Can hopelessness and adolescents' beliefs and attitudes about seeking help account for help negation?

A longitudinal study of self-injurious thoughts and behaviors transitions and help-seeking intentions among young adults

PURPOSE

Engagement in self-injurious thoughts and behaviors (SITBs) is associated with low help-seeking intentions. Nevertheless, prior research has primarily relied on cross-sectional data, leaving uncertainties about the longitudinal dynamics between SITBs and help-seeking intentions. This study aims to investigate the longitudinal relationship between SITBs and help-seeking intentions for them.

METHOD

A one-year interval follow-up investigation was conducted among 1788 Chinese students (71.5% girls, Mage = 19.5). Changes in help-seeking intentions were initially analyzed among four SITBs transition groups. Subsequently, a cross-lagged model was employed to explore the possible bidirectional associations.

RESULTS

232 participants (12.90%) experienced changes in SITBs, while 65 participants (3.60%) exhibited sustained SITBs between two measurement time points. Changes in help-seeking intentions varied across SITBs transition groups. Participants whose SITBs faded 1 year later showed a significant increase in help-seeking intentions, whereas those who experienced newly developed SITBs across two measurement time points demonstrated a significant decline. The cross-lagged analysis revealed that help-seeking intentions negatively predicted the subsequent risk of experiencing SITBs.

CONCLUSIONS

Greater help-seeking intentions predicted decreased SITBs 1 year later. Changes in help-seeking intentions serve as a valuable indicator for distinguishing between different types of SITBs transition. These findings underscore the importance of implementing prevention and intervention strategies targeted at enhancing help-seeking intentions to reduce SITBs.

Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors

OBJECTIVE

Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs).

PARTICIPANTS

College students with STBs in the 2018-2020 Healthy Minds Study.

METHODS

Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions.

RESULTS

Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress.

CONCLUSIONS

Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Mental health problems and help-seeking behaviours of Syrian refugee adolescents: mediating role of self-stigma

BACKGROUND

Although common mental health problems have been widely studied with self-stigma, few studies have focused on the mediating effect of self-stigma in the relationship between mental health problems and help-seeking behaviours of refugee adolescents. Therefore, the purpose of the present study was to examine whether self-stigma mitigates the adverse effects of stress, anxiety, and depression symptoms on the help-seeking behaviours of Syrian adolescents living in Turkey.

METHODS

The participants of this study included 488 Syrian refugee adolescents (boys, 63.73%; girls, 3627%) living in Turkey. Participants completed the Depression Anxiety Stress Scale and General Help-Seeking Scale and Self-Stigma of Seeking Psychology Help Scale.

RESULTS

The findings revealed that stress (β = 0.19, p < 0.01), anxiety (β = 0.12, p < 0.05), and depression (β = 0.17, p < 0.01) had significant and positive predictive effects on self-stigma, but not on help-seeking behaviours. Also, self-stigma (β = -0.12, p < 0.01) had a significant negative predictive effect on help-seeking behaviours. With regard to the indirect effects, the findings showed that self-stigma fully mediated the associations between stress - help-seeking [effect = -0.05, 95% confidence interval (CI) -0.11 to -0.01], anxiety - help-seeking (effect = -0.04, 95% CI -0.09 to -0.01)], and depression - help-seeking (effect = -0.05, 95% CI -0.12 to -0.01).

CONCLUSIONS

Our findings highlight the potential negative effects of self-stigma on the help-seeking behaviours of Syrian refugee adolescents, both directly and indirectly. These results can be used to develop and implement effective and efficient interventions to address the unmet mental health needs of refugee adolescents.

Young people's pathways to a specialist suicide prevention service and the influence of caregiver prior suicidality and mental health treatment

AIM

Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognized, caregivers also play a significant role in these pathways. Caregiver's familiarity with mental health issues may influence an adolescent's PtC. This study explores the relationship between a caregiver's prior suicidality and mental health treatment on their children's pathways to entering a specialist suicide prevention treatment program.

METHOD

Caregivers (n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child's onset of symptoms, help-seeking, PtC and the caregiver's prior suicidality and mental health treatment.

RESULTS

Parents were the source most likely to recognize the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration.

CONCLUSION

Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver's prior experience of suicidality to these pathways. These complexities warrant further exploration to minimize obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers.

The role of mental health and protective factors in student academic persistence and retention during a global crisis

The COVID-19 pandemic has exacerbated challenges for millions of students globally, leading to enrollment cliff. This study addresses the existing research gap by investigating the influence of students' mental health and various protective factors (i.e., optimism, help-seeking behaviors, social support) on academic persistence, an indicator of student retention. We utilized the structural equation modeling approach to examine the effect of students' mental health conditions, risk perception of COVID-19 and protective factors on academic persistence through a sample of 1,051 students from 45 states. Students' mental health positively predicted academic persistence. Risk perception of COVID-19 was negatively associated with mental health but positively predicted academic persistence and help-seeking behaviors. Optimism fully mediated the effect of mental health on help-seeking behaviors but did not mediate the effect of risk perception on help-seeking behaviors. Social support positively predicted academic persistence. This study underscores the integral role of mental health and protective factors in supporting student retention. Universities should develop targeted programs to address students' mental health needs and promote protective behaviors. These initiatives can enhance academic persistence, thereby aiding in the retention of students affected by this pandemic or any future global crisis.

Crisis-management, Anti-stigma, and Mental Health Literacy Program for University Students (CAMPUS): A preliminary evaluation of suicide prevention

Background: University students have specific risk factors for suicide, necessitating targeted prevention programs. This preliminary study evaluated the efficacy of the Crisis-management, Anti-stigma, Mental health literacy Program for University Students (CAMPUS) for reduction of risk factors and promotion of preventative behaviors. Methods: A total of 136 medical students attended the CAMPUS as a required course at the national university in Japan. The CAMPUS consisted of a lecture and two group sessions covering mental health literacy, self-stigma, and gatekeeper efficacy (e.g., identifying and helping at-risk individuals). The students were asked to role-play based on a movie about gatekeepers and scripts about self-stigma and suicide-related issues. Participants completed questionnaires on suicidal thoughts, depression, help-seeking intentions, self-efficacy as gatekeepers, self-concealment, and self-acceptance. A total of 121 students completed the questionnaires pre- and post-program, and 107 students also responded six months later. Results: Students demonstrated significantly reduced overall suicide thoughts six months post-program compared to before the program. In addition, gatekeeper self-efficacy, help-seeking intentions for formal resources, and self-acceptance were improved in the students six month after the program. Conclusions: The CAMPUS suggested effective at reducing suicidal people and promoting preventative psychological tendencies among medial students. This study was a one-group pre post design study without control group. The CAMPUS program was delivered as a mandatory requirement to a group with relatively low suicide risk. Further studies are required to assess its suitability for the general university student population.

Development and validation of a universal mental health literacy scale for adolescents (UMHL-A)

Mental health literacy (MHL) grows in importance as the prevalence of mental health conditions rises worldwide. There is a need for valid MHL measures especially among adolescents. The current study aims to develop and validate a Universal mental health literacy scale for adolescents (UMHL-A), a self report scale to assess MHL of children between ages 10 and 14 across all four components within Kutcher's framework for MHL. The development of the UMHL-A was initiated by a literature review and followed by item generation. Then, we tested the face and content validity of the scale via a delphi study, focus groups and cognitive interviews with the target group. Next with a convenience sample, we established the factor structure and construct validity of the scale using exploratory and confirmatory factor analyses. Lastly, we tested the scale convergent validity with other measures. The final form of the scale was refined on a representative sample of Czech asolescents. The UMHL-A scale comprises 17 items measuring four components of MHL. The scale has substantial methodological advantages in comparison to existing measures of MHL, especially considering its brevity and comprehensive coverage of MHL. Further studies are needed to test its application and validity globally.

Psychological Factors That Suppress Help-Seeking among Middle-Aged and Older Adults Living Alone

Help-seeking among destitute adults has not been adequately investigated. Therefore, this study clarifies the mechanisms that suppress help-seeking in middle-aged and older adults living alone. Data were collected from 1274 individuals (aged 50-79 years) who were living alone, using a survey that measured future time perspective, barriers to help-seeking, help-seeking intentions, and current and childhood economic statuses. Men living alone experienced lower help-seeking intention than women, were more likely to try to solve problems by themselves, and experienced greater distrust in others. No sex differences were observed in "future anxiety" and "resignation to the future." Poor economic status was associated with high "resignation to the future," "future anxiety," and "distrust of others" for both sexes. "Resignation to the future" was particularly higher among men with a poorer current economic status, which suppressed help-seeking. Abandoning hope for the future, which is characteristic of middle-aged and older men living alone, may inhibit help-seeking behavior.

Inventory of Attitudes toward Seeking Mental Health Services: Psychometric Properties among Adolescents

Mental health is an essential element of wellness; however, some populations are more vulnerable to mental health problems. Suicide is the second-highest cause of death in young people and help-seeking unwillingness is a significant obstacle to mental health interventions. Young people are especially reluctant to seek help and negative attitudes stand out as help-seeking barriers, highlighting the importance of evaluating these constructs. The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS) is a measure that evaluates help-seeking attitudes; nevertheless, it lacks applicability in Portuguese youth. This study aims to explore the psychometric characteristics of the IASMHS in 750 Portuguese adolescents (52.3% female, Mage = 14.67), through exploratory and confirmatory factor analysis, and reliability and validity analyses. Results suggest that a three-factor structure was adequate, those factors being help-seeking propensity, indifference to stigma, and psychological openness. The IASMHS was shortened to 20 items and revealed satisfactory properties regarding internal consistency, convergent/discriminant validity, and temporal stability. These findings validate the IASMHS as an adequate tool in the assessment of young people’s help-seeking attitudes.

Lessons learned from two feasibility trials of a translated and minimally monitored iCBT program for young adults among community and university samples

Young adults are less likely to use traditional mental health services than adults. iCBT may be more youth friendly, but its access remains limited in several countries. This study aims to evaluate the feasibility of a minimally monitored transdiagnostic iCBT program translated from English to French and offered in Canada for the treatment of anxiety and depression among young adults. The impact of the program on resilience was also assessed. Twenty-five participants from community and university samples were included in the analyses in two separate single-group feasibility trials with a 3-month follow-up. Feasibility outcomes were attrition, adherence, treatment acceptability and treatment gains. Outcome measures included the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC). In Trial 1 (N = 10), recruiting among the general population proved to be challenging. Low adherence (20%) and high attrition (80%) rates were observed. Methodological changes to recruitment were made and a second trial was conducted among university students using incentives (N = 15). About half of the participants completed treatment (55%, n = 8/15), 12/15 provided post-treatment data and 8/15 provided 3-month follow-up data. All study completers (100%; n = 14) reported they would recommend the program. Mixed effects model analyses revealed significant and large pre-post treatment reductions on the PHQ-9 and GAD-7 (Cohen's d = 1.09 and 1.64 respectively) with treatment gains maintained at follow-up. Moderate improvements were found on the CD-RISC post-treatment with further gains at follow-up (ds = 0.55 and 1.10 respectively). These finding suggest that future research on this French-Canadian version of the Mood Mechanic Course is feasible with appropriate attention to recruitment. Translating existing iCBT interventions and using minimal monitoring may be an optimal first step to initiate the cross-cultural dissemination of iCBT while increasing access to treatments among young adults. Lessons learned are discussed.

An exploration of young people's, parent/carers', and professionals' experiences of a voluntary sector organisation operating a Youth Information, Advice, and Counselling (YIAC) model in a disadvantaged area

Background

The present evaluation explored young people’s, parents/carers, and healthcare professionals’ perceptions of the Youth Information, Advice and Counselling (YIAC) model operated by a voluntary sector organisation in North West England. With an aim to understand the key components that contribute to enhancing the success of the YIAC model.

Method

Semi-structured interviews and focus groups with young people, parents/carers, and healthcare professionals were conducted. Data were analysed using thematic analysis.

Results

Five main themes were identified from the data: 1) Accessibility and flexibility; 2) Non-clinical model and environment; 3) Staff; 4) Partnership working; and 5) Promotion of positive mental health and wellbeing.

Conclusion

Findings highlight the importance of non-clinical, community-based, ‘one-stop-shop’ hubs for young people in disadvantaged areas. The key components highlighted as facilitating access and engagement include: opportunity to self-refer, choice of location, timely provision of support, non-clinical environment, age appropriate services, a non-hierarchical workforce, inclusive support for family and carers, a focus on wider, often social, issues, and collaboration with partner organisations. These findings suggest that early support hubs for young people’s mental health should have consistent, long-term funding and should exist in every local area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07800-1.

Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study

BACKGROUND

Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments.

OBJECTIVE

This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW.

METHODS

We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups.

RESULTS

We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions.

CONCLUSIONS

We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.

Help-Seeking for Eating Pathology Among Collegiate Athletes: Examining Stigma and Perfectionism as Moderating and Mediating Mechanisms

Despite elevated risk of eating pathology (EP) among athletes, utilization of EP-treatment among athletes is low. Factors that may inhibit EP-help-seeking among athletes include perceived social stigma, self-stigma, and perfectionism. Heightened stigma associated with EP and sport climates may be exacerbated by negative perfectionism characteristic of athletes and decrease intentions to seek help for EP. We tested the following moderated-mediation model among a sample of collegiate athletes (N = 201) via online questionnaires: EP indirectly relates to EP help-seeking intentions through perceived and self-stigma and these relations are conditional on negative perfectionism. EP help-seeking intentions were negatively associated with EP severity, stigma, and negative perfectionism. EP was related to eating-specific help-seeking intentions through perceived social stigma, influencing self-stigma, but this was not moderated by negative perfectionism. Targeting mental-health treatment stigma among athletes may reduce risk of untreated EP among collegiate athletes.

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.

"Unless you overdose or something you're not going to get help": What do adolescent experiences reveal about the mental health system in Perth, Western Australia?

ISSUES ADDRESSED

To explore adolescents' experiences of access to and continued use of mental health services, and identify factors influencing their perceived satisfaction with their care. This paper focusses on the role of organisational and policy-level factors in the mental health system.

METHOD

Qualitative semi-structured face-to-face interviews with 22 adolescents aged 14-18 years living in Perth, Western Australia.

RESULTS

Adolescents identified key policy, systemic and service-based factors which influenced their access to and continued use of mental health services. These were strongly related to the processes of service intake, level of orientation towards person-centred care and adequacy of service resourcing and funding. Areas of concern for adolescents included, complex service intake procedures, suboptimal mental health service environments, lack of client-centred care and the quality of mental health support provided in school settings.

CONCLUSIONS

Our research has identified a wide spectrum of factors influencing mental health service access and use amongst adolescents. The findings further support the growing national consensus for major reform to address the mental health needs of this age group. The current strengths within mental health services and the system identified by adolescents need to be supported and extended. SO WHAT?: Although there have been numerous recommendations on ways to improve mental health service access and ongoing engagement for Australian adolescents, a number of the major challenges faced by this high-risk population have shown little improvement. The findings of this research indicate the importance of now moving towards implementing meaningful plans for action.

Is there an app for that? A cluster randomised controlled trial of a mobile app-based mental health intervention

Demand for the use of mobile apps in mental health interventions has grown in recent years, particularly among adolescents who experience elevated levels of distress. However, there is a scarcity of evidence for the effectiveness of these tools within this population. The aim of this study was to test the effectiveness of CopeSmart, a mental health mobile app, using a multicentre cluster randomised controlled trial design. Participants were 15-18-years-olds (N = 560) recruited from 10 schools randomly assigned to an intervention or control condition. Intervention participants used the app over a 4-week period. Multi-level modelling analyses revealed no significant changes in the intervention group from pre-test to post-test, when compared to the control group, in terms of emotional distress, well-being, emotional self-awareness or coping strategies. Findings suggest that a 4-week app-based intervention may not be enough to elicit intra-personal changes in mental health outcomes in a general adolescent population.

A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents With Depression and/or Anxiety and Their Parents: Protocol for a Pilot Randomized Controlled Trial

Background

Few adolescents who experience depression or anxiety connect to mental health treatment. Supporting Our Valued Adolescents (SOVA) is a stakeholder-informed technology intervention that consists of 2 blog-format websites—one for adolescents and another for parents. SOVA is designed to intervene on targets, which may increase the mental health treatment uptake when adolescents with depression or anxiety are identified in primary care settings.

Objective

This study aims to describe the protocol for a pilot randomized controlled trial designed to refine recruitment and retention strategies, document intervention fidelity and implementation outcomes, and assess changes in health beliefs and knowledge, emotional or informational support, and parent-adolescent communication quality in adolescents and their parents.

Methods

Adolescents identified with symptoms of depression or anxiety, for which a health care provider recommends treatment, and their parents will be recruited from clinics where adolescents are seen for primary care. Adolescent-parent dyads will be randomized at 1:1 to both receive the SOVA websites and enhanced usual care or enhanced usual care alone. Baseline measures and 6-week and 3-month outcomes will be collected by Web-based self-report surveys and electronic health record review. The main pilot outcome is the 6-week study retention rate. Analyses will also assess changes in health beliefs and knowledge, emotional support, and parent-adolescent communication in both adolescents and their parents.

Results

The project was funded in 2017. Recruitment commenced in April 2018 and enrollment is ongoing, with completion anticipated at the end of 2019 with subsequent plans for data analysis and publication submission in early 2020.

Conclusions

The findings of this research will inform the design of a multisite hybrid effectiveness-implementation randomized controlled trial examining the effectiveness and optimal implementation strategies for using SOVA in community primary care settings.

Trial Registration

ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666

International Registered Report Identifier (IRRID)

PRR1-10.2196/12117

Help-seeking Pathway among Working-Age Adults with Suicidal Ideation: Testing the Integrated Model of Suicide Help-seeking

Despite a high suicide rate among working-age adults, there is a significant lack of empirical evidence on their help-seeking behavior. This study tested the integrated model of suicide help-seeking to examine help-seeking behavior as a continuous decision-making process. Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health (N = 1,414). Results from structural equational modeling analyses demonstrated that the integrated model fit reasonably well among the sample. Suicide help-seeking behavior is characterized by an inequitable access, where enabling factors affect throughout the help-seeking pathway. The results provide a foundation for future help-seeking interventions.

Development and pilot evaluation of an online psychoeducational program for suicide prevention among university students: A randomised controlled trial

INTRODUCTION

Suicide is the second leading cause of death for the university aged population globally. A significant proportion of students with suicidal ideation or behaviours do not seek professional help. Few primary suicide prevention programs have specifically targeted help seeking for suicidal ideation or behaviours among university students.

METHODS

This study reported the development and pilot test of a brief, two-module online psychoeducational program (ProHelp) that aimed to encourage help seeking for suicidal ideation and behaviours among university students. The program consists of two five-minute modules that address the risk factors and warning signs of suicide, stigmatising attitudes, and perceived barriers to help seeking. 156 Chinese university students and 101 Australian university students were recruited to evaluate the effectiveness of this program at post-test and one-month follow-up. Participants were randomly assigned to the psychoeducational program or an attention control program.

RESULTS

Of the Chinese and Australian students who were randomised into the study, around 50% completed the two-day post-test survey, and 30% completed the one-month follow-up survey. Although no significant difference was found between the control and experimental group on professional help-seeking beliefs and intentions, both groups' help-seeking attitudes increased during the study (p = 0.003 for the post-test survey, and p = 0.008 for the follow-up survey). The experimental group in both countries demonstrated a significant improvement in suicide literacy at the post-test survey (p = 0.015) compared to control. Qualitative feedback indicated that the ProHelp program was user-friendly, clear, and helpful.

CONCLUSIONS

This study provides initial evidence that a brief online psychoeducational program could enhance university students' suicide literacy in both China and Australia. It also suggests that increasing suicide literacy might not be sufficient to improve students' help seeking, although effect sizes indicated that this low-intensity online approach shows promise in encouraging more positive beliefs towards help seeking and preparedness to help individuals with suicidal ideation among young people.

Factors Influencing Professional Help-Seeking for Suicidality

BACKGROUND

Evidence suggests that the majority of people with suicidality do not seek help. Little systematic evaluation of factors influencing professional help-seeking has been done.

AIMS

To systematically evaluate the factors that influence professional help-seeking for suicidality.

METHOD

Published quantitative and qualitative studies in Medline and PsycInfo databases were reviewed following PRISMA.

RESULTS

In all, 55 relevant studies were identified. Of these, 15 studies examined professional help-seeking intentions for perceived suicidal ideation, among people with or without suicidality; 21 studies examined professional help-seeking behavior among people with suicidality; and 19 studies examined suicidal decedents' health services use. Several potential important barriers were identified including high self-reliance, lack of perceived need for treatment, and stigmatizing attitudes toward suicide, toward mental health issues, and toward seeking professional treatment. The presence of suicidality and mental health issues was found to generally decrease help-seeking intentions for perceived suicidal ideation while facilitating actual service use. Social support and informal support from family and friends also played an important role in professional help-seeking.

LIMITATIONS

Although the majority of the included studies were of sound quality, some of the factors identified in the review were assessed in relatively few studies, and most of the included studies were conducted in industrialized countries.

CONCLUSION

Further quantitative and qualitative studies examining the potential important factors in broader community samples, especially in developing countries, are needed.

[Effects of help-seeker's predictions about helper's emotions and costs of help-seeking intentions]

The present study examined effects of predictions made by a help-seeker about the emotions and costs of a helper on help-seeking behavior. We surveyed undergraduate and graduate students who completed a questionnaire and scenario task. The scenario presented that a person would face the trouble. The questionnaire presented a case where a person was troubled. Respondents were required to answer the following questions: (a) whether they would seek help; (b) whether the helper would respond to help-seeking; (c) the helper’s costs; (d) the negative moods of the helper. Covariance structure analysis of 189 participant responses revealed that help-seeker predictions about the helper’s emotions and costs were used to predict the intentions of the helper, which affected the intentions to seek help. We discuss these results with respect to interpersonal cognition in intimate relationships.

Individuals at Risk for Suicide

BACKGROUND

Individuals experiencing suicidal ideation and/or behaviors are often difficult to engage in treatment. Up to 50% of individuals presenting to an ER for treatment of a suicidal crisis refuse outpatient treatment referrals. This study examined outpatient mental health clinicians' perceptions of the barriers to and facilitators of mental health treatment engagement of individuals at risk for suicide.

METHOD

Thirty-six mental health clinicians working with clients with past and/or current suicidality (ideation, behaviors) in outpatient mental health centers participated in four focus groups. Data were collected using semistructured interview. A process of content analysis was utilized in which data were analyzed thematically.

RESULTS

Five main domains of barriers and facilitators emerged including (a) client-level, (b) clinician-level, (c) service-level, (d) agency-level, and (e) intervention-level variables. In all, 38 barriers and 31 facilitators were identified. The most frequently identified facilitator was the clinician's own sense of engagement with the client, identified by 31% of the clinicians. The most frequently identified barrier was housing instability, identified by 34% of the clinicians.

CONCLUSION

Knowledge of clinicians' perspective on treatment engagement of clients at risk for suicide may inform the development and implementation of interventions and guide training/supervision programs for those working with this vulnerable population.

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).

Hopelessness in adolescents

BACKGROUND

The hopelessness scales devised by Beck and by Kazdin have been used in hundreds of studies of both non-clinical and clinical samples. The present study identified non-clinical adolescent samples to see if the mean scores differed by age, sex, year of publication of the study, and nation.

METHODS

Studies of school students administered the Beck Hopelessness Scale or the Kazdin Hopelessness Scale for Children were identified from a literature search using PsycINFO and the search term "hopelessness" anywhere in the text. Seventy-eight studies were found reporting mean scores, 44 for American students and 34 for students in other countries.

RESULTS

The scores of American students were significantly lower than those of students in other countries, and there was a tendency for boys to have higher scores than girls (in 18 of the 27 studies which reported differences by sex). There was no tendency for the hopelessness scores of American students to have increased in recent years.

CONCLUSIONS

American adolescents appear to be less hopeless than adolescent in other nations, and the scores of American adolescents do not seem to have changed significantly over the last 30 years.

Suicidal feelings interfere with help-seeking in bullied adolescents [corrected]

Purpose

Being bullied is associated with the manifestation of suicidal feelings, which sharply increase in middle(-late) adolescence. Whether or not bullied middle(-late) adolescents with suicidal feelings seek help is therefore a critical issue, given that help-seeking plays a key role in the prevention of suicide. The aim of the present study is to investigate the effects of bullying, suicidal feelings and the interaction between these two factors on help-seeking behavior in adolescents.

Methods

Japanese middle(-late) adolescents (aged 15–18 years; n = 9484) were studied using self-report questionnaires. The rate of adolescents who actually sought help was examined for bullying status and suicidal feelings.

Results

The rate of adolescents who sought help was significantly higher when they were bullied (p<0.001) and also when they had mild suicidal feelings (p<0.001), but not when they displayed serious suicidal feelings. In the case of adolescents who were bullied, however, having suicidal feelings significantly decreased the rate of help-seeking (OR = 0.47, p<0.05 and OR = 0.32, p = 0.002 for having mild and serious suicidal feelings, respectively). The decrease was remarkable when suicidal feelings were serious. Specifically, the decrease was significant in seeking help from peers and family members, who are the most frequent source of the help for adolescents, when they had serious suicidal feelings (OR = 0.21, p<0.01 and OR = 0.13, p<0.001, respectively).

Conclusions

Suicidal feelings may interfere with help-seeking behavior, which could be critical in suicide prevention in bullied middle(-late) adolescents.

Intention to seek professional psychological help among college students in Turkey: influence of help-seeking attitudes

BACKGROUND

Depression rates are high among college students in Turkey, but often students do not seek mental health care. This study aimed to examine the association between attitudes toward seeking professional psychological help and intention to seek professional psychological help among such college students. We also examined the factors associated with students' professional psychological help-seeking attitudes. We conducted this cross-sectional study among 456 conveniently sampled graduate and undergraduate students in Ankara. We collected students' data using self-administered, structured questionnaires in the Turkish language and then analyzed the data using both descriptive and multivariate methods.

RESULTS

In the multiple linear regression analyses, students' attitudes towards seeking professional psychological help were positively associated with intention to seek such help (p < 0.001). Other factors positively associated with students' attitudes towards seeking professional psychological help included the following: age (p < 0.001), perceived social support from family (p < 0.05), perceived social support from friends (p < 0.01), and perceived social support from significant other (p < 0.05). Students with less positive attitudes toward seeking professional psychological help were more likely to be men (p < 0.001), undergraduate students (p < 0.001), and students who were not aware of the presence of the on-campus counseling center (p < 0.01).

CONCLUSIONS

Students' positive attitudes toward seeking professional psychological help were positively associated with their intentions to seek such help. To encourage utilization of the counseling center inside the campus more frequently when in need, interventions might be necessary to improve students' attitudes toward seeking professional psychological help-in particular among young male students.

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.

Three scales assessing high school students' attitudes and perceived norms about seeking adult help for distress and suicide concerns

Validated measures that can be administered to school populations are needed to advance knowledge of help-seeking processes and to evaluate suicide prevention programs that target help-seeking. With 6,370 students from 22 high schools, we assessed the psychometric properties of three brief measures: Help-Seeking Acceptability at School, Adult Help for Suicidal Youth, and Reject Codes of Silence. Internal consistency coefficients ranged from .64 to .84. In support of construct validity, lower scores on each scale were associated with more maladaptive coping norms; for each one unit increase on each scale, students were one third to one half as likely to report suicidal ideation, suicide attempts, and elevated depression.

The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review

Anxiety disorders are the most common mental health problems experienced by young people, and even mild anxiety can significantly limit social, emotional, and cognitive development into adulthood. It is, therefore, essential that anxiety is treated as early and effectively as possible. Young people are unlikely, however, to seek professional treatment for their problems, increasing their chance of serious long-term problems such as impaired peer relations and low self-esteem. The barriers young people face to accessing services are well documented, and self-help resources may provide an alternative option to respond to early manifestations of anxiety disorders. This article reviews the potential benefits of self-help treatments for anxiety and the evidence for their effectiveness. Despite using inclusive review criteria, only six relevant studies were found. The results of these studies show that there is some evidence for the use of self-help interventions for anxiety in young people, but like the research with adult populations, the overall quality of the studies is poor and there is need for further and more rigorous research.

What are young adults saying about mental health? An analysis of Internet blogs

BACKGROUND

Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care.

OBJECTIVE

To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18-25 years of age) with mental health concerns to understand their experiences.

METHODS

We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18-25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods.

RESULTS

Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others.

CONCLUSIONS

The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults' sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.

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.

METHODS

Relevant help-seeking research is reviewed, and prominent help-seeking barriers are discussed.

RESULTS

Prominent barriers for young people include: incomplete mental health and emotional literacy, beliefs about having little need for help versus having a need for autonomy, and the process of help-negation for different symptoms of psychological distress.

CONCLUSIONS

To improve early access to appropriate help and mental health services, barriers that can be reduced, and in particular, psychological distress symptoms that promote the help-negation process, must be reduced as soon as they can be. Strategies that can be used by clinicians, parents and others, including young people, to encourage appropriate help-seeking are provided. Examples of how these strategies are implemented in several innovative programs and approaches are discussed.

College students' intentions to seek help for suicidal ideation: accounting for the help-negation effect

Prior research has identified a negative association between suicidal ideation and help-seeking, a phenomenon called "help-negation." Help-negation has been documented to occur for both professional and nonprofessional sources of help. In this study help-seeking attitudes, stigma concerns, and perceptions of social support were examined as possible mediators of help-negation. Data were collected from a nonclinical sample of college undergraduates at a midwestern university (N = 321). Findings provided partial support for the mediation hypotheses. Help-seeking attitudes and stigma were significant predictors of help-seeking intentions (β = .34 and β = -.17, p < .05, respectively), but did not mediate help-negation for professional sources. Perceptions of social support, on the other hand, fully mediated help-negation for nonprofessional sources (β = .27, p < .05).

Adolescents’ Willingness to Access School-Based Support for Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a prevalent behaviour among youth. School is an opportune setting for intervention with this population, but it is unknown how many youth who engage in NSSI would be willing to access school-based support. The current study surveyed 7,126 middle and high school students. Those that indicated that they engaged in NSSI ( n = 654; 168 boys, 486 girls) responded to follow-up questions regarding the behaviour and willingness to participate in a school-based support program for NSSI. Self-injurers who responded that they would be willing to access help at school ( n = 88; 13.5% of the sample) and a matched group of those who would not be willing were compared on a number of variables. Willingness to access school-based support did not differ by gender or ethnicity but differed between middle and high school students. On indices of NSSI and worries about safety, the adolescents willing to access support reported that they used more methods of injury as well as increased worries about safety in their neighbourhood and sexual harassment.

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.

Help-negation and suicidal ideation: the role of depression, anxiety and hopelessness

Help-negation is expressed behaviorally by the refusal or avoidance of available help and cognitively by the inverse relationship between self-reported symptoms of psychological distress and help-seeking intentions. The current study examined the association between suicidal ideation and intentions to seek help from friends, family and professional mental health sources in a sample of 302 Australian university students. Participants were 77.5% female and aged from 18-25 years old, with 85.4% aged 21 years or younger. Higher levels of suicidal ideation were related to lower help-seeking intentions for family, friends, and professional mental health care, and higher intentions to seek help from no one. Moderation effects indicated that higher levels of depressive symptoms strengthen the help-negating effect of suicidal ideation for seeking help from friends, family and no one. The results indicate that, even at subclinical levels, suicidal ideation impedes the cognitive help-seeking process at the decision making stage. The results also highlight the importance of improving our understanding of why young people become reluctant to seek help as their levels of suicidal ideation and depressive symptoms increase. Raising awareness that the experience of suicidal ideation and depressive symptoms can promote intentions to avoid help might reduce the help-negation effect when symptoms are first recognized.

Adolescents' suicidal thinking and reluctance to consult general medical practitioners

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13-18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.