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Asia-Pacific Journal of Oncology Nursing logoLink to Asia-Pacific Journal of Oncology Nursing
. 2025 Jul 11;12:100755. doi: 10.1016/j.apjon.2025.100755

Attitudes toward seeking professional psychological help among patients with colorectal cancer: A latent profile analysis

Min Hu a,b, Tingting A a, Xinxin Zhang a, Xinxin Huang a, Qingqiu Wu a, Tingting Wei b, Beibei Song b, Shaohua Hu b,⁎
PMCID: PMC12308003  PMID: 40741042

Abstract

Objective

This study aimed to explore the attitudes of patients with colorectal cancer (CRC) toward seeking professional psychological help and to identify latent profiles and associated influencing factors.

Methods

A total of 236 patients with CRC were recruited through convenience sampling. Participants completed validated instruments assessing attitudes toward seeking professional psychological help, mental health literacy, and stigma related to psychological help-seeking. Latent profile analysis was conducted to identify distinct subgroups.

Results

Attitudes scores were moderate to low, with three profiles identified: “negative attitudes-high independence” (26.6%), “general attitudes” (51.8%), and “positive attitudes-high affirmation” (21.6%). Multivariate analysis revealed that age, mental health literacy, and stigma were significant predictors of subgroup membership.

Conclusions

The findings reveal significant heterogeneity in attitudes toward psychological help-seeking among patients with CRC. Medical staff should tailor interventions to patient subgroups, particularly older individuals and those with low mental health literacy or high perceived stigma, to improve access to psychological care. This study offers evidence-based guidance for developing targeted mental health interventions in oncology care.

Keywords: Colorectal cancer, Attitudes toward seeking professional psychological help, Mental health literacy, Stigma for seeking professional psychological help, Latent profile analysis, Oncology nursing

Introduction

Colorectal cancer (CRC) is a prevalent malignant tumor encompassing colon and rectal cancers. Global Cancer Statistics 2022 reveal CRC as the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide, accounting for 1.92 million new cases and 904,000 deaths.1 In China, CRC maintains its position as the second most common cancer diagnosis and the fourth leading contributor to cancer mortality.2 Based on the BAPC model, Jin et al.3 predicted that the standardized incidence of CRC in China could rise to 47.61/100,000 by 2035, representing a 42.2% increase from 2022 levels. Notably, this epidemiological shift coincides with heightened psychological vulnerability, as patients with CRC exhibit substantially elevated risks of psychological distress compared to the general population.4 This psychological distress is significantly compounded by the nature of CRC treatments themselves.

Surgical intervention for CRC may require stoma creation. According to a national survey in China, 33.6% of stomas were permanent versus 66.4% temporary.5 Both types negatively impact patients’ mental health, including stigma, loneliness, low self-esteem, depression, and anxiety.5, 6, 7 Even patients undergoing sphincter-preserving surgeries remain susceptible to Low Anterior Resection Syndrome (LARS). This bowel dysfunction combines symptoms like urgency, incontinence, and evacuation difficulties, frequently leading to psychological distress—including embarrassment, emotional dysregulation, and social withdrawal.8, 9, 10, 11 Furthermore, a range of treatment side effects, such as fear of cancer recurrence, chronic pain, and fatigue, collectively erode psychological resilience and impair quality of life.12,13 However, when confronted with this psychological distress, patients with CRC lack adequate coping abilities.14, 15, 16

Therefore, understanding their attitudes towards help-seeking is crucial, as these attitudes serve as a key determinant of whether they will actually utilize available psychological support. The Theory of Planned Behavior (TPB) offers a robust framework to examine such attitudes and their behavioral outcomes. The TPB posits that behavioral intentions determine actual behavior, with these intentions being influenced by attitudes, perceived behavioral control, and subjective norms.17 Attitudes toward seeking professional psychological help (ATSPPH) represent an individual's predisposition to seek or avoid mental health services when confronting unresolved psychological distress,18 and thus constitute a key attitudinal component within the TPB framework applied to this context. Consequently, this study, grounded in the TPB framework, investigates ATSPPH and its influencing factors among patients with CRC. This approach aims to predict behavioral intentions and, ultimately, actual psychological help-seeking behavior, thereby improving access to psychological care. Notably, ATSPPH varies among different populations. A study of Japanese cancer patients documented that 15.6% would utilize psychological services.19 In Saudi adults, 10.6% of participants expressed willingness to seek psychological help.20 Iranian medical residents reported moderate ATSPPH levels.21 Additionally, in China, research on ATSPPH has focused on populations in psychology and education.22, 23, 24 Evidence suggests college students prefer online non-professional consultations over professional psychological services.25 This highlights the need to investigate ATSPPH patterns specifically in Chinese patients with CRC.

Current oncology nursing literature predominantly focuses on the prevalence of psychological distress among cancer patients,26, 27, 28 with limited attention to their ATSPPH. Moreover, existing studies have mainly examined general oncology populations,19,29 thereby overlooking variations in ATSPPH influenced by tumor characteristics, treatment modalities, and stigma. To date, no literature has explored the ATSPPH and influencing factors specifically among patients with CRC as a distinct tumor subgroup.

As an important cognitive component, mental health literacy (MHL) critically influences attitudes formation.30 Defined as the knowledge and beliefs enabling mental disorder identification, management, and prevention, MHL constitutes a key determinant of ATSPPH.31 Previous studies have shown that positive ATSPPH are associated with high mental health literacy.32,33 Kılınç et al.34 found that individuals with high mental health literacy demonstrate enhanced symptom recognition, service navigation competence, and higher engagement with care. In contrast, those with low mental health literacy are often unaware of or underestimate the harm of psychological distress to their health, lacking adequate knowledge and beliefs about it, thus exhibiting negative ATSPPH.35

Cultural barriers perpetuate stigmatization by associating mental illness with personal failings, directly inhibiting help-seeking.36 This culturally mediated stigma manifests as Stigma for Seeking Professional Psychological Help (SSPPH) – a derogatory and insulting label for individuals seeking psychological help, including public stigma and self-stigma.37 SSPPH was therefore selected as a critical sociocultural determinant of ATSPPH. Individuals with high perceived stigma harbor negative stereotypes about psychological help-seeking and distrust of psychological care, exacerbating psychological distress.38 This can further intensify negative ATSPPH, thereby creating substantial barriers to mental health improvement.39,40

This study will recruit patients with CRC using a cross-sectional design to assess their attitudes scores. Additionally, it seeks to further explore the relationships among ATSPPH, mental health literacy, and perceived stigma. Thereby, this study provides a basis for future nursing interventions and addresses the research gap in oncology nursing literature regarding ATSPPH among patients with CRC.

Contemporary research on ATSPPH predominantly relies on aggregate scale scores to assess overall group-level characteristics, overlooking potential intrapopulation heterogeneity. Latent profile analysis (LPA), a person-centered statistical method, identifies heterogeneous subgroups through model fitting and quantifies their proportional representation within the population.41 Compared with traditional clustering methods, LPA eliminates the need for data standardization. It also provides more objective estimates of an individual's likelihood of belonging to a specific category. These advantages lead to more accurate classification outcomes.42 In contrast, traditional cluster analysis relies on subjective criteria selection, which may yield meaningless clusters.43 The application of LPA to assess ATSPPH among patients with CRC enables medical staff to accurately identify distinct latent subgroups and develop tailored intervention strategies.

Therefore, this study aimed to: (1) identify latent subgroups of ATSPPH among patients with CRC and (2) analyze associations between predictors (demographic data, mental health literacy, and perceived stigma) and these subgroups, thereby informing the development of targeted interventions to improve their mental health.

Methods

Study design and sample

From September to December 2024, 236 patients with CRC admitted to the department of gastrointestinal surgery and oncology of a tertiary hospital in Anhui Province were recruited via convenience sampling. Inclusion criteria: (1) aged ≥ 18 years with pathologically confirmed CRC; (2) provision of informed consent and voluntary participation. Exclusion criteria: (1) communication impairments or cognitive disorders; (2) comorbid severe systemic illnesses precluding study compliance.

Sample size determination followed the 5–10 participants per predictor variable guideline. With 17 independent variables and a 20% anticipated attrition rate accounted for, the required sample range was 102–204 participants. Finally, 236 patients with CRC were recruited, including 155 males and 81 females.

Measures

General information questionnaire

Demographic and clinical characteristics were collected using a self-designed questionnaire, including age, gender, religious beliefs, occupation, educational level, marital status, family monthly income per capita, payment method, current residence, psychiatric history, self-rated health status, cancer type, tumor stage, presence of stoma, and treatment modalities (Appendix A).

Attitudes toward seeking professional psychological help scale-short form

Attitudes Toward Seeking Professional Psychological Help Scale-short Form (ATSPPH-SF) was developed by Fischer and translated into Chinese by Kong.18,44 It includes 10 items across three dimensions: openness (3 items), effectiveness (4 items), and independence (3 items). Responses are rated on a four-point Likert scale ranging from “strongly agree” (3 points) to “strongly disagree” (0 points), with 5 reverse-scored items. Higher total scores indicate more positive ATSPPH. This instrument has been previously validated in Chinese populations, including patients undergoing maintenance hemodialysis and elderly individuals with hypertension.35,45 In this study, the scale demonstrated good internal consistency (Cronbach's α ​= ​0.853).

Multicomponent mental health literacy scale

The Multicomponent Mental Health Literacy Scale (MMHL) was developed by Jung and translated into Chinese by Ming.46,47 It includes three dimensions: knowledge dimension (10 items), belief dimension (8 items), and resource dimension (4 items), with a total of 22 items. A dichotomous scoring system was employed, with “strongly agree” and “agree” scored as 1 and the others as 0. The belief dimension contains reverse-scored items, with higher total scores indicating greater mental health literacy. This scale has demonstrated excellent internal consistency in the current study (Cronbach's α ​= ​0.904).

Questionnaire of stigma for seeking professional psychological help

The Questionnaire of Stigma for Seeking Professional Psychological Help (SSPPH) was developed by Hao through cultural adaptation of the Stigma Scale for Receiving Psychological Help and the Self-Stigma of Seeking Help Scale, incorporating Chinese sociocultural characteristics.48, 49, 50 It contains two dimensions of self-stigma and public stigma, with a total of 10 items. Items are rated on a five-point Likert scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points), with higher total scores indicating greater perceived stigma. The scale demonstrated excellent reliability in this study (Cronbach's α ​= ​0.977).

Data collection

Before study initiation, researchers underwent standardized protocol training to ensure strict adherence to inclusion/exclusion criteria during participant recruitment. Participants received standardized verbal explanations of study objectives and provided informed consent before administering the Chinese version of the paper questionnaire. Clear instructions emphasized the absence of correct answers, encouraging truthful responses requiring approximately 15–20 minutes for completion. Researchers provided neutral clarification of ambiguous items without influencing participants’ responses. Completed questionnaires were immediately collected with content verification, while maintaining participant confidentiality through anonymized data collection. All collected data were utilized exclusively for academic purposes.

Data analysis

LPA was performed in Mplus 8.3 to examine the 10 items of ATSPPH among patients with CRC, testing models with 1–5 latent subgroups. Model selection followed established criteria:43,51 (a) Information criteria: Lower Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and adjusted BIC (aBIC) values indicated better model fit; (b) Likelihood ratio tests: Significant Lo-Mendell-Rubin (LMR) test and Bootstrap Likelihood Ratio Test (BLRT) results (P ​< ​0.05) supported k-class solutions over k-1-class models; (c) Classification quality: Entropy values approaching 1 denoted superior classification accuracy; (d) Practical consideration: Minimum subgroup sample size exceeding 5% of the total participants. Statistical analyses were performed using SPSS 26.0. Continuous variables were expressed as mean ​± ​standard deviation (SD) and compared using analysis of variance (ANOVA). Categorical variables were summarized as frequencies with percentages, with group comparisons conducted via Wilcoxon rank-sum test, Kruskal–Wallis H test, χ2 test or Fisher's exact test as appropriate. Multivariate logistic regression analysis identified predictors of categorical outcomes across patient subgroups. A two-tailed α level of 0.05 defined statistical significance.

Results

Demographic characteristics of participants

This study enrolled a total of 236 patients with CRC. The patients had a mean age of 63.48 ​± ​10.32 years. The majority of participants were male (65.7%), reported religious beliefs (0.8%), engaged in farming (33.9%), had a primary education level or below (43.2%), were unmarried (2.1%), had a monthly per capita family income below 2000 yuan (68.6%), were covered by urban resident medical insurance (44.5%), resided in urban areas (66.1%), and had a psychiatric history (0.4%). Clinical profiles included self-rated poor health status in over half (55.1%), rectal cancer (53.4%), and cancer stage III (74.6%). Surgery intervention was the primary treatment modality (74.6%), while enterostomy procedures were performed in 12.7% of cases.

Scores of each scale

Participants demonstrated moderate to low attitudes scores (13.69 ​± ​3.98), with dimension scores of 4.67 ​± ​1.39 (openness), 6.04 ​± ​1.90 (effectiveness), and 2.97 ​± ​1.29 (independence). Mental health literacy and perceived stigma scores were 5.50 ​± ​4.85 and 31.68 ​± ​7.78, respectively.

Classification and nomenclature of latent profiles

Using scores from a 10-item ATSPPH-SF as exogenous indicators, five latent profile models were tested (Table 1). Within-class distributions of indicator variables were examined using histograms and Q–Q plots, confirming no severe deviations from normality. As model complexity increased, AIC, BIC, and aBIC values demonstrated progressive decreases. The 3-class solution achieved favorable classification quality (Entropy ​= ​0.976) with significant likelihood ratio test results (LMR P ​< ​0.05; BLRT P ​< ​0.05). Furthermore, for the 3-class model, the average posterior probabilities ranged from 0.979 to 1.000, indicating excellent classification quality and profile separation. Comprehensive evaluation of fit indices confirmed the 3-class model as optimal. Final latent profiles are presented in Fig. 1.

Table 1.

Latent profile model fit indices.

Model AIC BIC aBIC Entropy P (LMR) P (BLRT) Class probability (%)
1 4238.438 4307.714 4244.322 – – – 100.0
2 3486.764 3594.142 3495.884 1.000 0.2360 < 0.001 78.4/21.6
3 3113.672 3259.153 3126.029 0.976 0.0068 < 0.001 26.6/51.8/21.6
4 2907.390 3090.973 2922.984 0.982 0.5651 < 0.001 26.7/51.7/20.3/1.3
5 2691.898 2913.583 2710.728 0.983 0.7592 < 0.001 22.0/5.4/46.8/16.1/9.7
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AIC, Akaike information criteria; BIC, Bayesian information criteria; aBIC, adjusted BIC; LMR, Lo–Mendell–Rubin; BLRT, Bootstrap-based likelihood ratio test.

Fig. 1.

Fig. 1

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Latent profile characteristics of ATSPPH. ATSPPH, attitudes toward seeking professional psychological help.

Based on item scores and their respective dimensions, the three latent profile categories were named. Class 1, characterized by low scores across all items with the lowest score on item 10 (independence dimension), reflects participants’ tendency to resolve psychological issues independently rather than seek professional help. Therefore, it was named the “negative attitudes-high independence group”. Class 2, which scored close to the medium level in all items, was named the “general attitudes group”. Class 3, showing uniformly high scores with peak performance on item seven (effectiveness dimension) and indicating strong endorsement of professional psychological help-seeking efficacy, was therefore named the “positive attitudes-high affirmation group”.

Univariate analysis of the ATSPPH latent profiles among patients with CRC

As shown in Table 2, univariate analysis of patients with CRC in Model 3 revealed statistically significant differences in age, occupational status, education level, family monthly income per capita, payment method, current residence, self-rated of health status, treatment modalities, mental health literacy scores, and perceived stigma scores (all P ​< ​0.05). Further Post-hoc analysis revealed that as scores of MMHL, knowledge, and belief dimensions increased from low to moderate to high, the positivity of ATSPPH increased successively. Patients in the negative attitudes-high independence group demonstrated lower scores in the resource dimension than those in the general attitudes group and positive attitudes-high affirmation group. As scores of SSPPH and its two dimensions decreased from high to moderate to low, the positivity of ATSPPH increased accordingly. Additional details are presented in Table 3.

Table 2.

Univariate analysis of the ATSPPH latent profiles among patients with CRC.

Variables Negative attitudes-high independence group (n ​= ​63) General attitudes group (n ​= ​122) Positive attitudes-high affirmation group (n ​= ​51) Statistic P
Age (years, mean ​± ​SD) 68.87 ​± ​7.44 62.95 ​± ​10.38 58.08 ​± ​10.21 F ​= ​18.041 < 0.001
Occupational status (n) χ2 ​= ​45.630 < 0.001
Jobless 16 25 7
Incumbency 2 10 12
Retire 4 31 20
Farm 30 46 4
Other 11 10 8
Education level (n) H ​= ​34.178 < 0.001
Primary and below 42 49 11
Middle school 20 42 18
High school 1 21 15
College and above 0 10 7
Family monthly income per capita (n) H ​= ​42.604 < 0.001
< 2000 yuan 60 83 19
2000-4000 yuan 3 36 32
> 4000 yuan 0 3 0
Payment method (n) χ2 ​= ​24.403 < 0.001
Employee medical insurance 5 27 18
Urban resident medical insurance 28 49 28
New rural cooperative medical insurance 30 46 5
Current residence (n) χ2 ​= ​18.141 < 0.001
Towns 34 76 46
Rural 29 46 5
Self-rated health status (n) H ​= ​13.100 0.001
Preferably 1 0 1
General 17 56 31
Mediocre 45 66 19
Treatment modalities (n) Fisher ​= ​10.969 0.011
None 2 0 0
Surgery 38 96 42
Surgery and chemotherapy/radiotherapy 23 26 9
MMHL scores (mean ​± ​SD) 2.94 ​± ​2.66 4.78 ​± ​4.29 10.41 ​± ​4.79 F ​= ​49.604 < 0.001
SSPPH scores (mean ​± ​SD) 36.76 ​± ​3.95 32.52 ​± ​7.26 23.39 ​± ​5.76 F ​= ​99.352 < 0.001
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CRC, colorectal cancer; ATSPPH, attitudes toward seeking professional psychological help; SD, standard deviation; MMHL, mental health literacy; SSPPH, stigma for seeking professional psychological help.

Table 3.

Comparison of scores of MMHL, SSPPH among 3 latent profiles (Mean ​± ​SD).

Variables Negative attitudes-high independence group (C1) General attitudes group (C2) Positive attitudes-high affirmation group (C3) F P Post hoc
MMHL 2.94 ​± ​2.66 4.78 ​± ​4.29 10.41 ​± ​4.79 49.604 < 0.001 C1 ​< ​C2 ​< ​C3
Knowledge 1.16 ​± ​1.31 1.99 ​± ​2.05 4.71 ​± ​2.48 42.694 < 0.001 C1 ​< ​C2 ​< ​C3
Belief 1.78 ​± ​1.75 2.50 ​± ​2.04 4.86 ​± ​1.91 41.689 < 0.001 C1 ​< ​C2 ​< ​C3
Resource 0.00 ​± ​0.00 0.29 ​± ​1.01 0.84 ​± ​1.63 9.347 < 0.001 C1 ​< ​C2; C1 ​< ​C3
SSPPH 36.76 ​± ​3.95 32.52 ​± ​7.26 23.39 ​± ​5.76 99.352 < 0.001 C1 ​> ​C2 ​> ​C3
Self-stigma 18.97 ​± ​2.21 16.75 ​± ​3.82 11.71 ​± ​3.12 97.883 < 0.001 C1 ​> ​C2 ​> ​C3
Public stigma 17.79 ​± ​2.64 15.76 ​± ​4.04 11.69 ​± ​3.11 61.951 < 0.001 C1 ​> ​C2 ​> ​C3
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MMHL, multicomponent mental health literacy; SSPPH, stigma for seeking professional psychological help; SD, standard deviation; Post hoc comparisons confirmed significant differences in mean scores between specific profiles.

Multivariate analysis of the ATSPPH subgroups among patients with CRC

The latent profiles of ATSPPH among patients with CRC were set as dependent variables, with the “positive attitudes-high affirmation group” serving as the reference category. Variables statistically significant in the univariate analysis were included as independent variables in the multivariate logistic regression analysis. The results demonstrated that age, mental health literacy, and perceived stigma were significant predictors of attitudinal classification among patients with CRC (all P ​< ​0.05), with complete regression parameters detailed in Table 4.

Table 4.

Multivariate logistic regression of ATSPPH subgroups.

Dependent variables Independent variables β SE Wald χ2 P OR 95% CI
Negative attitudes-high independence groupa Age 0.111 0.042 7.046 0.008 1.117 1.029–1.212
SSPPH 0.294 0.072 16.438 < 0.001 1.341 1.164–1.546
General attitudes groupa MMHL −0.149 0.070 4.595 0.032 0.861 0.751–0.987
SSPPH 0.134 0.050 7.071 0.008 1.143 1.036–1.262
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Nagelkerke R2, 0.628.

a

“Positive attitudes-high affirmation group” as the reference category; ATSPPH, attitudes toward seeking professional psychological help; SE, Standard Error; OR, Odds Ratio; CI, Confidence Interval; SSPPH, stigma for seeking professional psychological help; MMHL, multicomponent mental health literacy.

Discussion

Heterogeneity in ATSPPH exists among patients with CRC

This study employed LPA to reveal significant heterogeneity in ATSPPH among CRC patients, categorizing them into three distinct subgroups. The “negative attitudes-high independent group” subgroup (26.6% of the total sample) exhibited the lowest attitudes score (9.00 ​± ​1.63) compared with the other two classes. Notably, Item 10 (“Emotional problems resolve spontaneously like many other issues”) received the lowest score within this subgroup, indicating a prevalent belief that psychological distress self-resolves and reluctance to seek psychological care, reflecting their negative attitudes. This may be attributed to traditional Chinese cultural values, where physical illnesses are more readily sympathized with and accepted. However, mental health problems are often associated with personal morality, rendering it a stigma to seek psychological help.22 Therefore, it is particularly important for these individuals to acknowledge their psychological distress and trust psychological care.

The “general attitudes group” accounted for the largest proportion (51.8%) and had an attitudes score (14.02 ​± ​2.02) which was close to the median. Further, the average score of each item in this subgroup was at a middle position, suggesting a neutral positioning in ATSPPH. The “positive attitudes-high affirmation group” (21.6%) demonstrated the highest attitudes score (18.69 ​± ​2.83), indicating positive ATSPPH. Additionally, Item 7 (“I believe psychological counseling could alleviate my distress during severe emotional crises”) achieved higher scores than the other items. The present study revealed that perceived efficacy affirmation of psychological interventions significantly reduces help-seeking barriers and improves engagement with psychological care, which aligns with previous research.52 Given that positive attitudes towards psychological help-seeking play a crucial role in the initiation and modification of help-seeking behaviors.53, 54, 55 In this context, it is imperative to highlight the timely provision of psychological service resources and channels for these individuals, thereby maintaining their positive attitudes.

Moderate to low attitudes scores among patients with CRC

Patients with CRC scored (13.69 ​± ​3.98) on attitudes scores, with an overall moderate to low level that was significantly lower than that of international oncology patients (26.48 ​± ​2.52).29 This may be attributed to differences in cultural values and mental health service resources between domestic and international contexts. Culturally, the Chinese population, rooted in Confucian values that emphasize face and familialism, may avoid seeking mental health services to protect family and personal reputation.30 Instead, they tend to address psychological distress independently or seek support from family and friends. By contrast, Western cultures emphasize individualism and self-expression, encouraging individuals to openly express psychological distress.56 Thus, such cultural differences may explain why Western societies demonstrate more positive ATSPPH. Regarding mental health service resources, international counterparts have initiated services earlier and offer more diverse forms of care.57,58 In China, however, the development of mental health services is uneven, with resources predominantly concentrated in economically developed eastern cities, while the central and western regions suffer from an insufficient supply and a lack of publicity.59 Thereby, patients in these regions have limited awareness of the need for psychological help-seeking, leading to more negative attitudes toward it.

Influencing factors of ATSPPH among patients with CRC

Age

The results of this study showed that older patients had a higher probability of belonging to the “negative attitudes-high independence group” (OR ​= ​1.117, P ​= ​0.008). Although clinically modest, this OR reflects an 11.7% increase in the odds of group membership per additional year of age. Its significance is reinforced by evidence of a rapidly expanding population of cancer survivors aged ≥ 65, who present unique psychological needs, establishing them as a high-priority group to study.60 The current study revealed that the mean age of patients with CRC was (63.48 ​± ​10.32) years, with a predominance of older individuals, which aligns with the findings of previous research.61,62 Despite older individuals facing various psychological stressors with aging,63 their utilization rate of mental health services remains lower than expected.64 This may be attributed to their limited capacity to process and integrate health information,65 reduced receptiveness to new concepts, and adherence to more traditional perspectives.66 In addition, this population grew up during the early stages of China's economic development, a period characterized by society's prioritization of basic subsistence needs over educational development.67 In this context, they struggle to recognize their psychological distress and demonstrate low awareness of mental health services. Consequently, these findings highlight the need to prioritize geriatric populations in psychological oncology care through age-adapted interventions. Targeted mental health education, for instance, could enhance awareness of psychological distress and improve ATSPPH.

Mental health literacy (MHL)

Our study identified that patients with high mental health literacy were less likely to belong to the “general attitudes group” (OR ​= ​0.861, P ​= ​0.032). These results are consistent with existing evidence,68 highlighting the imperative of improving mental health literacy. Previous studies have shown that mental health literacy is positively associated with individuals’ ATSPPH.69 Further, mental health literacy positively correlates with health information-seeking efficacy.70 Individuals with elevated mental health literacy demonstrate enhanced capacity to access diversified psychological support resources, thereby improving access to psychological care. N Osman et al.71 showed that high mental health literacy facilitates help-seeking behaviors that ultimately improve mental health outcomes. Medical staff should tailor interventions to individuals with limited mental health literacy. For example, adopting therapeutic communication strategies to establish trust-based clinician-patient alliances, thereby enhancing recognition of psychological distress. Additionally, systematic dissemination of mental health service information through accessible channels can optimize care accessibility, fostering positive help-seeking attitudes.

Stigma for seeking professional psychological help (SSPPH)

This finding emphasizes that patients with high perceived stigma were more likely to belong to the “general attitudes group” or “negative attitudes-high independence group”. A significant negative correlation was observed between perceived stigma and ATSPPH, which is consistent with the findings of Swisher et al.72 High perceived stigma may lead individuals to fear encountering public prejudice and discrimination.39 Simultaneously, when these negative social evaluations are internalized, anticipated self-stigma occurs.73 Consequently, the subgroup exhibiting these distinct psychological characteristics demonstrates negative ATSPPH and avoids psychological care. On the contrary, individuals with low perceived stigma are more positive in seeking psychological help and demonstrate higher acceptance of treatment modalities and therapists’ backgrounds.74 Therefore, it is recommended that medical staff and mental health service providers intensify public education campaigns, while policymakers prioritize the enhancement of mental health infrastructure to elevate public awareness of professional psychological help-seeking. Further, cultivating correct mental health values among patients with CRC is critical to improving ATSPPH.

Implications for nursing practice and research

The findings reveal the current status and influencing factors of ATSPPH among patients with CRC, providing pivotal guidance for nursing interventions and policy development. Attitudes scores were moderate to low, with significant heterogeneity. Stratified nursing intervention strategies are proposed for patient subgroups characterized by older age, low mental health literacy, or high perceived stigma: (1) At the cognitive intervention level, implement precise psychological education; (2) At the service mechanism level, optimize access to psychological care. (3) At the social support level, establish peer support networks with the “positive attitudes-high affirmation group” to reinforce social validation of help-seeking behaviors. Regarding policy development, it is recommended to integrate the assessment of ATSPPH into standardized CRC diagnostic and treatment protocols, with the required allocation of psychiatric nurse specialists in tertiary hospitals. Meanwhile, specialized nurses such as stoma therapists should serve as integral members of multidisciplinary surgical teams. They are positioned to facilitate early identification of psychological distress, encourage professional psychological help-seeking, and initiate appropriate interventions. Furthermore, mental health literacy enhancement programs should be established, complemented by advancing digital health policies to deliver online psychological care to patients. These changes can improve ATSPPH and enhance the accessibility of psychological care.

Limitations

The cross-sectional design precludes causal inference and temporal assessment of variable relationships. Furthermore, self-reported measures are subject to recall and social desirability biases. In addition, although demographic variables were controlled, residual confounding from unmeasured factors (e.g., social support, personality traits, cultural influences) may persist. Meanwhile, both the original and Chinese versions of the ATSPPH-SF, MMHL, and SSPPH scales lack established thresholds. Future studies should address this methodological limitation through large-sample psychometric validation to derive empirically based cut-offs. Finally, the sample was restricted to one tertiary hospital in Anhui Province, potentially leading to selection bias due to limited generalizability. The restricted sampling frame restricts extrapolation to populations with distinct demographic, socioeconomic, or regional characteristics. Consequently, future studies may consider stratified or multicenter sampling to improve representativeness. Future studies should expand the sample size to include more relevant factors and adopt multicenter longitudinal designs, enabling more scientifically rigorous and comprehensive analyses.

Conclusions

This study revealed that the attitudes scores were moderate to low among patients with CRC, with three profiles identified: “negative attitudes-high independence group”, “general attitudes group”, and “positive attitudes-high affirmation group”. Age, mental health literacy, and perceived stigma emerged as significant determinants of profile membership. Medical staff are advised to recognize heterogeneity and develop tailored intervention strategies to optimize psychological care accessibility. While acknowledging constraints, these findings provide new perspectives for developing future psychological interventions for patients with CRC.

CRediT authorship contribution statement

Min Hu: Conceptualization, Data curation, Formal analysis, Writing. Tingting A, Xinxin Zhang: Conceptualization, Methodology, Formal analysis, Data curation. Xinxin Huang, Qingqiu Wu: Formal analysis, Writing - Revised draft preparation, Data curation. Tingting Wei, Beibei Song: Resources, Investigation. Shaohua Hu: Writing - review & editing, Supervision. All authors have read and agreed to the published version of the manuscript.

Ethics statement

This study was approved by the Ethics Committee of Anhui Medical University (IRB No. 82240227) and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants provided written informed consent.

Declaration of generative AI and AI-assisted technologies in the writing process

No AI tools/services were used during the preparation of this work.

Funding

This study was supported by the Seedling Cultivation Project for Graduate Students of the School of Nursing, Anhui Medical University (Grant No. Hlqm12025083), the Health Research Project of Anhui Province (Grant No. AHWJ2023A20058). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Data availability statement

The data that support the findings of this study are available from the corresponding author, SH, upon reasonable request.

Declaration of competing interest

The authors declare no conflict of interest.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.apjon.2025.100755.

Appendix A. Supplementary data

The following is the Supplementary data to this article:

Multimedia component 1
mmc1.docx (10.6KB, docx)

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author, SH, upon reasonable request.

Articles from Asia-Pacific Journal of Oncology Nursing are provided here courtesy of Elsevier

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