1. Introduction

Mental health stigma refers to the negative attitudes, beliefs, and stereotypes that individual holds about mental illness and those who experience mental health challenges [1]. Stigma can manifest in various forms, including discrimination, prejudice, and social exclusion, and it often leads to individuals feeling ashamed, misunderstood, or marginalized because of their mental health condition. Stigma can act as a significant barrier to seeking help and support, as it can discourage people from seeking treatment, disclosing their condition, or accessing mental health services [2]. This barrier remains significant for many individuals, particularly among international college students, because they face unique challenges due to cultural differences, language barriers, and the pressure to succeed in a foreign academic environment [3]. Consequently, international students frequently endure elevated levels of stress, anxiety, and depression. However, the stigma associated with mental health issues often deters them from pursuing professional assistance.

In recent years, online resources have emerged as powerful tools for mental health awareness and support. Emotional support systems such as BetterHelp, 7 Cups, Talkspace, and some artificial intelligence (AI)-driven emotional support systems allow users to share experiences, access information, and find community support. They provide accessible and often anonymous assistance, making it easier for individuals to seek help without fear of judgment. Researchers have conducted numerus studies on using online support to reduce mental health stigma among different student groups [4, 5, 6], but there is limited research specifically examining their impact on international college students.

The National Institute of Mental Health (NIMH) reports that over one in five (57.8 million) U.S. adults experience mental illness [7]. This ratio increases to approximately one in four among populations of typical college age [7, 8] and further escalates to nearly one in three for college freshmen specifically [9, 10]. Observations indicate that these numbers have been increasing over the years [8]. Research also suggests that this upward trend includes international students, a 6 percent rise reporting in the number of international students indicating that health issues have affected their academic performance – of which nearly 83 percent were classified as "mental" or "psychological" [11].

Therefore, this study aims to fill this gap by analyzing the content of online resources to understand their role in shaping mental health attitudes and behaviors among international college students.

1.1. Research Goal

The primary goal of this study is to explore how online resources contribute to reducing the stigma associated with seeking mental health help among international college students. By conducting a case study, this research seeks to discuss some prevalent themes and messages that address or perpetuate mental health stigma.

1.2. Research Questions

To achieve this goal, the study is guided by the following research questions:

How do online platforms address mental health stigma for this population?

What themes and messages are prevalent in these resources?

By addressing these questions, this research aims to provide valuable insights into the effectiveness of online resources in combating mental health stigma and to offer recommendations for enhancing their impact.

2. Literature Review

The purpose of the literature review is to explore the current literature on mental health stigma among international college students and their influences on help-seeking behavior. The term 'help-seeking' encompasses all stages of the process, including the initiation and engagement with care [12]. In addition, the review synthesizes existing research on the impact of social media and online resources in shaping mental health attitudes and behaviors, with a specific focus on reducing stigma among international college students. By examining the current state of knowledge, this review aims to identify key themes, gaps, and trends that inform the broader context of this study. The review will provide a foundation for understanding how digital platforms can either contribute to or alleviate the stigma associated with mental health issues. In doing so, it aligns with the study's objectives to explore effective strategies for leveraging social media and online resources to improve mental health outcomes and help-seeking behaviors among international students. Through this comprehensive analysis, the literature review will highlight the critical areas needing further research and offer insights into practical applications for reducing mental health stigma in this vulnerable population.

2.1. Mental Health Stigma

Social stigma has been widely recognized as a significant issue in health care and human services globally. Initially conceptualized by Goffman [13] as a tarnished identity that diminishes an individual's standing in society, stigma affects people by attributing them with characteristics that are socially devalued in specific contexts [14]. Stigma involves a combination of prejudicial attitudes, negative emotional reactions, discriminatory behaviors, and biased social structures directed towards members of a marginalized subgroup [15]. This process includes labeling, stereotyping, social separation, status degradation, and discrimination against stigmatized individuals within power dynamics [16].

Indeed, stigma can be internalized by minority group members and their associates. Known as self-stigma, this phenomenon occurs when individuals internalize the prejudicial attitudes of the public, leading to negative emotional responses and behaviors directed towards themselves [17]. Similarly, affiliate stigma refers to the psychological impact on individuals closely associated with the stigmatized persons, such as caregivers, family members, and friends. These associates may internalize the stigma, which can adversely affect their own well-being. Although various concepts of stigma are often used interchangeably in the literature, this study specifically operationalizes stigma as self-stigma experienced by international college students.

According to Maeshima and Parent [18], self-stigma plays a crucial role in understanding the propensity for professional help-seeking among Asian American and Asian international students. For Asian international students, stigma often acts as a significant barrier to seeking psychological help, underscoring the necessity of addressing mental health stigma within this population. The lower rates of help-seeking are strongly associated with cultural attitudes towards mental health services, highlighting the importance of targeting stigma in the practice. Furthermore, Asian international students may encounter more barriers to mental health help-seeking compared to Asian Americans, emphasizing the critical need for interventions designed to reduce stigma and promote mental health support among this group. They suggest that future research can examine whether culture-sensitive mental health marketing will effectively increase help-seeking intentions in the Asian population [18].

Another research highlights the importance of addressing stigma related to mental health issues among international students in Japan through targeted anti-stigma education programs. They suggest that by focusing on increasing mental health literacy, promoting awareness, and providing tailored support, these programs can contribute to creating a more inclusive and supportive environment for international students [19].

2.2. Impact of Stigma on Help-Seeking Behavior

A systematic review in 2014 explores this issue on individuals from ethnic minority groups, who face double stigma, where racism both outside and within mental health services compounds the public and self-stigma of mental illness, deterring help-seeking. For males, gender stereotypes (e.g., being strong and stoical) may exacerbate the stigma associated with mental illness, perceived as a sign of weakness. Adolescents, whose identities and peer group affiliations are highly significant, may experience a greater dissonance between their self-identity and mental illness stereotypes, intensifying the stigma of seeking help. Therefore, the study highlights the negative impact of mental-health related stigma on help-seeking behaviors among ethnic minority college groups [20].

Subsequently, the impact of stigma on help-seeking behavior is profound, particularly among minority groups. Stigma can create significant barriers to accessing mental health services, as individuals may fear judgment, discrimination, and social exclusion. This fear often leads to delays in seeking help, exacerbating mental health issues and overall well-being.

A study on medical students finds that stigma is a significant factor influencing help-seeking behaviors among medical students [21]. It is found that several factors contribute to perceived stigma among medical students, influencing their willingness to seek help for mental health issues. A significant concern is the fear of discrimination from residency program directors, supervisors, and peers, which can discourage students from disclosing their mental health struggles. Concerns about confidentiality further exacerbate this issue, particularly when breaches of confidentiality by supervisors have been observed. Additionally, there is a prevalent belief that residency program directors are less likely to accept applications from students with emotional or mental health problems, a belief that is especially strong among students experiencing burnout. Comparatively, the level of stigma reported by medical students in this study aligns with findings from other studies on medical students. These students share similar beliefs regarding personal stigma, the competitiveness of residency applications, public stigma, and the perceived need to conceal mental health treatment. Notably, medical students who experienced burnout and sought help within the last year were more likely to agree with items related to perceived stigma, indicating a heightened sensitivity to stigma. These students were twice as likely to report experiencing negative judgments from supervisors and peers for seeking care. Consequently, a smaller percentage of these students were willing to seek professional help for serious emotional problems compared to the general population and their age-matched peers, underscoring the pervasive impact of stigma on help-seeking behavior.

2.3. The Role of Online Resources in Mental Health

Digital mental health interventions, delivered through mobile and web-based platforms, provide treatment opportunities college students facing common mental health issues. These interventions help to overcome many of the barriers associated with traditional mental health services, such as stigma and time constraints [22]. Various online resources support these interventions, offering a range of services tailored to different needs. For instance, BetterHelp and Talkspace provide accessible online counseling and therapy sessions with licensed therapists via text, voice, and video, making professional support more flexible and convenient [23, 24]. Platforms like 7 Cups offer free emotional support from trained listeners, which can be particularly valuable for students seeking immediate, informal assistance [25]. Headspace focuses on promoting mental well-being through guided meditation and mindfulness exercises, helping students manage stress and anxiety on their own schedules [26]. Additionally, resources like the National Institute of Mental Health (NIMH) and Mental Health America (MHA) provide comprehensive information on mental health disorders, screening tools, and educational materials, empowering students with knowledge and self-help strategies [27].

These digital platforms not only enhance accessibility but also help to reduce the stigma associated with seeking mental health services, as students can receive support in a private and discreet manner. By integrating these online resources into their lives, college students can more effectively manage their mental health, thereby improving their overall well-being and academic performance.

3. Theoretical Framework

Albert Bandura's Social Learning Theory (SLT) indicates that people learn behaviors, attitudes, and norms through observation, imitation, and modeling [28]. Online resources, such as blogs, forums, and social media platforms, can serve as powerful tools for modeling positive attitudes towards mental health. This theory supports the idea that exposure to supportive content can alter perceptions and reduce stigma. There are four key components in SLT: 1) Observational learning – people learn by watching the behaviors of others and the outcomes of those behaviors; 2) Modeling – individuals are more likely to adopt behaviors if they observe role models performing those behaviors, especially if the models are perceived as similar, admirable, or authoritative; 3) Imitation – after observing, individuals may imitate the behaviors if they believe it will lead to positive outcomes; and 4) Reinforcement and punishment – behaviors are influenced by the consequences that follow. Positive reinforcement encourages the repetition of behavior, while punishment discourages it [28].

4. Application of SLT in the Case Study

College Confidential Forums is an online platform designed to support international college students from college preparation to adaption [29]. The author created a “Mind Care Campus Community” page that features a variety of resources, including articles, discussions, forums, and social media channels. The page is designed to be culturally inclusive. The users on College Confidential Forums are all invited to this page. This case study follows the four components of SLT.

First, observational learning. This page showcases posters from international students who share their experiences with mental health challenges and how they overcame them. For example, a student from China discusses how she sought help for anxiety and found support through campus counseling services. These testimonials receive a high number of positive comments, likes, and shares. Other students see that discussing mental health issues leads to supportive and encouraging responses.

Second, modeling and positive behaviors. The “Mind Care Campus Community” collaborates with mental health advocates who are also international students. These influencers regularly post about their own mental health journeys, coping strategies, and tips for balancing academics and well-being. International students can ask questions, share their stories, and offer support to each other. The forums are moderated to ensure a safe and respectful environment.

Third, imitation of positive attitudes and behaviors. Students actively engage with the content by commenting on articles, participating in discussions, and sharing their own experiences. Over time, they start to use the same positive language and attitudes towards mental health that they observe in the influencers and community members. The supportive environment encourages more students to open up about their mental health issues. For example, a student from India posts about her struggles with depression and receives an outpouring of support and advice from other users.

Lastly, reinforcement and punishment. Students who share their mental health struggles receive positive feedback, such as supportive comments and messages of encouragement. This reinforces the behavior of discussing mental health openly. The community actively moderates content to ensure that negative or stigmatizing comments are minimized. Students learn that they can discuss mental health without facing judgment or criticism.

5. Analysis and Findings

The author observes three behavioral patterns:

A significant increase in the number of students discussing mental health issues over a six-month period. A rise is noticed in first-time posters who were previously silent on these issues.

A noticeable shift in the language used by students, with more positive and supportive terminology becoming prevalent. For example, terms like “crazy” or “weak” decrease by 44%, while terms like “brave”, “support”, and “courage” increase by 59%.

There is a notable increase in participation from students from various cultural backgrounds.

Furthermore, it shows a reduction in self-reported stigma among the users in the page. Discussions assessing comfort in seeking help, discussing mental health, and perceptions of mental health services all show significant positive changes. International students are more likely to discover the services from campus counseling services. In addition, a strong peer support network forming within the community. Students frequently share advice, resources, and emotional support, indicating a collective effort to combat stigma. For example, a student from Nigeria, Jane, shares her story about struggling with depression while studying abroad. She talks about feeling isolated and afraid to seek help due to stigma. The post receives numerous supportive comments like, "Jane, your courage is truly inspiring. I’ve been through similar experiences, and knowing I’m not alone gives me strength," and "Thank you for sharing, Jane. This community is here for you."

Here is another example on social media interaction. A mental health advocate on the platform shares a post about the importance of self-care and seeking help, stating, "It’s okay to not be okay. Reaching out for support is a sign of strength, not weakness." The post is widely shared and commented on, with users adding their own experiences and words of encouragement. One comment reads, "This message came at the right time. I’ve been struggling but felt ashamed to talk about it. Now I feel more confident to seek help."

In short, the analysis and findings from "Mind Care Campus Community" highlight the platform's success in utilizing SLT to reduce mental health stigma among international college students. By providing a supportive environment, showcasing positive role models, and reinforcing healthy behaviors, the platform has significantly impacted students' attitudes and behaviors towards mental health.

6. Conclusion

This study aimed to explore how online resources can reduce mental health stigma among international college students by analyzing content and interactions on the "Mind Care Campus Community" platform. Guided by Social Learning Theory, the research demonstrates that online platforms can significantly influence students' attitudes and behaviors towards mental health. The findings indicate that these resources effectively increase discussions about mental health, promote the use of positive and supportive language, and encourage participation from a diverse student body.

The case study reveals that international students benefit from observing and interacting with peers who share their experiences and coping strategies. Positive reinforcement, such as supportive comments and shared success stories, encourages students to discuss their mental health openly and seek help when needed. The reduction in self-reported stigma and the increase in help-seeking behaviors highlight the potential of online resources to create a more inclusive and supportive environment for international students.

These results underscore the importance of leveraging digital platforms to address mental health stigma and promote well-being among international college students. Future research should continue to explore the impact of online resources on different student populations and develop strategies to enhance their effectiveness. By fostering supportive online communities, educational institutions can better support the mental health needs of their diverse student bodies and contribute to the overall reduction of mental health stigma.