The influence of attitudes and social norms on seeking psychological help among Russian adults

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BACKGROUND

Recent years in Russia have seen a significant increase in the proportion of people with mental disorders¹. By 2023, the proportion of respondents experiencing depression symptoms reached 39%, and 23% of those surveyed reported symptoms of uncontrollable anxiety [1]. Prior studies also indicated high levels of psychological issues in society. For example, in 2018, approximately 40% of the adult population in Vologda Region reported symptoms of anxiety, depression, and neurosis [2]. This concerning trend has been linked to various factors, including the COVID-19 pandemic (2020–2021) [3], escalating international tensions, and increased perceptions of future uncertainty [4].

WHO mental health studies highlight the issue of unmet mental health needs, manifested by low utilization rates of relevant services [5]. Unmet needs prolong the period during which individuals live with the burden of poor mental health and are associated with higher disability rates, reduced quality of life, and increased likelihood of suicidal ideation and attempts.

Studies on seeking psychological help typically examine four primary sources of psychological and emotional support: professional (psychologists, psychotherapists, and other specialists), alternative (religious leaders, fortune-tellers, psychics, etc.), close social networks (family, friends), and self-help (obtaining information and support through books and the Internet) [6]. Surveys among the Russian population indicate that psychological challenges are most commonly overcome with support from relatives and friends. When explaining refusal of professional help, Russians cite stoicism, distrust of psychologists, and perceptions of high cost and ineffectiveness of services². A significant portion of the population prefers managing psychological challenges with antidepressants and sedatives [7], likely due to rapid and pronounced symptomatic relief. Actual adult help-seeking rates remain low. According to the Russian Public Opinion Research Center, only 12% sought psychological help in 2022³. According to HSE University reports, 5.2% sought help in 2022, which is almost similar to the 2021 rates (5.3%) [7]. Help-seeking is more common among youth, women, and university-educated individuals⁴. The gap between recognized mental health issues and professional help utilization is likely to widen.

According to modern concepts, seeking psychological help represents the pursuit of external support to cope with mental health-related issues [8]. While no universally accepted theory or model exists in this domain, the Theory of Planned Behavior developed by Ajzen [9] is considered the predominant approach for explaining factors influencing psychological help-seeking [10, 11]. Of note is that research typically analyzes three core components of this process: help-seeking readiness (primarily determined by attitudes), intention (conscious plan to seek help), and behavior (actual help-seeking actions) [6]. Eritsyan et al. examined barriers and drivers of psychological help-seeking among young adults in general education using the Theory of Planned Behavior [12]. This study confirmed the impact of subjective standards: stronger belief in approval from significant others correlates with greater help-seeking intention. Anikina et al. report that gender socialization contributes to help-seeking behaviors [13], noting that masculinity correlates with denying the need for support. Additionally, men demonstrate lower mental health literacy, further negatively impacting their intention to seek help when needed. Studies on seeking psychotherapeutic help [9, 10] reveal that attitudes (e.g., beliefs about psychotherapy’s safety and efficacy), social norms (experiences with and attitudes toward therapy of a person’s close ones), and prior personal therapy experience significantly influence this process.

The extent to which anticipated social reactions actually impact help-seeking behavior when considering other factors remains understudied. To better understand societal attitudes toward psychological help and help-seeking practices, research must identify facilitating and impeding factors.

AIM To assess the influence of attitudes and social norms on seeking psychological help among the adult population in Russia.

METHODS

Study Design

This is a cross-sectional study. Empirical data were collected through a structured telephone survey of individuals aged 18 years and older permanently residing in St. Petersburg.

The theoretical framework is the Theory of Planned Behavior. Table 1 shows the variables analyzed (dependent and independent) alongside question wordings. The tool used was an original questionnaire specifically developed for this research.

Table 1. Variables used in analysis, question and answer wordings

According to the Theory of Planned Behavior, social norms denote perceived social pressure regarding whether to perform a particular behavior. Subjective norms help individuals evaluate their social circle’s views on this behavior, which may either encourage or deter it [9]. Grounded in this definition, statements were developed to assess acquaintances’ help-seeking experiences and attitudes toward help. Within this theory, attitude is defined as an individual’s positive or negative evaluation of performing the specific action. This is reflected in the following statements: «help is only accessible to the wealthy», «only people with disorders seek help», «psychological help is infallible», «belief in magic».

Eligibility Criteria

The sample population comprised 1,200 residents of St. Petersburg—a group representative by sex and age: the mean age was 46.1 years (SD = 15.6), with 45% men and 55% women. Table 2 shows sex-age group proportions in the sample population matching those of the general population during the study year. Representativeness was achieved according to St. Petersburg residents’ official sex-age statistics from Rosstat publications [14].

Table 2. Sex-age respondent composition, %

The CATI (Computer Assisted Telephone Interview) system was used for data collection. The survey was conducted at St. Petersburg State University Center for Applied Sociology, focusing on psychological help-seeking experiences, help-seeking practices, significant others’ attitudes toward psychological help, and respondents’ overall attitudes toward psychological help. Interviews were performed throughout July 2023. The study did not collect personal information, and random digit dialing (post area code/carrier prefix) was implemented.

Sample size calculation principles: the sample size was calculated for a 2.83% confidence interval and 95% confidence probability; sex and age were representativeness parameters; sex-age composition was determined using current Rosstat data.

Statistical methods: binary logistic regression identified psychological help-seeking predictors. The analysis was conducted in SPSS statistical package. The differentiation criterion was respondent answers to «Have you ever consulted a psychologist?» («yes, multiple times/yes, once» = 1; «no» = 0). Significance of intergroup differences (help-seekers vs. non-help-seekers) was assessed using Pearson’s chi-square test.

To generate binary logistic regression consistent with theoretical model assumptions and those outlined in the sources review, the following independent variables were included: sex, age, education, minor children, income, social norms, and attitudes toward psychological help.

RESULTS

Participants

The age ranged from 18 to 79 years, with a median age of 44 years. The respondent education was distributed as follows: 14.8% had secondary professional education, 68.9% had higher education, and the rest had secondary general education or below. A total of 47.4% were employed, 15.3% were pensioners, 20.1% were self-employed, and 3.2% were students. One-third of respondents (33.0%) had minor children. Financial well-being indicators revealed the following: approximately 2.0% reported lacking sufficient funds for basic food, 9.0% could afford only food expenses, 12.0% had sufficient means for both clothing and food, nearly 41.0% could purchase small household appliances, 29.0% could afford major appliances, and approximately 7.0% could make substantial purchases (e.g., a car or property).

Primary Results

Regarding changes in psychological state over the past year, 38.2% reported no change, 43.5% indicated it «rather worsened» or «significantly worsened,» and 16.6% noted it «significantly improved» or «rather improved». A total of 15.4% currently require psychological help; 38.2% ever consulted a psychologist (including 11.5% single-session users); 20.8% attended psychologist for several sessions within ≤1 month/several months; 5.4% attended psychologist for ≥1 year.

A significant place among help-seeking sources for psychological support is held by professional help. Family members (33.8%), partner/spouse (29.6%), psychologist/psychotherapist (28.2%) were those to turn to in case of mental health issues and life challenges. Spiritual and paranormal support options were relevant for <8.0%. A total of 18.4% would not seek any help.

Primary reasons for the latest psychologist consultation included anxiety/depressive symptoms (28.2% of help-seekers), partner relationship issues (19.6%), parent-child dynamics (13.7%), personal growth and self-development (16.6%), and relations with parents or other older relatives (11.1%).

Paid psychological services predominated (57.7%), followed by free access (28.1%); 13.3% used both modalities. Most help-seekers reported full (39.0%) or partial (27.0%) satisfaction with received services during their last consultation. Table 3 shows descriptive statistics for the dependent variable and its associations with independent variables.

Table 3. Descriptive statistics of the variables used in the analysis and their differences for different categories of the dependent variable, Pearson’s chi-square test (seeking psychological help)

Approximately ⅖ residents of Saint-Petersburg indicated their acquaintances hold positive/rather positive views toward psychological help; 63.0% reported acquaintances who sought such help. The prevailing belief towards seeking psychological help agrees with the statement that such help is accessible only to the wealthy (32.0% of responders). Approximately ¹/₁₀ of responders believe that psychological help is sought by people with mental disorders (12.0%). The same proportion (13.0%) believes in magic. In contrast, every third respondent (31.0%) expressed confidence in psychological help infallibility.

Attitudes towards psychological help demonstrated the most significant differences between help-seekers and non-help-seekers. Notably, respondents who consulted psychologists exhibited a realistic outlook on psychological help efficacy: they less frequently endorsed beliefs about psychological help being infallible or exclusively accessible to the wealthy. The «psychological help is accessible only to the wealthy» belief did not significantly differ between help-seekers and non-help-seekers. Psychological help-seeking predominated among younger individuals, women, and child-rearing respondents. Education level and income demonstrated no statistically significant differences between help-seekers and non-help-seekers.

A logistic regression model (Table 4) explaining 18.6% of dependent variable variance was used to analyze the correlation between the factors selected and help-seeking experiences. The result demonstrated that significant predictors for help-seeking include sex (OR = 2.576; p < 0.001), age (OR = 1.404; p = 0.015), acquaintances’ positive attitudes toward psychological help (OR = 1.545; p = 0.001), and acquaintances’ help-seeking experience (OR = 2.366; p < 0.001). The model indicates greater help-seeking probability among women, older individuals, those with acquaintances holding favorable psychological help attitudes, and those with acquaintances experienced in help-seeking. Attitudes toward psychological help emerged as significant predictors. Help-seekers were less likely to agree with the statement that «psychological help is only for people with mental disorders» (OR = 0.479; p < 0.001). Belief in the potential fallibility of psychological help positively influenced help-seeking (OR = 1.370; p = 0.024).

Table 4. Regression models for help-seeking factors (Nagelkerke R2 = 18.6)

Note. Method: binary logistic regression adjusted for all variables; direct step-by-step method.

DISCUSSION

Key factors influencing psychological help-seeking identified in the study include sex, age, social norms (reflected in respondents’ assessments of help-seeking prevalence among acquaintances and expectations of approval should they seek help), and attitudes rejecting beliefs that psychological help is sought exclusively by people with illnesses or mental disorders or that psychological help is always beneficial.

These findings align with international and Russian psychological help-seeking research. Particularly, Cheng et al. [15] demonstrated that male sex and attitudes toward psychological help negatively correlate with help-seeking intentions. Türküm [16] reports significant gender differences in help-seeking readiness among Turkish university students. Traditional masculinity norms, including stoicism and emotional restraint, likely constitute major barriers to professional help-seeking. Studies show that this effect is particularly pronounced among men groups experiencing multiple vulnerabilities (refugees, migrants, low-income individuals, long-term unemployed, health-stigmatized groups, etc.) [17].

Social norms reflected in assessments of respondents in terms of the prevalence of help-seeking behaviors among acquaintances and anticipated approval are supported by studies focusing on the Russian young population. Eritsyan et al. [12] found peer approval expectations (but not peers’ actual help-seeking) were associated with predicted intentions to seek help among Russian students. These differences were largely mitigated among adult respondents in our study. Moreover, perceived help-seeking prevalence among acquaintances emerged as a stronger predictor in our regression model than anticipated approval or disapproval. These patterns may reflect generational differences in attitudes toward psychological help and distinct social norm influences on adolescent versus adult behavior.

Approximately one-third of survey respondents reported actual psychological help-seeking behavior, indicating relatively high help-seeking rates. This help-seeking experience among St. Petersburg residents significantly exceeds 5.2%–12.0% rates documented in Russian national surveys by the Public Opinion Foundation and Russian Public Opinion Research Center. Enhanced environmental accessibility encompassing financial and geographical service availability appears to play a major role for St. Petersburg citizens. In this region, free psychological services are rendered through municipal polyclinics, hospitals, multidisciplinary medical centers, family and childhood support centers, and psychological hotlines^5. Paid psychological services are available via non-governmental medical centers, independent practitioners, and online platforms.

Topkaya’s research [18] agrees with our findings regarding psychological help not being exclusively for individuals with disorders. However, while Topkaya identifies optimism about psychological help as a facilitating factor, our respondents rejected beliefs of its invariably beneficial nature. This difference may stem from Topkaya’s methodology. Topkaya’s interviews included not only questions regarding the views on psychological help but also its benefits with requests for specific examples. Such contextual framing may have influenced participants’ interpretations of benefit-related questions.

In our study, young and middle-aged women (18–44 years) were the most frequent help-seeking age group. International research on barriers to help-seeking among older adults yields conflicting results. On one hand, studies indicate that help-seeking is habitual for older generations, who display minimal stigma-related concerns [19]. We suppose that in Russia, reduced help-seeking among older adults may stem from limited mental health literacy, stigma, and fears of losing independence or life control upon acknowledging psychological needs [20].

Our cross-sectional design precluded help-seeking intentions, a critical precursor to actual behavior. However, a systematic review of 49 studies established subjective norms as statistically significant predictors of help-seeking intentions in 23 studies (59.0%); additionally, 7 of 8 studies examining intention-behavior links confirmed statistically significant associations [6].

Study Limitations

Geography is among key study limitations. While the observed effects may exist in other Russian cities, their magnitude likely applies specifically to St. Petersburg residents. Telephone surveys as a data collection tool limited both questionnaire length and response options for specific questions due to heightened refusal risks and auditory processing difficulties with complex scales. The mere fact of seeking help does not indicate that the respondent’s issue has been addressed. We excluded other factors influencing help outcomes: service quality, client adherence to recommendations, treatment completion, therapy selection methods, etc. A total of 13,644 individuals participated in the survey, with 12,444 refusing participation at various stages and 1200 completing the full survey. These methodological drawbacks combined with the inability to account for non-participants’ perspectives constitute significant study limitations. Additionally notable is our replacement of standardized scales with more flexible variables assessing self-perceived psychological state, social norms, and attitudes toward psychological help.

CONCLUSION

The study findings yield several practical implications. Understanding of identified factors (sex, age, and social norms) will optimize programs promoting psychological help-seeking. Particularly, interventions should specifically target sex and age groups to broaden the coverage.

Recognizing the critical role of social approval in help-seeking underscores the need to destigmatize mental health challenges and cultivate environments where seeking support is socially endorsed. Attitudes toward psychological help revealed in results may provide foundations for awareness campaigns dispelling myths about mental health help. Such campaigns can engage diverse social groups to enhance understanding of psychological help’s accessibility and benefits. Future research should explore barriers to help-seeking through in-depth interviews and standardized instruments measuring psychological needs, attitudes, and norms. Although our analysis shows women seek psychological help more frequently, it does not directly investigate explanatory factors for this correlation. Detailed examination of these factors represents another perspective for further research.

ADDITIONAL INFORMATION

Authors’ contribution. S. Tkach — design of survey methods, description and interpretation of results, discussion, literature review; V.A. Odinokova — statistical analysis, description and interpretation of results, discussion, literature review; O.I. Burdinа — literature review, problem statement, discussion. All authors confirm that their authorship meets the international ICMJE criteria (all authors have made a significant contribution to the development of the concept, preparation of the article, read and approved the final version before publication).

Funding source. The authors acknowledge Saint Petersburg State University for a research project 121062300141-5.

Competing interests. The authors confirm the absence of obvious and potential conflicts of interest related to the publication of this article.

Patients’ consent. Verbal consent was obtained from all the study participants before the study.

¹ Russia is facing an increase in mental health issues [Internet]. Available at https://www.vesti.ru/article/3593532 Accessed on June 26, 2024.

² Who do people seek mental health help from? [Internet]. Available at https://fom.ru/Obraz-zhizni/14183 Accessed on February 26, 2024.

³ Seeking for mental health help [Internet]. Available at https://wciom.ru/analytical-reviews/analiticheskii-obzor/v-poiskakh-psikhologicheskoi-pomoshchi Accessed on February 26, 2024.

⁴ Analyze it: why are Russians seeking psychological help more often? [Internet] Available at https://wciom.ru/expertise/analizirui-ehto-pochemu-rossijane-stali-chashche-obrashchatsja-k-psikhologam Accessed on February 26, 2024.

⁵ Mental health services [Internet]. Available at https://gorzdrav.spb.ru/information/content/poleznaya-informatsiya/kontakty/psihologicheskie-sluzhby Accessed on February 26, 2024.

About the authors

Sergey Tkach

Author for correspondence.
Email: s.tkach@spbu.ru
ORCID iD: 0000-0001-5016-9187
SPIN-code: 6740-2773
Russian Federation, St. Petersburg

Veronika A. Odinokova

Email: v.odinokova@spbu.ru
ORCID iD: 0000-0002-9850-9109
SPIN-code: 8054-7794

Cand. Sci. (Sociology), Assistant Professor

Olga I. Burdina

Email: o.burdina@spbu.ru
ORCID iD: 0009-0000-6638-4500
SPIN-code: 5133-6122
Russian Federation, St. Petersburg

References

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