Int J Adv Counselling (2008) 30:262–267

DOI 10.1007/s10447-008-9062-0

ORIGINAL ARTICLE

University Counselling Service Utilisation by Local

and International Students and User Characteristics:
A Review

Adam Raunic & Sophia Xenos

Published online: 4 October 2008

# Springer Science + Business Media, LLC 2008

Abstract This paper reviews research on students’ usage of university counselling services
across countries and their demographic and psychological characteristics. In doing so,
emphasis is given to reported distinctions between local and international university
students. Utilisation rates, encouraging factors and barriers to utilisation, presenting
problems, and methodological problems with existing studies are each examined. The
findings suggest that only a minority of between 2% and 4% of university students access
such services, with females being more likely to use them than males. International students
in particular underutilise these services, and this is primarily due to such students’
preference for seeking help from family or friends over outside sources. When students do
seek assistance, their presenting issues most commonly involve symptoms of depression or
anxiety, as well as academic and relationship difficulties.

Keywords University counselling services . University students . College students .

International students . Local students . Help-seeking behaviour . Review studies

Introduction

It has been documented that only a minority of university students who experience
psychological distress seek professional counselling (Kahn and Williams 2003). This is
despite the fact that most universities in Western (and increasingly, non-Western) countries
provide free access to counselling services to students on their campuses. This paper
reviews research on students’ usage of university counselling services and their
demographic and psychological characteristics, with an emphasis on reported distinctions
between local and international students. Firstly, utilisation rates of university counselling
services are examined across studies, followed by both encouraging factors and barriers to
utilisation. The most frequently occurring presenting problems of university students are
also presented. Finally, methodological problems with existing studies and subsequent

A. Raunic (*) : S. Xenos

Division of Psychology, School of Health Sciences, RMIT University, GPO Box 2476V, Melbourne,
Victoria 3001, Australia
e-mail: adam_raunic@bigpond.com
Int J Adv Counselling (2008) 30:262–267 263

recommendations for future research, including the need for Australian data on university
counselling service usage, are discussed.

Utilisation Rates

Knowledge about the proportion and type of students who actually use university
counselling services is an important preliminary consideration in evaluating the
effectiveness of such services (Morgan et al. 2003). In a recent study involving 4,699
first year university students at a British university (which was 84% of first year students at
the university), it was reported that 3% had used the university counselling service by the
end of the second semester (Cooke et al. 2006). In the same study, only 5% of students
categorised as ‘vulnerable’ on the basis of their GP-CORE psychological wellbeing scores
had accessed university counselling, with the majority indicating that they had not used
alternative services (Cooke et al. 2006). Similar overall utilisation rates of between 2% and
4% have been reported in American (Yoo and Skovholt 2001), South African (Flisher et al.
2002), and Indonesian (Setiawan 2006) university student samples.
Some studies have reported gender differences in university counselling service
utilisation rates. In general, studies have reported that females are more likely to use these
services than males (e.g., Connell et al. 2007; Flisher et al. 2002). However, Yi et al. (2003)
reported the opposite to be the case amongst international students attending an American
university. Gender differences in utilisation rates may, therefore, reflect cultural influences,
and may not be immediately generalisable between countries. Moreover, the reportedly
higher counselling service utilisation rates of female students may be inaccurate in some
studies due to their failure to take into account the fact that females outnumber males on
many university campuses. For example, in a study of Spanish university students, it was
reported that females were 10% more likely to attend counselling services than males;
however, no significant differences due to gender remained when those students receiving
counselling were compared with the general university population (Arco et al. 2005). Many
studies fail to make this comparison, and this represents a simple albeit important
methodological limitation of many existing studies.
In addition to gender differences, a number of studies have examined differences in
university counselling service utilisation rates between local and international students. In
general, studies have reported that international students underutilise these services (e.g.,
Morgan et al. 2003; Nilsson et al. 2004). Nilsson et al. (2004) reported that only 2% of all
international students at an American university sought counselling from the counselling
centre during a 1-year period. Similar findings have been reported for non-international
ethnic minority groups attending universities in the US, including Hispanic and Asian
(Davidson et al. 2004) and African American (Ayalon and Young 2005) students.
Therefore, it may be that cultural background or ethnic minority status is a more important
predictor of counselling service usage than local or international student status, however
additional research is needed to investigate this directly.

Encouraging Factors and Barriers to Utilisation

A number of factors have been hypothesised to be responsible for students’ underutilisation

of university counselling services. These include perceived self-sufficiency, denial as a
coping style, unwillingness to discuss personal problems, lack of knowledge about
264 Int J Adv Counselling (2008) 30:262–267

counselling services, and the perception of stigma related to receiving counselling (Komiya
et al. 2000; Surf and Lynch 1999). Setiawan (2006) examined factors that facilitate and
inhibit the seeking of counselling in Indonesian undergraduates. She reported that the major
encouraging factors were the provision of information about the existence of counselling
services and the procedure for making an appointment to see a counsellor, and the
assurance of strict confidentiality. By far the most important barrier to students seeking
counselling was having family or friends who could help them, followed by a belief in their
ability to solve their own problems (Setiawan 2006).
Additional research has suggested the importance of the presence of social support as
an inhibitory factor to students seeking counselling. In a study involving American
college students, Kahn and Williams (2003) reported that the tendency to conceal
distressing information, social support, psychological distress, and attitudes toward seeking
help predicted students’ intended use of university counselling services. Specifically,
students who tended to conceal personally distressing information had more negative
attitudes towards seeking help and weaker social support networks, and these weaker
networks in turn were associated with higher levels of distress and greater use of
counselling services. Thus, students who conceal distressing information may find them-
selves in a ‘double jeopardy’ type scenario in which they are drawn towards counselling
because of their lack of social support and high levels of distress, but at the same time
repelled by these services because of their negative attitudes towards seeking help (Kahn
and Williams 2003).
Some research suggests that international students may experience heightened barriers to
seeking counselling. For some international students, poor language proficiency within their
adopted educational environment is both a source of distress as well as a discouraging
factor to seeking counselling assistance (Morgan et al. 2003). In addition, studies have
shown that international students frequently possess underlying negative attitudes towards
seeking help from university counselling services (Yi et al. 2003; Yoo and Skovholt 2001).
These attitudes may be shaped in part by cultural values such as collectivism which is more
prevalent in Asian than in European societies and which may discourage students from
seeking help from outside sources in favour of support from family members and friends.
Related cultural influences that inhibit help-seeking include the perceived stigma and shame
associated with using counselling services, as well as cultural restrictions placed on the
external expression of emotion (Setiawan 2006).

Presenting Problems

A number of studies have examined the primary presenting problems of those students who
do seek assistance from university counselling services. Surtees et al. (1998) reported that
symptoms of depression, course-related problems, relationship difficulties, and feelings of
anxiety were the most frequently cited problems of British university students attending a
university counselling centre. Overall, 62% of clients were experiencing depression as the
dominant psychological symptom of their presenting problems, while 53% were
experiencing anxiety (Surtees et al. 1998). Another study investigating users of campus
counselling services across several British universities reported that the most common
presenting problems were anxiety (63%), interpersonal problems (57%), depression (54%),
low self-esteem (43%), and academic concerns (41%) (Connell et al. 2007). Similar
presenting problems and concerns have been reported amongst Spanish (Arco et al. 2005)
and Turkish university students (Güneri et al. 2003).
Int J Adv Counselling (2008) 30:262–267 265

Several studies have also reported gender differences in university students’ presenting
problems. For example, Surtees et al. (1998) reported some significant sex differences in
students’ presenting issues, with females reporting more self-harm, eating disorders, and
sexual abuse, while males exhibited greater academic and social problems. Connell et al.
(2007) also reported that male students were more likely to present with academic
problems, as well as anxiety and addictions when compared with females. Women, on the
other hand, were more likely to have presenting issues surrounding eating disorders, trauma
or abuse, and self-esteem.
Few studies have examined the specific presenting problems of international students
who access university counselling services. However, in one study Nilsson et al. (2004)
reported that most international students who sought counselling at an American university
did so because of depression, lack of assertiveness, course-related difficulties, and anxiety.
Significantly, approximately one-third of the international students dropped out of
counselling following the initial intake session (Nilsson et al. 2004). Further research
conducted by Yi et al. (2003) indicated that anxiety (83%), academic problems (82%), and
depression (74%) were the major presenting concerns of international students at an
American university. Interestingly, male international students were significantly more
likely to present with ‘personal’ problems, while female international students were more
likely to present with ‘career’ difficulties (Yi et al. 2003).
Some researchers have, however, recommended special caution when interpreting the
presenting problems of international students. This is because research suggests that the
expression of certain psychological distress symptoms may be culturally determined, and
may differ in particular between students from Western and non-Western cultures (Ayalon
and Young 2005). For example, in a study conducted by Yoo and Skovholt (2001) that
examined cross-cultural differences in depression expression and help-seeking behaviour,
there was a significant difference between American and Korean university students in the
way that depression was expressed. Specifically, Korean students reported more somatic
symptoms than American students such as having poor appetite, feeling that everything was
an effort, and talking less than usual. Furthermore, American students showed significantly
more positive attitudes towards seeking help than Korean students, and somatisation of
depression symptoms was negatively correlated with seeking professional assistance (Yoo
and Skovholt 2001). It may also be culturally more acceptable for some Asian students to
present with somatic or academic problems rather than with depression or anxiety, thus
counsellors need to assess international students’ overall functioning carefully (Yi et al.
2003).

Australian Research

Very few published studies have examined the characteristics of users of university
counselling services in Australia. This is despite the fact that counselling services were first
established on Australian university campuses about 50 years ago, which is earlier than
most comparative countries (Quintrell and Robertson 1996). In addition, a relatively wide
access to tertiary education has existed in Australia longer than in the US or the UK, and
together these factors may have an impact on both students’ adjustment to university and
their utilisation of counselling services. Australian society is also amongst the most
multicultural in the world, while at the same time international students make up a large
proportion of the total university student population (Department of Immigration and
Citizenship 2007). These factors may contribute to making university counselling services
266 Int J Adv Counselling (2008) 30:262–267

more appealing and accessible to ethnic minority students in Australia; however research is
clearly needed to examine such students’ actual usage patterns.
A few studies have examined the psychological wellbeing and adjustment of
international students attending Australian universities. For instance, Oei and Notowidjojo
(1990) reported that international students with one or more years of Australian residence
were significantly more likely to experience moderate to severe depression and loneliness
than Australian students. In another study, the level of difficulty experienced by Asian and
Australian university students in dealing with social and academic situations was examined
(Barker et al. 1991). It was reported that Asian students had more difficulty in dealing with
academic situations that involved interpersonal interactions (such as tutorials), and in
relating to people of different status to themselves. The primary reason Asian students
found interpersonal interactions difficult was because they were worried about their English
language proficiency (Barker et al. 1991).

Methodological Problems

There are a number of methodological problems with research concerning students’ usage
of university counselling services. Firstly, many studies have reported the characteristics of
counselling centre clients without comparing them with the total general student population.
This can give an inaccurate impression of the demographic profile of counselling service
users on the basis of gender, and ethnic minority and international student status. Secondly,
few studies have examined the characteristics of those students who do not use university
counselling services, and more importantly, the reasons why they do not seek counselling
when they have problems. Future research will need to investigate these reasons more
directly in order to help find ways to make existing counselling services more appealing to
university students.

Summary and Conclusion

Research on students’ usage of university counselling centres suggests that only a small
minority of between 2% and 4% of university students seek professional assistance from
such services (Cooke et al. 2006; Flisher et al. 2002; Setiawan 2006). Females are
reportedly more likely to use these services than males (Connell et al. 2007); however this
finding may be inaccurate due to the methodological flaws of research studies. In general,
studies have reported that international students in particular underutilise counselling
services (Nilsson et al. 2004), and this is primarily due to such students’ preference for
seeking help from family and friends over outside sources (Kahn and Williams 2003;
Setiawan 2006). Cultural values such as collectivism probably also influence some
international students’ underlying negative attitudes towards seeking professional help (Yi
et al. 2003). When students do seek assistance, their presenting problems typically involve
symptoms of depression or anxiety, and academic and relationship difficulties (Connell et
al. 2007; Surtees et al. 1998).
In conclusion, research has demonstrated some of the demographic and psychological
characteristics of students who utilise university counselling services. Future research will
need to pay more attention to the characteristics of those students who do not access these
services, both amongst the local and international student population. A thorough analysis
of the reasons underlying such students’ reluctance to use counselling services would be
Int J Adv Counselling (2008) 30:262–267 267

particularly valuable. This knowledge could assist in finding ways to make university
counselling services more appealing and accessible to university students who are
experiencing difficulties.

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