Examining Help-Seeking Intention for Mental Health Helplines among Adults in Lebanon

Abstract

Lebanon's ongoing socioeconomic and political crises have exacerbated mental health challenges in the country. Despite the high prevalence of mental health disorders and elevated suicide rates, access to professional services remains limited due to structural and cultural barriers. Helplines can be a crucial resource in this context, offering emotional support and connecting callers to appropriate resources when needed. Thus, this study examined predictors of the intention to call mental health helplines among adults in Lebanon (N = 232). It aimed to apply an extended Theory of Planned Behavior (TPB) framework (integrating loss of face, self-reliance, and perceptions of mental health concerns) to helpline use in Lebanon. Using a quantitative cross-sectional survey design, hierarchical regression and mediation analyses were conducted to examine these relationships. The final hierarchical regression model accounted for 45% of the variance in intention to call. Consistent with the TPB, attitudes toward calling and perceived behavioral control (PBC) were both significant positive predictors of intention, with attitudes emerging as the strongest. However, the primary analyses showed no evidence of an association between stigma and intention, although stigma was significant in some sensitivity analyses. Past helpline use and lower educational attainment also significantly predicted higher intention to call. The study revealed complex cultural dynamics. While self-reliance served as a significant deterrent by predicting lower intention to call through unfavorable attitudes, loss of face unexpectedly functioned as a facilitator. Specifically, mediation analyses showed that higher loss of face concerns predicted more favorable attitudes toward helplines, which subsequently predicted higher intention to call, likely due to the anonymity and confidentiality these services offer. Contrary to prior local literature on professional help-seeking, perceptions of mental health concerns did not show evidence of being an independent predictor of intention or attitudes toward calling helplines. Our findings suggest that the role of helplines may be particularly crucial in this population, especially since they may serve as a face-saving resource for individuals who might otherwise avoid traditional services. Implications for public health strategies include tailoring interventions and outreach efforts to address attitudinal deterrents while emphasizing the anonymous and confidential nature of helplines to accommodate cultural concerns.