Contextualizing Help-Seeking Attitudes and Help-Seeking Intention: The Role of Superwoman Schema among Black College Women

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-024-02075-0 Contextualizing Help‑Seeking Attitudes and Help‑Seeking Intention: The Role of Superwoman Schema among Black College Women Tamara Nelson1 · Samrawit B. Gebretensay1 · Andrea M. Sellers1 · Oswaldo Moreno2 Received: 14 January 2024 / Revised: 21 June 2024 / Accepted: 25 June 2024 © The Author(s) 2024 Abstract Black women are less likely to seek psychological help and underutilize mental health services. Although help-seeking attitudes and intentions are associated in the general population, less is known about this relationship among Black women in college. In this cross-sectional study, we investigated the relationship between help-seeking attitudes and intention among 167 self-identified Black women in college. We also investigated if dimensions of the Superwoman Schema (i.e., an obligation to display strength, resistance to being vulnerable, an obligation to suppress emotions, an intense motivation to succeed despite limited resources, and an obligation to help others) moderated this relationship. Findings indicated a significant positive relationship between help-seeking attitudes and help-seeking intention. Regarding moderation, an obligation to suppress emotions, resistance to vulnerability, and an obligation to help others interacted with help-seeking attitudes in predicting help-seeking intention. Notably, low adherence to an obligation to suppress emotions, resistance to vulnerability, and an obligation to help others were associated with high levels of help-seeking intention. However, more favorable help-seeking attitudes improved help-seeking intention for participants high in adherence to these dimensions. Our findings suggest that understanding the relevance of the Superwoman Schema among Black women is critical for increasing help-seeking behavior. Keywords Help-seeking attitudes · Help-seeking intention · Superwoman schema · Black women In a nationally representative sample of college students (i.e., National Healthy Minds Study), 50.4% of Black college students reported clinically significant symptoms of one or more mental health conditions (e.g., depression, anxiety, nonsuicidal self-injury) during 2020–2021; yet only 30% reported receiving mental health treatment [1]. Generally, Black college students underutilize mental health services and are reluctant to seek help partly due to negative experiences associated with the help-seeking process * Tamara Nelson Samrawit B. Gebretensay Andrea M. Sellers Oswaldo Moreno 1 Department of Psychology, Rutgers University Camden, 311 N. Fifth Street, Camden, NJ 08102, USA 2 Department of Psychology, Virginia Commonwealth University, 806 W. Franklin St., Richmond, VA 23284, USA [2, 3]. Additionally, cultural mistrust, stigma, discrimination, spiritual practices, beliefs, and reliance upon informal sources of support explain less use of mental health treatment [3–9]. Moreover, attitudes about help-seeking for mental health tend to be negative in this population [10–12]. As help-seeking attitudes predict help-seeking intention in the general population [13], one study found that help-seeking attitudes did not predict help-seeking intention among Black college students [14]. Thus, it is crucial to examine these relationships among Black college women who experience unique stressors at the intersection of racism and sexism that predict psychological distress [15–18]. To counter stressors, some Black college women may cope by adhering to gendered racialized roles, such as Superwoman Schema (SWS), which may help and hinder the help-seeking process [19–22]. SWS is a culturally salient phenomenon operationalized as an obligation to display strength, resistance to being vulnerable, an obligation to suppress emotions, an intense motivation to succeed despite limited resources, and an obligation to help others [20, 22, 23]. SWS is associated with both positive (i.e., resilience, pride) and negative outcomes (i.e., anxiety, depression, Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities stress, and decreased help-seeking [21, 22, 24–27]. Thus, investigating SWS is critical to understanding mental health treatment-seeking behaviors. In this study, we examined the relationship between help-seeking attitudes and help-seeking intention. We also examined the potential moderating role of the Superwoman Schema. Planned Behavior Theory A theoretical model of behavioral change may help to understand the complexity of mental health help-seeking behavior [28] in this population. According to Planned Behavior Theory [29] help-seeking intention (i.e., the intention to seek help from a mental health professional when having a mental health concern) [30] is the most robust determinant of help-seeking behavior [29]. Help-seeking intention depends on an individual’s attitudes toward help-seeking, the opinions of others in the individual's social environment, and the perceived barriers to treatment [28, 29, 31]. While findings from previous research in the general population have indicated that recognition of the need for help is associated with help-seeking intention [32] another study found that attitudes were the strongest predictor of intention to seek mental health services [33]. Taken together, investigating potential factors that shape help-seeking attitudes may be critical for a deeper understanding of help-seeking intention [3]. A deeper understanding of these processes may result in targeted areas for intervention and decrease the gap in service use in this population [3]. Help‑Seeking Attitudes and Intention among Black College Women There are significant disparities in mental healthcare utilization: Black Americans tend to seek and receive less mental healthcare treatment than their White counterparts [34–38]. Several factors (i.e., affordability, cultural mistrust, discrimination, and stigma) account for these differences [8, 9, 39]. For example, in previous research, Black college students have reported seeking help from myriad sources including professional clinicians, roommates, friends, significant others, family members, religious counselors, support groups, or other non-clinical sources [40, 41]. Nonetheless, Black college students typically use informal support networks [40, 41]. The reliance upon informal sources of support may be due in part to the lack of culturally sensitive providers and past negative experiences with mental healthcare treatment [3, 42]. Indeed, in a study of Black Americans’ experiences of mental health treatment and providers, some reported negative experiences with providers noting that they were unhelpful, insensitive, and in some cases harmful [42]. However, in another study among Black college women, past mental health treatment buffered the negative association between psychological distress and help-seeking attitudes, suggesting a potential protective effect of past mental h (...truncated)