Refining the Attitudes Toward Seeking Professional Psychological Help Scale: factorial invariance across two Asian samples.(ARTICLES)(Report)

This article describes the validation and refinement of the short, 10-item version of the Attitudes Toward Seeking Professional Psychological Help (E. H. Fischer & J. L. Turner, 1970) scale using 2 separate samples. Confirmatory factor analyses results provided evidence of factorial invariance across both samples, thus supporting the cross-validation of a revised 9-item measure.

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The Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH; Fischer & Turner, 1970) measures an individual's tendency to seek or resist professional aid during a personal crisis or following prolonged psychological discomfort. The ATSPPH scale has been widely used and cited since its development more than 30 years ago and consists of four subscales derived from exploratory factor analysis (EFA). The four subscales are Recognition of Personal Need for Professional Psychological Help, Tolerance of the Stigma Associated With Psychological Help, Interpersonal Openness Regarding One's Problems, and Confidence in the Mental Health Professional. Fischer and Turner recommended the use of the overall ATSPPH score because of the modest internal consistencies of some of the subscales. Subsequent research has also revealed low-to-moderate internal consistencies in the range of .50s and .60s for some of the subscales (e.g., Duncan, 2003; Good & Wood, 1995; Yeh, 2002). Despite its popularity and use, few published studies have directly examined the replicability of the 29-item ATSPPH scale with four underlying factors (subscales). Through the use of EFA, Surgenor (1985) and Morgan (1992) found support for a five-factor ATSPPH scale. More recently, Al-Darmaki (2003) attempted, yet failed, to replicate the original four-factor structure of the ATSPPH scale with a college sample from the United Arab Emirates. Instead, three factors were found, with equally modest internal consistencies for the subscales (Al-Darmaki, 2003). Using EFA, Williams, Skogstad, and Deane (2001) found the ATSPPH scale to have a single unitary factor with a sample of male prison inmates from New Zealand. Collectively, these findings suggested that the underlying structure of the scale could be unstable across different populations.

The instability of the original four-factor structure of the ATSPPH scale, together with Fischer and Farina's (1995) belief that the construct of interest to most investigators would be best defined by a unidimensional measure of attitude toward seeking professional help, led Fischer and Farina to revise the original scale. This resulted in a 10-item, unidimensional version of the Fischer and Turner (1970) scale that measures a general help-seeking attitude and orientation. Sample items include "If I believed I was having a mental breakdown, my first inclination would be to get professional attention" and "If I were experiencing a serious emotional crisis at this point in my life, I would be confident that I could find relief in psychotherapy." A literature search using major databases such as PsycINFO, PsycLIT, EBSCO Host, Web of Science, and ScienceDirect generated at least a dozen articles that had used the short version of the ATSPPH scale since its publication in 1995.

Both the original and the short versions of the ATSPPH scale have been used extensively in previous studies carried out both in and outside of the United States. The following review illustrates the extent and scope of use of the ATSPPH scale internationally. In the United States, a substantial amount of research has focused on individuals from largely Caucasian samples (Cepeda-Benito & Short, 1998; Komiya, Good, & Sherrod, 2000; Lopez, Melendez, Sauer, Berger, & Wyssmann, 1998; Uffelman & Hardin, 2002).

In addition, the ATSPPH scale has been used to examine the help-seeking attitudes of ethnic minority groups in the United States (Duncan, 2003; Kim & Omizo, 2006; Tata & Leong, 1994; Wallace & Constantine, 2005). These authors raised concerns about the reluctance of individuals in ethnic minority groups to seek professional psychological intervention. For example, it has been observed that African American men underutilize mental health services, despite telling signs that they are at high risk of experiencing psychological distress (Duncan, 2003). Wallace and Constantine suggested that Africentric cultural values, such as collectivism and communalism, may be additional factors affecting the attitudes of African American men toward seeking professional psychological help. An explanation provided by Duncan is that African Americans may prefer to handle problems without displaying signs of stress or may choose to suppress the intensity of their stress. Consequently, they view professional psychological intervention as a last resort to cope with their distress. Several studies have also used the ATSPPH scale to measure the help-seeking orientations of Asian American individuals. These studies on Asian Americans have sought to explore the relationship between acculturation and help-seeking orientation (Kim, Li, & Ng, 2005; Tata & Leong, 1994). Results appeared to demonstrate that greater acculturation was linked to a more positive help-seeking orientation (Tata & Leong, 1994). Conversely, adherence to Asian values correlated with less positive attitudes toward seeking professional psychological help (Kim et al., 2005).

Researchers have used the ATSPPH scale with culturally diverse groups in countries outside of the United States. Studies using the scale with Caucasian samples outside of the United States include those carried out in Australia (e.g., Wrigley, Jackson, Judd, & Komiti, 2005) and New Zealand (e.g., Skogstad, Deane, & Spicer, 2006). For example, Wrigley et al. explored the role of various psychological variables, such as perceived stigma, in the willingness of people to seek professional psychological help in a rural setting in Australia. Their study was based on observations from previous research that people living in rural areas possess stoic and self-reliant attitudes, which made it difficult for them to admit to experiencing problems and to ask for help (Fuller, Edwards, Procter, & Moss, 2000; Weinert & Long, 1987).