Reluctance to seek help

Studies have found that approximately 18 to 34% of young people with high levels of depression or anxiety symptoms seek professional help. For example, a school-based study of 12 to 17 year old German adolescents reported that only 18.2% of those with diagnosable anxiety disorders, and 23% of those with depressive disorders had ever used mental health services [7]. Similarly, a large study of over 11,000 Norwegian adolescents in school aged 15 to 16 years found that only 34% of those with high levels of depression and anxiety symptoms had sought professional help in the previous year [8].Depression as a Health Barrier Essay.  According to an Australian national mental health survey of young people only 25% of children aged 4 to 17 years with a diagnosable mental disorder had used any health services in the 6 months prior to the survey [5]. This reluctance to seek help is not limited to children and adolescents. Adults of all ages often do not seek help for a mental illness [9], with only 35% of those surveyed with a common mental disorder seeking help during the previous year [4].

Proposed reasons for not seeking help

Many reasons have been proposed to explain why adults in the general population do not seek professional help for common mental disorders. These include negative attitudes towards seeking help generally [10], as well as concerns about cost, transportation or inconvenience, confidentiality, other people finding out, feeling like they can handle the problem on their own, and the belief that the treatment will not help [11]. Similar concerns have been found in a rural population, with the addition of worry that that the care will be unavailable when needed, about being treated unkindly, and not knowing where to go [12]. Conversely, facilitators have been proposed to include prior treatment, higher education, and greater mental disorder episode length [13], and the influence of intimate partners and general practitioners [14].

Likewise, research has sought to explain the reluctance of young people and adolescents to seek professional help when it is necessary. Friends and family are often the preferred sources of help over health professionals [6,15]. In two reviews of help-seeking studies, Rickwood and her collaborators concluded that a high reliance on self to solve problems, a lack of emotional competence, and negative attitudes about seeking professional help were barriers to help-seeking [6,16]. Conversely, the authors identified a number of possible facilitators of help-seeking. These included emotional competence, knowledge, positive attitudes towards seeking professional help, social encouragement, and the availability of established and trusted relationships with professionals such as general practitioners [6].Depression as a Health Barrier Essay.  These reviews were based around a model of help-seeking [16] in which seeking professional help is conceptualised as a multi-step process beginning with the individual’s development of an awareness of the problem, followed by the expression of the problem and a need for help to others, the identification of appropriate of sources of help for the individual to access, and finally, the willingness of the individual to actually seek out and disclose to potential sources of help. In another review, Barker and colleagues [17] differentiated between structural and personal determinants of help-seeking. They maintained that individual factors, such as personal beliefs, internalised gender norms, coping skills, self-efficacy, and perceived stigma interact with structural factors including the national health system, accessibility and affordability of services, and social support. However, none of these reviews were systematic syntheses of the available quantitative and qualitative literature. Moreover, they focused primarily on quantitative cross-sectional correlational studies (e.g., primarily survey studies which measured the association between a measured barrier such as low emotional competence and the young person’s intentions to seek help [18]) and largely overlooked the qualitative research. The qualitative research in particular may provide additional and different information about the reasons that young people do not seek help to structured survey questions. Moreover, currently no review has systematically identified and synthesised the literature which asks young people themselves what they perceive are the barriers and facilitators to help-seeking. This systematic review seeks to address this gap.

Study Selection

Figure ​Figure11 presents the flow chart for the selection of the included studies. The initial database search returned 3637 published English-language abstracts after removing duplicates. One of the researchers (AG) then screened the abstracts and excluded studies that did not address barriers or facilitators to help-seeking for a mental health problem. This resulted in 260 potentially relevant studies. An additional 32 studies were located through hand-searching the reference lists of reviews and key papers found through the systematic search and which were considered likely to satisfy the inclusion criteria.

The second stage of the study selection process involved examining each of the 292 articles and excluding those which met the following exclusion criteria.

1. Participants were not explicitly asked what they considered were barriers or facilitators to help-seeking for mental health problems.

2. Study participants were neither adolescents nor young adults (aged 12-25 years).Depression as a Health Barrier Essay.  This criterion was considered met if more than 25% of the participants fell outside the 12 to 25 years age range, the sample mean age was 26 years or more, the sample was specifically described as “adults” with the age of the participants no further described.

3. Study was a review.

4. Study participants were not members of the general community, or university, or school students (e.g., studies of groups with restricted access to a range of help-seeking opportunities such as prisoners and members of the military).

5. Study was focused on help-seeking on behalf of another person (e.g., carer seeking help for a consumer, or parent seeking help for a child).

6. Study contained no extractable data on barriers or facilitators.

7. Study addressed a mental health condition other than depression, or anxiety, or general “mental distress” (e.g., psychosis, obsessive compulsive disorder). Studies of pre- or post-natal depression were also excluded.

270 studies met one or more of these criteria and were excluded from further consideration. No studies were excluded on the basis of research quality. A summary of the excluded studies grouped by the primary reason for the exclusion is provided in additional file 2: List of studies excluded from the review by exclusion category. This process resulted in a total of 22 relevant studies [20-41] for inclusion into the review.

Coding of Studies

Each of the 22 included studies was coded using a pre-formulated rating sheet according to the following characteristics: Author name, year published, country (location of study), age of participants (age range or mean), population description, whether the study participants were selected regardless of mental health status or risk profile (universal) or not, sample size (for target variable), gender (male, female, both), setting (e.g., high school, community, university), research type (qualitative, quantitative), specified barriers to help-seeking (description of barrier themes or items as listed in the study), and specified facilitators of help-seeking (description of facilitator themes or items as listed by the study). Depression as a Health Barrier Essay.