Self-Stigma of Seeking Help Scale (SSOSH)

Abstract

The Self-Stigma of Seeking Help scale (SSOSH) is a widely used 10-item instrument developed to quantify the degree of internalized negative beliefs or shame associated with the decision to pursue professional psychological help. It specifically assesses the personal costs, such as feelings of inadequacy or inferiority, that individuals anticipate if they were to seek counseling or therapy. This scale is crucial for understanding barriers to mental health treatment, as self-stigma often acts as a significant deterrent, even when services are readily available.

The SSOSH operates on a 5-point Likert scale and measures a single, unidimensional construct. It is a powerful predictor of an individual’s willingness to seek counseling, mediating the relationship between perceived public stigma and actual help-seeking behavior.

Keywords

Self-stigma, Stigma, Help-seeking behavior, Counseling psychology, Mental health barriers, Psychological assessment, Psychological construct, Vogel scale.

Authors

David L. Vogel, Nathaniel G. Wade, Susan Haake, Anne H. Hackler.

Purpose

The primary purpose of the SSOSH scale is to provide a reliable and valid measure of self-stigma related to utilizing professional mental health services. This measurement allows researchers and clinicians to quantify an individual’s internal barriers—specifically, the fear of self-devaluation or loss of self-esteem—that may prevent them from seeking necessary psychological assistance.

The scale was developed to move beyond measuring general attitudes toward counseling and focus specifically on the internalized negative self-judgments. High scores on the SSOSH indicate a greater perceived threat to one’s self-worth associated with seeking help, which is often found to be a stronger predictor of reluctance to seek counseling than perceived public stigma alone.

Construct

The SSOSH measures the psychological construct of self-stigma concerning help-seeking. This construct is defined as the personal endorsement of negative stereotypes associated with receiving psychological treatment, leading to internalized feelings of shame, inadequacy, or inferiority.

The scale posits that individuals who internalize these stigmas believe that seeking assistance implies personal failure or weakness, thereby threatening their self-confidence and self-esteem. The items reflect various facets of this self-devaluation, such as feeling “less intelligent” or “inadequate” if professional support is required.

Validity

Extensive research supports the validity of the SSOSH scale. Construct validity has been demonstrated through Confirmatory Factor Analysis (CFA), confirming its intended unidimensional structure across various populations. Furthermore, the scale exhibits strong convergent validity, showing significant negative correlations with general attitudes toward counseling and positive correlations with measures of perceived public stigma.

Its predictive validity is high, as SSOSH scores consistently mediate the relationship between perceived public stigma and the actual willingness to seek counseling, confirming its role as a critical internal barrier. Vogel et al. (2013) also established the cross-cultural validity of the SSOSH, demonstrating its robust factor structure and measurement equivalence across six different nations, suggesting its utility in global mental health research.

Reliability

The SSOSH scale demonstrates excellent internal consistency reliability. Across numerous studies utilizing diverse samples, the scale consistently yields high Cronbach’s alpha coefficients, typically ranging between 0.83 and 0.92.

This high level of internal consistency suggests that the 10 items reliably measure the same underlying construct of self-stigma associated with seeking help. Test-retest reliability, though less frequently reported than internal consistency, has also shown acceptable stability over short intervals, indicating the measure is consistent across time.

Factor Analysis

The developers, Vogel, Wade, and Haake (2006), utilized both Exploratory and Confirmatory Factor Analysis (CFA) during the scale’s development. The results consistently supported a strong, unidimensional factor structure, meaning all 10 items load onto a single factor representing the overall construct of self-stigma of seeking help.

Subsequent CFAs performed in different cultural and clinical samples have generally replicated this single-factor model, confirming that the scale effectively measures a unitary concept rather than distinct sub-components of stigma. This structural clarity is a major strength of the SSOSH instrument.

Instrument

Test Type: Self-report questionnaire, Psychological assessment

Format: 10 items scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree)

Language Available: English, Spanish, Chinese, Korean, and others (as validated in cross-cultural studies)

Population Group: General population, University students, Clinical samples

Age Group: Adolescents and Adults (typically 18+)

Population Details: Originally validated on undergraduate samples, but widely used in community and clinical settings globally due to its established cross-cultural validity.

Test Methodology: Summation of responses (after reverse-scoring items 2, 4, 5, 7, and 9) to yield a total self-stigma score. Higher scores indicate greater self-stigma.

Keywords

Stigma measurement, Counseling barriers, Mental health stigma, Unidimensional scale, Likert scale, Self-devaluation.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Contact D. L. Vogel via institutional channels.

Correspondence Address: Counseling Psychology Program, Iowa State University (Affiliation at time of publication).

Permissions & Fee and Test Year

The SSOSH scale was first published in 2006. The scale is generally considered available for non-commercial academic research use, though researchers should always cite the original publication (Vogel, Wade, & Haake, 2006). For commercial use or large-scale implementation, researchers may need to contact the primary author, David L. Vogel, regarding specific permissions and potential fees.

Test Year: 2006

The original PDF of the instrument and its development paper, authored by Vogel et al. (2006), can be downloaded here: Vogel et al., 2006 (PDF).

References

1. Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53(3): 325-337.
2. Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1): 40-50.
3. Vogel, D.L., Armstrong, P.I., Tsai, P.C., et al. (2013). Cross-cultural validity of the Self-Stigma of Seeking Help (SSOSH) scale: examination across six nations. Journal of Counseling Psychology, 60(2):303-10.

Items of the Self-Stigma of Seeking Help scale (SSOSH)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Response Format:

(1) strongly disagree‚ (2) somewhat disagree‚ (3) agree and disagree equally‚ (4) somewhat agree‚ or (5) strongly agree.