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. 2025 Mar 19:17449871241268451. Online ahead of print. doi: 10.1177/17449871241268451

Help-seeking in nursing and medical students: a concept analysis

Varha Bamine 1,✉, Koji Tanaka 2
PMCID: PMC11924047  PMID: 40123784

Abstract

Background:

The prevalence of mental health issues in healthcare students is a growing concern. However, many healthcare students do not seek help because of the strong stigma attached to mental illness. This reluctance has been extensively researched, but a clear understanding of help-seeking behaviour among healthcare students remains elusive.

Aims:

To clarify the concept of help-seeking in order to develop effective strategies aimed at encouraging help-seeking behaviour in students.

Method:

Concept analysis of help-seeking behaviour among nursing and medical students in the context of mental health, based on Rodgers’ evolutionary model.

Results:

Attributes: (a) consulting a healthcare professional, (b) talking to family/peers/friends and (c) self-treatment. Antecedents: (a) self-awareness, (b) relationship and previous experiences with a help-provider, (c) social perception and (d) availability of university-offered help services. Barriers: (a) barriers specific to healthcare students, (b) misconceptions about mental healthcare services, (c) negative social perception, (d) cost and (e) culture. Consequences included: positive and negative consequences.

Conclusion:

This concept analysis aimed to fill in the gap in concept-analysis research and to provide a new conceptualisation of help-seeking by examining subjective reports. The findings of this study will contribute to implementing effective incentives aimed at encouraging help-seeking behaviour in nursing and medical students.

Keywords: concept analysis, help-seeking, medical students, mental health, nursing students

Introduction

University students are at higher risk of developing serious mental health issues compared with the general population (Bashir et al., 2020). This risk is even higher in nursing and medical school students (Anosike et al., 2022). There is an abundance of literature on the prevalence of depression and suicide in healthcare students (Martin et al., 2020). Approximately 25% of nursing students reported experiencing moderate to severe levels of negative emotional states (Rosenthal et al., 2021).

Around one-third (34%) of nursing students experience depression, with nursing students in Asia having an even higher incidence of depression (Tung et al., 2018). In a survey of healthcare students in 43 countries, 27.2% of respondents reported experiencing depression and 11.1% suicidal ideation, whereas only 15.7% of those who reported experiencing depression sought treatment (Rotenstein et al., 2016).

There is a concern that untreated mental health issues among health practitioners may lead to a decline in patient care (Thistlethwaite et al., 2010). Healthcare students must work and study long hours and often witness medical conditions that can lead to emotional and psychological distress (Knipe et al., 2018), including frequent exposure to death (Larrahondo et al., 2021). In addition, healthcare students can fall victim to a culture of ‘maladaptive perfectionism’ that contributes to the deterioration of their mental health (Martin et al., 2020).

Despite the prevalence of mental health issues among healthcare students, the stigma attached to mental illness remains quite strong (Volpe et al., 2019). Therefore, many healthcare students do not seek appropriate help. One in four healthcare students exhibits depressive symptoms (Knipe et al., 2018; Rotenstein et al., 2016). The reluctance of students to seek professional help has received extensive research attention. However, little has been done to develop a clear and concise conceptual understanding of help-seeking behaviour among healthcare students (Rickwood and Thomas, 2012).

Concept analysis helps researchers to clarify a concept’s shared applications, which can highlight different viewpoints and foster collective understanding of a concept within a particular field (Jaeb, 2022). In the present study, we perform an analysis aimed at defining the concept of ‘help-seeking’ in the context of healthcare students, with the aim of creating more effective help-seeking promoting strategies.

Method

Concept analysis clarifies the meaning of a concept in its present usage, aiding the future development of that concept (Chinn, 1983). It presumes that the meaning of a concept is reliant on the context of its usage (Risjord, 2009). Given the abstract nature of the concepts under analysis, understanding them – especially in nursing – is fundamental to advancing the discipline (Parse, 2023).

This analysis of help-seeking behaviour among nursing and medical students in the context of mental health follows the evolutionary model of Rodgers and Knafl (1989), who stated that concept analysis is ‘the dissection of a concept into simpler elements to promote clarity while providing mutual understanding’ (p. 70). His evolutionary model was deemed the most appropriate for analysing the concept of help-seeking because it facilitates the examination of a process that unfolds over time, including its multiple progressive stages and features. The model analyses the concept’s attributes, related and surrogate terms, antecedents and consequences (Jaeb, 2022; Rodgers, 2000).

Data collection

According to Tofthagen et al. (2010), researchers should choose databases that are considered to be the most representative of their field of study. Therefore, in this study, data were collected using CINHAL (Cumulative Index to Nursing and Allied Health Literature), PsycArticles and PubMed. These databases were selected because of their relevance to the objective of the study. CINHAL includes publications on nursing, health, education, behavioural science and health administration (Bahaadinbeigy et al., 2010). PsycArticles, with over 200,000 records from 119 journals, is a comprehensive full-text journal repository provided by the American Psychological Association. PsycArticles not only offers access to the papers but also includes editorial correspondence and corrections (Arnold et al., 2006). PubMed is the largest database for biomedical papers, with more than 20 million indexed citations as of 2010 (Lu, 2011; Sayers et al., 2010).

The data analysed in this study were collected from January 2000 to July 2023 and are reported in accordance with the PRISMA guidelines (Page et al., 2021).

A search performed using the terms ‘medical students’, ‘nursing students’, ‘mental health’ and ‘help-seeking’ yielded 3486 papers (2389 concerning medical students, 1097 concerning nursing students). Duplicates and irrelevant papers, which did not include in the title or abstract mentions of help-seeking, mental health and medical and/or nursing students or an equivalent word or term for each concept, were excluded (n = 3317). The second round of screening excluded everything but qualitative studies.

Most studies on the help-seeking behaviour of healthcare students are quantitative. Although quantitative studies are important for elucidating the prevalence of a phenomenon, qualitative research can provide a deeper understanding of the phenomenon. In healthcare research, qualitative methodologies can be employed to investigate the complex phenomena experienced by nurses, other healthcare providers, policymakers and patients (Tong et al., 2007; Vaismoradi et al., 2013). Qualitative approaches aim to understand specific phenomena from the perspective of those directly involved (Vaismoradi et al., 2013).

According to Cornally and McCarthy (2011), help-seeking is a behaviour that ‘is shown to be a complex decision-making process instigated by a problem that challenges personal abilities’. To gain a deeper understanding of this complex phenomenon, only qualitative studies were included in this conceptual analysis.

The second screening excluded (a) studies that were not qualitative and (b) papers for which the full text was not accessible. Finally, 13 qualitative studies were included in the analysis (12 concerning medical students, 1 concerning nursing students; Figure 1).

Figure 1.

Figure 1.

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Screening process.

Results

Because only one research paper concerning nursing students satisfied the criteria, and for readability reasons, below both student groups are referred to as healthcare students.

Help-seeking with regard to healthcare students can be defined as a process that begins with self-awareness, that is, an admission of the presence of a mental health problem. The students’ experiences (antecedents or barriers) will then dictate what type of help they might seek (self-treatment, family/friends, counselling/tutors or no help). However, healthcare students can encounter a variety of barriers (e.g. fears of having their credibility questioned, stigma and shame). After seeking and receiving help, students – now armed with a new perspective and an awareness of their own mental health – become more empathetic towards their patients, thereby becoming better healthcare professionals (Figure 2).

Figure 2.

Figure 2.

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Help-seeking model.

Attributes

Rodgers (2000) defined attributes as items that signify the ‘essence’ of a given concept. The attributes of help-seeking were found to be (a) consulting a healthcare professional, (b) talking to family/peers/friends and (c) self-treatment.

Consulting a healthcare professional

Healthcare students were less likely to utilise university help sources and to disclose most of their symptoms compared with students in other fields of study. Most students chose to seek off-campus services instead (Shahaf-Oren et al., 2021).

Talking to family/peers/friends

Healthcare students have expressed a preference to seek support from their peers, partners, family members and friends (Chew-Graham et al., 2003; Shahaf-Oren et al., 2021). Specifically, healthcare students favoured seeking help from friends who, like them, were also healthcare students. ‘[. . .] Your medical friends tend to be more helpful than, you know, non-medical friends. Medical friends on the same course may know about the problems and say, “Well, you need help, go and see so-and-so.” Non-medical friends will provide support but won’t direct us to the proper places’ (Chew-Graham et al., 2003: 876).

Self-treatment

Because of their medical education, healthcare students may become overconfident in their ability to assess their own condition and decide the appropriate treatment (Oláh et al., 2022; Thistlethwaite et al., 2010). One student attested, ‘because a medical student really has this pride or even conceit and they think they know everything so they are not going to go to a psychologist, that would be very rare’ (Oláh et al., 2022: 7).

Surrogate and related terms

Surrogate terms encapsulate the essence of the concept without employing the specific terminology of the concept, whereas related terms share greater similarities with the concept, although the characteristics of the term may differ (Jaeb, 2022; Rodgers, 2000). We did not find any surrogate terms but we did identify multiple related terms, namely, seeking-advice (Shahaf-Oren et al., 2021; Thistlethwaite et al., 2010), seeking mental healthcare (Shahaf-Oren et al., 2021, seeking mental help (Oláh et al., 2022), seeking support (Rich et al., 2023), seeking medical advice (Thistlethwaite et al., 2010), seeking treatment (Hankir et al., 2014; Veal, 2021) and seeking medical attention (Hankir et al., 2014).

Antecedents

Antecedents are events that are ‘generally found to precede an instance of the concept’ (Rodgers and Knafl, 1989: 334). The antecedents identified in this analysis were classified as follows: (a) self-awareness, (b) relationship and previous experiences with a help-provider, (c) social perception and (d) availability of university-offered help services.

Self-awareness

Students who recognised that they had a problem were able to receive appropriate help (Winter et al., 2017). Because of their educational background, healthcare students may believe they are over-identifying with the symptoms in their textbooks. One student said, ‘We all sit around telling each other our hypochondriac conclusions . . . you come up with that conclusion and you worry about it for a little while but you still don’t see a doctor about it’ (Thistlethwaite et al., 2010: 165).

Another significant factor in encouraging students to seek help was the presentation of apparent symptoms that the students were unable to conceal anymore, or a friend or a significant other pushing them to seek help (Winter et al., 2017).

Relationship and previous experiences with the help-provider

The degree of closeness with the person providing help, whether it is a healthcare professional or a university staff member or tutor, as well as previous positive experiences dictate the willingness of students to seek help and the degree to which they will disclose mental health concerns (Shahaf-Oren et al., 2021; Thistlethwaite et al., 2010; Winter et al., 2017). One student said, ‘If you failed the qualifiers you had to go see pastoral services. So I went to see Dr XXXX and she was really, really nice, so I told her everything that had happened, I started crying to her as well . . . she was more reassuring to me’ (Winter et al., 2017: 482).

Social perception

The positive attitudes of support providers (Shahaf-Oren et al., 2021), the normalisation of vulnerability and self-care (Veal, 2021) and decreased stigma (Rich et al., 2023) may encourage the students to seek help. One student stated, ‘I shared [my mental health concerns] with [two teachers] because they were very accessible and friendly’ (Shahaf-Oren et al., 2021: 6).

Availability of university-offered help services

It is crucial to make students aware of existing on-campus help-seeking institutions (Chew-Graham et al., 2003; Rich et al., 2023; Shahaf-Oren et al., 2021; Veal, 2021). In many cases, the students may be unaware of these institutions. Some students have stated that what persuaded them to seek help was the staff members creating spaces for them to reach out (Byrnes et al., 2020). Others expressed the need to have a staff member whose role is solely pastoral (Awad et al., 2019). ‘I think having someone dedicated to a more pastoral role would be great, given that I sometimes find it difficult to approach my tutor because they play mainly an academic role’ (Awad et al., 2019: 315).

Barriers

We cannot talk about antecedents to help-seeking without acknowledging the barriers. Despite barriers not being part of the original evolutionary concept analysis, we considered it necessary to include because it is inseparably linked in the literature. The finding that only 15.7% of healthcare students seek mental health treatment (Rotenstein et al., 2016) has led many researchers to raise concerns about the barriers to seeking help.

The following themes emerged in the analysis: (a) barriers specific to medical students, (b) misconceptions about mental healthcare services, (c) negative social perception, (d) cost and (e) culture.

Barriers specific to medical students

The idea of becoming a medical student is often accompanied by notions of ‘excellence’ and ‘perfectionism’. Healthcare students may perceive asking for help as damaging their credibility as future doctors (Awad et al., 2019; Chew-Graham et al., 2003; Hankir, 2014; Shahaf-Oren, 2021; Tawse and Demou, 2022; Veal, 2021). As one student explained, ‘If more people can realise that doctors and medical students, like other human beings, struggle from time-to-time with our mental health but can still go on to have a successful career, maybe more doctors will feel comfortable seeking help for themselves, or be more understanding of colleagues and patients who need support’ (Hankir, 2014).

Another major barrier specific to healthcare students is the fear of negative consequences in their academic and future careers (Awad et al., 2019; Chew-Graham et al., 2003; Shahaf-Oren et al., 2021). Students feared that if they sought counselling, they might be punished or disciplined by the university (Byrnes et al., 2020). They worried that it would be documented in their academic records (Awad et al., 2019; Simpson et al., 2019; Veal, 2021). One student explained, ‘I think a worry that goes through all of our minds is what gets passed onto the hospitals we will be working in next year. Really most people don’t want anything put to their name’ (Awad et al., 2019: 314).

Some of the healthcare students interviewed in the analysed papers expressed a hesitance towards disclosing mental illness and seeking help (Oláh et al., 2022; Shahaf-Oren et al., 2021). They believed they were capable of diagnosing and treating themselves (Shahaf-Oren et al., 2021; Thistlethwaite et al., 2010). Moreover, observing the prevalence of mental health issues among their peers, students tended to normalise them as a part of the medical school experience (Winter et al., 2017).

Other barriers mentioned by the students included competition (Awad et al., 2019; Byrnes et al., 2020; Chew-Graham et al., 2003; Tawse and Demou, 2022) as well as the long hours and heavy workload inherent to medical school (Shahaf-Oren et al., 2021; Tawse and Demou, 2022; Winter et al., 2017).

Misconceptions about mental healthcare services

More often than not, the students exhibited negative attitudes and distrust towards university mental healthcare services (Chew-Graham et al., 2003; Oláh et al., 2022; Shahaf-Oren et al., 2021; Simpson et al., 2019). Some students were reported to have ‘unrealistic expectations’ about the counselling staff. One student expressed disappointment when they did not get the help they expected from a university counsellor, saying, ‘I think they didn’t have as much experience of dealing with grief as they probably should’ (Simpson et al., 2019: 358).

Past negative experiences with professional healthcare services deterred some from turning to formal healthcare services (Byrnes et al., 2020; Tawse and Demou, 2022). ‘I think there are things that you don’t want to tell [. . .] especially if you have been in counselling when you are a young teenager, there is definitely a limit on what you can say to them before they will report you [. . .]’ (Shahaf-Oren et al., 2021: 4).

Other misconceptions about healthcare services included doubts regarding the effectiveness of counselling and treatments (Oláh et al., 2022) as well as fears about side effects (Shahaf-Oren et al., 2021). At times, the students were either completely or partially unaware of services offered by the university (Awad et al., 2019; Rich et al., 2023; Oláh et al., 2022). ‘I just didn’t really know about it [student support services] until I think they started advertising more things online over this past—well like over the pandemic’. (Rich et al., 2023: 4).

Some students stated that the degree of closeness with the help provider in formal services had discouraged them from disclosing or seeking help for their mental health problems (Byrnes et al., 2020; Shahaf-Oren et al., 2021). ‘For me, one of the deciding factors is how close I am to that person. I think that definitely dictates whether I will tell them’ (Shahaf-Oren et al., 2021: 5).

Negative social perception

Stigma, shame, embarrassment and unwanted attention were among the major barriers stated in almost all of the sampled papers (Bravo et al., 2023; Byrnes et al., 2020; Chew-Graham et al., 2003; Hankir, 2014; Oláh et al., 2022; Rich et al., 2023; Shahaf-Oren et al., 2021; Tawse and Demou, 2022; Veal, 2021; Winter et al., 2017).

One student expressed their frustration regarding the stigma that mental illness means someone is unfit to be a doctor, saying, ‘well people said it to me mostly, “you’re not allowed to be a doctor if you suffer from depression”’ (Winter et al., 2017).

Cost

Cost was also an issue, particularly for international students (Oláh et al., 2022). One student complained, ‘we don’t get any more support unless we have the TAJ card [Hungarian health insurance], which not everyone has . . . Most of us just can’t afford [private care] because one session with a psychiatrist if needed will cost around 25,000 HU F [appx. 70 EUR] without medication’ (Oláh et al., 2022: 10).

Culture

Cultural background may also play a role in preventing students from seeking help (Oláh et al., 2022; Shahaf-Oren et al., 2021). Students have also expressed that their native culture made them reluctant to seek help (Bravo, et al., 2023; Kaiser et al., 2023; Shahaf-Oren et al., 2021). ‘That’s where I think culture comes in because, I mean, where most of us come from, I guess mental health is a myth and therapy is like magic’. (Oláh et al., 2022: 10).

Consequences

Consequences are the events that happen after the occurrence of the concept (Rodgers, 2000). In this analysis, both negative and positive consequences were found. The negative consequences were due mainly to the barriers to help-seeking. However, the positive consequences were the result of the antecedents to help-seeking.

Negative consequences

The negative consequences that emerged were: (a) avoidance behaviour, (b) inadequate response from the university staff, (c) lack of helpful guidance and (d) negative response from the university staff.

When students fail to seek help, some turn to negative avoidance behaviour through alcohol, smoking, cannabis and even hard drugs, or focusing more intensively on their studies instead of dealing with the problem (Chew-Graham et al., 2003). ‘[. . .] Instead of seeking help you could be trying to revise, just try and get more information in there’ (Chew-Graham et al., 2003: 878).

Inadequate response and lack of helpful guidance from the university staff were among the negative consequences expressed by the students (Shahaf-Oren et al., 2021; Simpson et al., 2019).

Positive consequences

The positive consequences were divided into those resulting from formal help pathways and those resulting from informal help pathways.

Positive consequences resulting from formal help pathways were (a) helpful advice and confidentiality, (b) academic flexibility, (c) a better understanding of one’s own mental issues, (d) reduced feelings of guilt, (e) hope, (f) receiving treatment, (g) learning to accept academic failures and (h) becoming a better doctor.

The positive consequences resulting from informal help pathways were (a) receiving class material, (b) receiving support and (c) positive coping mechanisms.

Most students preferred seeking informal help. When seeking help, they relied on their family (Chew-Graham et al., 2003) or their peers and friends (Byrnes et al., 2020; Chew-Graham et al., 2003; Shahaf-Oren et al., 2021; Simpson et al., 2019; Tawse and Demou, 2022).

As one student put it, ‘We kind of do it without being labelled a support network, so we all come home from placement and will be like, “I saw this thing today”, and we tell the story, and we maybe don’t consciously realise but we’re saying it to get it off our chest’ (Tawse and Demou, 2022: 5).

Class materials and support received from classmates were among the benefits reported by students when disclosing their mental health problems to their peers (Shahaf-Oren et al., 2021). ‘I spoke to a friend and she told me how last year she went through the same thing. [. . .] it normalizes the whole thing’ (Shahaf-Oren et al., 2021: 5). Some students resorted to coping mechanisms such as going out to the movies, going out to eat, exercising, visiting their family and engaging in spirituality and religion (Chew-Graham et al., 2003).

Some of the stated benefits of seeking professional outside the university included confidentiality and receiving helpful advice (Shahaf-Oren et al., 2021). However, other students believed that seeking on-campus help gave them ‘academic flexibility’ and ‘useful referrals’ (Shahaf-Oren et al., 2021; Simpson et al., 2019).

Other perceived benefits of professional help-seeking were a better understanding of one’s own mental issues, reduced feelings of guilt, an increased sense of hope (Shahaf-Oren et al., 2021; Veal, 2021), receiving Cognitive Behavioural Therapy, and learning to accept academic failures and cope with them (Veal, 2021). Other students reported that treating their mental health issues made them better doctors and increased their empathy towards their patients (Chew-Graham et al., 2003; Hankir et al., 2014).

Model case

A second-year medical student starts feeling stressed before her mid-term exams. She is unable to concentrate or keep up with her classes or studies. She feels she is likely going to fail her exams. She thinks about how disappointed her parents will be when she fails. She experiences greater anxiety with each passing day. Feeling like the failure she believes she is, she decides to deactivate all of her social media accounts. ‘Who would want to talk to me anyway?’ she thinks to herself. She is aware of the services offered by her university but believes seeking help might negatively impact her record, and thus potential employers will see her as an incompetent doctor. On her way to school, she runs into a friend who is worried about her sudden disappearance from social media. She confides in her friend who reassures her and encourages her to speak to a professional. Realising that she is spiralling downward, she decides to talk to the university’s counsellor. The counsellor refers her to a psychiatrist and writes an email to her advisor to let him know that he recommends she take a short leave of absence from school. The advisor reassures the student that this is completely fine and that she must not worry about any negative academic consequences.

Discussion

Medical and nursing students have higher rates of mental health issues compared with their counterparts in other fields of study. They have a heavy school workload and spend long hours in hospitals caring for patients. Despite this, very few seek professional help. This paper analyses help-seeking as a concept in order to clarify the meaning of the concept, highlight subtle differences and increase accuracy.

To our knowledge, this is the first study to perform a concept analysis of help-seeking. It is also the first concept analysis to focus exclusively on qualitative research. This choice was made in order to explore the concept of help-seeking from the perspective of medical (and nursing) students based on their own personal accounts. The results provide an insight into the help-seeking behaviour of these students and how they conceptualise it, thereby contributing new knowledge to the field.

The two most significant barriers to seeking professional mental healthcare services identified in this analysis were perfectionism and the fear that university services might disclose their mental illness history to their tutors and/or to hospitals they might work at in the future (i.e. confidentiality).

Perfectionism

Physicians and nurses are seen as competent practitioners of noble professions in the eyes of the public. Even as students, they are expected to be the smartest and best students in their universities. Perfectionism in doctors has been reported to cause burnout (Martin et al., 2022; Rallis et al., 2021), chronic feelings of guilt and stress (Peters and King, 2012), imposter syndrome, anxiety and depression (Rallis et al., 2021). Maladaptive perfectionism increases depression rates. The relentless pursuit of perfectionism in the workplace impacts nurses’ capacity to find joy in their day-to-day life, increasing their risk of depression (Christman, 2012).

Academic burnout is defined as ‘a combination of emotional exhaustion, cynicism and academic inefficacy that is caused by the ongoing failure to manage study pressure effectively’ (Schaufeli et al., 2002). It is one of the most common mental health issues faced by nursing and medical students. One of the main causes of burnout is the pressure that students feel to fulfil higher moral standards, medical ethics and selflessness, in addition to the expectation to excel academically.

Confidentiality

As future healthcare professionals, many students feared that their mental health problems would be revealed to hospitals they may be interested in working at. Some students expressed concerns over disclosing their mental health issues because of the stigma of being seen as unfit to practice medicine. This stigma comes not only from the public but also from their colleagues.

An anonymous doctor (2012) described how their colleagues’ attitude towards them changed after learning about their self-harm, saying, ‘Mental illness in a colleague is somehow “too close to home”’ (Anonymous, 2012). In the same paper, the anonymous doctor raised the important point that therapy sessions should be tailored to fit the intelligence level of the patient. ‘I was once assigned to an occupational therapy class where the chief activity was colouring pictures in children’s drawing books. I eventually told the occupational therapist that being reduced to this was making me more depressed, and she was able then to find a correspondence course that I could work on while the others coloured and drew’ (Anonymous, 2012: 106).

Some students were able to see the ‘bright side’ of having a mental health issue; in that, it would make them ‘better doctors’ because they would be ‘more empathetic to their patients’. This is consistent with previous studies, such as Roth et al. (2000), who found that people who had experienced mental health related issues, whether personally or professionally, are more likely to be more empathetic towards people with a mental illness. This might even be interpreted as a sign of post-traumatic growth, which occurs when a person uses a traumatic event in their life to improve themselves (Affleck and Tennen, 1996; Harmon and Venta, 2021).

Tanaka (2019) investigated the enormous impact of post-traumatic growth among nurses in Japan. Some nurses in his qualitative study said that experiencing and recovering from a mental health problem themselves made them better at supporting their patients (Tanaka, 2019). Moreover, others have reported having a ‘free spirit’, which they associated with elevated levels of empathy (Tanaka, 2019).

None of the papers analysed in this study defined the term ‘help-seeking’. However, in previous studies, help-seeking has been described as a ‘dynamic process’ starting with the recognition of the existence of a problem that requires help. Subsequently, symptoms begin to manifest, followed by the acknowledgement of the need for help, the identification of available sources of help, and ultimately, the intention to seek help and disclose relevant information (Rickwood et al., 2007).

Most students generally prefer reaching out to friends and family instead of professionals or tutors when they struggle with their mental health. However, many healthcare students expressed a tendency to self-diagnose and self-medicate. This trend was observed in previous literature as well (Brimstone et al., 2007; Hooper et al., 2005).

Conclusion

Despite having the highest rates of mental health problems compared with their peers in other fields of study (Bashir et al., 2020), nursing and healthcare students are the most reluctant to seek help (Awad et al., 2019). This concept analysis was performed to fill in the gap in concept-analysis research and to add a new conceptualisation of help-seeking by examining subjective reports. In doing so, this study contributes to the implementation of effective incentives aimed at encouraging help-seeking behaviour in nursing and medical students.

Implications for clinical practice

We were able to find only one paper about nursing students that satisfied the criteria for inclusion. However, nursing and healthcare students share similar challenges in their daily lives because of a difficult learning environment, demanding practical and class workload, and competitiveness (Anosike et al., 2022). Compared with students in other fields of study, nursing and healthcare students are more likely to experience anxiety and depression (Melaku et al., 2015), which if not treated properly, can negatively impact their academic and even professional performance (Thistlethwaite et al., 2010). Cultivating an empathetic and resilient mindset is essential to empower nursing and healthcare students in navigating the challenges they will inevitably encounter in their chosen profession.

For these reasons as well as other factors beyond the scope of this analysis that affect the mental health of young people every day, it is imperative that a radical change be made. There is no shortage of papers about the rising rates of mental illness in healthcare students or the underlying causes, yet it seems not much has been done to address the problem, based on Abraham Flexner’s reforms in the 20th century.

Despite a number of reforms suggested in the past, most medical and nursing curricula revolve around extensive classwork and long hours working in hospitals. Reform that prioritises the students’ well-being must consider not only the educational workload but also include classes and workshops that aim to normalise talking about and seeking help for mental illness. Special workshops on how to respond to and help a classmate or colleague dealing with a mental illness or a mental health issue should be held in the first year of nursing and medical school programmes. Reform should also consider the everyday challenges of our times, including social media and its effects on students’ mental health.

Students should be given breaks in which they do not need to worry about school or hospital work. They need to receive scholarships and paid internships so that they do not need to work in addition to studying. Moreover, the students must be included in the process of restructuring their time, and more effective and engaging teaching methods must be integrated.

Only by fully understanding the nuances of help-seeking behaviours can universities and educators tailor effective early intervention programmes, which will enable them to provide supportive academic environments that promote mental health and destigmatise disclosure. Ensuring the well-being of nursing and healthcare students is essential to prepare future healthcare professionals who will be entrusted with saving lives.

Key points for policy, practice and/or research.

  • None of the papers analysed in this study defined the term ‘help-seeking’.

  • This concept analysis contributes to the implementation of effective incentives aimed at encouraging help-seeking behaviour in nursing and medical students.

  • The most significant barriers to seeking professional mental healthcare services identified were perfectionism and concerns about confidentiality.

  • By understanding the nuances of help-seeking behaviours, universities and educators can tailor effective early intervention programmes.

Biography

Varha Bamine Abd Selam, is a PhD candidate at the Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan. Her research interests include depression and suicidal behaviour in youths and students.

Koji Tanaka, RN, PhD, is a Professor at the Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University. He has published numerous papers about psychiatric and mental health nursing, clinical nursing, and community health nursing.

Footnotes

Author contributions: VB and KT contributed to the conception and design of this study. VB acquired the data. KT and VB performed the data analysis. VB drafted the manuscript. All the authors read and approved the final manuscript.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical approval: No ethical permissions were needed for this concept analysis.

Contributor Information

Varha Bamine, PhD Candidate, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.

Koji Tanaka, Professor, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.

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