International Journal of Health and Medicine E-ISSN: 3047-793X P-ISSN: 3047-7948 Research Article Factors That Influence the Desire of Nursing Students of The Ministry of Health Poltekkes Semarang in the Mental Health Counseling Guidance Process Dela Savitri Dwi Astuti ¹,*, Sri Endang Windiarti², Wien Soelistyo Adi 3 Undergraduate Programs Applied Nursing Major Nursing, Politeknik Kesehatan Kementerian Kesehatan Semarang, Indonesia * Corresponding Author: delasavitri30@gmail.com 1 Abstract: Student mental health is an important issue in higher education, yet many students remain reluctant to utilize counseling services. Several factors are suspected to influence students’ willingness to participate in counseling, including stress levels, social support, public stigma, and self-stigma. This study aimed to determine the relationship between stress level, social support, public stigma, and selfstigma with students’ intention to engage in mental health counseling. The research used a quantitative design with a cross-sectional approach. A total of 202 first-year nursing students from Campus I of Poltekkes Kemenkes Semarang were selected using a total sampling technique. The research instrument was a questionnaire that had been tested for validity and reliability, and data were analyzed using Spearman’s rho correlation test. The results showed that most students had a moderate level of stress (52.8%), adequate social support (58.1%), moderate public stigma (53.7%), and moderate selfstigma (55.3%). Students’ willingness to seek counseling was also in the moderate category (63.4%). Statistical analysis indicated a significant relationship between stress level (p=0.000), social support (p=0.002), public stigma (p=0.000), and self-stigma (p=0.000) with the intention to engage in mental health counseling. These findings highlight the importance of promotive and preventive approaches from educational institutions to enhance students’ awareness and access to mental health counseling services. Keywords: Guidance Counseling; Mental Health; Nursing Students; Social Support; Stress. Received: April 27, 2025 Revised: June 13, 2025 Accepted: August 28, 2025 Published: October 31, 2025 Curr. Ver.: October 31, 2025 Copyright: © 2025 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY SA) license (https://creativecommons.org/li censes/by-sa/4.0/) 1. Introduction Student mental health has become an increasingly pressing issue in recent years. Students often face pressure from various aspects of life, ranging from academic and social demands to personal problems, which can affect their psychological condition. These pressures often trigger mental health disorders such as stress, anxiety, and depression. As a group in the phase of self-discovery, students tend to be more prone to emotional changes and psychological stress. Guidance and counseling services play an important role in helping students deal with psychological problems. Unfortunately, many students are still reluctant to use these services due to various barriers such as lack of knowledge, limited access, and stigma toward mental health issues. Stigma—both in the form of public stigma and self-stigma—becomes one of the main factors preventing students from seeking professional help. Kesyha et al. (2024) emphasized that stigma toward student mental health has a significant impact on their reluctance to seek psychological assistance. Negative perceptions from the surrounding environment often cause feelings of shame, fear, or discomfort in accessing professional support. Public stigma, in the form of negative attitudes and discrimination from society toward individuals with mental disorders, can worsen self-stigma, which occurs when individuals internalize these negative views. This leads to decreased self-esteem, confidence, and DOI : https://doi.org/10.62951/ijhm.v2i4.532 https://international.arikesi.or.id/index.php/IJHM International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 26 of 31 willingness to seek help. In the long term, this condition may result in social isolation and a decline in students’ mental well-being. This concern is reflected in the growing attention to mental health issues among students. Data from the Indonesian Ministry of Health (2023) recorded that depression cases among students increased by up to 15% over the last five years. Furthermore, the number of suicide cases among the productive age group has also risen, indicating that many individuals still lack adequate mental health services. Several tragic cases occurred in Semarang City, such as NJW (20), a female student from a public university who was found dead at Paragon Mall Semarang on October 10, 2023, and EN (24), a student from a private university who was found dead in her boarding house on October 11, 2023. These incidents highlight the importance of paying attention to students’ mental health amid academic demands and complex social dynamics. Data from the Indonesian Suicide Prevention Association (2020) showed 670 officially recorded suicide cases, with an estimated underreporting rate of up to 303%, bringing the actual number to around 2,700 cases. Moreover, Balitbangkes (2016) reported that suiciderelated deaths reached about 1,800 cases per year, with 47.7% occurring among individuals aged 10–39 years—the productive age group (Nurdin et al., 2024). Based on these conditions, it is important to examine the factors influencing students’ willingness to access mental health counseling services, particularly among nursing students at the Health Polytechnic of the Ministry of Health Semarang. As future health professionals, they are expected to have awareness and willingness to maintain and utilize mental health services. However, in reality, many are still reluctant to seek professional help when experiencing psychological pressure. This study aims to determine the relationship between stress levels, social support, public stigma, and self-stigma with nursing students’ willingness to engage in mental health counseling. 2. Method 2.1. Type of Research The type of research used in this study is quantitative research. Quantitative research is research that aims to answer questions scientifically with a concrete, objective, structured, rational, and systematic approach. The data obtained are in the form of numbers and are analyzed using statistical methods (Nursallam, 2016). The research design used in this study is a cross-sectional design. A cross-sectional design is used because data collection is carried out at a specific point in time, where the independent and dependent variables are assessed simultaneously to identify the relationship between them at a single moment (Nursallam, 2016). 2.2. Place and Time of Research The research was conducted from February to March 2025. The research was conducted at Campus I of the Ministry of Health Polytechnic of Semarang, Nursing Department, located on Jalan Tirto Agung, Pedalangan, Banyumanik, Semarang City. 2.3 Population and Sample The population in this study was all first-year students of the Nursing Department at Campus I of the Ministry of Health Polytechnic of Semarang in the 2024/2025 academic year, totaling 246 students. The sampling technique used was total sampling, involving all members of the population as research respondents. However, of the total population, only 202 students were willing and met the criteria and completed the questionnaire completely, resulting in a total sample of 202 respondents analyzed in this study. 2.4 Data Collection Data collection used a structured questionnaire consisting of five parts, namely: a questionnaire on the desire to participate in the mental health counseling process, stress levels, social support, public stigma, and self-stigma. The questionnaire on the desire to participate in the mental health counseling process adopted the Attitude Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF) developed by Fischer and Farina (1995), with Cronbach's Alpha reliability ranging from 0.72 to 0.84 and good construct validity based on factor analysis. The stress level questionnaire adopted the Perceived Stress Scale (PSS-10) questionnaire developed by Cohen, Kamarck, and Mermelstein (1983), with reliability values International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 27 of 31 ranging from 0.78 to 0.91, and construct validity that has been tested through confirmatory factor analysis. questionnaire adopted a questionnaire developed by Maura (2023) based on four dimensions of support: emotional, instrumental, informational, and companionship. This questionnaire was modified and underwent a Confirmatory Factor Analysis (CFA) process to ensure model fit, with a significant T-value indicating good construct validity. The public stigma questionnaire used the Perception of Stigmatization by Others for Seeking Help (PSOSH) questionnaire from Vogel et al. (2009), which has a strong single-factor structure with an internal reliability of 0.89. Meanwhile, self-stigma was measured using the Self-Stigma of Seeking Help (SSOSH) Questionnaire also developed by Vogel et al. (2006), with Cronbach's Alpha values ranging from 0.86 to 0.91 and confirmed construct validity. All questionnaires were structured on a four-point Likert scale and were translated and adapted to the Indonesian cultural context before being used in data collection. 2.5 Data Analysis and Processing The collected data were analyzed quantitatively using IBM SPSS Statistics software version 25. Prior to analysis, the data were first checked for completeness and consistency. The data processing process began with editing, coding , and data entry into the system. Data analysis was conducted in two stages, namely univariate and bivariate analysis. Univariate analysis was used to describe the frequency distribution and percentage of respondent characteristics and the variables studied, including stress levels, social support, public stigma, self-stigma, and the desire to participate in mental health counseling. Next, bivariate analysis was used to determine the relationship between the independent and dependent variables. The statistical test used was the Spearman's rho test, because the data obtained were ordinal and not normally distributed. The significance value was determined at a p-value <0.05, which indicates that the relationship between the variables was statistically significant. 3. Results Table 1. Distribution Frequency Factors that Influence Desire Student Nursing Polytechnic of Health Ministry of Health Semarang in the Guidance Process Mental Health Counseling. No Frequency Percentage (%) Characteristics 1. Gender Man 31 15.3 Woman 171 84.7 2. Study program 3-year diploma 80 39.6 Bachelor Applied 122 60.4 Variables 3. Stress Level Light 71 35.1 Currently 44 21.8 Heavy 87 43.1 4. Support Social Not enough 15 7.4 Enough 47 23.3 Tall 150 69.3 5. Public Stigma Low 87 43.1 Sedan 44 21.8 Tongue 71 35.1 6. Send Stigma Low 79 39.1 Sedan 87 43.1 Tongue 36 17.8 7. Desire Follow Low 47 23.3 Counseling Currently 102 50.5 Tall 53 26.2 International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 28 of 31 Majority respondents in study This variousfemale genitalia with percentage 84.7%. Based on the study program, some big is student Bachelor Applied with percentage 60.4%. The highest level of stress experienced by respondents is stress heavy by 43.1%. Support social owned by some big respondents is in the category tall with percentage of 69.3%. Respondents also partly big own low level of public stigma by 43.1%, and level of self- stigma in category currently with the same percentage, namely 43.1 %. As for the level of desire follow the guidance process counseling the most dominant mental health is in the category moderate, with percentage 50.5%. Table 2. Analysis Connection Factors with Desire Student Nursing Polytechnic of Health Semarang Ministry of Health in the Guidance Process Mental Health Counseling. No Independent Variables Correlation Mark Correlation Variables Dependent Coefficient P Direction 1 Stress Level Desire Follow -0.276 0,000 - (negative) Health Counseling Guidance Process 2 Social Support 0.176 0.012 + (positive) Mental 3 Public Stigma -0.467 0,000 - (negative) 4 Self-Stigma -0.502 0,000 - (negative) The results of the Spearman's rho bivariate test showed that all independent variables (stress level, social support, public stigma, and self-stigma) had a significant relationship (p < 0.05) with students' willingness to participate in mental health counseling. Stress level, public stigma, and self-stigma were negatively related, while social support was positively related. Self-stigma (-0.502) and public stigma (-0.467) showed a moderate negative correlation, while stress level (-0.276) and social support (0.176) showed a weak correlation. 4. Discussion 4.1 Characteristics Respondents The majority of respondents in this study were female and came from the Applied Undergraduate Study Program (146), outnumbering the Diploma III students (100). This reflects the predominance of women in nursing education, which may also influence their tendencies to respond to mental health issues. Women tend to be more open about discussing emotional issues and are more likely to actively seek help, such as counseling. Conversely, men may face cultural barriers that prevent them from seeking psychological help. This finding is consistent with a report by the Central Statistics Agency (2022), which reported that more than 70% of nursing staff in Indonesia are women. This research also aligns with research by Mahalik et al. (2021), which highlights that masculine norms can hinder men from accessing mental health services. Putra et al. (2023) stated that women tend to be more open about emotional problems and more readily utilize mental health services. This is supported by Wang et al. (2022), who found that despite women's higher stress levels, they are more aware and prepared to seek help than men. 4.2 Level of Students' Desire to Participate in the Mental Health Counseling Guidance Process The results showed that the majority of students (63.4%) had a moderate desire to participate in mental health counseling services. Twenty-eight percent (20.8%) had a high desire, while 15.8% indicated a low desire. This suggests that while the majority of students are interested, a significant proportion are still unprepared or reluctant to participate in these services. Through analysis of questionnaire responses, it was found that the majority of students agreed with items such as "I will seek counseling if I feel anxious for a long time ," reflecting an understanding that counseling is a positive solution to emotional problems. However, many also agreed with items such as "A person should be able to solve their problems alone, so counseling is a last resort." This suggests that there are cultural values that still emphasize excessive independence, which can hinder the intention to seek help. These findings align with a study by Zafar et al. (2024) that identified the influence of a culture of shame and a preference for self-directed problem-solving among South Asian International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 29 of 31 students. Liu et al. (2023) also found that positive attitudes toward mental health issues were strongly correlated with help-seeking behavior. Research in Indonesia by Susilawati et al. (2022) showed that in addition to a suboptimal service system, internal barriers such as discomfort with self-disclosure pose a real challenge. 4.3 Stress Levels and Students' Desire to Participate in Mental Health Counseling Guidance Process The majority of students experienced moderate stress (52.8%), followed by severe stress (30.7%) and mild stress (16.3%). This confirms that academic pressure, clinical practice, and social demands are the main sources of stress for nursing students. In the questionnaire, many students gave high responses to the items "I find it difficult to complete the piling up of coursework" and "I feel overwhelmed by dealing with several problems simultaneously." However, items such as “I feel confident in dealing with personal problems” also received positive responses from some respondents, indicating the existence of adaptive coping mechanisms such as self-control and optimism. Statistical analysis using Spearman's rho test showed a significant negative relationship between stress levels and willingness to seek counseling (r = -0.276; p = 0.000). This means that the higher the stress level, the lower the student's likelihood of seeking counseling. This phenomenon suggests that students with high levels of stress are at risk of avoiding help due to feeling emotionally overwhelmed, unsure where to begin, or fearing additional stigma. Kartasasmita's (2022) research supports these findings by showing that high academic stress can decrease psychological well-being and reduce motivation to seek help. However, these findings differ from Marseal's (2024) findings, which found that high stress can increase help-seeking, depending on factors such as mental health literacy, attitudes toward counseling, and social support. Therefore, it is important to consider mediating factors such as knowledge about counseling, access to services, and personal openness in responding to stress. 4.4 Social Support and Students' Desire to Participate in Mental Health Counseling Guidance Process The results of the study showed that the majority of respondents assessed the social support they received as being in the high category (69.3 %), followed by the sufficient category (23.3 %), and low (7.4 %). These findings confirm that most students feel they receive adequate support from their social environment. This high level of social support can be a crucial asset in maintaining students' mental health and can also encourage them to be more open about accessing counseling services if they experience psychological distress. Based on the questionnaire analysis, statements such as "I feel like the people around me understand me well" and "I have friends to do activities with" received positive responses from the majority of respondents. This reflects strong emotional and social support from peers and those closest to them. However, regarding direct support, as reflected in the statement "I receive sufficient financial assistance from my parents or family," not all respondents responded positively. This situation indicates an imbalance between emotional support and direct support. These results indicate that strong social support plays a crucial role in shaping students' psychological readiness for counseling. Support provided through emotional, instrumental, informational, and appraisal channels helps create a sense of security, reduces feelings of loneliness, and increases confidence in communicating personal problems. This aligns with Sarafino and Smith's (2011) theory of social support, which states that these four dimensions of social support contribute to improving an individual's overall psychological well-being. Bivariate analysis using Spearman's rho test showed a significant relationship between the level of social support and students' willingness to participate in mental health counseling services, with a p-value of 0.012. A correlation coefficient of 0.176 indicates a very weak positive relationship. This means that the higher the level of social support perceived by students, the higher their tendency to participate in counseling. These results align with research by Kurniawati et al. (2023), which suggests that individuals with strong social networks tend to be more open to seeking help when experiencing psychological distress. Furthermore, Agustina et al. (2024) stated that support from parents, peers, and lecturers contributes to increased resilience and stress management skills in students. Research by Ciarrochi et al. (2020) shows that healthy social relationships are positively correlated with increased utilization of mental health services, particularly among first-year International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 30 of 31 college students. Similarly, Maharani and Widyastuti (2023) stated that positive perceptions of social support are closely related to increased student awareness of the importance of psychological care and reduced psychological barriers to accessing these services. 4.5 Public Stigma and Students' Desire to Participate in Mental Health Counseling Guidance The results showed that the majority of respondents had low levels of public stigma (43.1%), followed by moderate (37.9%) and high (19.0%). Although the majority of students appeared open to counseling services, a significant proportion in the moderate to high categories indicated continued concerns about social perceptions. From the questionnaire item analysis, students with low stigma tended to disagree with statements such as "If I go to counseling, I believe others will think I'm unlikable ," reflecting an openness to professional help. Conversely, students with high stigma tended to agree with similar statements, indicating a concern about negative judgment from their social environment. The group with moderate stigma showed hesitation and ambivalence in deciding to seek help. Bivariate analysis using Spearman's rho test showed a significant negative relationship between public stigma and the desire to participate in counseling (r = -0.467; p = 0.000), which means that the higher the level of public stigma, the lower the tendency of students to access counseling services. These findings indicate that negative public perceptions of seeking psychological help remain a barrier. In academic settings, particularly in nursing, the demand to appear mentally strong can increase pressure to avoid showing weakness. This aligns with Goffman's (1963) labeling theory, which states that individuals with negative labels tend to experience social withdrawal and loss of self-esteem. These findings also align with several previous studies. Pattyn et al.'s (2014) study showed that public stigma is a major barrier to help-seeking behavior among college students. Xing (2020) also found that Asian-American college students refrained from seeking counseling due to social concerns about being labeled "weak" or "incapable." Furthermore, Corrigan and Crowe (2004; 2016) revealed that individuals with high levels of public stigma often fear being perceived as emotionally weak if they seek psychological help. 4.6 Self-Stigma and Students' Desire to Participate in Mental Health Counseling Guidance Process The majority of nursing students at the Poltekkes Kemenkes Semarang experienced moderate self-stigma (43.1%), followed by low (32.8%) and high (24.1%). Although the majority of students experienced moderate and low levels, nearly a quarter of respondents reported high self-stigma, which can be a barrier to seeking psychological help. Questionnaire analysis revealed clear differences in response patterns. Students with low self-stigma were more likely to agree with statements such as, "I would feel better about myself if I decided to seek counseling." and “My self-confidence will remain the same if I go to counseling .” This shows that they don’t view counseling as a sign of weakness, but rather as a form of concern for their own well-being. In contrast, students with high self-stigma endorsed items such as "Going to counseling would make me feel inferior" and "If I go to a counselor, I would become less confident in my abilities ." These responses reflect a belief that seeking professional help could damage self-image. The moderate stigma group exhibited hesitation, ambivalent between an awareness of the importance of counseling and concerns about its impact on self-esteem. Bivariate analysis showed a significant negative relationship between self-stigma and willingness to seek counseling (r = -0.502; p = 0.000). This means that the higher a student's self-stigma, the lower their willingness to access counseling services. Conversely, students with low self-stigma were more open and willing to seek help when facing psychological distress. These findings suggest that self-stigma remains a powerful psychological barrier. Ambivalence or resistance to counseling is influenced not only by a lack of information but also by internalized values of independence and resilience. This aligns with Beatie et al. (2016), who found that students with high self-stigma tend to view seeking help as a form of personal weakness. Research by Oktaviani & Putri (2025) also shows that Indonesian students are still influenced by cultural values that emphasize self-control, making suppressing problems a more common choice than openly seeking help. International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Astuti, et al. 31 of 31 5. Conclusion This study highlights the importance of understanding the psychosocial factors that influence nursing students’ willingness to participate in mental health counseling. The majority of students experienced high levels of stress, had strong social support, and showed low levels of public stigma and moderate levels of self-stigma. However, some students still demonstrated reluctance to access counseling services. There was a significant relationship between students’ willingness to participate in counseling and the variables of stress level, social support, public stigma, and self-stigma. Higher levels of stress, public stigma, and self-stigma were associated with lower willingness to engage in counseling. Conversely, strong social support showed a positive correlation with an increased willingness to seek professional help. References Beatie, B. E., Stewart, D. W., & Walker, J. R. (2016). 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