CC BY
47https://doi.org/10.32921/2663-1768-2019-2-31-32-41 Original article
The prevalence of depression among Nazarbayev University students and the use of psychological counselling on campus
Ainur Kagarmanova 1, Neil Collins 2
1 BSC - Executive Assistant to the Director General of the Republican Center for Health Development,
Nur-Sultan, Kazakhstan 2 PhD - Emeritus Professor to the University College Cork, Ireland
Abstract
Background. Depression is a treatable medical condition that is considered to be a single most significant contributor to non-fatal health loss worldwide. Although some patients cannot access proper treatment due to a lack of resources and trained medical personnel, others avoid utilising health facilities because of the specific social environment. This paper focuses on the social environment around depressive disorders in Kazakhstan and its influence on the public sentiments towards mental healthcare services. This ethnographic study was carried out in the Nazarbayev University community that offers its students a particular set of privileges. More specifically, students are provided with free psychological counselling services on campus; this eliminates two obstacles in receiving professional counselling at once: physical distance and financial insufficiency.
Methods. The major tool for primary data collection in this study is a questionnaire. Its first part is Beck's Depression Inventory, a self-administered instrument meant to measure the severity of depressive symptoms. The second part of the survey evaluates students' attitudes towards receiving psychological help; and finally, the third part of a questionnaire is a demographic survey, which is meant to assess the representativeness of the sample. It is anticipated that one of the major causes of not making use of counselling is fear of being socially stigmatised. Another may be mistrust in university services.
The statistical analysis used the R Studio software, and Microsoft Excel for computing the odds ratios. The odds ratio (OR) - a measure of association between exposure and outcome - is to be applied in this study to compare the relative odds of depression occurrence for a certain demographic variable (school, gender, age, nature of hometown location, and residence).
Results. The census response rate was 10.81%, which is enough for a 24.01% of surveyed students self-diagnosed with moderate, severe or extreme depression, while 10.04% were diagnosed with borderline clinical depression. When the depression level was correlated with gender, it was revealed that female students are twice as likely to develop depression as their male peers. The results indicated that 29.61% of all females and 14% of all males were experiencing clinical depression of certain severity; however, 39% of male respondents have mild mood disturbance compared with only 23.46% of female respondents. Age analysis revealed that students younger than 20 years of age are more likely to experience depression. When linking depression level to the year of academic study, no correlation was revealed. Meanwhile, students living on-campus (and away from families) are more likely to experience depression than those living off-campus (and with families).
Conclusions. Female sex, on-campus residency, being under 20 years of age is correlated with a depressive disorder. The major reason for students not to make use of university counselling services is its perceived insufficiency in solving the problem, and lack of available psychologists at the given moment in time.
Key words: Depression, mental health, college students, Kazakhstan, Central Asia.
Назарбаев Университетшщ бакалавриат багдарламасы студенттершщ арасында депрессияга ушырауы мен психологтьщ кецесше жупнушщ жиiлiгi
Кагарманова А.1, Neil Collins 2 1 Денсаулы; са;тауды дамытудын республикалы; орталыгы директорынын квмекш/d,
Нур-Султан, ^аза;стан 2 Корк университетт1к колледж/'н/'н ;урметт1 профессоры, Ирландия
TYÜ^eMe
Цысца аньщтама. Депрессия - емге багынатын медициналы; ауытиушылы; жэне ол денсаулы;ты твмендетет/'н манызды факторлардын б1р1. Депрессияга ушыраган кейб1р нау;астарда ;аражат пен ^уз/'ретт/' медициналы; ;ызметкерлерге ;аралу ;олжет/'мд1' болмайды. Ал ек/ншлер/' элеуметт/'к ортасынын ерекшел/'ктер/'не байланысты мамандандырылган медициналы; ;ызметкермен байланысудан бас тартады. Бул зерттеу элеуметт/'к ортанын депрессивт1 бузылыстарга деген квз;арасы мен осы квз;арастын менталды ауыт;ушылы;тар кез/'нде медициналы; квмекке жуг/'нудегi эсер/'н зерттеуге багытталган. Зерттеу жумысы студенттерге б1р;атар жагдай жасалган Назарбаев университет/'нде жYргiзiлдi. Эс/'ресе атап втет1н1 - аталмыш университетт1н студенттер1не психолог маманнын кенес/'н/'н ;олжет/'мдт/'гi. Бул вз кезег/'нде орналасуы мен ;аражатты сек/'лдi ею кедерг1н1 жояды.
Зерттеу эд/'стер/'. Зерттеуге ;ажеттi а;паратты жинаудагы нег/'згi ;урал Yш бвл1мнен туратын сауалнама болды. Сауалнаманын б1р1нш1 бвл/'мi - Бект1н депрессия шкаласы, ;атысушыда депрессиянын денгей1н аны;тауга арналган сура;тардан турады.
Статистикалы; саралау R Studio жэне Microsoft Excel багдарламаларын ;олдану ар;ылы жYргiзiлдi. МYмкiндiктер ;атынасы (odds ratio) аны;талды. МYмкiндiктер ;атынасы - ек жагдайдын арасындагы байланыстын тыгыздыгын сипаттайтын влшем болып табылады. Б/'зд/'н жагдайымызда - депрессиянын денгейi мен белглi бiр демографиялы; кврсеткiштiн (жас, жыныс, кафедра, тургылыцты жерi жэне т.б.) арасындагы байланыс зерттелдi (Szumilas, 2010).
Нэтижелерi: Сауалнамага ;атыс;ан студенттерд/'н Yлесi 10,81% ;урады. Олардын 24,01 пайызында депрессиянын твмен, ауыр жэне твтенше денгейлерi аны;талды. Сауалнамага ;атысушылардын 10,04 пайызында клиникалы; депрессиянын шекарасындагы жагдай диагностикаланды. Депрессиянын денгейiн жынысты; кврсеткшпен корреляциялаганда зерттелген эйел жынысты студенттерде депрессия даму ;ау/'пi ерлерге цараганда ек есе жиi екендiгi аны;талды. Зерртеудiн нэтижелерi кврсеткендей, ;атысушы эйелдерд/'н 29,61%-ы жэне ерлердiн 14%-ы белглi бiр ауырлы; дэрежес/'ндегi клиникалы; депрессияны бастан кешкенi аны;талды. Алайда ер жынысты респонденттердiн 39%-ы эйелдерд/'н 23,46%-ымен салыстырганда кв^л-^й&н женцл ауыт;ушылыгын бастан кешуде. Саралау нэтижеанде 20 жас;а дейiнгi шэк/'рттерд/'н депрессияга жиi ушырайтындыгы бай;алды. Депрессияны о;у жылымен байланыстырып квргенде еш;андай корреляция аны;талмады. Алайда, студенттiк ;алашы;та туратын (жануясынан жыра;та) студенттерд/'н ;алашы;та турмайтын (жануямен) студенттерге ;араганда жи депрессияга ушырайтындыгы бай;алады.
Цорытынды. Студенттiк ;алашы;та туратын 20 жас;а дейiнгi эйел жынысты студенттер депрессияга жиi ушырайды. Студенттерд/'н психологиялы; кенес ;ызметiне жYгiнбеуiнiн нег/'згi себептерi болып психологтын квмегi мэселенi шешуге квмектеспейдi деген п/'к/'р мен ;ажеттт1'к туындаган белглi бiр уа;ыт аралыгында писихолог маманнын ;олжет/'мд1' болмауы аталды.
К'ттт/ свздер: депрессия, психикалы; денсаулыколледж студенттерi, К,аза;стан, Орталы; Азия.
Распространенность депрессии и обращений к услугам психологического консультирования среди студентов программ бакалавриата в Назарбаев Университете
Кагарманова А.1, Neil Collins 2 1 Помощник генерального директора Республиканского центра развития здравоохранения, Нурсултан, Казахстан 2 Почетный профессор Университетского колледжа Корка, Ирландия
Резюме
Краткая справка. Депрессия - излечимое медицинское расстройство, которое является самым значительным фактором, способствующим потере здоровья при отсутствии смертельного исхода в мире. Хотя некоторые пациенты не имеют доступа к лечению из-за отсутствия ресурсов и доступа к компетентному медицинскому персоналу, другие избегают обращения к специализированным медицинским работникам ввиду специфичности социальной среды. Данное исследование фокусируется на социальной среде по отношению к депрессивным расстройствам и ее влиянии на общественное мнение о получении медицинской помощи при ментальных расстройствах. Исследование было проведено в Назарбаев Университете, который предлагает своим студентам ряд определенных привилегий. В частности, студентам предлагаются бесплатные услуги психологического консультирования, что устраняет сразу два
наиболее распространенных препятствия - географическое расстояние и нехватка финансовых средств.
Методы исследования. Основным инструментом для сбора первичной информации является опросник, состоящий из трех частей. Первая, Шкала Депрессии Бека, состоит из вопросов для самостоятельного заполнения используется для определения степени депрессии у участника.
Для проведения статистического анализа использовались программы R Studio и Microsoft Excel, были вычислены Отношения шансов (odds ratio). Отношение шансов - это величина, количественно описывающая тесноту связи между двумя событиями; в нашем случае - между степенью депрессии и определенным демографическим показателем (пол, возраст, кафедра, место проживания и т.д.) (Szumilas, 2010).
Результаты: Доля студентов, принявших участие в опроснике, составил 10,81%. Из них 24,01% диагностировали у себя умеренный, тяжелый или экстремальный уровень депрессии. У 10,04% опрошенных была диагностирована пограничная клиническая депрессия. При корреляции уровня депрессии с полом, было выявлено, что у учащихся-женщин вероятность развития депрессии в два раза выше, чем у их сверстников. Результаты показали, что 29,61% всех женщин и 14% всех мужчин испытывали клиническую депрессию определенной степени тяжести; однако 39% респондентов мужского пола имеют легкое расстройство настроения по сравнению только с 23,46% респондентов женского пола. Анализ возраста показал, что ученики младше 20 лет чаще страдают депрессией. При привязке уровня депрессии к году учебы корреляции не выявлено. Между тем, студенты, живущие в студенческом городке (и вдали от семей), более подвержены депрессии, чем те, кто живет вне студенческого городка (и с семьями).
Выводы. Женский пол, проживание в студенческом городке, возраст до 20 лет чаще всего коррелирует с депрессивным расстройством. Основная причина, по которой студенты не пользуются услугами психологического консультирования в университете, заключается в том, что они считают психологов неэффективными в решении проблем и отсутствие доступных психологов в определенный момент времени.
Ключевые слова: Депрессия, психическое здоровье, студенты колледжа, Казахстан, Средняя Азия.
Corresponding author: Ainur Kagarmanova, BSc - Executive Assistant to the Director General of the Republican Center for Health Development of the MoH RK, Nur-Sultan, Kazakhstan Postal code: 010000
Address: 95 Kashaubayev street, Nur-Sultan, Kazakhstan E-mail: Ainur.kagarmanova@nu.edu.kz
J Health Dev 2019;2(31): 32-41 UDC 61:001.12/.18; 61:001.83(100) Recieved: 18-04-2019 Accepted: 06-05-2019
This work is licensed under a Creative Commons Attribution 4.0 International License
Introduction
Depression is a mood disorder that causes severe symptoms affecting how one feels, thinks, and handles daily activities [1]. The signs must be observed for at least two weeks for a person to be diagnosed with depression. In 2015, 322 million people around the globe were diagnosed with a depressive disorder [2]. On top of that depression is also the most common mental health disorder associated with suicide [3].
Mental health of the university students is giving rise to concern worldwide. Previous research on the topic have produced unequivocal results that undergraduate students are indeed more vulnerable to depressive disorders than the general population [4]. According to Wahed et al., university students are a special group of people because at this age people are going through one of the most stressful periods in one's life. That is, they are transitioning from adolescence to adulthood. This age group is also significant because most mental diseases start during youth and late childhood [5]. The most common mental health disorder among university students worldwide is depression [6]. According to Beiter et al., academic pressure, examination success, post-graduation plans, and finances are amongst top four reasons contributing to the development of depression, anxiety or stress in university students. Moreover, depression is also proved to bring about a number of adverse effects such as smoking, poor diet, lack of exercise, poor sleep habits, and noncompliance with medical treatment recommendations [7]. The sense of isolation and disturbed sleep due to the increased use of technology, depressed parents, homesickness and financial stress are among the reasons why college students are at a higher risk of being depressed nowadays [8]. This research suggests that it is more efficient to invest in preventive methods such as training peer support groups, and to spread awareness that depression is indeed a treatable condition [8].
Depression is the most recognisable of
Materials & Methods
The goal of this study is to identify how students, who have experienced depression symptoms, feel about receiving professional psychological counselling services. Therefore, research relies on self-reported method such as questionnaire. The survey is to be distributed online to undergraduate students via university mailing list, which is advantageous in several ways. Firstly, administering an online survey protects both anonymity and confidentiality of subjects. Secondly, it reinforces the sense of security since students may take a survey from the comfort of their own house or dormitory room. Hence, students are more likely to partake and be sincere in the questionnaire if it is
mental health disorders, as 75% of the subjects in the study by Reavley et al. correctly labelled symptoms of depression [9]. Even though people can self-diagnose depression, the average help-seeking delay is 8.2 years [10]. Since depression is a treatable condition, one of the significant questions is why people, and university students in particular, are reluctant to seek professional help. According to Pidgeon et al., at least 40% of students with diagnosable mental health conditions do not seek clinical services or access university support services [11].
In Kazakhstan, where both depression and suicide are widely prevalent, there is a strong need for providing mental health care services and conducting research on attitudes towards receiving such services. It is worth noting that 4.4% of Kazakhstani population have experienced depression as of April 2017 [2]. In addition, in 2002 Kazakhstan was ranked fourth in global suicide rates among adolescents aged 15-19, which is indicative of high depression rates among this age group [12].
In addition to academic dialogue, the issue of depression among the young people of Kazakhstan has been the focus of popular comment. According to The Diplomat, Kazakhstani youngsters are caught between two stools: they hope to get a government scholarship to attend a university, even if they realise that it is «possible to earn more than their parents without focusing on education, but just by artfully and wisely using their social media presence and their digital skills" [13]. But the discrepancy goes further. While uncertain about the state's future, young adults see their prospects in a positive light. This inconsistency between group and individual identities perhaps is one of the reasons for Kazakhstan to be ranked third for youth suicide [14].
This paper aims to identify social factors contributing to the patient avoidance of counselling services in Kazakhstan.
to be distributed online. To encourage participation students will be granted a way to exit the study at any time. Only fully completed surveys were analyzed.
Prior to the survey distribution the Institutional Review Board approval was obtained. The survey was emailed to all undergraduate full-time students of Nazarbayev University; every participant was to read the consent form before taking the survey. It familiarized one that survey results are completely anonymous, and it is possible to withdraw from taking the survey at any time.
Beck's Depression Inventory (BDI)
The most widely-used tool to identify depression among university students is the Beck's Depression Inventory (BDI) [6]. BDI consists of 21 set of statements, and requires the respondents to choose one, which they find the most resonating with themselves. BDI is meant to measure the symptoms of depression, and differentiates the following conditions: normal, mild mood disturbance, borderline clinical depression, mild depression, severe depression, and extreme depression [15]. Each statement participant choses are worth a certain amount of points - 0 being the minimum, 3 being the maximum. When sum is calculated, person's symptoms are diagnosed according the following scale (Table 1).
The survey consisted of three parts: BDI, questions about the use of counselling services, and, lastly, demographic survey. First part of the survey was intended to diagnose respondents with a depressive condition by severity: normal (N), mild mood disturbance (MMD), borderline clinical depression (BCD), moderate depression (MD), severe depression (SD) and extreme depression (ED). The last three conditions are considered cases of clinical depression.
The statistical analysis used the R Studio software, and Microsoft Excel for computing the odds ratios. The odds ratio (OR) - a measure of association between exposure and outcome - is to be applied in this study to compare the relative odds of depression occurrence for a certain demographic variable (school, gender, age, nature of hometown
Results
The census response rate was 10.81%. Since the sample of respondents exhibits characteristics not corresponding to the general population (Table2),
location, and residence) [16]. In order to calculate OR data will be organized in contingency tables, ones where cells contain frequency counts of outcomes in sample.
Then OR will be calculated by the following formula:
OR=(a/c)/(b/d) (1)
where cases = cases of clinical depression (MD, SD, ED),
non-cases = cases of no depression diagnosis (N, MMD, BCD).
In order to compare the odds of students in School of Humanities and Social Sciences (SHSS) to be depressed "exposed" means enrolment in SHSS, while "unexposed" in this case is number of students in School of Science and Technology (SST) and School of Engineering (SEng). Then, OR is to be interpreted in the following way:
OR=1 Exposure does not affect odds of outcome.
OR>1 Exposure associated with higher odds of outcome.
OR<1 Exposure associated with lower odds of outcome.
95% confidence interval (CI) is then applied to check the precision of the OR calculation. In case CI contains the null value of OR=1, and p-value is less than 0.05 the results are considered statistically insignificant.
Human ethical considerations The topic of individual mental well-being is personal and may cause significant discomfort to subjects. It is crucial that every subject understands that they may withdraw from the study at any moment with no risks and no questions asked. Hence, the online questionnaire must include the consent form.
Biosafety
Not Applied. No parts of the research take place in a laboratory of any kind.
the results of the survey may not be generalized to the university undergraduate population.
Table 1 - The Scale for Explaining the BDI results
Score Level of Depression
0-10 Normal (N)
11-16 Mild Mood Disturbance (MMD)
17-20 Borderline Clinical Depression (BCD)
21-30 Moderate Depression (MD)
31-40 Severe Depression (SD)
41 or more Extreme Depression (ED)
Table 2 - Comparison between Demographic Characteristics of Population and the Responden
Population Sample
Average age 20.83 19.87
Gender Male 50.33% 35.84%
Female 49.67% 64.16%
School SEng 28.52% 15.77%
SHSS 29.10% 30.11%
SST 42.39% 53.41%
30
25 20 15 10
5 —-— ——
N MMD BCD MD SD ED
Depression Severity
Figure 1 - Percentage of Students Diagnosed with a Depressive Disorder by Condition Severity
Results in Table 3 indicate that female overlap the OR=1, and p-value is less than 0.05 this students' odds to be depressed are 2.58 compared may be considered statistically significant. to those of male students. Also, since CI does not
Table 3 - OR Calculation for Student Gender
Depressed Not Depressed
Female 53 126
Male 14 86
Total 67 212
Ratio 3.785714286 1.465116279
Probability 0.7910447761 0.5943396226
OR 2.58
CI (1.35; 4.95)
p-value 0.0042
Since contingency tables for OR calculation ought to be 2x2 tables, students were divided into two age groups: median and below, and above the median. Median was used since it does not get distorted by outliers as opposed to mean [16].
Median age for the sample was found to be 20. OR indicates that the odds of younger students experiencing depression are 1.55 higher than those of older students.
Table 4 - OR Calculation for Student Age
Depressed Not Depressed
20 and younger 48 132
Older than 20 18 77
Total 66 209
Ratio 2.666666667 1.714285714
Probability 0.7272727273 0.6315789474
OR 1.56
CI (0.84; 2.86)
p-value 0.1559
Students of SHSS and SEng have higher odds of developing depression (1.28 and 1.05 respectively), whereas the odds of SST students to develop depression are 0.79 less. OR calculation by year of study revealed the following for first-year (OR=1.05), second-year (OR=0.98), third-year (OR=1.03), fourth-year (OR=0.92) students.
Since CI for every year of study contains value of 1, each of them is considered not to be statistically
significant. Students living on-campus have 1.75 higher odds of being diagnosed with depression than students living off-campus (Table 5); whilst the odds of students living in urban environment to experience depression are 1.23 as high as those of living in rural environment.
Both of these ORs have CIs containing OR=1, meaning that data cannot be counted as statistically significant.
Table 5 - OR Calculation for the Residency of Students
Depressed Not Depressed
On-campus 60 176
Off-campus 7 36
Total 67 212
Ratio 8.571428571 4.888888889
Probability 0.8955223881 0.8301886792
OR 1.753246753
CI (0.741147051; 4.147455183)
p-value 0.2012
Analysing depressive conditions by gender, it was revealed that 29.61% of all females and 14% of all males were experiencing clinical depression of
certain severity; however, 39% of male respondents have mild mood disturbance compared with only 23.46% of female respondents.
Figure 2 - Students Diagnosed with Depressive Disorder by Gender
There are three undergraduate schools (SEng). When compared, 27.38%, 22.15% and
at Nazarbayev University: School of Humanities 25% of school representatives were diagnosed
and Social Sciences (SHSS), School of Science with clinical depression in SHSS, SST and SEng
and Technology (SST) and School of Engineering respectively (Figure 3).
Figure 3 - Students Diagnosed with Depressive Disorder by School
As may be seen from figure 3 above, in each of the three schools the proportion of female students diagnosed with clinical depression is considerably higher than male students with clinical
depression: 32.35% to 6.25% in SHSS, 26.67% to 15.25% in SST, and 33.33% to 17.39% in SEng, the only school where there is a higher percentage of male students.
Table 6 - Percentage of Students by Depressive Disorder broken down by School and Gender
SHSS SST SEng
F (80.95%) M (19.05%) F (60.4%) M (39.6%) F (47.73%) M (52.27%)
Normal 55.88% 93.75% 62.22% 76.27% 52.38% 73.91%
At Risk 11.76% 0.00% 11.11% 8.47% 14.29% 8.70%
Clinical Depression 32.35% 6.25% 26.67% 15.25% 33.33% 17.39%
Out of all students who accessed university counselling services 37.84% were diagnosed with clinical depression, while 8.11% were at risk of developing one, and 54.05% were considered
normal. At the same time there were 19.12% students with diagnosed depression and 10.78% students at risk amongst those, who has never used on-campus counselling.
Table 7 - Student Access to Psychological Counselling Center (PCC)
Attended University PCC Didn't Attend University PCC Attended Off-campus PCC Didn't Attend Off-campus PCC
Normal 54.06% 70.10% 43.33% 68.55%
At Risk 8.11% 10.78% 16.67% 9.27%
Clinical Depression 37.84% 19.12% 40.00% 22.18%
Figure 4 - Percentage of students in overall population and those diagnosed with depression by reason not to utilize university psychological counselling center
Discussion
This study is the first study of students' mental health carried out in Nazarbayev University. Its initial goal was to find out the percentage of students experiencing depression and look at the patterns of the counselling service use.
The survey results indicated that 24.01% of students were self-diagnosed with moderate, severe or extreme depression, while 10.04% were diagnosed with borderline clinical depression. When the depression level was correlated with gender, it was revealed that female students are twice as likely to develop depression as their male peers, which is consistent with the previous studies on the topic [4], [17]. The age analysis revealed that students younger than 20 years of age are more likely to experience depression. This may be indicative that incoming students are not well prepared to handle the difficulties of an undergraduate life and may benefit from additional guidance and support services. When linking depression level to the year of academic study, no correlation was revealed. Meanwhile, students living on-campus are more likely to experience depression than those living off-campus. It might be explained by the fact that most students living off-campus are Astana city residents and live with their parents; hence, they experience less changes during their undergraduate experience, less likely to suffer from changing living conditions, living in a shared space, and are less homesick.
As for the reasons for not attending university counselling centre, there was a lot of scepticism about usefulness of its services expressed by students self-diagnosed with depression. Further study needs to be done to find out the reason for service dissatisfaction. This might also indicate the need to improve the quality of the services to accommodate
students' needs. Amongst the other reasons for not using on-campus counselling services students listed unavailability of psychologists (which requires students to book an appointment almost two weeks in advance), lack of awareness of what services they provide, and the fact that mood disturbances were perceived as normal since starting studies at Nazarbayev University. Some students reported "I do not think that my sometimes stupid problems are worth people's time and nerves", "I thought my problems are not serious", which may be indicative that depression is normalized in university community and downplayed in some cases. Hence, students might benefit from regular mental health monitoring and campaigns aimed at raising awareness of mental health issues. At the same time, the results indicate that students might also benefit from emergency access to psychologists with less waiting time in certain conditions
There were two sources of limitations in this research. Firstly, in the research sample female students and students in SST were overrepresented, while students in SEng were underrepresented. Secondly, Beck's Depression Inventory may not differentiate between symptoms of general distress or anxiety and depression [18].
It is advised for the counselling center to regularly monitor mental health state of the students, organize campaigns to increase mental health awareness, collect student feedback after meetings and take those into consideration. Also, student body should have access to an immediate access to a psychologist in emergency situation; while first-year students may benefit from additional guidance and support to ease the beginning of their undergraduate experience.
Conclusion
Female sex, on-campus residency, being under 20 years of age is correlated with a depressive disorder. The major reason for students not to make use of university counselling services is its perceived insufficiency in solving the problem, and lack of available psychologists at the given moment in time. Overall, all three specific aims proposed in the Introduction section were achieved. More
specifically, the percentage of NU students who are experiencing depression is 24.01%, 26.52% of the survey sample attended university psychological counselling center, and the primary reasons for not utilizing it are mentioned above. Hence, the hypothesis that the primary reason for not attending counselling services lies in a fear of social stigma was rejected.
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