Adolescents' help-seeking behaviour: the difference between self- and other-referral

Help-seeking processes related to targeted school-based mental health services: systematic review

BACKGROUND

One in seven adolescents globally are affected by mental health conditions, yet only a minority receive professional help. School-based mental health services have been endorsed as an effective way to increase access to mental health support for people at risk, or currently presenting with mental health conditions, throughout adolescence. Despite this, low treatment utilisation prevails, therefore the aim of this review is to contribute insights into the processes related to adolescents' accessing and engaging with essential targeted mental health support within schools.

METHODS

This systematic review extracted qualitative, quantitative and mixed-methods data to determine what processes affect adolescents seeking help from targeted school-based mental health services (TSMS). Searches were conducted in EMBASE, Medline, PsycINFO, CINAHL, ERIC, Web of Science, in addition to manual searching and expert consultations. Data were synthesised following guidelines for thematic synthesis and narrative style synthesis.

RESULTS

The search resulted in 22 articles reflecting 16 studies with participant sample sizes ranging from n = 7 to n = 122. Three main themes were identified: 'access-related factors', 'concerns related to stigma', and 'the school setting'. These findings elucidate how help-seeking processes are variable and can be facilitated or hindered depending on the circumstance. We identified disparities with certain groups, such as those from low-socio economic or ethnic minority backgrounds, facing more acute challenges in seeking help. Help-seeking behaviours were notably influenced by concerns related to peers; an influence further accentuated by minority groups given the importance of social recognition. Conflicting academic schedules significantly contribute to characterising treatment barriers.

CONCLUSIONS

The findings of this review ought to guide the delivery and development of TSMS to facilitate access and promote help-seeking behaviours. Particularly, given the evidence gaps identified in the field, future studies should prioritise investigating TSMS in low- and middle-income settings and through quantitative methodologies.

REGISTRATION

The protocol for this systematic review was registered on PROSPERO (ID CRD42023406824).

Adolescent Mental Health Priorities During the Covid-19 Pandemic

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents' mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents' mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

The Influence of Stigma and Trust in Young People Seeking Support for Their Own or a Friend’s Symptoms: The Role of Threat Appraisals

Background

Stigma and trust influence how adolescents seek support for mental illness, though it is unclear how these influence their decisions to approach a range of potential sources of support. Moreover, even less is known about the ways in which these issues are related when a friend discloses symptoms of mental illness.

Objective

The study’s aims were to understand the role of stigma, trust, and threat appraisals in adolescents’ support seeking when exposed to their own, or to a friend’s, symptoms of mental illness.

Method

A vignette-based study comparing reports of support (friends, parents, teachers, professionals, and online) was completed with reference to either (i) experiencing symptoms of mental illness or (ii) having a friend disclose these types of symptoms. Two hundred and fifty adolescents (M = 12.75 years) answered questions pertaining to stigma (public and self), trust levels, threat appraisals, and support seeking.

Results

When dealing with their own symptoms, threat accounted for 4.8 and 2.5% of the variance when seeking support from parents and professionals, respectively. Self-stigma accounted for 2.4% of variance when seeking support from parents and 0.8% of variance when seeking support from professionals. Trust moderated the association between threat and the use of online support. When responding to a friend’s disclosure, higher levels of public-stigma were associated with lower support seeking from friends, parents, and professionals.

Conclusions

This study showed a distinction in how adolescents deal with their own or a friend’s symptoms of mental illness, and what resources they choose to ask for support from. Self-stigma, threat, and trust levels were particularly relevant when experiencing their own symptoms, while dealing with a friend’s disclosure was related to levels of public-stigma.

Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study

Background

Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences.

Objective

The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use.

Methods

The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include.

Results

The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app’s content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends.

Conclusions

The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others.

Young People’s Coping Strategies When Dealing With Their Own and a Friend’s Symptoms of Poor Mental Health: A Qualitative Study

Young people struggle to seek help for their mental health, despite having different resources available. As the coping process is very complex, and elements such as trust and availability of resources have been said to influence it, this study aimed to understand how young people cope with their own or a friend’s symptoms of poor mental health. Eleven young people (13–15 years old) were interviewed. Thematic Analysis of the interviews showed that participants reported different coping strategies for dealing with their own hypothetical symptoms and those of a friend. Participants identified the social impact of experiencing symptoms of poor mental health and choice of resources as the main factors influencing their coping strategies. For their own symptoms, young people expressed concern about being judged and that they would only disclose to someone they trust. Participants would not disclose a friend’s symptoms because they did not want to break their trust. Finally, choice of resources was mainly influenced by the severity of symptoms being experienced, especially when it comes to asking for professional help. This study contributes to a better understanding of the different ways in which young people cope with their own symptoms and symptoms experienced by a friend.

Teachers' Knowledge and Stigmatizing Attitudes Associated With Obsessive-Compulsive Disorder: Effectiveness of a Brief Educational Intervention

Because children and adolescents are vulnerable to developing obsessive-compulsive disorder (OCD), classroom teachers play an important role in the early identification and intervention in students with OCD. The present study aims to explore the recognition of OCD, general knowledge about this disorder, implications in the classroom, and stigmatizing attitudes among teachers, as well as the effectiveness of a brief educational intervention about OCD. Participants (n = 95; mean age = 43. 29 years old; 64.3% female) were primary and secondary school teachers who were randomly assigned to an experimental group or a control group. All of them completed a set of self-report questionnaires, read an educational fact sheet (either about OCD in the experimental group or about a healthy diet in the control group), and again completed the questionnaires. Results show that prior to the intervention, most of the teachers identified the contamination and order OCD symptoms described in a vignette as specific to OCD (82.1%) and would recommend talking about the problem (98.9%) and seeking help (94.7%). However, only a few (36.8%) knew about the most effective OCD treatments or identified compulsions as a main OCD symptom (33%). Moreover, only about half of the teachers correctly identified OCD's possible interference in classroom routines, such as delays to achieve perfection or concentration problems, and strategies for dealing with OCD, such as continuing with the class rhythm. Stigma levels were from low to moderate. After the brief educational intervention, participants in the experimental group increased their knowledge about OCD, improved their strategies for managing a student with OCD symptoms, and had fewer stigmatizing attitudes associated with pity (p < 0.05). These changes were not observed in the control group. We can conclude that this brief and easy-to-administer intervention is an effective educational intervention to significantly improve teachers' knowledge and attitudes, at least in the short-term. These results are especially relevant because OCD is associated with high interference and long delays in seeking treatment, and teachers have a unique opportunity to help with prevention, early identification, and recommending an adequate intervention for OCD.

Effect of lockdown on mental health during the COVID-19 pandemic among individuals attending services at a tertiary care center

BACKGROUND

Lockdown is an emergency measure or condition in which people are temporarily prevented from entering or leaving a restricted area or building during a threat or danger. Since the start of COVID-19 till date, almost one-third of the world's population is under some degree of restriction and lockdown, and the mental health effect of which is something that is being discussed widely.

AIM

The study aimed to assess the effect of lockdown on mental health among individuals (patients or accompanying person) seeking services at a tertiary care center.

MATERIALS AND METHODS

Kathmandu Medical College is a tertiary care center and a medical college in Kathmandu, Nepal. In this study, we enrolled every 4^th individual coming to the hospital's outpatient department registration counter to seek service and giving consent, for the duration of 1 month during the ongoing lockdown period. A semi-structured questionnaire was developed and approved by the department and was used to collect sociodemographic details and to rate the stress level. The General Health Questionnaire (GHQ-12) Nepali version was used to assess psychological well-being of the participants and a score of ≥3 by binary method was taken as positive case.

RESULTS

The total number of cases enrolled in the study was 204, out of them 62.2% were male and 32.8% were female and the mean age was 32.03 years. Twenty-three percent (23.5%) had preexisting health conditions. Out of the 204 participants, 67.6% said they were stressed following the lockdown and the mean rated stress was 2.90 in a scale ranging from 1 to 7. The frequently identified stressors were fear of contamination, restricted movement, and for inadequate supplies. Twenty-seven percent said they had some psychological symptoms and the most common symptoms were palpitation and sleep disturbance. Seventy-three individuals (36.5%) were found to have psychiatric problem according to their scores in GHQ-12. Rated stress and GHQ-12 scores were found to be strongly correlated (P = 0.000). Similarly, those who stated "Yes" in psychological symptoms significantly scored higher on GHQ-12 and stress (both P = 0.000).

CONCLUSION

The lockdown has caused stress in majority of cases, and a significant number of individuals have diagnosable mental health conditions. Mental health impact of the lockdown is something that needs to be addressed seriously.

Adolescents' First Choice for Help: Distinguishing Characteristics of Youth Who Select a Friend, a Parent, or No One

When adolescents encounter problems, many prefer to seek help from a friend or a parent and some are reluctant to seek help from anyone. Yet information is sparse about how youth who choose each of these options differ from one another, including the proportions who select each help option consistently across personal and interpersonal problems or the extent to which they endorse characteristics related to help seeking. To address this gap, the proportions of adolescents who selected a friend, a parent, or no one as their first choice for help with one personal problem (feeling depressed) and three interpersonal problems (problems with a parent, a good friend, and a boyfriend/girlfriend) and the proportions who selected each help option consistently across these problems were examined. Youth in the three groups for each problem were also compared on characteristics linked to help seeking (gender, self-concealment, self-disclosure, perceived support, and school community). Participants were 488 Canadian adolescents (56% girls; Grades 9-12) who completed a survey at school. A majority of youth chose a friend for help with each problem and a substantial minority chose one help option consistently across problems. For each problem, adolescents in the Friend group and those in the Parent group differed on composites of specific characteristics, and adolescents in the No One group differed from those in the other groups on multiple characteristics. The results highlight the complexity associated with adolescents choosing a help option and draw attention to specific groups of youth who merit further examination.

What do help-seeking measures assess? Building a conceptualization framework for help-seeking intentions through a systematic review of measure content

Mental health services are underutilised by people who could benefit from treatment. Research into help-seeking intentions (HSI) is required to support interventions to increase service use. Existing HSI measures are not psychometrically robust and problems with content validity undermine research in this field. Our purpose was to create a clear conceptualization of HSI and systematically review the content of existing measures. Previous researchers had defined help-seeking and intentions separately, so the first step was to create a more comprehensive definition. Seven theoretical perspectives identified in the HSI literature were mapped onto the new definition and aggregated to form a conceptual framework that reflects expert opinion. This framework guided an analysis of item relevance and a comparison of completeness across measures. Most individual items (99.1%) were relevant, lending credibility to the proposed framework. However, no measure provided a complete assessment of the HSI construct. This study used a novel methodology to develop a definition and conceptual framework, both of which reflect sound theoretical perspectives and represent the consensus-view of experts. The current results will guide the development of stronger measures with improved construct validity and will support interventions aimed at improving help-seeking.

What do Spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms

Obsessive-compulsive disorder (OCD) is a frequent and disabling disorder with a long delay in seeking help that could partly be due to poor mental health literacy and stigmatizing attitudes. This study analyzes the mental health literacy and stigma associated with symmetry/order and aggression-related OCD in a Spanish adolescent sample. This age group was chosen because adolescence is a vulnerable period for the development of OCD, and adolescents are often reluctant to seek professional help. One hundred and two non-clinical adolescents read two vignettes describing symmetry/order and aggression-related OCD. Then, referring to these two vignettes, they answered questions related to problem recognition, causality perception, need for treatment, treatment recommendations, and stigma. Results show that a high percentage of adolescents recognize the interference of order- and aggression-related OCD, consider that a peer with order- or aggression-related OCD needs treatment, and would recommend a formal source of help. Although order symptoms are highly recognized as OCD by adolescents, aggression-related OCD is frequently misidentified as schizophrenia or depression. Results also show higher levels of stigmatizing attitudes in adolescents, associated with aggression-OCD (versus order-OCD), especially in male adolescents and adolescents with no previous experience with mental health services/providers. Results suggest the need to develop school-based programs emphasizing OCD content heterogeneity, especially the aggression, sexual, and religious contents, and work toward eliminating stigma.

Help seeking in school by Israeli Arab minority adolescents with emotional and behavioral problems: results from the Galilee Study

BACKGROUND

Many distressed minority adolescents with little access to professional mental health services use teachers and school counselors as their main consultation sources. This paper presents data from the Galilee study on factors that may increase the probability of adolescents' help-seeking in school and discusses the needed linkage between the school mental health services and those provided by other agencies, in the framework of the Mental Health Reform in Israel.

METHODS

This cross-sectional survey included 1639, 9th grade students living in 5 Arab localities in the Galilee in northern Israel, representative of the Muslim and Druze populations. The study was carried out in two stages: in the screening stage, the Strengths and Difficulties Questionnaire (SDQ) was completed in the classroom. During the follow-up stage 704 students were selected and interviewed at home regarding service use in school and wellbeing at home. Their mothers were interviewed as well providing information on sociodemographic traits of the family. Total response rate was 69.3 % during the screening stage and 84.4 % during the follow-up. Students were categorized according to their SDQ scores and all students in the higher 25th percentile (high risk) and a simple systematic sample without replacement of those in the lower 75 % (low risk) were included in the follow-up study.

RESULTS

Significantly more high risk than low risk students reported having felt the need to seek professional help (14.0 and 6.5 % respectively) and more high risk than low risk consulted a school source (27.1 and 15.2 %, respectively). Bivariate analyses show that among Muslim adolescents more high risk than low risk consulted a school source (30 vs. 16.2 % respectively) and among high risk students more Muslim than Druze sought help from a school source (30 vs. 18 %). Higher consultation rates were found among adolescents who felt uncomfortable at home, than among those who felt very comfortable. Binary logistic regression showed that for high risk adolescents, only religion remained significantly associated with help-seeking in school: Muslim students were 2 times more likely to seek help than Druze students. In the low-risk group, students who do not feel comfortable at home were 3.3 times more likely to seek help than those who feel comfortable at home. The main sources of consultation for both risk groups were the school counselor and the grade teacher.

CONCLUSIONS

A constellation of factors may be associated with help-seeking in school by minority Israeli Arab adolescents: they are students at higher risk for an emotional or behavioral disorder, they have more socio-economic hardship, they feel less comfortable at home and they are more likely to live in the larger Muslim cities. Adolescents with less family support and particularly those not classified as being at high risk, are more likely to seek help from school counselors and teachers. The school staff may need additional training to care for the mental health needs of students. There is a need to integrate the school mental health services with the other government agencies that provide services to children and adolescents.

Towards a preventive strategy for complaints of arm, neck and/or shoulder (CANS): the role of help seeking behaviour

Background

When developing an effective early preventive strategy for employees and students with CANS (Complaints of Arm, Neck or Shoulder, not caused by acute trauma or systemic disease), insight in help seeking behaviour and knowledge of factors associated with help seeking behaviour within the target population, is a prerequisite. The aim of this study was to examine whether perceived hindrance is associated with help seeking behaviour, specifically in employees and students identified with CANS. Additionally, the associations of factors related to functioning and participation, work-environment and demographics with help seeking behaviour were explored in these groups.

Methods

A cross-sectional survey was conducted among employees and students of two universities in the South of the Netherlands. The questionnaire included questions to assess (1) demographics, work/study and activity related factors (2) experience of CANS (3) perceived hindrance (4) help seeking behaviour. A subpopulation of the survey, consisting of those employees and students with self-reported CANS, received additional questionnaires to examine the impact of (1) participant characteristics (2) complaint and health related variables (3) functioning and participation (4) work-environment and social support, on help seeking behaviour.

Results

37.3% of the employees and 41.4% of the students reported CANS. Of these, respectively 43.3% and 45.5%, did not seek help and had no intention to seek help either. Employees and students who had not sought help reported less hindrance, less perceived disabilities and shorter duration of complaints, compared those who did seek help. Employees and students within this group who had also no intention to seek help, perceived fewer disabilities and reported shorter duration of complaints.

Conclusion

The absence of help seeking behaviour in respondents with CANS is a bottleneck for implementation of preventive strategies. In employees and students with CANS, help seeking behaviour is primarily determined by factors related to experienced hindrance. Our findings emphasize the need to tailor preventive strategies, in order to optimize screening and participation in early interventions for CANS.

The gap between a mother seeking psychological help for her child and for a friend’s child

More children need psychological help than those who get it (‘‘service gap’’). Since parents are those who refer children for help, they are responsible for this gap. This study examined the difference between the reported willingness of schoolchildren’s mothers to seek help from a psychologist and from natural support systems for their own child and to refer another mother for such help. Participants were 321 mothers of 3rd- to 5th-grade children. Participants’ reported intentions to seek help for their own child or to refer another’s child were evaluated regarding a hypothetical externalisation or internalisation problem behaviour. Mothers were more willing to refer another’s child than their own for psychological help. Mothers of boys were more willing to refer their own or another’s child for psychological help than mothers of girls. Mothers tended to prefer natural support systems over professional help. Some relations were found between emotional responses and socialisation strategies, and help-seeking intentions.

Help Seeking Patterns in Urban and Rural Youth in Two South African Provinces

The help seeking patterns of 139 secondary school youth between the ages of 14 and 22 in two peri-urban and one rural secondary school in the Eastern Cape, and one urban and one rural secondary school in KwaZulu-Natal were studied. Youth were interviewed in focus groups about their problems and whether or not they seek help for these problems. Possibilities of, and problems with, help resources were also discussed. Data were analysed using qualitative data analysis software and interpreted in terms of the contextual dynamics which facilitate or hinder access to help seeking resources. This study illustrates the intricacy of help seeking behaviour. Contextual factors were found to be significant mediators of help seeking behaviour.

South African adolescents' beliefs about depression

PURPOSE

This study explores the depression literacy in adolescents in South Africa.

METHOD

A semi-structured questionnaire was administered to 2,050 students from disadvantaged secondary schools in Johannesburg region.

RESULT

A total of 90.9% reported depression as an illness, and 41.4% considered it a sign of weakness. Parents and siblings followed by friends and teachers were the preferred support options. The indicators of depression identified were socialisation pattern changes (24.6%), sad mood (23.6%), sleeping and eating pattern changes (18.3%), irritable behaviour (12.5%) and other health risk behaviours (9.7%).

CONCLUSION

The majority considered depression an illness. An improvement in adolescent mental health literacy will increase access to help when needed.

Career Decision-Making Difficulties and Help-Seeking Among Israeli Young Adults

The present research focused on the various types of support young adults consider using when making career decisions and located factors that affect their intentions to seek help. Career decision-making difficulties (assessed by the Career Decision-making Difficulties Questionnaire), self-reported intentions to seek help, and career decision status were elicited from 300 young adults deliberating about their future career. The results show that participants’ intentions to seek help were positively correlated with their career decision-making difficulties and with their career decision status. The results also show discrepancies between the perceived effectiveness of the various types of support (e.g., family and friends, career counselors, and Internet) and the participants’ intentions to use them. Young adults are more inclined to seek help from types of support that are easily accessible to them (e.g., family and friends, and the Internet), and less from those that have been proven to be beneficial (e.g., career counselors, online questionnaires).

The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of youths

BACKGROUND

While the ultimate goal of adolescent suicide-prevention efforts is to decrease the incidence of death by suicide, a critical intermediary goal is directing youths toward effective sources of assistance.

AIM

To comprehensively review the universal prevention literature and examine the effects of universal prevention programs on student's attitudes and behaviors related to help-seeking.

METHOD

We systematically reviewed studies that assessed help-seeking outcomes including prevention efforts utilizing (1) psychoeducational curricula, (2) gatekeeper training, and (3) public service messaging directed at youths. Of the studies reviewed, 17 studies evaluated the help-seeking outcomes. These studies were identified through a range of sources (e.g., searching online databases, examining references of published articles on suicide prevention).

RESULTS

The results of this review suggest that suicide-prevention programming has a limited impact on help-seeking behavior. Although there was some evidence that suicide-prevention programs had a positive impact on students' help-seeking attitudes and behaviors, there was also evidence of no effects or iatrogenic effects. Sex and risk status were moderators of program effects on students help-seeking.

CONCLUSIONS

Caution is warranted when considering which suicidal prevention interventions best optimize the intended goals. The impact on adolescents' help-seeking behavior is a key concern for educators and mental-health professionals.

Perceptions of support-seeking in young people attending a Youth Offending Team: an interpretative phenomenological analysis

High levels of mental health problems have been identified in young people who have offended (committed/been convicted of a criminal offence). However, as with many young people, they tend not to seek support for their difficulties. This research aimed to explore support-seeking in this population by asking 'What are the perceptions of support-seeking in young people attending a Youth Offending Team?' Semi-structured interviews were carried out with six males (aged 13-18) and the transcripts were analysed using interpretative phenomenological analysis. Four master themes were revealed: Youth Offending Team attendance prompting reflection, Damaged self, Complexity of relationships and Internal conflicts. Generally participants perceived support-seeking as beneficial, but various barriers meant that they did not tend to view it as a viable coping strategy for themselves. Interventions aimed at addressing these barriers may help young people who have offended to seek support.

Urban teens and young adults describe drama, disrespect, dating violence and help-seeking preferences

Adolescent dating violence is increasingly recognized as a public health problem. Our qualitative investigation sought input from urban, African-American adolescents at risk for dating violence concerning (Tjaden and Thoennes in Full report of the prevelance, incidence, and consequences of violence against women: findings from the national violence against women survey. US Department of Justice, Washington, DC, 2000) dating violence descriptions, (WHO multi-country study on women's health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women's responses. World Health Organization, Geneva, 2005) preferences for help-seeking for dating violence, and (Intimate partner violence in the United States. Bureau of Justice Statistics, US Department of Justice, Office of Justice Programs, Washington, DC, 2007) recommendations for a teen dating violence resource center. Four focus groups were conducted with urban, African American adolescents (n = 32) aged 13-24 recruited from an urban adolescent clinic's community outreach partners. Qualitative analysis was conducted. Participants assigned a wide range of meanings for the term "relationship drama", and used dating violence using language not typically heard among adults, e.g., "disrespect". Participants described preferences for turning to family or friends before seeking formal services for dating violence, but reported barriers to their ability to rely on these informal sources. When asked to consider formal services, they described their preferred resource center as confidential and safe, with empathetic, non-judgmental staff. Teens also gave insight into preferred ways to outreach and publicize dating violence resources. Findings inform recommendations for youth-specific tailoring of violence screening and intervention efforts. Current evidence that slang terms, i.e., "drama", lack specificity suggests that they should not be integrated within screening protocols. These data highlight the value of formative research in understanding terminology and help-seeking priorities so as to develop and refine dating violence prevention and intervention efforts for those most affected.

Overcoming stigma: how young people position themselves as counselling service users

Increasing attention has been focused on adolescent help-seeking in relation to services aimed at promoting mental health and wellbeing. Much research reinforces the ubiquity of concerns about negative stigmatisation by peers as a barrier to young people accessing services. This paper draws on interviews conducted with young people, who completed a course of counselling in school, to investigate how they managed and negotiated this. Drawing on positioning theory from discourse analysis, young people's accounts are analysed with reference to the variety of positions they articulated and adopted. This demonstrates how they elaborated and reinforced virtuous problem-solver positions within broader discourses of individualisation and normalisation, and resisted positioning within a stigmatised mental illness discourse. Although focused on a small sample, the analysis offers potential insights into the ways other people may negotiate stigma concerns to access mental health resources, while also demonstrating the utility of positioning theory for understanding stigma and normalisation.

Seeking professional help for mental health problems, among New Zealand secondary school students

OBJECTIVE

Our aim was to investigate whether secondary school students with mental health problems sought help from general practitioners and to investigate whether mental illness type, socio-demographic variables, family, school and community factors were associated with seeking help.

METHOD

A randomly selected sample of 9699 secondary school students from across New Zealand participated in the Youth2000 Health and Wellbeing Survey. Data analysis included uni-variate and regression analyses.

RESULTS

Having symptoms of anxiety (p<0.0001), depression (p<0.0001), and suicidal thoughts (p<0.0001) were associated with help seeking. However, 82%of students who had significant mental health problems had not sought help from a general practitioner. Rates of help seeking increased with age for girls and decreased with age for boys. Seeking help for mental health problems was also associated with living in a single parent family (p<0.0001), living in an over-crowded house (p=0.0006), and being well known by a teacher (p=0.0004).

CONCLUSIONS

The majority of New Zealand secondary school students with mental health problems do not obtain the help they need from general practitioners. Given the prevalence of mental health problems, it is important to find ways of identifying adolescents with difficulties and encouraging them to seek help.

Increasing Positive Perceptions of Counseling

This study assesses the effectiveness of repeated exposures to a video intervention based on the Elaboration Likelihood Model. The video was designed to increase help-seeking attitudes and perceptions of peer norms and to decrease the stigma associated with seeking counseling. Participants were 290 undergraduates who were randomly assigned to a repeated-exposure video intervention, a single-exposure video intervention, or a control video condition. Participants completed measures pre- and post-intervention and at a 3-week follow-up. Those in the repeated-exposure intervention improved significantly more than the single-exposure and control groups on help-seeking attitudes and perception of peer norms but not for stigma. The effect of repeated exposures on attitudes and peer norms showed both immediate and longer term effects. Effective, empirically supported interventions capable of reaching large numbers of people are necessary to improve utilization rates of counseling services. This study offers support for the use of repeated video interventions in changing attitudes and perceptions of counseling.

Experience of health complaints and help seeking behavior in employees screened for depressive complaints and risk of future sickness absence

INTRODUCTION

The aim of this study was to examine the associations between on the one hand depressive complaints and risk of future sickness absence and on the other hand experience of health complaints and help seeking behavior in the working population.

METHODS

Cross-sectional data were used from employees working in the banking sector (n = 8,498). The screening instrument included measures to examine the risk of future sickness absence, depressive complaints and help seeking behavior.

RESULTS

Of employees reporting health complaints, approximately 80% had already sought help for these complaints. Experience of health complaints and subsequent help seeking behavior differed between employees with mild to severe depressive complaints and employees at risk of future sickness absence. Experience of health complaints was highest in employees identified with both concepts (69%) compared with employees identified at risk of future sickness absence only (48%) and with mild to severe depressive complaints only (57%). In those employees identified with one or both concepts and who had not sought help already, intention to seek help was about 50%.

CONCLUSIONS

From a screening perspective, employees who do not experience health complaints or who do not have the intention to seek help may refuse participation in early intervention. This might be a bottleneck in the implementation of preventive interventions in the occupational health setting.

Healthy minds for country youth: help-seeking for depression among rural adolescents

OBJECTIVE

To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents.

DESIGN

Cross-sectional survey.

SETTING

Two rural secondary schools in south-east South Australia.

PARTICIPANTS

Seventy-four secondary school students aged 14 to 16 years.

MAIN OUTCOME MEASURE(S)

Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire.

RESULTS

Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0-100.0%) than a doctor (82.4%, 72.1-89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories.

CONCLUSIONS

Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.

Does the optimism bias affect help-seeking intentions for depressive symptoms in young people?

Help-seeking is an adaptive means to address mental health difficulties, but sufferers often fail to seek assistance. This inaction may reflect optimism bias--that is, believing one is less susceptible to negative events than others. In the present study, the authors investigate optimism bias by presenting depressive symptoms in vignette form to 263 undergraduate participants. Participants were asked to imagine oneself or a peer-group friend suffering from presented symptoms and provide ratings of problem seriousness, help-seeking importance, and prognosis. Results supported the optimism bias hypothesis in that participants reported lower levels of seriousness, lower need for help, and anticipated a more favorable prognosis for themselves compared to others on equivalent sets of symptoms. A contextual effect may exist and influence the evaluation of medium-severity symptoms when symptoms were presented from most to least severe. As symptom severity increased, females were less optimistic than males about prognosis and placed greater importance on help-seeking. The implications of these findings are discussed.

Using a vignette-based questionnaire to explore adolescents' understanding of mental health issues

The aim of this study was to examine levels of mental health literacy among a school-based sample of adolescents. To achieve this, a vignette-based questionnaire was developed, piloted, and completed. Mixed methods were used to collect and analyse data. Findings were analysed using content analysis, and descriptive and inferential statistics. Key findings include first, that socio-economic disadvantage and low levels of educational attainment are not necessarily synonymous with lower levels of mental health literacy. Second, female respondents, and those with experience of mental health problems, were more flexible in their choice of sources of help, and the perceived benefits of such help. Implications for practice are considered in terms of clinical understanding, mental health promotion for adolescents and training for professionals.

Racial differences in attitudes toward professional mental health treatment: the mediating effect of stigma

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.

When will adolescents tell someone about dating violence victimization?

This study examined factors that influence help-seeking among a diverse sample of adolescents who experienced dating violence. A sample of 57 high school students in an urban community reported on the prevalence and characteristics of dating violence in their relationships. Someone observing a dating violence incident and a survivor's attaching an emotional meaning to the event significantly influenced adolescents to talk to someone. When dating violence occurred in isolation, survivors were more likely to receive no support from others in the aftermath of the incident. Differences between boys' and girls' help-seeking and implications for dating violence intervention and prevention programming are discussed.

The personal service gap: factors affecting adolescents' willingness to seek help

The study explores adolescents' attitudes toward seeking help for emotional problems. The personal service gap is examined by asking adolescents about their willingness to refer themselves and others to formal (psychologists) and informal (friends) help sources, using a within-subjects design. The study included 662 Israeli adolescents in the 10th and 12th grades. The results indicate that adolescents refer peers more than themselves to a psychologist and to a friend. They are also more willing to refer themselves and peers to a friend rather than to a psychologist. Barriers to seeking psychological help are explored and significant correlations between perceptions of psychological benefit, problem severity and barriers to help seeking are described. Recommendations for increasing adolescents' awareness and use of help sources are suggested.

What prevents adolescents from seeking help after a suicide education program?

Perceived barriers to help-seeking among adolescents attending a suicide education program were examined. A total of 854 high school students in Colorado completed one of two questionnaires, measuring barriers to help-seeking for self or friend. The most prominent barriers for self were: inability to discuss problems with adults, self-overconfidence, fear of hospitalization, and lack of closeness to school adults. The most prominent barriers for troubled friends were: friendship concerns, unapproachability of school adults, fear of friend's hospitalization, and underestimating friend's problems. Results reveal multiple constraints limiting the program's utilization, supporting the need for comprehensive system approaches to suicide prevention.

Informal helpers’ responses when adolescents tell them about dating violence or romantic relationship problems

This study examines the responses of informal helpers to adolescents who disclose dating violence or upsetting but non-violent experiences in their romantic relationships. Based on a survey of 224 Midwestern high school students, the study found that youths were more likely to disclose problems to friends rather than others. A factor analysis of potential helpers' responses showed that, compared to avoidance and minimization, nurturing was the most typical response received. Adolescents who told someone about being victimized by severe dating violence were more likely to receive an avoidance response than those who told about less severe dating violence. Males encountered high levels of minimization regarding less severe dating violence. While friends and family seem to respond effectively to romantic relationship problems, youths need more training in how to respond helpfully to friends' difficulties with dating violence or how to encourage victims to seek help from trained practitioners.