INTRODUCTION

The teaching profession, due to its working conditions, is a stressful occupation (1-4). Teachers experience higher stress levels than professions such as doctors, dentists, or nurses, and their rate of leaving the profession is high (5). Earlier studies raised the issue of professional stress and mental health, reporting a high rate (62.9%) of minor psychiatric disorders among teachers (6); 30.7% were suffering from worries and insomnia, 38.3% from social functioning disorder, 5.5% from depression, and 17.7% from mental health problems (7). Teachers’ mental health is important because their performance in class is dependent especially on their emotional condition, including stress and depression levels (4). There is a positive correlation between teachers’ wellbeing and the effectiveness of their instructional effectiveness (8). Although the teaching profession is stressful and despite the known impact of teachers’ mental health on students during teaching, prospective teachers’ mental health is neglected in training and selection. Teacher training institutions focus on professional development, ignoring their psychosocial development.

The time students spend in teacher training institutions is also a time when mental problems emerge (9,10) that are going to affect the students’ present and future (11). There are studies demonstrating the severity of the suicide issue (12) and common social phobias (13). Other studies also show that the number of students with psychiatric disorders and serious mental diseases in university is increasing (14-17).

If we consider that the highly common presence of mental problem among university students poses an important problem, we could also say, on the other hand, that the university might represent an opportunity for solving these problems (10,17-19). If mental problems are not being addressed, they may have serious effects on the individuals’ academic, social, and autonomous functioning (20) and lead to serious mental disorders in adulthood.

An important issue in the assessment of mental health is if persons in situations of anxiety and stress are going to seek help. Help-seeking is effort to find a solution to a problem that they believe they cannot overcome by themselves. For unexperienced people, help-seeking is a protective factor (21,22) and an adaptive life skill (23,24). For a person inside a network of relationships, help-seeking means finding a solution for the problem/unease with the help of their relations. It is one of the ways of coping with unease and stress. Help-seeking draws on two different sources, a formal and an informal one. Studies have shown that there are different sources and that informal sources are more heavily employed (22,24-29). Some individuals, for various reasons, may not want to accept help (28,30-32). However, support from various sources can facilitate a person’s problem-solving, to overcome the issues before they grow and become more serious.

Teachers’ mental health is an issue to be confronted particularly during their training process, given that it occurs in an environment that is suitable for reaching the students and providing services identifying and addressing issues with the students’ personal development and formation of their character early on. In this environment, it is necessary to prepare prospective teachers in a healthy manner, ensuring that they pass the preparation process healthy, and if necessary to identify and confront problems and establish a planned intervention. However, mental as well as physical health is often overlooked and neglected to a degree that it can cause damage to the individual and the environment (33). Therefore, the present study aims at creating knowledge regarding provisions to support mental health in the process of teachers’ training. We intend to determine prospective teachers’ mental symptoms, sources for help they are seeking, and reasons for not seeking help. We analyze the mental symptoms according to sources sought and reasons for not seeking help.

METHOD

The study has been carried out in a sample of teacher candidates studying at the Faculty of Education at Canakkale Onsekiz Mart University, a State university in Canakkale in Western Turkey. The sample consisted of 724 prospective teachers, 501 (69.2%) of whom were female, 223 (30.8%) male. Mean age in the sample was 21.07 (SD=1.57) with a range between 18 and 26 years. Of the sample, 20.4% were first year students, 24.6% second year, 27.9% third year and 27.1% fourth year students.

The data collecting instruments were administered to the prospective teachers during the academic year 2012-2013 during class time, with permission from the lecturers teaching the class. Administration took around 15-20 min. Study participation was voluntary for the students. Participants completed the data collecting instruments anonymously.

Statistical Analysis

Data collected in the study were assessed with the SPSS 15 package. To establish the students’ mental health, mean and standard deviation were computed. Normal distribution of the Global Severity Index (GSI) and subscale scores of the BSI were evaluated with the Kolmogorov-Smirnov Test and found not to be normally distributed (p<0.05). Therefore, to determine correlations between dependent and independent data, the non-parametric Mann-Whitney U Test was used. In our study, the level of significance was set at p<0.05.

Measures

This study collected data using the Brief Symptom Inventory (BSI) (34) and a Sociodemographic Data Form prepared by the investigators.

Brief Symptom Inventory (BSI): This is a symptom search inventory developed by Derogatis and Melisaratos (35), a short version of the SCL-90-R consisting of 53 items, that can be used for psychiatric and medical patients as well as for normal samples for detecting psychopathologies. Validation of the BSI for Turkey was made by Sahin and Durak (34) with 5 subscales for somatization, depression, anxiety disorder, hostility, and negative self-concept. Internal consistency coefficients varied between 0.71 (somatization) and 0.85 (depression). Correlation values between the Social Comparison Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, and Satisfaction with Life Scale, used to confirm the criterion-dependent validity of the BSI, also demonstrated the validity of the instrument (36). In this study, Cronbach’s alpha coefficient, a measure for internal consistency, was calculated to be 0.93. Internal consistency of the subscales varied between 0.76 (hostility) and 0.90 (depression). Items on the instrument were answered on a 5-point Likert-type scale with selections like not/none, little/medium, to a degree/somewhat, much/considerable. The instrument generated 3 general indices, including Global Severity Index (GSI), Positive Symptom Total (PST), and Positive Symptom Distress Index (PSDI). In our study, we used the GSI for a general assessment of psychopathology.

Sociodemographic Data Form

The sociodemographic data form was prepared by the investigators with the purpose to record the prospective teachers’ demographic characteristics (gender, age, year of study) and their help-seeking behavior in case of unease and stress. This form consists of statements aimed at collecting information if the teacher candidates had sought help in situations of uneaseand stress, and if so, from whom, or if not, for what reasons. In the process of compiling these items, we created a pool from the reviewed literature and afterwards used expert views to assess the suitability of the items. Those appealed to for help were divided into informal (friend, mother, father, sibling, partner) and formal (psychological counselor, psychologist, psychiatrist, doctor). Items concerning reasons for not seeking help contained the following statements, to be completed by marking “yes” or “no”: “Because I can solve my problems on my own”, “Because I do not think that anyone will understand me”, “Because I do not want to talk about my problems”, “Because I do not think anyone is able to help me”, “Because I do not know where to ask”, “Because I believe my problems will improve with time”, “Because I was afraid others would judge me negatively if I seek help”, “Because in my environment, I could not find anyone suitable to ask for help”, “Because there was no specialist to ask for help in my environment”, and “Because I did not have the financial means”.

RESULTS

Data from our study found an intensity of distress

=0.99 (SD=0.66) for the prospective teachers. Their BSI subscale score averages were (from high to low): depression 1.29 (SD=0.85), hostility 1.28 (SD=0.76), negative self-concept 0.89 (SD=0.73), anxiety 0.83 (SD=0.68), and somatization 0.76 (SD=0.66). Scores above 1.00 were found in 40.6% of the candidates for intensity of distress, in 55.9% for hostility, in 53.6% for depression, in 32.9% for negative self-concept, in for 28.6% anxiety, and in for 25.4 somatization symptom level.

Analysis of help-seeking data showed that around two thirds of the candidates (67.3%) were disposed to seeking help. Among the various sources for help appealed to, the percentages obtained for informal sources were 68.7% for “a friend”, 62.2% “mother”, 41.9% “partner”, 41.9% “sibling”, and 35.1% “father”. Help-seeking from formal sources was directed to a psychological counselor (19.1%), a psychologist (23.2%), a psychiatrist (14.3%), or a doctor (4.1%). Percentages for help-seeking from informal sources were higher than for formal sources.

The teacher candidates were also asked to specify reasons why they did not seek help. Frequency and percentages for their replies are presented in Table 1.

As seen in Table 1, of the teacher candidates not seeking help, 71.5% declared that they refrained from seeking help “because [they] can solve the problems on [their] own”, 40.5% “because [they] believe [their] problems will improve with time”, 17.3% “because [they] do not think anyone is able to help [them]”, 18.0% “because [they] do not think anyone will understand [them]”, 16.2% “because [they] do not want to talk about [their] problems”.

In order to establish the differences between the candidates’ mental symptoms evidenced by BSI intensity of distress and subscale scores according to help-seeking and informal sources of help (friend, partner, mother, father, sibling, relative), Mann-Whitney U Test was applied; the results are presented in Table 2.

As seen in Table 2, no significant difference in BSI intensity of distress and subscale scores was found between teacher candidates seeking and those not seeking help. Regarding candidates’ informal sources for help (mother, father and sibling), significant differences in their mental symptoms were found. Mean ranks on the hostility subscale for those not seeking help from their mother were higher than for those seeking help (U=54339.00; p<0.05). Regarding seeking help from the father, those not seeking help scored higher on GSI (U=38056.00; p<0.01) and the subscales for depression (U=39134.50; p<0.05), anxiety (U=39438.00; p<0.05), negative self-concept (U=36758.00; p=0.001), and hostility (U=38354.00; p<0.01) compared to help seekers. Seeking help from a sibling showed a similar pattern. For candidates not seeking help from a sibling, GSI (U=42850.50; p<0.05) and depression (U=44134.00; p<0.05), anxiety (U=43997.50; p<0.05), negative self-concept (U=43502.000; p<0.05) and hostility subscale (U=40392.000; p<0.001) scores were higher than for those seeking help.

In order to establish the differences between the candidates’ mental symptoms evidenced by BSI intensity of distress and subscale scores according to help-seeking and formal sources of help (psychological counselor, psychologist, psychiatrist, doctor), Mann-Whitney U Test was applied; the results are presented in Table 3.

When we look at Table 3, analyzing the candidates mental symptoms according to formal sources of help, we find significant differences in the results for psychologists and psychiatrists. For those who sought help from psychologists, the GSI (U=27517.00; p<0.05), anxiety (U=27901.50; p<0.05), negative self-concept (U=28306.00; p<0.05), hostility (U=27575.00; p<0.05), and somatization subscale (U=28185.000; p<0.05) mean rank scores were higher than in those not seeking help. For the other formal source of help, psychiatrists, the GSI (U=17834.50; p<0.05) and the hostility subscale (U=17896.000; p<0.05) resulted in higher scores than for those not seeking help.

In order to determine if there was a significant difference between prospective teachers’ mental symptoms according to reasons for not seeking help, analysis with Mann-Whitney U Test was performed; the results are presented in Table 4.

As can be seen from Table 4, the analysis found a lower mean rank in intensity of distress (U=48897.50; p<0.05) and depression (U=48835.00; p<0.05) and anxiety (U=47705.00; p=0.01) for candidates not seeking help “because [they] can solve [their] problems on [their] own” compared to those seeking help. By contrast, the mean ranks for candidates not seeking help “because [they] do not think that anyone will understand them”, “because [they] do not believe that anyone is able to help [them]”, and “because [they were] afraid others would judge [them] negatively if [they] seek help” in their GSI (U=11763.00; p<0.001, U=11601.50; p<0.001, U=2191.50; p=0.001) depression (U=11719.00; p<0.001, U=12084.50; p<0.001, U=2115.50; p=0.001), anxiety (U=12252.50; p<0.001, U=12119.00; p<0.001, U=2559.00; p<0.01), negative self-concept (U=12992.00; p<0.001, U=12247.50; p=0.001, U=2176.50; p=0.001), hostility (U=11609.50; p<0.001, U=10546.00; p<0.001, U=2480.50; p<0.01), and somatization (U=12517.50; p<0.001, U=13240.50; p<0.01, U=2554.50; p<0.01) were higher than for those not using these reasons. The mean ranks for candidates not seeking help “because [they] do not want to talk about their problems” or “because [they] did not know where to ask” in their GSI (U=12145.50; p<0.05, U=2292.50; p<0.05), depression (U=11196.00; p=0.001, U=2124.00; p<0.01), negative self-concept (U=12720.00; p<0.05, U=2148.00; p=0.01), and hostility (U=12404.50; p<0.05, U=2523.00; p<0.05) were higher than for those seeking help.

DISCUSSION

While analyzing teacher candidates’ mental health, this study found a value for the students’ intensity of distress near 1.00, which is accepted as a cut-off point (37). This value is lower than the mean value of university students with psychiatric problems, which is 1.28 (38), and that of persons presenting to crisis centers, 1.42 (39). In a study outside Turkey, the average of a general population sample reached a far lower value (0.60), while the patient sample scored far higher (1.56) (40) than in our study.

The study results show that two out of five prospective teachers have a high intensity of distress. In more than half of them, hostility and depression levels are elevated, as are negative self-concept and anxiety levels in almost one-third and somatization levels in one-fourth. A study with students of a faculty of education determined that 31.5% of the students had experienced burnout (41). Another study with prospective teachers found that 42.5% of the candidates were at danger of burnout, 20.6% experienced burnout, and 8.6% showed a serious level of burnout (42). A study carried out with trainee teachers in Nigeria detected psychological problems in 36.0% of the candidates (43). A study with student teachers in Germany found mental health problems in 44.0% of the candidates (1). These rates are of great significance for teacher training institutions and demonstrate that there is a great need to diagnose mental health and disorders early and provide treatment.

The most common mental symptoms among teacher candidates were depression and hostility, the rarest were somatization symptoms. In another study conducted with a prospective teacher sample, depression and hostility were again the most frequently seen signs (44). Depression is a commonly found and serious disorder among adolescents and youths, also affecting their academic performance (45). It has been reported that a number of disorders like depression and anxiety increase during adolescence and young adulthood. The National Institute of Mental Health (NIMH) carried out a study in five communities, finding a median age of 15 years for anxiety disorders and of 24 years for major depressive disorders (46). The lifetime prevalence rate for mood disorders was reported to be 18.6%, for anxiety disorders 12.5%, and for somatoform disorders 6.2% (47).

One strategy in situations of unease and stress is to seek help from persons who can reduce external stress factors. It has been reported that 39.2% of the teacher candidates do not seek help. According to Gulliver et al.’s (48) review of 15 quantitative and 7 qualitative studies, adolescents and young adults, despite frequently experiencing mental disorders, do not seek help, which is a serious problem, because help-seeking is an important step towards problem-solving in many life situations (49), and sharing problems is the first stage of finding a solution.

In unease and stress situations, the source prospective teachers turned to most was a friend. This finding is supported by a body of literature (22,24,26,28,29,50-52). In the second place, the mother is chosen (26,28,52). Our study assessed the generally neglected variable of help-seeking from a sibling, and we could show that siblings are a more important source for help than the father. Within the family, the first place is taken by the mother, the second by siblings, and the last by the father. In this order, the partner comes after the mother, indicating that during the university years, friendship with the opposite sex is of great importance. It is worth noting in this ranking that prospective teachers in situations of unease and stress direct their help-seeking to persons outside the professional realm. They put more trust in informal support networks (25).

The fact that friends come in the first place may be related to the teacher candidates’ young age and to their living away from their families. Their mother’s position in second place is not surprising. The mother, who has resolved children’s distress and needs since birth, will be among the first persons to turn to for social support. A study carried out in 8 universities in Turkey found that between 2.0 and 8.0% of students presented to the Psychological Counseling and Guidance service offered within the universities (53). It seems that the rate of help-seeking from official sources is fairly low. This may be due to concerns that formal support might cause embarrassment within the family (54). Therefore, young people experience informal help-seeking as less threatening than formal support (51).

In order to increase help-seeking as one of the ways to improve wellbeing in situations of unease and stress, it is necessary to know the reasons for the reluctance to seek help. It is known that especially seeking formal help is a way that can improve wellbeing (55). Therefore, identifying the reasons for not seeking help can contribute to increasing help-seeking and accessing formal supportive interventions.

In our study, a large part of our sample not seeking help in situations of unease and stress justified their reluctance saying that they believed to be able to solve their problems on their own and that their problems were going to improve with time. The intention to solve problems by oneself is the greatest obstacle for seeking help from a therapist (56). When asked why they did not seek help, most of the persons feeling the need for treatment replied that they preferred to manage on their own (57). In a study with a university sample, 73.0% of the students said that they were looking for a solution to lighten their psychological concerns themselves rather than sharing these with others (58). Among prospective teachers, the belief to be able to solve problems on their own may derive from an encouragement of autonomous problem-solving in their environment.

In the second place, teacher candidates state a belief that their problems will improve over time as a reason for not seeking help. In a study with university students supporting this finding, 37.0% said that they believed their problem would resolve on its own (18). In another study, 20.0% of university students declared that it was appropriate to “let the problem hanging” (58). In Turkish society, when people encounter problems, they frequently use expressions like “leave it to time”, “time solves everything”, “time is medicine for everything”, which may account for their attitude to find it more right and adequate leaving problems to time instead of seeking help.

Other reasons included not believing that others would understand them or that others would not be able to help, and not wanting to share problems with others. In another university student sample similar to our study, 20.0% of the students expressed the belief that “no one will understand their problems”, and 20.0% stated their “concerns about what others were going to think” (18). These negative beliefs may be results of learned experiences.

If parents bringing up their children interfere with their expression of emotions, they may create the idea in the children that emotions are bad, and children learn the necessity not to experience emotions (59). A psychological counseling process focused on emotions can thus be negatively affected by this situation.

In candidates not seeking help from their mother, the hostility level was found higher than in help-seeking individuals; in those not seeking help from their father and siblings, GSI, depression, anxiety, negative self-concept and hostility levels were found to be higher. These findings emphasize the importance of relationships with the mother and particularly with father and siblings for mental health. In the end, it can be said that seeking help from parents and siblings supports and strengthens mental health. Time spent with siblings and shared events contribute to the process of socialization (60). Therefore, siblings can be an important source of support for one another (61).

Looking at formal sources of support, those seeking help from psychologists had a higher GSI, anxiety, negative self-concept, hostility, and somatization level than those not seeking help, while candidates seeking help from psychiatrists were found with a higher BSI intensity of distress and hostility level than those not seeking help. We saw that users of informal sources of support had fewer mental symptoms than those not seeking help, while those using formal help had more mental symptoms than those not seeking help. If the willingness to refer to informal sources might show the existence of supportive relationships, it can be said that in relation with the increase of mental symptoms, individuals tend towards formal sources of help.

Candidates not seeking help “because [they] can solve [their] problems on [their] own” had lower intensity of distress, depression and anxiety level. This finding is consistent with the expectation that self-confident persons have fewer mental symptoms. In candidates believing that others would not understand them or not be able to help and those fearing to be judged by others, GSI and all subscales found strong mental symptoms. In candidates who were unwilling to share or did not know where to seek help, GSI and all subscales except for somatization found strong mental symptoms. Eventually, it can be assumed that these justifications inhibiting help-seeking are related to the individuals’ mental symptoms.

The teaching profession with its manifold tasks is a difficult and quite problematic occupation. The literature mentions disruptive and aggressive student behavior as the primary stress factor for teachers (62), and the increasing rate of psychological disorders diagnosed after the year 2000 has attracted attention (63). In addition, teacher candidates’ difficult experiences with finding work and the appointment process lead to uncertainty affecting mental health and reducing life satisfaction (64). Teachers’ health is closely related with students’ health (62). From this perspective, measures to improve mental health and taking the necessary precautions need to be seen as an inseparable element of teachers’ training. Institutions training teachers should be conceived as places where young people of a risk group can access required interventions and suitable environments.

The necessary coping behaviors to reduce stress and solve problems are a result of learning experiences and contribute to the psychological adaptation and wellbeing of the individual (65). Developing young people feel the need for effective coping skills (66). In this realm, psychological counseling and guidance can provide effective life skill training, mental health education, and psychosocial interventions (67).

Considering that 18-25-year-old young adults have a high risk of developing severe mental illnesses such as schizophrenia and bipolar disorder (68), it should be said that the education environment needs to be conducive to mental health and personal development. At the same time, students with emotional and behavioral problems can potentially affect their environment and constitute a risk for other people around them. Educational institutions are the place where mental health problems are first identified (67). These institutions can help teacher candidates with mental problems restoring their health through early diagnosis and intervention.

Seeking help can contribute as a first step to the solution of problems in situations of stress and unease. When encountering psychological problems, seeking out counseling services can affect students’ wellbeing, academic success, and sustainability positively (69). Interventions to develop prospective teachers’ help-seeking attitude and behavior are necessary. The neglected relations with father and siblings as well as support from formal sources can be seen as protective factors for mental health, and reinforcing these relationships may have a positive effect on mental health. In particular, normalizing help-seeking from formal sources can contribute to problem-solving (49).

To prevent the factors inhibiting help seeking, like concerns of not being understood or not being able to find help and fear to be judged by others, it may be helpful to encourage the interaction of people who are unwilling to accept help or do not know where to ask with people who have received support. This may help them to see that accepting help is one of the possible ways to solve problems.

In the realm of preventive mental health services in the phase preparing prospective teachers for a stressful professional life, it may be useful to develop psychological support services in the teacher training facilities with a view to improve mental health, to advise prospective teachers to seek help, and to involve units inside the universities actively in providing students with mental support.

This study has a number of limitations. In order to determine obstacles for help-seeking, true-false answers to statements provided by the researchers were used, but these statements may not include all possible obstacles. In the study, help-seeking behavior was analyzed according to mental symptoms determined by the BSI used for survey purposes; a comparison between candidates who received a diagnosis of mental disorder and those who did not can provide information that is more valid. The sample consisted of teacher candidates from a small, developing university campus and can thus not be generalized to all prospective teachers. In our study, teacher candidates’ mental health and help-seeking behavior were determined cross-sectionally; longitudinal research should shed light on long-term changes in mental health and help-seeking behavior.

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