma resulting from seeking help for psychological issues. However, it is unclear if the respondents would seek help when they experienced a need for it. More research is needed in this area.

Students' negative attitudes toward interpersonal openness can be explained within the Arab cultural context. Self-disclosure to outsiders is considered unacceptable behavior in this culture. People are encouraged to share personal and emotional issues and discuss problems within their families only. In counseling, self-disclosure is expected in order to get psychological help. Therefore, individuals who have negative attitudes toward interpersonal openness may become reluctant to self-disclose to professional help providers or may decide not to seek help for psychological issues. Counselors need to address clients' fear of self-disclosure and counseling outreach programs should focus on educating people about counseling expectations and goals.

Overall, the factor structure of the ASPPH for the UAE sample was found to be different from the factor structure reported in previous research using American samples. Subjects in the current investigation revealed slightly positive attitudes toward seeking professional help. With the exception of interpersonal openness, the UAE sample reported more confidence in psychological- health practitioners and more tolerance to stigma about seeking professional help. Participants with more education and social sciences majors exhibited favorable attitudes toward professional help-seeking. High self-esteem and low depression were associated with more positive attitudes toward professional help-seeking.

This study has some limitations. First, the dimensions of the Attitudes Toward Seeking Professional Psychological Help Scale found for the Emirates sample were different from those reported for samples from other cultures. Therefore, comparing these results to previously reported findings from other cultures should be done with caution. Also, these findings may suggest that more evidence is needed to establish the reliability and validity of the ASPPH for the UAE college student population. Second, this study was conducted using a college population. Findings of this study may not be generalizable to other populations. Replicating the current findings with samples from the UAE college population and other populations (high school students and psychiatric clients) would enhance the generalizability of the results. Attitudes toward seeking professional help may be culturally determined. Therefore, developing a scale to measure help-seeking attitudes in the Emirates society would give a better picture of how psychological services are considered in this culture. The attitudes of those who sought psychological services compared to those who have not had contact with professional help providers should be examined. Serving a student population requires more knowledge and understanding of the characteristics and expectations of such a population. Therefore, the relationship between the type of problems and problem severity should be investigated in relation to help- seeking attitudes and choices of help providers.

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Appreciation is due to reviewers including Joan M. Oliver

PhD

Department of Psychology

St. Louis University

221 N. Grand Blvd.

St Louis

MO 63103

USA

Dr. Mohammad A. Sayed and Dr. Taha Amir

Faculty of H. &

SS

UAE University

P.O. Box 17771

Al-Ain

UAE.