Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review

Amelia Gulliver, Kathleen M Griffiths, Helen Christensen, Amelia Gulliver, Kathleen M Griffiths, Helen Christensen

Abstract

Background: Adolescents and young adults frequently experience mental disorders, yet tend not to seek help. This systematic review aims to summarise reported barriers and facilitators of help-seeking in young people using both qualitative research from surveys, focus groups, and interviews and quantitative data from published surveys. It extends previous reviews through its systematic research methodology and by the inclusion of published studies describing what young people themselves perceive are the barriers and facilitators to help-seeking for common mental health problems.

Methods: Twenty two published studies of perceived barriers or facilitators in adolescents or young adults were identified through searches of PubMed, PsycInfo, and the Cochrane database. A thematic analysis was undertaken on the results reported in the qualitative literature and quantitative literature.

Results: Fifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. Facilitators were comparatively under-researched. However, there was evidence that young people perceived positive past experiences, and social support and encouragement from others as aids to the help-seeking process.

Conclusions: Strategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance.

Figures

Figure 1
Figure 1
Study selection flow diagram.

References

    1. King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, Bellon-Saameno JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, de Almeida MC, Correa B, Torres-Gonzalez F. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry. 2008;192(5):362–367. doi: 10.1192/bjp.bp.107.039966.
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627. doi: 10.1001/archpsyc.62.6.617.
    1. Australian Bureau of Statistics. Canberra, editor. Australian Bureau of Statistics. 2004-05 National Health Survey: Summary of Results. 2006.
    1. Australian Bureau of Statistics; Canberra, editor. Australian Bureau of Statistics: National Survey of Mental Health and Wellbeing: Summary of Results. 2007.
    1. Sawyer MG, Arney FM, Baghurst PA, Clark JJ, Graetz BW, Kosky RJ, Nurcombe B, Patton GC, Prior MR, Raphael B, Rey JM, Whaites LC, Zubrick SR. The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Aust N Z J Psychiatry. 2001;35(6):806–814. doi: 10.1046/j.1440-1614.2001.00964.x.
    1. Rickwood D, Deane F, Wilson C. When and how do young people seek professional help for mental health problems? Med J Aust. 2007;187(7 Suppl):S35–39.
    1. Essau CA. Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depress Anxiety. 2005;22(3):130–137. doi: 10.1002/da.20115.
    1. Zachrisson HD, Rodje K, Mykletun A. Utilization of health services in relation to mental health problems in adolescents: a population based survey. BMC Public Health. 2006;6:34. doi: 10.1186/1471-2458-6-34.
    1. Bland RC, Newman SC, Orn H. Help-seeking for psychiatric disorders. Can J Psychiatry. 1997;42(9):935–942.
    1. Jang Y, Kim G, Hansen L, Chiriboga DA. Attitudes of older Korean Americans toward mental health services. J Am Geriatr Soc. 2007;55(4):616–620. doi: 10.1111/j.1532-5415.2007.01125.x.
    1. Mojtabai R. Unmet need for treatment of major depression in the United States. Psychiatric Services. 2001;60(3):297–305. doi: 10.1176/appi.ps.60.3.297.
    1. Fox JC, Blank M, Rovnyak VG, Barnett RY. Barriers to help seeking for mental disorders in a rural impoverished population. Community Ment Health J. 2001;37(5):421–436. doi: 10.1023/A:1017580013197.
    1. Blumenthal R, Endicott J. Barriers to seeking treatment for major depression. Depress Anxiety. 1996;4(6):273–278. doi: 10.1002/(SICI)1520-6394(1996)4:6<273::AID-DA3>;2-D.
    1. Cusack J, Deane F, Wilson C, Ciarrochi J. Who influence men to go to therapy? Reports from men attending psychological services. International Journal for the Advancement of Counselling. 2004;26(3):271–283. doi: 10.1023/B:ADCO.0000035530.44111.a8.
    1. Rickwood D, Braithwaite V. Social-psychological factors affecting help-seeking for emotional problems. Social science & medicine (1982) 1994;39(4):563–572.
    1. Rickwood D, Deane F, Wilson C, Ciarrochi J. Young people's help-seeking for mental health problems. AeJAMH (Australian e-Journal for the Advancement of Mental Health) 2005;4(3)
    1. Barker G, Olukoya A, Aggleton P. Young people, social support and help-seeking. International. journal of adolescent medicine and health. 2005;17(4):315–335.
    1. Ciarrochi J, Wilson C, Deane F, Rickwood D. Do difficulties with emotions inhibit help-seeking in adolescence? The role of age and emotional competence in predicting help-seeking intentions. Counselling Psychology Quarterly. 2003;16(2):103–120. doi: 10.1080/0951507031000152632.
    1. Raphael B. In: Promoting the mental health and wellbeing of children and young people. Discussion paper: Key principles and directions. National Mental Health Working Group, editor. Department of Health and Aged Care, Canberra.: Commonwealth of Australia; 2000.
    1. Aisbett DL, Boyd CP, Francis KJ, Newnham K, Newnham K. Understanding barriers to mental health service utilization for adolescents in rural Australia. Rural Remote Health. 2007;7(1):624.
    1. Biddle L, Donovan J, Sharp D, Gunnell D. Explaining non-help-seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour. Sociology of health & illness. 2007;29(7):983–1002.
    1. Boey KW. Help-seeking preference of college students in urban China after the implementation of the "open-door" policy. International Journal of Social Psychiatry. 1999;45(2):104–116. doi: 10.1177/002076409904500203.
    1. Boyd C, Francis K, Aisbett D, Newnham K, Sewell J, Dawes G, Nurse S. Australian rural adolescents' experiences of accessing psychological help for a mental health problem. Australian Journal of Rural Health. 2007;15(3):196–200. doi: 10.1111/j.1440-1584.2007.00884.x.
    1. Brimstone R, Thistlethwaite JE, Quirk F. Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students. Medical Education. 2007;41(1):74–83. doi: 10.1111/j.1365-2929.2006.02649.x.
    1. Chew-Graham CA, Rogers A, Yassin N. 'I wouldn't want it on my CV or their records': Medical students' experiences of help-seeking for mental health problems. Medical Education. 2003;37(10):873–880. doi: 10.1046/j.1365-2923.2003.01627.x.
    1. Dubow E, Lovko K Jr, Kausch D. Demographic Differences in Adolescents' Health Concerns and Perceptions of Helping Agents. Journal of Clinical Child & Adolescent Psychology. 1990;19(1):44–54.
    1. Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access to mental health care in a university student population. Medical Care. 2007;45(7):594–601. doi: 10.1097/MLR.0b013e31803bb4c1.
    1. Francis K, Boyd C, Aisbett D, Newnham K, Newnham K. Rural adolescents' attitudes to seeking help for mental health problems. Youth Studies Australia. 2006;25(4):42–49.
    1. Gilchrist H, Sullivan G. Barriers to help-seeking in young people: community beliefs about youth suicide. Australian Social Work. 2006;59(1):73–85. doi: 10.1080/03124070500449796.
    1. Helms JL. Barriers to Help Seeking Among 12th Graders. Journal of Educational & Psychological Consultation. 2003;14:27–40.
    1. Jorm AF, Wright A, Morgan AJ. Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents. Med J Aust. 2007;187(10):556–560.
    1. Kuhl J, Jarkon-Horlick L, Morrissey R. Measuring barriers to help-seeking behavior in adolescents. Journal of Youth and Adolescence. 1997;26(6):637–650. doi: 10.1023/A:1022367807715.
    1. Lindsey C, Kalafat J. Adolescents' views of preferred helper characteristics and barriers to seeking help from school-based adults. Journal of Educational and Psychological Consultation. 1998;9(3):171–193. doi: 10.1207/s1532768xjepc0903_1.
    1. Lindsey MA, Korr WS, Broitman M, Bone L, Green A, Leaf PJ. Help-seeking behaviors and depression among African American adolescent boys. Soc Work. 2006;51(1):49–58.
    1. Sheffield JK, Fiorenza E, Sofronoff K. Adolescents' Willingness to Seek Psychological Help: Promoting and Preventing Factors. Journal of Youth and Adolescence. 2004;33(6):495–507. doi: 10.1023/B:JOYO.0000048064.31128.c6.
    1. Timlin-Scalera RM, Ponterotto JG, Blumberg FC, Jackson MA. A grounded theory study of help-seeking behaviors among White male high school students. J Couns Psychol. 2003;50(3):339–350. doi: 10.1037/0022-0167.50.3.339.
    1. West J, Kayser L, Overton P, Saltmarsh R. Student perceptions that inhibit the initiation of counseling. School Counselor. 1991;39:77–83.
    1. Wilson C, Deane F, Marshall K, Dalley A. Reducing adolescents' perceived barriers to treatment and increasing help-seeking intentions: effects of classroom presentations by general practitioners. Journal of Youth and Adolescence. 2008;37(10):1257–1269. doi: 10.1007/s10964-007-9225-z.
    1. Wilson C, Rickwood D, Deane F. Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist. 2007;11(3):98–107. doi: 10.1080/13284200701870954.
    1. Wilson CJ, Deane FP. Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement. Journal of Educational & Psychological Consultation. 2001;12(4):345–364.
    1. Wisdom JP, Clarke GN, Green CA. What teens want: barriers to seeking care for depression. Administration and Policy in Mental Health and Mental Health Services Research. 2006;33(2):133–145. doi: 10.1007/s10488-006-0036-4.
    1. Liamputtong P, Ezzy D. Qualitative Research Methods. Melbourne: Oxford University Press; 2005.
    1. Wrigley S, Jackson H, Judd F, Komiti A. Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. The Australian and New Zealand journal of psychiatry. 2005;39(6):514–521.
    1. Farrand P, Perry J, Lee C, Parker M. Adolescents' preference towards self-help: Implications for service development. Primary Care & Community Psychiatry. 2006;11(2):73–79.
    1. Biddle L, Donovan JL, Gunnell D, Sharp D. Young adults' perceptions of GPs as a help source for mental distress: a qualitative study. Br J Gen Pract. 2006;56(533):924–931.
    1. Kelly C, Jorm A, Wright A. Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust. 2007;187(7 Suppl):S26–30.
    1. McDonald S, Taylor L, Adams C. Searching the right database. A comparison of four databases for psychiatry journals. Health libraries review. 1999;16(3):151–156. doi: 10.1046/j.1365-2532.1999.00222.x.
    1. Hopewell S, Clarke M, Lefebvre C, Scherer R. Handsearching versus electronic searching to identify reports of randomized trials. Cochrane database of systematic reviews (Online) 2007. p. MR000001.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed) 2009;339:b2535. doi: 10.1136/bmj.b2535.

Source: PubMed

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