Factors influencing help-seeking for mental health problems in adolescents

Abstract

The numerous biological and psychosocial changes that occur during adolescence tend to make adolescents more vulnerable to mental disorders. Up to 50% of mental disorders in adults tend to become established in adolescence before the age of 14 years, with depression being one of the most commonly occurring disorders and if left untreated, it may have devastating effects on the adolescent's life. For this purpose, this study addressed the factors that influence help-seeking for mental health problems in individuals who are 14 to 15 years of age. Depression was one of the factors studied in relation to help-seeking. A mixed methods approach consisting of a cross-sectional school-based survey with adolescents followed by qualitative semi-structured interviews with general practitioners was used in order to provide a comprehensive picture of the barriers and facilitators to help-seeking. The prevalence of moderate to severe depressive symptoms was found to be 27.3% and of these, only 20.7% had sought help from a health care professional in the 6 months prior to the survey. The most preferred help sources for this adolescent sample were parents, followed by friends and self-help sources, namely websites, while a general reluctance to seek help from professionals was evident. One pertinent finding was that adolescents most at risk, being those with higher depressive symptom severity, manifested a greater reluctance to seek professional help and had lower intentions to seek help from parents or other family members when compared to adolescents with lower or no depressive symptoms. This was attributed to the help-negating effect of depression which was identified as a major barrier to help-seeking. Other barriers to help-seeking were related to aspects of the developmental changes occurring during adolescence. One such barrier was the perceived need to be autonomous which was found to be more prominent in boys. Also prominent were barriers due to poor mental health literacy and feelings of embarrassment and fear to divulge information to the professional. These findings highlight the importance of early recognition of depression which could be achieved through interventions to improve mental health literacy among adolescents as well as their parents, who could in turn facilitate help-seeking for their children. Finally, there were also a number of barriers related to service provision and use in primary care. The doctor-patient relationship was found to be extremely important when dealing with adolescents. In order to trust the provider, adolescents expect that confidentiality is maintained, that the provider listens to them, gives them enough time and is non-judgemental. In addition, a service that is more "welcoming", delivered in an environment that is appropriate for the adolescent, with accessible clinic hours and with adequate continuity of care was deemed essential. While these service goals may seem ambitious and difficult to achieve, these are the ideals we need to aim for in order to reduce the reluctance of adolescents to use health care services for mental health problems and improve the mental well-being of the Maltese adolescent population.