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Cited by 207Mental Health Treatment and AccessPsychometric Methodologies and TestingGender Roles and Identity Studies

Mental Help Seeking Attitudes Scale (MHSAS): Development, reliability, validity, and comparison with the ATSPPH-SF and IASMHS-PO.

Open access
Hammer, Joseph H., Parent, Mike C., Spiker, Douglas A.·2018·Journal of Counseling Psychology
DOI 10.1037/cou0000248PMC PMC10460514
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Abstract

Attitudes is a key help-seeking construct that influences treatment seeking behavior via intention to seek help, per the theory of planned behavior (TPB). This article presents the development and psychometric evaluation of the Mental Help Seeking Attitudes Scale (MHSAS), designed to measure respondents' overall evaluation (unfavorable vs. favorable) of their seeking help from a mental health professional. In Study 1 (N = 857 United States adults), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory (IRT) analysis were used to identify an optimal set of 9 items that demonstrated initial evidence of internal consistency, unidimensionality, and strong measurement equivalence/invariance (ME/I) across gender, past help-seeking experience, and psychological distress. Initial convergent evidence of validity was demonstrated via theoretically anticipated relationships between the MHSAS and key variables in the help-seeking nomological network (e.g., subjective norms, perceived behavioral control, intention, public stigma, self-stigma, anticipated risks and benefits, gender, previous help seeking). Initial incremental evidence of validity was demonstrated when the MHSAS demonstrated the ability to account for unique variance in help-seeking intention, beyond that accounted for by the Attitudes Toward Seeking Professional Psychological Help-Short Form scale (ATSPPH-SF) and the Psychological Openness subscale of the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS-PO). Study 2 (N = 207 United States adults at Times 1 and 2) provided initial evidence of test-retest reliability over a 3-week period. The MHSAS offers mental health professionals a new tool for measuring attitudes that may avoid limitations of current help seeking-attitudes measures (e.g., construct-irrelevant variance). (PsycINFO Database Record

AI snapshot

Written from the paper’s full text.

TL;DR

This paper develops and psychometrically evaluates the 9-item Mental Help Seeking Attitudes Scale (MHSAS), a Theory of Planned Behavior–based measure of overall favorable versus unfavorable evaluation of seeking help from a mental health professional. Across two studies, the MHSAS showed unidimensional structure, internal consistency, measurement invariance across key groups, convergent/incremental validity, and 3-week test–retest reliability.

Key findings

  • Study 1 (N = 857 U.S. community adults) selected a 9-item MHSAS via EFA, IRT, and CFA; the unidimensional CFA showed good fit: scaled χ²(27) = 54.02, p < .001, RMSEA = .052, CFI = .976, TLI = .969, SRMR = .025, with all item loadings significant (βs > .74).
  • The MHSAS demonstrated internal consistency (α = .93 exploratory, α = .94 confirmatory), factor determinacy = .97, H index = .94, and strong measurement equivalence/invariance across gender, past help-seeking experience, and psychological distress.
  • The MHSAS added incremental variance in help-seeking intention beyond the ATSPPH-SF and IASMHS-PO: Step 1 explained 48% of intention variance; adding MHSAS explained an additional 9% (ΔR² = .085, p < .001).
  • Known-group validity showed more favorable attitudes among those with previous help seeking (M = 5.76, SD = 1.00) than without (M = 5.48, SD = 1.03), t(855) = 3.60, p < .001, d = .28, and among women (M = 5.77, SD = .95) than men (M = 5.51, SD = 1.12), t(847) = 3.23, p < .001, d = .25. Study 2 found 3-week test–retest r = .76, ICC(2,k) = .86, and no significant mean difference, t(207) = .147, p = .88.

Methods

  • Study 1 recruited 857 U.S. community adults via ResearchMatch; participants were 18–85 years old (M = 44.30, SD = 26.34), mostly White (67%), and 72% reported previous help seeking. The sample was randomly split into exploratory (n = 490) and confirmatory (n = 367) subsamples.
  • Item development began with 46 adjective pairs, expanded to a 49-item evaluative pool plus 16 potency/activity items, yielding a 65-item pool. Analyses included EFA, Rasch/IRT using Winsteps, CFA using Mplus, factor determinacy/H index, internal consistency, multiple-group CFA for measurement invariance, bivariate correlations, hierarchical regression for incremental validity, and t tests for known-group validity.
  • Study 2 recruited 285 community adults currently experiencing a mental health concern at Time 1; 207 provided Time 2 data 3 weeks later. Analyses repeated unidimensional CFA, FD, H index, and internal consistency, then examined test–retest reliability via bivariate correlation, ICC(2,k), and paired-samples t test.

Limitations

  • The paper states that findings are tied to a U.S. community adult sample; racial/ethnic cell sizes were too small for properly powered measurement invariance analyses, and the sample was generally well-educated, had relatively favorable attitudes, and had high past help-seeking experience, with possible selection bias because the study was advertised as a therapy questionnaire.
  • The paper states that future research should test cross-cultural/international and translated versions, examine performance among those with unfavorable attitudes or little exposure to mental health care, and provide test-criterion evidence by predicting future help-seeking behavior.
  • The text makes evident that the studies rely on self-report and online volunteer registry recruitment, and the validation evidence is initial rather than definitive.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1037/cou0000248

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

5 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 20 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The bivariate correlation between Time 1 and Time 2 MHSAS scores was .76.

    “The bivariate correlation between the Time 1 and Time 2 scores was .76 and the intraclass correlation coefficient (2,k) for the two scores was .86.”
    Quote in the paperSubstantial claim
  • Findingown data

    In Study 2, all items loaded significantly on the help-seeking attitudes factor (βs > .61, .79 < Bs < 1.26, ps < .001).

    “All items loaded significantly on the help-seeking attitudes factor (βs > .61, .79 < Bs < 1.26, ps < .001), further supporting H16.”
    Quote in the paperSubstantial claim
  • Findingown data

    In Study 1, the MHSAS score showed internal consistency in the exploratory (α=.93) and confirmatory (α=.94) subsamples.

    “The MHSAS score demonstrated internal consistency in both the exploratory (α = .93) and confirmatory (α = .94) subsamples, supporting H14.”
    Quote in the paperSubstantial claim
  • Findingown data

    When the regression was rerun without the ATSPPH-SF or without the IASMHS-PO, the hypothesized effect remained.

    “When this regression was rerun without including ATSPPH-SF (MHSAS ΔR2 = .085) or IASMHS-PO (MHSAS ΔR2 = .24), the hypothesized effect remained.”
    Quote in the paperSubstantial claim
  • Findingown data

    The MHSAS was fully metric invariant across men and women according to the ΔCFI < -.01 and ΔRMSEA < .015 rules.

    “Metric invariance results indicated that the MHSAS was fully metric invariant across men and women per the ΔCFI < −.01 and ΔRMSEA < .015 rules.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 4
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 6

  • The quote only partly states this claim.

    Findingown data

    The multiple-group model comparing low and moderate-to-high psychological distress samples had an overall acceptable fit to the data.

    “The multiple-group model comparing the samples showed an overall acceptable fit to the data (see Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For men and women separately, the model fit the data (men: scaled χ2(27, n=257)=40.24, p<.001; RMSEA=.044; 90% CI [.004,.070]; CFI=.988; TLI=.984; SRMR=.022; women: scaled χ2(27, n=592)=66.22, p<.001; RMSEA=.050; 90% CI [.035,.065]; CFI=.977; TLI=.969; SRMR=.026).

    “Each gender’s model fit the data (men: scaled χ2(27, n = 257) = 40.24, p < .001; RMSEA = .044; 90% CI [.004, .070]; CFI = .988; TLI = .984; SRMR = .022; women = scaled χ2(27, n = 592) = 66.22, p < .001; RMSEA = .050; 90% CI [.035, .065]; CFI = .977; TLI = .969; SRMR = .026), with all item factor loadings >.68 (p < .001) for each sample.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The MHSAS was fully metric and scalar invariant across low and moderate-to-high psychological distress groups.

    “Metric and scalar invariance testing results indicated that the MHSAS was fully metric and scalar invariant across the two groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 12-item MHSAS version had an approximate test information function of 12.5, but its fit began to weaken.

    “The 12-item version had an approximate test information function of 12.5, but fit began to weaken; fit continued to drop for the 15- and 18-item versions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The nine-item MHSAS version showed good fit and had an approximate test information function of 8.5.

    “The nine-item version of the MHSAS had good fit and an approximate test information function of 8.5.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Study 2, the MHSAS score's FD (.96), H index (.93), and internal consistency (α=.92) were above recommended thresholds.

    “The MHSAS score’s FD (.96), H index (.93), and internal consistency (α = .92) estimates were above the recommended thresholds, further supporting H14.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 9-item MHSAS demonstrated initial evidence of internal consistency, unidimensionality, and strong measurement equivalence/invariance across gender, past help-seeking experience, and psychological distress.

    “that demonstrated initial evidence of internal consistency, unidimensionality, and strong measurement equivalence/invariance (ME/I) across gender, past help-seeking experience, and psychological distress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The six-item MHSAS version showed good fit, but its test information function was below 5.

    “The six-item version had good fit but less than desirable test information function of less than 5.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For previous help seekers and non-previous help seekers separately, the model fit the data (previous: scaled χ2(27, n=623)=87.60, p<.001; RMSEA=.060; 90% CI [.046,.074]; CFI=.971; TLI=.961; SRMR=.024; no previous: scaled χ2(27, n=234)=38.82, p<.001; RMSEA=.043; 90% CI [.000,.072]; CFI=.985; TLI=.980; SRMR=.027).

    “Each group’s model fit the data (previous help seeking: scaled χ2(27, n = 623) = 87.60, p < .001; RMSEA = .060; 90% CI [.046, .074]; CFI = .971; TLI = .961; SRMR = .024; no previous help seeking = scaled χ2(27, n = 234) = 38.82, p < .001; RMSEA = .043; 90% CI [.000, .072]; CFI = .985; TLI = .980; SRMR = .027), with all item factor loadings >.70 (p < .001) for each sample.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For low and moderate-to-high psychological distress groups separately, the model fit the data (below K6 cutoff: scaled χ2(27, n=387)=48.79, p<.001; RMSEA=.046; 90% CI [.024,.066]; CFI=.982; TLI=.975; SRMR=.024; above K6 cutoff: scaled χ2(27, n=470)=75.82, p<.001; RMSEA=.062; 90% CI [.046,.079]; CFI=.972; TLI=.962; SRMR=.025).

    “Each group’s model fit the data (below K6 cutoff: scaled χ2(27, n = 387) = 48.79, p < .001; RMSEA = .046; 90% CI [.024, .066]; CFI = .982; TLI = .975; SRMR = .024; above K6 cutoff = scaled χ2(27, n = 470) = 75.82, p < .001; RMSEA = .062; 90% CI [.046, .079]; CFI = .972; TLI = .962; SRMR = .025), with all item factor loadings > .70 (p < .001) for each sample.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The theory of planned behavior treats attitudes as a single construct measured with a unidimensional instrument that produces a single overall evaluation score.

    “while the TPB treats attitudes as a single construct to be measured with a unidimensional instrument that produces a single overall evaluation score (Ajzen, 2006)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ajzen, 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    From the perspective of the theory of planned behavior, IASMHS subscale scores contain construct-irrelevant variance and are invalid measures of attitudes, subjective norms, and perceived behavioral control.

    “However, from the perspective of the TPB, these subscale scores contain construct-irrelevant variance and are invalid measures of these three constructs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    An instrument should measure only what it is intended to measure and not more, i.e., it should avoid construct-irrelevant variance.

    “The Standards for Educational and Psychological Testing (Standards; American Education Research Association [AERA], American Psychological Association, & National Council on Measurement in Education, 2014) state that an instrument should only measure what the instrument is intended to measure, not more (i.e., construct-irrelevant variance).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites AERA et al., 2014

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    According to the theory of planned behavior, help-seeking attitudes, subjective norms, and perceived behavioral control together predict behavioral intention to seek help.

    “When applied to the help-seeking context, the TPB (Ajzen, 1985), an extension of the theory of reasoned action (Ajzen & Fishbein, 1980), states that help-seeking attitudes, in combination with subjective norms (i.e., perceived social pressure from important others to seek or not seek help) and perceived behavior control (i.e., perceived efficacy and control regarding seeking help), predict people’”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ajzen, 1985

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Instruments should consistently demonstrate their intended factor structure and adequate reliability to be considered psychometrically sound.

    “This is problematic, as instruments should consistently demonstrate the intended factor structure and adequate reliability to be considered psychometrically sound (DeVellis, 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites DeVellis, 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Inaccurate measurement of psychological constructs such as help-seeking attitudes can lead to incorrect inferences and misleading conclusions.

    “Inaccurate measurement of psychological constructs such as help-seeking attitudes can lead to incorrect inferences and misleading conclusions (Carmines & Zeller, 1979).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Carmines & Zeller, 1979

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The theory of planned behavior is parsimonious, has strong empirical support within and outside help-seeking contexts, and demonstrates cross-cultural utility.

    “Specifically, the TPB is parsimonious, enjoys strong empirical support both within (Vogel & Heath, 2015) and outside (Armitage & Conner, 2001) of help seeking contexts, and demonstrates cross-cultural utility (e.g., Kaiser & Gutscher, 2003; Mo & Mak, 2009; Nigg, Lippke, & Maddock, 2009).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Vogel & Heath, 2015

      Not checked in the free run.

    • cites Armitage & Conner, 2001

      Not checked in the free run.

    • cites Kaiser & Gutscher, 2003

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Existing help-seeking attitudes instruments have serious limitations that necessitate developing a new instrument meeting modern psychometric standards.

    “We argue that existing help-seeking attitudes instruments have serious limitations that necessitate the development of a new instrument that meets modern psychometric standards: the MHSAS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The MHSAS can help researchers advance scholarship on help seeking and help clinicians more accurately understand clients' perceptions of seeking help.

    “The MHSAS can help researchers advance scholarship on what helps and stops people from seeking mental health care, and could help clinicians more accurately understand their clients’ perceptions of seeking help.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Study design and conductown data

    Each final MHSAS item was rated as clear by at least 94% of 126 community adults.

    “Each item selected for the final version of the instrument (see below) was rated as clear by at least 94% of the respondents (i.e., binary response of “clear” vs. “unclear”).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Five experts rated each final MHSAS item's fit to the construct; all selected items except unsatisfying/satisfying achieved a mean test content validity score of at least 4.0.

    “With the exception of unsatisfying/satisfying (M = 2.8), each item selected for the final version of the instrument achieved a mean test content evidence of validity score of at least 4.0.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The MHSAS demonstrated strong measurement equivalence/invariance across gender, past help-seeking experience, and psychological distress.

    “Furthermore, results from the ME/I analyses indicated that the MHSAS demonstrated strong ME/I (i.e., invariance of all factor loadings and intercepts) across gender, past help-seeking experience, and psychological distress.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationown data

    The MHSAS score demonstrated 3-week test-retest reliability.

    “Thus, all three test–retest reliability analyses supported H15.”
    Quote in the paperSubstantial claim
23 of 23

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • p-value fits an unstated one-tailed test: t(847) = 3.23, p < .001

    Minor

    The paper reports p < .001 here; recomputing from the test statistic and its degrees of freedom gives p = .001 (two-tailed). The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .001 · recomputed p = .001

  • Inconsistent p-value: χ2(27) = 54.02, p < .001

    Minor

    The paper reports p < .001 here; recomputing from the test statistic and its degrees of freedom gives p = .002. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p < .001 · recomputed p = .002

2 of 2

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upχ²(27) = 54.02reported p < .001 · recomputed p = .002

    “χ2(27) = 54.02, p < .001”

  • Doesn’t add upt(847) = 3.23reported p < .001 · recomputed p = .001

    “t(847) = 3.23, p < .001”

  • Consistentt(855) = 3.6reported p < .001 · recomputed p < .001

    “t(855) = 3.60, p < .001”

  • Consistentχ²(27) = 59.31reported p < .001 · recomputed p < .001

    “χ2(27) = 59.31, p < .001”

  • Consistentt(207) = 0.147reported p = .88 · recomputed p = .883

    “t(207) = .147, p = .88”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Paired-test degrees of freedom exceed the number of Time 2 respondents

    Minor

    The paper reports 207 Time 2 respondents. A paired-samples t test on at most 207 complete pairs would have at most 206 degrees of freedom, not 207.

  • Perceived behavioral control scale assigns opposite answers the same value

    Minor

    The stated response scale assigns both "definitely false" and "definitely true" a value of 1, so the two endpoints cannot distinguish opposite responses.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Carmines EG, & Zeller RA (1979). Reliability and validity assessment: Vol. 17. Quantitative applications in the social sciences. Beverly Hills, CA: Sage.
  2. Chong SS (2016). Help-seeking models for Asian international and American students (Unpublished doctoral dissertation). Arizona State University, Tempe, AZ.
  3. Fischer EH, & Farina A (1995). Attitudes toward seeking professional psychological help: A shortened form and considerations for research. Journal of College Student Development, 36, 368– 373.
  4. Heise D (1970). The semantic differential and attitude research. In Summer GF (Ed.), Attitude measurement (pp. 235– 253). Chicago, IL: Rand McNally.
  5. Miller MJ, & Sheu H (2008). Conceptual and measurement issues in multicultural psychology research. In Brown SD & Lent RW (Eds.), Handbook of counseling psychology (pp. 103– 120). Hoboken, NJ: Wiley.
  6. Muthén LK, & Muthén BO (1998– 2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Author.

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Related

Authors
Hammer, J. H., Parent, M. C., & Spiker, D. A.
Affiliations
  • University of Kentucky (US)
  • The University of Texas at Austin (US)
ORCID
Venue
Journal of Counseling Psychology
Publisher
American Psychological Association (APA)
Published
2018-01
Volume
65
Issue
1
Pages
74-85
ISSN
  • 0022-0167 (ISSN-L)
  • 1939-2168
DOI
10.1037/cou0000248
PMC
PMC10460514
OpenAlex
W2784669474
Semantic Scholar
c41b90603d328fefdc0bc826ff1db99ea06d514a
Cited by
207
References
72
Citations by year
2026: 29 · 2025: 37 · 2024: 29 · 2023: 27 · 2022: 23 · 2021: 21 · 2020: 21 · 2019: 10 · 2018: 10
FWCI
21.03
Type
journal article
Language
en
Open access
Locations
  • Journal of Counseling Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD042849)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Social Sciences › Gender Studies › Gender Roles and Identity Studies
Keywords
help-seeking attitudes, mental health help-seeking, scale development, psychometric properties, theory of planned behavior, help-seeking intentions, subjective norms, perceived behavioral control, public stigma, self-stigma, measurement invariance, test-retest reliability, open-mindedness, mental health professionals
MeSH terms
Adolescent, Adult, Aged, Mental Disorders, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Mental Health, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Psychological Tests, Psychometrics, United States, Reproducibility of Results, Intention, Young Adult, Social Stigma

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