Context guides illness-identity: a qualitative analysis of Dutch university students' non-help-seeking behavior

The purpose of this article is to develop a context-based and identity-centered perspective on help-seeking. Recent approaches have indicated the inability of conventional models of help-seeking to account for the non-utilization of health care services in situations for which services, resources and information are adequately provided. We address this non-utilization from a perspective that explores the interactions between notions of health, illness, and identity formation, especially in highly transitional situations in which people are confused about their identity and sense of belonging. More specifically, we explore the non-utilization of health care services by Dutch university students. The results of 36 in-depth interviews show that the help-seeking behaviors of university students are closely associated with questions about identity, forms of agency, and styles of self-presentation, and are deeply influenced by the uncertain social and cultural context in which students are inserted. For example, being a 'normal' student was often regarded as more important than solving health problems, and stress was repeatedly portrayed as a constant and inevitable condition of everyday student life, giving a common language to express the burdens of the shared student experience. Some students even romanticized health problems. Eventually students with serious health problems avoided accessing health services.