Coralie J Wilson

Young people's help-seeking for mental health problems

Abstract This paper summarises an ambitious research agenda aiming to uncover the factors that affect help-seeking among young people for mental health problems. The research set out to consider why young people, and particularly young males, do not seek help when they are in psychological distress or suicidal; how professional services be made more accessible and attractive to young people; the factors that inhibit and facilitate help-seeking; and how community gatekeepers can support young people to access services to help with personal and emotional problems. A range of studies was undertaken in New South Wales, Queensland and the ACT, using both qualitative and quantitative approaches. Data from a total of 2721 young people aged 14–24 years were gathered, as well as information from some of the community gatekeepers to young people’s mental health care. Help-seeking was measured in all the studies using the General Help Seeking Questionnaire (Wilson, Deane, Ciarrochi & Rickwood, 2005), which measures future help-seeking intentions and, through supplementary questions, can also assess prior help-seeking experience. Many of the studies also measured recent help-seeking behaviour using the Actual Help Seeking Questionnaire. The types of mental health problems examined varied across the studies and included depressive symptoms, personal-emotional problems, and suicidal thoughts. The help-seeking process was conceptualised using a framework developed during the research program. This framework maintains that help-seeking is a process of translating the very personal domain of psychological distress to the interpersonal domain of seeking help. Factors that were expected to facilitate or inhibit this translation process were investigated. These included factors that determine awareness of the personal domain of psychological distress and that affect the ability to articulate or express this personal domain to others, as well as willingness to disclose mental health issues to other people. The results are reported in terms of: patterns of help-seeking across adolescence and young adulthood; the relationship of help-seeking intentions to behaviour; barriers to seeking help—lack of emotional competence, the help-negation effect related to suicidal thoughts, negative attitudes and beliefs about help-seeking and fear of stigma; and facilitators of seeking help—emotional competence, positive past experience, mental health literacy, and supportive social influences. The paper considers the implications of the findings for the development of interventions to encourage young people to seek help for their mental health problems, and concludes by identifying gaps in the help-seeking research and literature and suggesting future directions.

Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help seeking. Memories of successful prior helping episodes were also important. Education about appropriate help seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking barriers. Education should include key adults who act as gatekeepers within adolescent networks (e.g., parents and teachers). Assertive outreach and follow-up might be important factors for continued help-source engagement. Themes provide a basis for suggestions about ways to facilitate adolescent help seeking and maintain appropriate help-source engagement.

Adolescents who need help the most are the least likely to seek it: The relationship between low emotional competence and low intention to seek help

It has been found that university students who were the least skilled at managing their emotions also had the lowest intention of seeking help from a variety of nonprofessional sources (e.g. family and friends). The present study sought to extend these findings by focusing on adolescents, examining a larger number of emotional competencies, and exploring the possibility that social support explains the relationship between emotional competence and help-seeking. A total of 137 adolescents (aged 16-18) completed an anonymous survey that assessed social support, emotional competencies, and intention to seek help from a variety of professional and nonprofessional sources. As expected, adolescents who were low in emotional awareness, and who were poor at identifying, describing, and managing their emotions, were the least likely to seek help from nonprofessional sources and had the highest intention of refusing help from everyone. However, low emotional competence was not related to intention to seek help from professional sources (e.g. mental health professionals). The significant results involving nonprofessional sources were only partially explained by social support, suggesting that even adolescents who had high quality support were less likely to make use of that support if they were low in emotional competence.

Do difficulties with emotions inhibit help-seeking in adolescence? The role of age and emotional competence in predicting help-seeking intentions

We examined whether adolescents who are poor at identifying, describing, and managing their emotions (emotional competence) have lower intentions to seek help for their personal-emotional problems and suicidal ideation, as observed in adult studies. We also examined whether age moderated the relationship between competence and help-seeking. Two hundred and seventeen adolescents completed measures of emotional competence, help-seeking, hopelessness, and social support. Results indicated that adolescents who were low in emotional competence had the lowest intentions to seek help from informal sources (i.e., family and friends) and from some formal sources (e.g., mental health professionals), and the highest intentions to seek help from no-one. There was one important age-related qualification: difficulty in identifying and describing emotions was associated with higher help-seeking intentions amongst young adolescents but lower intentions among older adolescents. Social support, hopelessness, and sex could not entirely explain these relationships. Thus, even those who had high quality social support had less intention to use it if they were low in emotional competence.

Emotional Expression, Perceptions of Therapy, and Help-Seeking Intentions in Men Attending Therapy Services

Seventy-three men who were currently accessing or had recently accessed mental health services completed a questionnaire regarding their emotional expression, engagement in therapy, perceptions of treatment helpfulness, and future help-seeking intentions. Perceptions of treatment helpfulness were inversely predicted by alexithymia (mediated by bond) and restrictive emotionality, although these emotional expression variables were unrelated to future help-seeking intentions. Bond was positively related to perceptions of treatment helpfulness and both variables predicted future help-seeking intentions. Contrary to expectations, perceptions of treatment helpfulness did not mediate the relationship between bond and future help-seeking intentions. It was concluded that, once in therapy, bond and perceptions of treatment helpfulness are more important to future help-seeking intentions than a man’s difficulty or discomfort with emotional expression.

Early access and help seeking: practice implications and new initiatives

Aim: Seeking appropriate help for early signs and symptoms of psychological distress can reduce the long‐term impact of many mental disorders. This article describes practice implications and new initiatives for promoting early access and help‐seeking among young people.

Brief report: Need for autonomy and other perceived barriers relating to adolescents’ intentions to seek professional mental health care

The current study examined the relationship between belief-based barriers to seeking professional mental health care and help-seeking intentions in a sample of 1037 adolescents. From early adolescence to adulthood, for males and females, the need for autonomy was a strong barrier to seeking professional mental health care. Help-seeking fears were weaker in the older age groups. Having lower perceived need for autonomy and believing that prior mental health care was helpful was significantly associated with higher intentions to seek future professional mental health care. Implications for prevention and overcoming barriers to seeking mental health care are suggested.

The effects of need for autonomy and preference for seeking help from informal sources on emerging adults' intentions to access mental health services for common mental disorders and suicidal thoughts

Abstract Emerging or early adulthood is the life stage spanning 18–25 years of age. In Australia, anxiety and affective disorders (often classifi ed as ‘common mental disorders’) are prevalent in this age group and suicide is also a concern. Professional mental health care can reduce the long-term impact of these mental health problems and protect against the development of severe forms of these disorders. However, up to three-quarters of young people with mental health needs do not seek professional help for their condition. This study aimed to examine the extent to which belief in the need for autonomy and intentions to seek help from informal help-sources act as barriers or facilitators to seeking help from a mental health service for symptoms of a common mental disorder and suicidal thoughts, in a sample of 641 emerging adults aged 18–25 years. For common mental disorders and suicidal thoughts, results reveal that the family of origin has an important influence on mental health service access among emerging adults, but also, that the growing independence and autonomy of emerging adults needs to be accommodated if mental health treatment services are to be accessible to this important age group.

General psychological distress symptoms and help-avoidance in young Australians

Abstract Epidemiological studies suggest that young people might have a tendency to avoid help when they experience symptoms of psychological distress. There is growing evidence that many young people prefer no help from anyone for their mental health problems. The current study examined the association between symptoms of general psychological distress and intentions to seek help from friends, family and professional mental health sources in a sample of 109 trade (TAFE) students from regional and rural Australia. Participants were 67% male and aged from 15–25 years. Higher levels of general psychological distress symptoms were associated with stronger intentions to not seek help from anyone and weaker intentions to seek help from friends and family for mental health problems. The variable ‘negative beliefs about treatment’ was also associated with a stronger intentions to not seek help and weaker intentions to seek help from mental health professionals. Help-avoidance in relation to symptoms of general psychological distress and beliefs about mental health treatment is discussed, together with suggestions for encouraging appropriate and effective help-seeking in young people.

Differences in the expression of symptoms in men versus women with depression: a systematic review and meta-analysis

Objective While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression. Methods PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender. Results The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges’s g = 0.26 [95% confidence interval (CI), 0.11–0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47–0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = −0.20 [95% CI, −0.33 to −0.08]), appetite disturbance/weight change (g = −0.20 [95% CI, −0.28 to −0.11]), and sleep disturbance (g = −0.11 [95% CI, −0.19 to −0.03]). Conclusions Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.