Medical students are future doctors. Therefore, reliable estimates of the PHSI among them are critical, especially given recent studies indicating a high prevalence of depression among resident physicians [32]. In our study, 16.4% of students had moderate to severe depression, indicating that depressive symptoms are common among medical students.
Depression was reported to be prevalent among medical students in America (17.0%) [33], Mexico (16.2%) [34], and New Zealand (16.9%) [35], all of which were comparable with findings. It is worth mentioning that the same depression screening instrument (PHQ-9) was used in the above mentioned studies, including ours.
Moreover, although our study showed that 72.0% of the students with PHSI, only 13.6% “definitely would go” to seek help if they encountered future psychological problems.
Although most colleges and universities have established relevant institutions that provide mental health services, this study found that, while nearly three-quarters of medical students reported having PHSI, 28% had no intention of seeking such professional help once they graduated; medical students may be a risk group with insufficient utilization of mental health services. Concerning utilization barriers, our study found that the top perceived utilization barrier among medical students was "the desire to handle their problems on their own." This barrier among our medical students is consistent with previous research, which reported that the individuals who believed they could solve their mental health problems were reluctant to admit their problems and had negative attitudes toward seeking professional help [36].
Our findings also show that male college students had lower PHSI than female students (68.0% VS 74.6%). The previous studies from Turkey [37] and Norway reported similar results [18]. Self-disclosure may be essential, and females are more willing to disclose themselves than males from the perspective of social psychology [16]. Women are more likely to seek emotional support and talk to others once faced with a stressful event or negative emotions. In traditional stereotypes, men are virtuous as a "tool of silence" and should not experience unfavorable emotional fluctuations. "A man's tears do not flick easily," according to an old Chinese proverb. Men are generally thought to be more robust than women. Men were likely to be more stressed when seeking professional psychological help under the influence of this type of gender role conflict, and they are more likely to have a negative attitude and a lower PHSI [38]. Considering these beliefs, it is necessary to develop gender-sensitive help-seeking interventions for male students based on evidence-based practice in the future.
In the present study, family dysfunction was significantly associated with lower PHSI. This finding is in line with a study conducted in Turkey [37]. Individuals and families in China are inextricably linked in the context of collectivist culture, and family is the most important social support network for Chinese college students. Good family functionality allows individuals to feel loved, cared for, and respected within the family, resulting in a positive emotional experience in social life. It also acts as a powerful buffer against social pressure [39]. Compared with students with low-income family functionality, students with good family functions may interact with their families more often and establish trusting relationships. This interaction may include conversation and exchange of ideas [40]. Therefore, if family members have positive attitudes toward seeking professional psychological help, students may be influenced by them and form more positive attitudes.
Furthermore, this study found that self-reported mobile phone addiction is associated with lower PHSI. Smartphones are now an essential part of daily life, bringing convenience to everyone's lives. However, college students excessive use of mobile phones can have negative consequences, such as disrupting sleep and schoolwork, as well as stress and other psychological issues [41–43]. In addition, college students suffering from depression may use smartphones to cope with negative emotions or as an "exit" to relieve stress [43]. They are obsessed with mobile technology and are unwilling to seek professional psychological help, creating a vicious circle of poor mental health. Therefore, college students should be informed about the potential risks associated with excessive smartphone use and encouraged to use smartphones responsibly.
Finally, it is worth noting that stigma is strongly linked to depression and lower PHSI. Public stigma is the negative impression of society on the help-seeking group [44]. Many people with depression refuse psychological help or hide their condition to avoid being labeled [45]. When people with mental illness internalize public stigma, it can lead to personal stigma and lower levels of self-esteem, believing themselves to be flawed and pathetic. We also discovered that medical students regard depression as an unpredictable and personal weakness. Physical illnesses are easier to receive sympathy and acceptance in traditional Chinese culture. However, the Chinese tend to define mental illness as a personal weakness and relate it to moral character. Young college students who conflict with the accepted prerequisites of interpersonal dependence and independence, intimacy and avoidance of such are eager to advance in the group and gain understanding and respect from others [46]. As a result of their fear of discrimination and rejection by others in interpersonal communication, they choose to hide and avoid psychological help.
The current education offered by colleges and universities in our country mainly focuses on acquiring professional knowledge while ignoring how to reduce the stigma associated with mental health. As a result, mental health education in schools should aim to break down stereotypes about seeking help.
There are several limitations to our study. First, cross-sectional data limits our ability to establish causal relationships between study variables, so future research using a cohort design is preferred. Second, although this is the first study focusing on PHSI among Chinese medical students, our sample was limited to medical students in a southern province surrounded by the sea. Hence, the findings of our study cannot be generalized to the entire Chinese population, and future research may consider this when selecting study samples. Second, the variation in sociocultural aspects in different countries or regions may influence the status of PHSI and the associated factors. Therefore, the findings of our study may not be generalized to the entire China population, and additional research in different countries and regions is required.