Help-seeking behavior among college students with suicidal ideation: barriers, facilitators, and social actors

Suicide among university students is a serious public health concern, often exacerbated by academic pressure, mental health stigma, and limited institutional support. Understanding contextual factors is key to developing effective prevention strategies. This study aimed to analyze the barriers and facilitators of help-seeking behavior among college students with suicidal ideation and to identify the social actors involved in help-seeking. A mixed methods approach was adopted, integrating qualitative and quantitative data to obtain a comprehensive understanding of help-seeking behavior. Qualitative data was collected through interviews with 20 students and 12 course coordinators, and a focus group with 6 administrative staff members. Quantitative data were obtained from a questionnaire completed by 22 mental health professionals, which included both multiple-choice and open-ended questions. The integration of findings occurred during the interpretation phase, allowing the quantitative results to complement and expand the qualitative analysis. Content Analysis and simple descriptive statistics were used. Seventeen barriers and twelve facilitators of professional help-seeking were identified and organized across individual, interpersonal, organizational, and social levels. The main barriers included low perceived need for professional care, self-stigma, emotional avoidance, insufficient social support, and institutional fragility. Facilitators comprised mental health literacy, encouragement from close individuals, previous positive experiences with therapy, financial aid for mental health treatment, and having accessible on-campus services. Professors, peers, and administrative staff emerged as key social actors in referring students to support services, highlighting the relevance of peer and faculty networks in suicide prevention. Low perceived need, self-stigma, and institutional barriers significantly hinder help-seeking among university students with suicidal ideation. Conversely, mental health literacy, social support, and institutional engagement foster professional help-seeking and trust in mental health care. These findings underscore the need for integrated, context-sensitive university strategies that combine psychoeducational interventions, gatekeeper training, and structural support to promote a culture of early intervention and belonging. The study contributes to suicide prevention efforts in higher education by emphasizing that collective, equity-oriented approaches are more recommended than exclusively individual interventions.