Abstract
BACKGROUND:
Nursing students experience multiple challenges related to patients, educators, clinical learning environment, and also professional identity. This study aims to investigate the relationship among perceived social support, self-esteem, and the help-seeking behavior of nursing students in Iran.
MATERIALS AND METHODS:
The present study is a cross-sectional study conducted on 216 nursing students in 2023. The sampling method was proportional stratified random sampling. Inclusion criteria were nursing students at bachelor’s, master’s, and PhD. levels, who have passed more than one semester since their studies. Data collection tools included a demographic information questionnaire, Rosenberg self-esteem scale, perceived social support questionnaire, help-seeking behavior, and general help-seeking behavior questionnaire. Data analysis was conducted using descriptive statistical tests and analytical tests (independent t-test, Mann-Whitney-U test, Spearman correlation coefficient, and multivariate linear regression), at a significance level of less than 0.05, using SPSS software version 20.
RESULTS:
The results showed that there is a positive correlation among perceived social support and students’ self-esteem (r = 0.448, P < 0.001), social support and general help-seeking behavior (r = 0.331, P < 0.001), and social support and academic help-seeking behavior of students (r = 0.402, P < 0.001), which means that students’ help-seeking behavior and academic help-seeking behavior are strengthened by improving perceived social support.
CONCLUSION:
The findings of the present study can facilitate the help-seeking behavior of nursing students, by identifying and activating the sources of social support and strengthening self-esteem. Therefore, it is suggested to provide such an environment in the university that strengthens the feelings of being valuable and cultivates a positive attitude in students, while increasing their self-esteem by meeting their needs and providing emotional support.
Keywords: Help-seeking behavior, nursing, self-esteem, social support, students
Introduction
College education is a challenging transition to adulthood. Nursing students struggle with many stresses and challenges like nurses in the clinical fields.[1] These problems may be related to patients, educators, clinical learning environment, and professional identity, which have deep and long-term consequences on their future career, economic and physical security.[2,3] The results of a comprehensive review revealed that in 24 cross-sectional studies, there was a significant 34% prevalence of depression among nursing students; while Asian nursing students had the highest prevalence of depression (43%),[4] which, in turn, provides grounds for leaving the nursing profession.[5] Nursing education in Iran also faces countless challenges regarding clinical and theoretical education. The results of a literature review conducted on the level of satisfaction of nursing students between the years 2011 and 2022, showed that the level of satisfaction in nursing students in clinical and educational fields low.[6] This issue, reveals the importance of physical, psychological, and practical support to deal with stresses and challenges in this period.[7]
Perceived social support refers to a metaphorical experience of kindness and support that comes from receiving respect, care, and help from others (such as family and friends). Social support acts as a shield against stress, empowering individuals to face the problems.[2,3,6,7] Social support plays a crucial role in academic performance, well-being, stress management, and mental health. It serves as a protective factor for young people facing high levels of stress in their daily lives.[8,9,10] Research shows that perceived social support leads to less academic burnout and greater academic achievements of nursing students.[11,12] Students experiencing higher quality of social support, have positive self-esteem and self-evaluation.[7]
The level of self-esteem is determined by the degree of worth individuals perceive in themselves. Self-esteem is a subjective evaluation of how an individual perceives their worth in relation to society and others.[13] High self-esteem addresses a desired evaluation of oneself, a precise, reasonable, and balanced appreciation of one’s value as a person and his/her merits. Having positive self-esteem enables nursing students to face and overcome obstacles more efficiently, and to actively focus on solving challenges in new environments.[14,15] Students who have positive feelings about themselves are less likely to be pressured by peers, use fewer drugs and drink less alcohol, are more persistent in difficult tasks, are happier, and most importantly, they have a greater desire for better academic performance.[16] Self-esteem has an impact on how nursing students professionalize themselves, affecting their behavior in the workplace and the level of care they offer.[17]
In addition to increasing self-esteem, social support is associated with the use of effective coping strategies. Although the prediction mechanism of social support regarding coping strategies is not clear, it has been proposed that self-esteem may have a mediating effect on social support and effective coping strategies.[18] In justifying this finding, it can be stated that social support leads to maintaining or increasing reduced self-esteem in facing undesirable events. In addition, self-esteem can create a good sense of self-efficacy in people and create more self-confidence when facing difficulties, thus enabling people to use effective coping strategies in coping with challenges.[14,19]
There are different types of effective and ineffective coping strategies like problem-solving, rationalization, help-seeking, imagining, avoiding, and self-accusation. Help-seeking involves actively seeking help from others by discussing problems to receive support and guidance for effective stress management and problem-solving.[20]
Help-seeking behavior is a type of self-regulating behavior that can be used by any student to solve their learning problems, with the help of other people as a learning aid.[21] Help-seeking behavior refers to students’ intentional activities when they encounter academic problems they cannot overcome on their own. Research shows that the help-seeking behavior of students has a lower level, compared to the public. Results of a study in the United States of America showed that only 26.9% of students who needed counseling for academic, physical, or psychological reasons sought help from official sources,[22] and in other studies, this rate has been reported as 12.9–30.5%.[22,23]
Reviewing research and studies show that most of the research conducted in the field of social support, self-esteem, and help-seeking behavior in students, especially nursing students, has been done individually or with other influencing variables. Since university plays an important role in perceived social support and developing students’ self-esteem, to eliminate the gap between the studies and considering that help-seeking behavior is different in various cultures,[24,25] the present study aims to determine the relationship between perceived social support and self-esteem, with help-seeking behavior of nursing students of Shahid Beheshti University of Medical Sciences.
Materials and Methods
Study design and setting
The current research is a cross-sectional (descriptive-correlation) study, which was conducted on nursing students in the School of Nursing and Midwifery of Shahid Beheshti University of Sciences in 2023.
Study participants and sampling
The research environment in this study the modern, well-equipped School of Nursing and Midwifery of Shahid Beheshti located in Tehran. Inclusion criteria were nursing students at bachelor’s, master’s, and PhD. levels, who have passed more than one semester since their studies, and had the tendency to answer the questionnaire. Exit criteria included incomplete completion of the questionnaires and transfer students.
According to a similar study,[14,25] the sample size was calculated to be 194 people with 90% power and 95% confidence interval, which increased to 216 students, by applying 10% for distorted and incomplete questionnaires. The sampling method in the present study was proportional stratified random sampling, so that, first, the number of nursing students studying at different levels of the School of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences was prepared; then, the classes of statistical population were divided into three groups including bachelor’s, master’s and PhD. The sample size was determined in categories, based on educational level, and the ratio of size of each category to the size of population. The total number of students studying nursing were 1388, including 1112 undergraduate, 214 masters, and 62 PhD. The sample population was calculated; out of 216 samples of 166 undergraduate students, 32 masters, and 18 doctoral students were selected and sampled. After completing the demographic information form, the study samples responded to the tools of help-seeking behavior, self-esteem, and social support.
Data collection tools and technique
Demographic information questionnaire: This questionnaire includes questions such as age, gender, marital status, place of residence, academic year, and education level.
Rosenberg self-esteem scale
The Rosenberg Self-Esteem Scale (1965) includes 10 general phrases that measure life satisfaction and feeling good about oneself. 5 statements are presented in a positive form (items No. 1–5) and another 5 statements are presented in a negative form (items No. 6 to 10). The score range on this scale extends from −10 to +10, with a score of +10 indicating extremely high self-esteem and a score of −10 indicating extremely low self-esteem. The validity and reliability of this scale were confirmed in different studies, 47% of self-esteem is explained by these two factors and Cronbach’s alpha coefficients with high values of 0.86 and 0.87 indicate the reliability and stability of the scale.[26] The reliability coefficient of the questionnaire in this study was obtained as 0.79, using the internal consistency method.
Perceived social support questionnaire
Perceived Social Support Questionnaire by Zimmet et al. (1998) measures the level of perceived social support from family, friends, and important people in an individual’s life, with 12 items on a 5-point Likert scale. The range of scores on this scale is 12–84, and an increase in the score means an increase in perceived social support. The validity and reliability of this scale have been reported as desired by Zimet et al.[27] Bagherian et al.[28] examined the psychometric properties of the Persian version of this scale and confirmed its reliability with Cronbach’s alpha coefficient as 0.84. The reliability coefficient of the questionnaire in current study was obtained as 0.88, using the internal consistency method.
Help-seeking behavior scale
Ryan and Pentrich’s help-seeking behavior questionnaire (1997) includes 14 questions in 2 dimensions: accepting of help-seeking and avoiding help-seeking (questions 9, 4, 2, 10, 12, 6, 8); each dimension has 7 items and is scored using a Likert scale from one to five (1 = completely disagree, 5 = completely agree). A score of 14–35 indicates low help-seeking behavior, a score of 35–49 indicates moderate help-seeking behavior, and a score higher than 49 indicates high help-seeking behavior. The validity of the questionnaire was confirmed using the factor analysis and principal component analysis method. The reliability of the questionnaire, using Cronbach’s alpha coefficient, was reported to be 0.74, which was acceptable for the scale of attitude toward accepting help-seeking behavior, and it was 0.72 for avoiding help-seeking, which was also acceptable.[29] The questionnaire in current study demonstrated a high level of reliability, with a coefficient of 0.85, as determined through the internal consistency method.
Questionnaire of general help-seeking behavior
This questionnaire was designed by Wilson et al.[30] in 2005 and has two subscales, which are scored based on sources of help (formal/informal) and type of problem (emotional/personal/and suicide thoughts) in a 7-point Likert scale. The source of help and the type of problem can be changed based on the purpose of the study and its requirements. Higher scores indicate more help-seeking behavior. The convergent validity of the questionnaire was supported by a positive correlation between students’ intention to get counseling and the perceived quality of their previous mental health experiences. The divergent validity of the questionnaire was also confirmed through the negative correlation between students’ intention to get counseling and their self-reported barriers to seeking professional psychological help. The reliability of the whole scale was reported as 0.85 through the internal consistency method, and test–retest reliability was reported as 0.92, which was considered favorable. In the present study, emotional/personal problems subscale was used. The reliability coefficient of the questionnaire in current study was obtained as 0.74, using the internal consistency method.
Data analysis method
Data analysis was conducted using descriptive statistical tests (frequency, relative frequency, mean, and standard deviation) and analytical tests (independent t-test, Mann–Whitney U test, Spearman correlation coefficient, and multivariate linear regression) at a significance level of less than 0.05 with SPSS software version 20. In this study, the relationships among social support, self-esteem and help-seeking behavior of the participants were examined [Figure 1].
Figure 1.
Model of relationship between variables
Ethical consideration
This study was approved by Research Ethics Community of Shahid Beheshti University of Medical Science (No. IR.SBMU.PHARMACY.REC.1402.179). Participants did not receive any incentive, and participation was voluntary. Informed consent for participation was obtained based on the proposal approved by the ethics committee. The participants were also assured of the confidentiality of their information, and it was explained that the results would only be used for research objectives.
Results
216 people participated in this study and the paper-pencil questionnaire was distributed among these 216 students, and all of them completed the questionnaire. The present study revealed that 62.5% of the participants identified as male. Additionally, 81% of the participants reported being single. 58% of the participants fell within the age range of 18–22 years old, and 77% possessed a bachelor’s degree [Table 1].
Table 1.
Demographic characteristics of participants in this study
| Variable | Number (%) | |||
|---|---|---|---|---|
| Gender | M | 135 (62.5%) | ||
| Female | 81 (37.5%) | |||
| Marital status | Single | 175 (81%) | ||
| Married | 41 (19%) | |||
| Age | 18–22 years old | 126 (58%) | ||
| 23–28 years old | 56 (26%) | |||
| 29–32 years old | 22 (10%) | |||
| More than 32 years old | 12 (6%) | |||
| Educational level | Bachelor’s | 166 (77%) | ||
| Master’s | 32 (15%) | |||
| PhD. | 18 (8%) | |||
| Academic year | First-year | 56 (26%) | ||
| Second year | 77 (36%) | |||
| Third year | 49 (23%) | |||
| Fourth-year | 34 (15%) | |||
| Place of residence | Dormitory | 109 (50.5%) | ||
| With family | 80 (37%) | |||
| Alone | 27 (12.5%) |
The results of the present study showed that the average score of perceived social support was 62.39 ± 12.04, the average score of self-esteem was 6.12 ± 4.52, the average score of general help-seeking behavior was 26.45 ± 5.93, and the average score of academic help-seeking behavior was 51.60 ± 8.29.
The results of Table 2 indicate that, there is a positive correlation between perceived social support and students’ self-esteem (P value < 0.001). There is no significant relationship between self-esteem and the general help-seeking behavior of students (P value: 0.114). However, the correlation between self-esteem and students’ academic help-seeking behavior is statistically meaningful (P value < 0.001). There is a positive correlation between perceived social support with help-seeking behavior and academic help-seeking behavior of students (P value < 0.001) [Table 2].
Table 2.
Determining the relationship of research variables
| Variable | Spearman’s correlation coefficient | P | ||
|---|---|---|---|---|
| Perceived social support and self-esteem | 0.448 | <0/001 | ||
| Self-esteem and help-seeking behavior | 0.108 | 0/114 | ||
| Self-esteem and academic help-seeking behavior | 0.185 | 0/006 | ||
| Perceived social support and help-seeking behavior | 0.331 | <0/001 | ||
| Perceived social support and academic help-seeking behavior | 0.402 | <0/001 |
The results indicate that, by adjusting the confounders of age, gender, marriage, and residence, using multivariate linear regression, one unit increase in social support score causes an increase of 0.09 of help-seeking score, and an increase of 0.262 in academic help-seeking score (P < 0.05), and for a one unit increase in self-esteem score, the academic help-seeking score increases by 0.331 (P < 0.05). Self-esteem had no significant relationship with seeking help (P > 0.05) [Table 3].
Table 3.
Correlation of research variables
| Variable | Beta coefficient | CI 95% |
P | |||||
|---|---|---|---|---|---|---|---|---|
| LL | UL | |||||||
| Social support with help-seeking | 0.091 | 0.024 | 0.157 | 0.008 | ||||
| Social support with academic help-seeking | 0.262 | 0.175 | 0.349 | 0.000 | ||||
| Self-esteem with help-seeking | 0.131 | -0.046 | 0.308 | 0.147 | ||||
| Self-esteem with academic help-seeking | 0.331 | 0.088 | 0.574 | 0.008 | ||||
The scores of the questionnaire were compared in subgroups of demographic variables. The results showed that there is a significant relationship among age with general help-seeking behavior, academic help-seeking, and social support. Also, there is a positive correlation between education (academic level) and help-seeking behavior, as well asacademic help-seeking and social support (P < 0.05). However, there is a negative correlation between education and self-esteem, between gender and marriage with general help-seeking behavior and academic help-seeking behavior, and between gender and marriage with self-esteem and social support (P > 0.05). There is a negative correlation between self-esteem and age (P > 0.05). Also, there is negative correlation between academic year and lifestyle with help-seeking behavior, academic help-seeking behavior, self-esteem, and social support (P > 0.05) [Table 4].
Table 4.
Relationship among demographic characteristics and perceived social support, self-esteem and help-seeking behavior of nursing students
| Dependent variables Demographic variables |
General help-seeking behavior | Academic help-seeking behavior | Self-esteem | Social support | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|||||||||||||||
| MD±SD | Sig (2-tailed) | MD±SD | Sig (2-tailed) | MD±SD | Sig (2-tailed) | MD±SD | Sig (2-tailed) | |||||||||||
| Gender | Female | 26.01±6.28 | 0.15* | 50.62±8.66 | 0.02* | 5.95±4.67 | 0.81** | 61.37±12.66 | 0.18** | |||||||||
| Male | 27.19±8.20 | 53.23±7.39 | 6.39±4.27 | 64.09±10.77 | ||||||||||||||
| Marriage status | Single | 26.18±5.80 | 0.15* | 51.40±5.80 | 0.46* | 5.87±4.69 | 0.89** | 62.63±11.36 | 0.14** | |||||||||
| Married | 27.63±6.39 | 27.63±6.39 | 7.17±3.54 | 61.36±14.70 | ||||||||||||||
| Age categories | 22-18 | 25.50±5.67 | 0.01*** | 62.15±10.9 | 0.02*** | 5.52±4.92 | 0.18**** | 50.66±8.48 | 0.04**** | |||||||||
| 23-28 | 28.16±5.81 | 62.19±13.2 | 6.67±3.98 | 51.32±7.83 | ||||||||||||||
| 29-32 | 28.27±5.22 | 67.00±9.52 | 8.18±2.68 | 56±7.92 | ||||||||||||||
| >32 | 25.25±8.18 | 57.41±13.6 | 6.00±4.08 | 54.66±6.42 | ||||||||||||||
| Educational level | BSN | 25.69±5.56 | 0.002*** | 61.75±11.81 | 0.021*** | 5.63±4.75 | 0.12**** | 50.75±8.25 | 0.01**** | |||||||||
| MSN | 28.46±6.23 | 65.96±8.94 | 7.62±3.49 | 54.03±8.47 | ||||||||||||||
| PhD | 29.88±6.87 | 61.88±17.42 | 7.88±2.60 | 55.11±6.78 | ||||||||||||||
| Academic year | First | 26.03±6.48 | 0.78*** | 61.53±13.26 | 0.34*** | 6.03±4.75 | 0.52**** | 50.62±8.18 | 0.98**** | |||||||||
| Second | 26.23±5.58 | 61.79±11.89 | 5.87±4.73 | 50.92±8.65 | ||||||||||||||
| Third | 27.12±6.23 | 64.55±10.65 | 6.40±4.30 | 53.14±8.77 | ||||||||||||||
| Fourth | 26.79±5.43 | 62.05±12.31 | 6.41±4.05 | 52.52±6.70 | ||||||||||||||
*Independent Samples t-Test, **Mann-Whitney U, ***One-way ANOVA, ****Kruskal-Wallis
Discussion
The present study aims to test the relationship between: social support and self-esteem; social support and help-seeking behavior; and self-esteem and help-seeking behavior; also, demographic variables and dependent variables.
Based on the first hypotheses of the study, there was a significant positive correlation between self-esteem and social support. This finding is in accordance with other studies among students.[31,32,33,34,35] In the explanation of this relationship, it can be mentioned that the positive and negative reactions of people around them and their support for people, cause changes in a person’s judgment about self-esteem.[14] Self-esteem is a judgment about oneself; it is the core and structure of a person’s psychology, which, as a protective shield, protects a person from stress and negative stressful life events.[36] Social support can increase an individual’s sense of being useful and valuable, so that he/she can find a more favorable attitude about himself/herself in self-evaluation and gain more self-esteem.[37]
Based on the second hypotheses of the study, there was a significant correlation between the perceived social support and the general help-seeking behavior of nursing students. The results of Lian et al.’s (2020)[38] study, which investigated the relationship between social support and help-seeking among Chinese international students in the U.S. Higher Education System, showed that when facing problems, the participants reported the most help-seeking behavior from partners, parents, and close friends, respectively, and a higher level of social support was significantly related to students’ help-seeking behavior.[39] It can be said that social support such as parental support, support of friends, and support of important people in life increases attitude and intention to seek help and leads to improvements in educational environments. Through social support, people meet their basic needs, which leads to positive perception, security, self-acceptance, attention, and self-respect, all of which provide necessary opportunities for growth and development, dynamism, and self-actualization.[40]
In the present study, based on the third hypotheses of the study, there was a relationship between self-esteem and the help-seeking behavior of nursing students, which is consistent with other studies.[41,42] Wang et al.[41] concluded that the higher the level of students’ self-esteem, the more compatible the help-seeking behavior, and the lower the self-esteem level, and the more likely they are to adopt maladaptive help-seeking behavior. Students with low self-esteem may underestimate their abilities and may not have enough self-confidence in themselves. The results of a study show that there is a negative relationship between the perceived threat to students’ self-esteem and formal help-seeking It also suggests that students may prefer to seek informal help because it is less threatening than formal support.[43] Higher self-esteem makes it easier for people to manage stressful situations by asking for help when needed. However, people with low self-esteem are more likely to have poor help-seeking behavior, which leads to depression, anxiety, loneliness, and poor academic performance.[44,45]
Based on the fourth hypotheses of the study, the results of the present study showed that there is a difference between academic help seeking in women and men. Other studies show that gender significantly affects help-seeking behavior.[46] In one study, women were more likely than men to seek non-professional help, while men were more likely than women to seek professional help.[47,48] More research is needed in this field.
The study shows a significant relationship between age and education level with general and academic help-seeking. Research shows that few young people seek help in formal and professional support resources, because they do not feel comfortable in disclosing personal problems.[49] Therefore, peer support plans can be an available and effective tool to support young students, which needs to be considered in the policies of academic environments.
On the other hand, student’s metacognitive skills increase with age, and they can better monitor their performance and use adaptive help seeking.[48] Future research should also consider the influence of student characteristics such as age on the decision to seek for academic assistance.
Limitations and recommendations
Although the findings of the present study extend previous research, it has limitations that are pointed out. First, considering that the current study was conducted cross-sectionally, the relationships obtained among the variables of academic help-seeking, self-esteem and social support cannot be considered causal. Maybe the relationships are due to the effect of other variables. Second, Nursing students were selected only from one of the medical sciences universities in Tehran, so the results cannot be generalized to nursing students from other universities and other students such as medicine and paramedicine. Third, in this study, a self-report tool was used. Among the limitations of self-report questionnaires is the tendency of participants to show pro-social bias. Finally, due to the fact that four questionnaires were used in this study, it is possible that the mental and psychological states of the respondents and even their fatigue may affect the results of the questionnaires. It is also suggested to conduct a study on the effect of an intervention based on strengthening the self-esteem of nursing students on help-seeking behavior in the future.
Conclusion
The review literature showed that most of the research studies conducted in the field of help-seeking behaviors in students, especially nursing students, have been done with various variables. The present study is innovative because of examining the relationship between perceived social support and self-esteem with the help-seeking behavior of nursing students. The results of this study confirm the necessity of providing social support for nursing students. Therefore, it is essential for managers and policy makers to provide educational periods and social support, especially in the area of bonding of students with their family, friends, and community as support networks to strengthen their self-esteem and provide effective coping strategies. It is suggested to provide such an environment in the university, which strengthens the feeling of being valuable and having a positive attitude in students, and increases self-esteem in students by meeting their needs and emotional support. The educational periods can be compromised of self-awareness, stress coping skills, problem solving, decision making, communication skills, creative and critical thinking, anger management, and the ability to say no.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
The authors appreciates all the students who contributed to completing this work. We appreciate the Research Vice-chancellor of Shahid Beheshti University of Medical Sciences who supported this study.
Funding Statement
This study was conducted with the financial support of the Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, under the code of IR.SBMU.PHARMACY.REC.1402.179.
References
- 1.Raesi R, Farajzadeh Z, Saadatjoo SA. The effect of development program of leadership style based on concept mapping on the components of nurses’ leadership style. J Nurs Educ. 2018;7:10–6. [Google Scholar]
- 2.Li J, Han X, Wang W, Sun G, Cheng Z. How social support influences university students’ academic achievement and emotional exhaustion: The mediating role of self-esteem. Learn Individ Differ. 2018;61:120–6. [Google Scholar]
- 3.Çamaş G, Yalçın İ. The relationships between stigma toward psychological help seeking, self-efficacy, family sense of coherence and social support. Kastamonu Educ J. 2021;29:233–45. [Google Scholar]
- 4.Xie N, Qin Y, Wang T, Zeng Y, Deng X, Guan L. Prevalence of depressive symptoms among nurses in China: A systematic review and meta-analysis. PLoS One. 2020;15:e0235448. doi: 10.1371/journal.pone.0235448. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.El Fadely A, Babram MA, Hassani SL, Selmaoui S, Agorram B. The individuals’ initial reasons to pursue a nursing career and subsequent study dropout intentions: A cross-sectional study. Nurs Pract Today. 2024 [Google Scholar]
- 6.Fang G, Chan PWK, Kalogeropoulos P. Social support and academic achievement of Chinese low-income children: A mediation effect of academic resilience. Int J Psychol Res. 2020;13:19–28. doi: 10.21500/20112084.4480. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Shang Y, editor, editor. 2021 International Conference on Social Development and Media Communication (SDMC 2021) Atlantis Press; 2022. Social support and subjective well-being: The critical role of mediator. [Google Scholar]
- 8.Taylor SE. Social support: A review. The Oxford handbook of Health Psychology. 2011;1:189–214. [Google Scholar]
- 9.Bagci SC. Does everyone benefit equally from self-efficacy beliefs? The moderating role of perceived social support on motivation. J Early Adolescence. 2018;38:204–19. [Google Scholar]
- 10.Fandokht OM, Ahmadzade M, Azizmohamadi S, Amjadi M. The role of social support and perfectionism in nursing and midwifery students’ academic engagement. Educ Strat Med Sci. 2020;13:260–6. [Google Scholar]
- 11.Kim HO, Lee I. The mediating effects of social support on the influencing relationship between grit and academic burnout of the nursing students. Nurs Open. 2022;9:2314–24. doi: 10.1002/nop2.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Clark KN, Dorio NB, Eldridge MA, Malecki CK, Demaray MK. Adolescent academic achievement: A model of social support and grit. Psychol Sch. 2020;57:204–21. [Google Scholar]
- 13.Liu Q, Jiang M, Li S, Yang Y. Social support, resilience, and self-esteem protect against common mental health problems in early adolescence: A nonrecursive analysis from a two-year longitudinal study. Medicine. 2021;100:e24334. doi: 10.1097/MD.0000000000024334. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Karaca A, Yildirim N, Cangur S, Acikgoz F, Akkus D. Relationship between mental health of nursing students and coping, self-esteem and social support. Nurs Educ Today. 2019;76:44–50. doi: 10.1016/j.nedt.2019.01.029. [DOI] [PubMed] [Google Scholar]
- 15.Pandey RA, Chalise H. Self-esteem and academic stress among nursing students. Kathmandu Univ Med J. 2015;13:298–302. doi: 10.3126/kumj.v13i4.16827. [DOI] [PubMed] [Google Scholar]
- 16.Brajsa-Zganec A, Lipovcan LK, Ivanovic D, Larsen ZP. Well-being of nursing students: Role of affect regulation, self-esteem, family cohesion and social support. Open Public Health J. 2017;10:69–79. [Google Scholar]
- 17.Vasli P, Mortazavi Y, Aziznejadroshan P, Esbakian B, Ahangar HG, Jafarpoor H. Correlation between critical thinking dispositions and self-esteem in nursing students. J Educ Health Promot. 2023;12:144. doi: 10.4103/jehp.jehp_1481_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Cui S, Cheng F, Zhang L, Zhang C, Yuan Q, Huang C, et al. Self-esteem, social support and coping strategies of left-behind children in rural China, and the intermediary role of subjective support: A cross-sectional survey. BMC Psychiatry. 2021;21:1–9. doi: 10.1186/s12888-021-03160-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Yıldırım N, Karaca A, Cangur S, Acıkgoz F, Akkus D. The relationship between educational stress, stress coping, self-esteem, social support, and health status among nursing students in Turkey: A structural equation modeling approach. Nurs Educ Today. 2017;48:33–9. doi: 10.1016/j.nedt.2016.09.014. [DOI] [PubMed] [Google Scholar]
- 20.Hamedani B, Alavi M, Taleghani F, Moghadam MF. Requirements for promoting help-seeking behaviors in family caregivers of cancer patients: A qualitative study. J Educ Health Promot. 2023;12:46. doi: 10.4103/jehp.jehp_512_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Rini PS, Wijanarko NA. The relationship of academic help-seeking with student achievement on nursing students in STIKes Muhammadiyah Palembang. Enfermería Clínica. 2020;30:106–9. [Google Scholar]
- 22.Dyrbye LN, Eacker A, Durning SJ, Brazeau C, Moutier C, Massie FS, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med. 2015;90:961–9. doi: 10.1097/ACM.0000000000000655. [DOI] [PubMed] [Google Scholar]
- 23.Kenny R, Dooley B, Fitzgerald A. How psychological resources mediate and perceived social support moderates the relationship between depressive symptoms and help-seeking intentions in college students. Br J Guid Counse. 2016;44:402–13. [Google Scholar]
- 24.Attis-Josias M. Minority Nursing Students’ Perceptions about Help-Seeking When Under Stress: A Basic Qualitative Study. Capella University. 2020 [Google Scholar]
- 25.Ombasa ZO. Factors Influencing Academic Help-Seeking Behavior of Basic Diploma Nursing Students in Kenya Medical Training College, Nairobi, Kenya. KeMU. 2019 [Google Scholar]
- 26.Ziaei F, Ghanbari H. Rosenberg self-esteem psychometric characteristics. Psychometry. 2022;10:1–6. [Google Scholar]
- 27.Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 1990;55:610–7. doi: 10.1080/00223891.1990.9674095. [DOI] [PubMed] [Google Scholar]
- 28.Bagherian-Sararoudi R, Hajian A, Ehsan HB, Sarafraz MR, Zimet GD. Psychometric properties of the Persian version of the multidimensional scale of perceived social support in Iran. Int J Prev Med. 2013;4:1277. [PMC free article] [PubMed] [Google Scholar]
- 29.Ganji K, Navabakhsh M. Relationship between identity styles and social well-being with help-seeking behavior of high school students in mathematic subject. Educ Psychol. 2011;7:95–123. [Google Scholar]
- 30.Wilson CJ, Deane FP, Ciarrochi JV, Rickwood D. Measuring help seeking intentions: Properties of the general help seeking questionnaire. 2005;39:15–28. [Google Scholar]
- 31.Ghorbani Dolatabadi M. The mediating role of self-esteem in the Relationship between social support with emotional exhaustion and psychological well-being. Journal of New Approaches in Educational Administration. 2021 Feb 19;11(46):151–70. [Google Scholar]
- 32.Samadifard H, Mikaeili N, Aghajani S. Relationship between happiness, perceived social support and self-Esteem with sexual addiction among couples. Iran Nurs Sci Assoc. 2019;6:75–81. [Google Scholar]
- 33.Hossein ZAA, Sepahmansour M. Relationship between social support and self-esteem with student. International Journal of Social Science and Human Research. 2024;7:7385–90. [Google Scholar]
- 34.Rajabi GR, Alibazi H, Jamali A, Abassi G. Relationship between self-esteem, social support with mental health in Shahid Chamran university students of Ahvaz. J Educ Psychol Stud. 2015;12:83–104. [Google Scholar]
- 35.Mohseni RA, Razavi SHR, Paghe B. Investigating the relationship between social support and self-esteem: A case study: Students of Gorgan public universities. Soc Res. 2015;28:19–48. [Google Scholar]
- 36.Hagen R, Havnen A, Hjemdal O, Kennair LEO, Ryum T, Solem S. Protective and vulnerability factors in self-esteem: The role of metacognitions, brooding, and resilience. Front Psychol. 2020;11:1447. doi: 10.3389/fpsyg.2020.01447. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Marzieh H, Massoud GD. The mediating role of self-esteem in the relationship between social support and emotional exhaustion and psychological well-being. Journal of New Approaches in Educational Administration. 2021;46:151–70. [Google Scholar]
- 38.Lian Z, Wallace BC, Fullilove RE. Mental health help-seeking intentions among Chinese international students in the US higher education system: The role of coping self-efficacy, social support, and stigma for seeking psychological help. Asian American Journal of Psychology. 2020;11:147. [Google Scholar]
- 39.Lemma A, Minichil W, Salelew E, Tadesa J, Kerebih H, Nigussie K, et al. University students’ help seeking intention for depression from health professionals; A cross sectional study. PLoS One. 2022;17:e0271392. doi: 10.1371/journal.pone.0271392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Javadi Elmi L, Asadzadeh H. Structural equation modeling of students’ academic engagement based on academic help-seeking, transformational teaching, perceived social support with the mediation role of academic buoyancy. Soc Psychol Res. 2020;10:101–22. [Google Scholar]
- 41.Wang J. Study of the relationship between self-esteem and academic self-seeking behavior among high school students. Educ Rev USA. 2023;7:817–22. [Google Scholar]
- 42.Zhang W. Relationships among Help-Seeking, Self-esteem, Work Avoidance and Locus of Control: A Path Analysis. The University of Arizona. 2018 [Google Scholar]
- 43.Qayyum A. Student help-seeking attitudes and behaviors in a digital era. Int J Educ Technol Higher Educ. 2018;15:1–16. [Google Scholar]
- 44.Adewuyi HO, Dwarika V. Psycho-personological correlates of academic help-seeking among in-school adolescents. Stud Learn Teach. 2023;4:195–204. [Google Scholar]
- 45.Li R, Che Hassan N, Saharuddin N. College student’s academic help-seeking behavior: A systematic literature review. Behav Sci. 2023;13:637. doi: 10.3390/bs13080637. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Topkaya N. Predictors of attitudes toward seeking professional psychological help among Turkish college students. Child Youth Serv Rev. 2021;120:105782. [Google Scholar]
- 47.Nurdiyanto F, Wodong GMA, Wulandari RM. Analysis on the attitude towards seeking professional psychological help. Unnes J Public Health. 2023;12:38–45. [Google Scholar]
- 48.Güney E, Aydemir AF, Iyit N, Alkan Ö. Gender differences in psychological help-seeking attitudes: A case in Türkiye. Front Psychol. 2024;15:1289435. doi: 10.3389/fpsyg.2024.1289435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Bryant A, Cook A, Egan H, Wood J, Mantzios M. Help-seeking behaviours for mental health in higher education. J Furth Higher Educ. 2022;46:522–34. [Google Scholar]