Journal of Affective Disorders 147 (2013) 255–261
Contents lists available at SciVerse ScienceDirect
Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad
Research report
Where would young people seek help for mental disorders and what stops them? Findings from an Australian national survey Marie Bee Hui Yap a,b,n, Nicola Reavley a,b, Anthony Francis Jorm a,b a b
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia Melbourne School of Population Health, University of Melbourne, Australia
a r t i c l e i n f o
abstract
Article history: Received 21 August 2012 Received in revised form 12 November 2012 Accepted 12 November 2012 Available online 8 December 2012
Background: In order to improve help seeking by young people for mental illness, a better understanding is required of their help-seeking intentions and barriers to their help seeking from various different sources and for different disorders. Methods: Young people’s help-seeking intentions and perceived barriers to help seeking were assessed by a national telephone survey of 3021 youths aged 15–25 years. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. Results: Embarrassment or shyness was the most frequently mentioned barrier to seeking help from most sources. However, different barriers featured prominently depending on the disorder and the helper. Age, sex, and knowing a family member or friend who had received professional help for mental illness predicted some barriers. Limitations: Help-seeking intentions and barriers were assessed with reference to a vignette character and may not reflect actual experience or behaviors. Conclusions: Findings can facilitate the targeting of future efforts to improve young people’s help seeking for mental disorders by highlighting the barriers that are more relevant for specific disorders, sources of help and personal characteristics. & 2012 Elsevier B.V. All rights reserved.
Keywords: Treatment Youth Depression Anxiety disorder Barriers
1. Introduction Half of all lifetime case-level mental disorders start by age 14 and three quarters by age 24, with affective disorders having the highest lifetime prevalence (29% and 25% for anxiety and depressive disorders respectively; Kessler et al., 2005). Moreover, recent evidence has highlighted that mental disorders are the largest contributors to disability in young people (Mathews et al., 2011). In particular, the long-term sequelae of mental disorders are often exacerbated by delayed help seeking or the lack thereof (de Girolamo et al., 2012; Harris et al., 2005). In order to more effectively target messages to increase appropriate help seeking by young people, a better understanding of what stops young people from seeking help and the predictors of this is required. A recent review revealed that stigma, embarrassment, problems recognizing symptoms (poor mental health literacy), and a preference for self reliance are the most important barriers to help seeking by young people (Gulliver et al., 2010). However, the review, like other more recent studies (Downs and Eisenberg, 2011; n Correspondence to: Population Mental Health Group, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia. Tel.: þ61 4 11989022; fax: þ61 3 9349 5815. E-mail address: mbhy@unimelb.edu.au (M.B.H. Yap).
0165-0327/$ - see front matter & 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2012.11.014
Evans et al., 2011; Mojtabai et al., 2011; Prins et al., 2011), focused primarily on professional help seeking. Although they are the ideal source of help for mental disorders, professionals are often not the first port of call for young people, who prefer to go to family or friends for help (Rickwood and Braithwaite, 1994; Rickwood et al., 2007). In some cases, these informal sources of help may be the only ones that young people would turn to, hence it is important to examine the barriers that might stop young people from seeking help, even from close others like family and friends, especially if they can become conduits to appropriate professional treatment (Rickwood et al., 2007). Another limitation of extant research on barriers to help seeking is the focus on more prevalent disorders like depression, anxiety or general ‘mental distress’, or an undifferentiated cluster of psychiatric disorders (Gulliver et al., 2010; Mojtabai et al., 2011; Prins et al., 2011). Some recent exceptions have examined suicidal college students (Downs and Eisenberg, 2011) and young women with eating disorders (Evans et al., 2011), and revealed some similarities but also some interesting differences in reported barriers compared with studies that focused on more prevalent or undifferentiated disorders. However, in a 2006 national survey of Australian youth, Jorm et al. (2007) found little differences in barriers for four different vignettes: depression, social phobia, psychosis, and depression with alcohol abuse.
256
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
Research examining perceived barriers to help seeking for different disorders is required to clarify whether barriers vary according to the type of disorder. Finally, not many studies have examined predictors of these barriers. Using data from the National Comorbidity Survey Replication of the US general population, Mojtabai et al. (2011) found that age (18–49 versus Z50 years) and severity of mental disorder amongst adults with 12-month DSM-IV disorders significantly predicted structural barriers to help seeking such as inconvenience, cost, and availability. However, attitudinal or evaluative barriers such as stigma or preference for self reliance were not predicted by sociodemographic variables or severity of disorder. Research on predictors of young people’s perceived barriers to help seeking is lacking, hence it remains unclear how efforts to minimize or remove these barriers and increase appropriate help seeking can be most effectively targeted. The current study seeks to address these gaps by examining young people’s help-seeking intentions and their barriers for a range of mental disorders and from various formal and informal sources, using data from a 2011 national survey of Australian youth. To identify subgroups of young people who may need to be targeted in future efforts to improve help seeking, we examined age, sex, psychological distress, and exposure to mental health problems in close family or friends (including whether professional help was received) as potential predictors of help-seeking intentions and their barriers.
2. Methods 2.1. Participants The survey involved computer-assisted telephone interviews with 3021 young people aged between 15 and 25 years. The survey was carried out by the survey company Social Research Centre using random-digit dialing of both landlines and mobile phones covering the whole of Australia from January to May, 2011. Up to six calls were made to establish contact. The response rate was 47.9%, defined as completed interviews (3021) out of sample members who could be contacted and were confirmed as in scope (6306). Interviewers ascertained whether there were residents in the household within the age range and, if there were multiple, selected one for interview using the nearest-birthday method.
2.3. Potential predictors of help-seeking intentions and barriers Given that age, sex, and personal exposure to mental disorders have been found to be associated with mental health literacy (Jorm et al., 2007; Jorm and Wright, 2008; Yap et al., 2011), young people were asked a range of questions to ascertain this information. Information about respondent sex and age (in years) was collected as part of the interview. To assess their lifetime exposure to mental health problems in family or friends, respondents were asked: ‘‘Has anyone in your family or close circle of friends ever had a problem similar to John’s/ Jenny’s?’’ and ‘‘Have they received professional help or treatment for these problems?’’. Responses were coded such that no experience of a similar problem¼0; having had a similar problem but not received any help¼1; and having had a similar problem and received help¼2. Respondents also reported on their psychological distress in the past 30 days using the interviewer– administered K6 questionnaire (Kessler et al., 2002). Responses were summed to give a score out of 24. 2.4. Content analysis of responses to open-ended questions Responses to where respondents would go for help were coded based on categories identified from the 2006 survey (Jorm et al., 2007), with additional categories formed that were relevant to the different mental disorders studied. Responses were coded with a ‘‘yes’’ or ‘‘no’’ in each category, so that multiple categories were possible. Categories included family, such as parents, spouse, or relative, general practitioner (GP)/doctor, psychologist, psychiatrist, mental health specialist/ service, counselor, helpline, teacher/ lecturer, and friend. Categories of barriers to seeking help were informed by barriers identified in previous research in adolescents (Kuhl et al., 1997; Sheffield et al., 2004; Wright et al., 2006), and included:
# structural barriers such as cost, distance to travel, and difficulty in getting an appointment;
# stigma-related barriers such as concern that the person might
#
2.2. Survey interview The interview was based on a case vignette of a young person (John or Jenny) with a mental disorder. On a random basis, respondents were read one of six vignettes—depression, depression with suicidal thoughts, depression with alcohol abuse, social phobia, PTSD, or psychosis (early schizophrenia)—portraying a person aged 15 years (for participants aged 15–17 years) or 21 years (for participants aged 18–25 years) of the same sex as the respondent (Reavley and Jorm, 2011b). All respondents were then asked a series of questions that assessed sociodemographic characteristics, mental health literacy, stigma, exposure to mental disorders, beliefs about interventions, and prevention for the mental disorder in the vignette, psychological distress (using the K6 screening scale; Kessler et al., 2002), and exposure to mental health media campaigns. Here, we report only on help-seeking intentions and perceived barriers. Young people were asked: ‘‘If you had a problem right now like (John/Jenny), would you go for help? Where would you go? What might stop you from seeking help from this (person/ service)?’’.
#
feel negatively about you, concern about what other people might think of you seeking help from the person, being too embarrassed/shy, and denial/pride; barriers related to treatment or support offered, such as concern that the helper might not be able to help (e.g., what they say might be wrong, lack of empathy or understanding, the problem involves the helper, lack of confidence in the helper’s competence), concern about treatment side effects, not liking the type of treatment expected to be offered, and thinking that nothing can help; and other barriers such as negative feelings/self-perceptions (e.g., fearing trouble, fearing the diagnosis, shame or guilt, lack of confidence, and apprehension about confiding in a stranger), confidentiality/privacy, the illness or symptoms themselves, difficulty talking about the problem, lack of insight about the problem, and wanting to deal with it themselves.
2.5. Statistical analysis The data were analyzed using percent frequencies and standard errors of respondents who reported that they would seek help from various formal and informal sources for each of the six vignettes. Given that barriers to help seeking may vary according to the source of help, the data were also analyzed using percent frequencies and standard errors of respondents who reported each barrier for each help source separately for the six vignettes. Patterns of findings will only be discussed if the error bar of a particular
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
vignette overlaps with the error bar of no more than one other vignette to which it is contrasted. Sample weights were not applied to the above analyses because the data apply only to those intending to seek a particular type of help, not to the whole population. We then conducted binary logistic regressions to explore whether age in years, sex, psychological distress (K6 score), and exposure to mental disorders and professional treatment in family or friends predicted the intention to seek help from various sources and the barriers to help seeking, after controlling for the vignette given. In each regression, the intended source of help or the barrier was the dichotomous dependent variable, and all five predictor variables were entered simultaneously. Age in years and K6 score were continuous variables, vignette had six categories (reference category: depression), sex was dichotomous (reference: males), and exposure to mental disorders had three categories as described above (reference: no disorder). All analyses were performed using Intercooled Stata 12 (StataCorp, 2011). Given the large number of associations evaluated, the po0.01 level was used in order to minimize the chance of Type I errors.
257
most commonly mentioned source of help in all but the psychosis and depression with alcohol abuse vignettes, where GPs were also frequently mentioned. GP was the most frequently mentioned source of professional help in all but the anxiety disorder vignettes, where counselors were more frequently mentioned. In descending order, the most common barriers (i.e., reported by at least 5% of respondents) to seeking help from any source were: being too embarrassed or shy (27%), concern that the helper might feel negatively about them (11%), no barrier (10%), structural barriers (7%), negative emotions or self-perceptions (7%), concern that the helper might not be able to help (6%), and concern about what others think (5%). Fig. 2 presents percent frequencies of respondents who reported these barriers for each help source, separately for the six vignettes. Overall, embarrassment was most frequently mentioned as a barrier to seeking help from most of the sources, especially by respondents given the depression with alcohol abuse and social phobia vignettes. Regardless of the vignette, structural barriers were more commonly mentioned for formal than for informal sources of help. 3.1. Barriers to seeking help from a GP
2.6. Ethics Oral consent was obtained from all respondents before commencing the interview. Respondents aged below 18 years could only commence their interviews after their parents provided oral consent. This study was approved by the University of Melbourne Human Research Ethics Committee.
3. Results The 3021 respondents were randomly assigned to one of six vignettes as follows: depression 506, depression with suicidal thoughts 502, depression with alcohol abuse 499, social phobia 507, PTSD 506, and psychosis 501. Fig. 1 shows the percent frequencies and standard errors of young people who reported that they would seek help from five of the most frequently mentioned sources, GP, counselor, mental health professional, family and friend, separately for each vignette. Family was the
Respondents given the depression with alcohol abuse vignette were more likely than those given other vignettes (except the psychosis vignette) to report embarrassment as a barrier. Respondents given the psychosis vignette were also more likely to be concerned that the GP might feel negatively about them. Respondents given the depression vignette were more likely to mention structural barriers; whereas those given the social phobia vignette were more likely to report having negative emotions or selfperceptions about seeking help from a GP. 3.2. Barriers to seeking help from a counselor Respondents given the depression with alcohol abuse vignette were more likely to mention embarrassment as a barrier, compared to the psychosis and both anxiety vignettes. Respondents given the psychosis, social phobia, or depression with alcohol abuse vignettes were less likely to report that nothing would stop them from seeking help from a counselor. Whilst none of the respondents
Friend (n = 479) Depression Family (n = 1033)
Depression with suicidal thoughts Depression with alcohol abuse
Mental Health Professional (n = 298)
Social Phobia PTSD Psychosis
Counsellor (n = 456)
GP (n = 704) 0%
20%
40%
60%
Fig. 1. Percent frequencies (with standard error bars) of respondents who would seek help from various formal and informal sources for different mental disorder vignettes. Note: n’s refer to the number of respondents who indicated an intention to seek help from each source of help. GP¼ General practitioner/doctor; PTSD ¼posttraumatic stress disorder.
258
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
What others think
What others think Depression Helper can't help
Depression with suicidal thoughts
Negative emotions/selfperceptions
Depression with alcohol abuse
Structural barriers
Social Phobia
No barriers
Depression Depression with suicidal thoughts
Helper can't help Negative emotions/selfperceptions
Depression with alcohol abuse
Structural barriers
Social Phobia
No barriers
PTSD
PTSD Helper's negative reaction
Psychosis
Psychosis
Helper's negative reaction Embarrassment
Embarrassment 0%
10%
20%
30%
40%
50%
0%
Proportion of respondents who mentioned each barrier to seeking help from a GP
What others think
Depression Depression with suicidal thoughts
Helper can't help Negative emotions/selfperceptions
Depression with alcohol abuse
Structural barriers
Social Phobia
No barriers
20%
30%
40%
50%
What others think Depression
Helper can't help
Depression with suicidal thoughts
Negative emotions/selfperceptions
Depression with alcohol abuse
Structural barriers
Social Phobia
No barriers
PTSD Psychosis
Helper's negative reaction
10%
Proportion of respondents who mentioned each barrier to seeking help from a mental health professional
PTSD
Helper's negative reaction
Psychosis
Embarrassment
Embarrassment 0%
10%
20%
30%
40%
50%
0%
10%
20%
30%
40%
50%
Proportion of respondents who mentioned each barrier to seeking help from their family
Proportion of respondents who mentioned each barrier to seeking help from a counselor
What others think Depression Helper can't help
Depression with suicidal thoughts
Negative emotions/selfperceptions
Depression with alcohol abuse
Structural barriers
Social Phobia
No barriers
PTSD Helper's negative reaction
Psychosis
Embarrassment 0%
10%
20%
30%
40%
50%
Proportion of respondents who mentioned each barrier to seeking help from their friends Fig. 2. Percent frequencies (with standard error bars) of respondents who reported the seven most common barriers for each of the five sources of help, separately for the six vignettes. GP Âź General practitioner/doctor; PTSD Âźpost-traumatic stress disorder.
given the PTSD vignette was concerned about what others might think about them seeking help from a counselor; in contrast 15% of respondents given the social phobia vignette were. 3.3. Barriers to seeking help from a mental health professional Respondents given the depression, depression with alcohol abuse, and social phobia vignettes were more likely to feel embarrassed. Respondents given the depression vignette were most likely to report being concerned about the specialist feeling
negative about them; whereas those given the depression with suicidal thoughts vignette were more likely to mention structural barriers. Respondents given the social phobia vignette were more likely to be concerned about what others might think of them seeking help from a specialist. 3.4. Barriers to seeking help from their family Respondents given the social phobia vignette were more likely to report feeling too embarrassed to do so.
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
3.5. Barriers to seeking help from their friends Respondents given the psychosis vignette were more likely to report concern that their friends might be unable to help them. 3.6. Predictors of help-seeking intentions and barriers To minimize the number of logistic regressions conducted, the five most commonly mentioned sources of help were categorized into formal (GP, counselor, and mental health professional) and informal (family and friend) sources. Two logistic regressions were conducted to examine the predictors of intentions to seek help from formal and informal sources. A logistic regression model was then conducted for each of the seven commonly mentioned barriers for formal and informal sources, resulting in another 14 models. The regressions revealed that older respondents were more likely to report the intention to seek help from formal sources, OR (age in years)¼1.10, 99% CI (1.06, 1.15), p o0.001; and less likely to seek help from informal sources, OR (age in years) ¼0.88, 99% CI (0.85, 0.92), p o0.001. Females were more likely to report the intention to seek help from formal sources, OR ¼1.40, 99% CI (1.12, 1.74), p o0.001. Respondents who knew a family member or friend who had sought professional help for a mental health problem were more likely to report the intention to seek help from formal sources, OR¼1.84, 99% CI (1.44, 2.35), p o0.001; but less likely to report the intention to seek help from informal sources, OR ¼0.65, 99% CI (0.51, 0.83), p o0.001. Older respondents were more likely to report structural barriers to seeking help from formal sources, OR (age in years) ¼1.16, 99% CI (1.06, 1.26), p o0.001. In contrast, older respondents were less likely to report embarrassment or shyness as a barrier to seeking help from both formal and informal sources; OR (age in years)¼0.93, 99% CI (0.88, 0.99), p¼0.002 and OR (age in years)¼ 0.94, 99% CI (0.88, 0.99), p ¼0.003 respectively. Females were more likely to report concern about the helper’s negative feeling about them as a barrier to seeking help from formal sources; OR¼ 1.80, 99% CI (1.06, 3.06), p¼0.004. Finally, respondents who knew a family member or friend who had sought professional help for a mental health problem were more likely to be concerned about what others think of them seeking help from formal sources; OR¼ 2.21, 99% CI (1.05, 4.64), p ¼0.006. Level of psychological distress did not significantly predict any of the barriers. None of the predictors examined predicted no barriers, negative emotions or self-perceptions, and concern that the helper might be unable to help.
4. Discussion 4.1. Sources of help for different disorders Consistent with past research (Jorm et al., 2007; Rickwood and Braithwaite, 1994; Rickwood et al., 2007), our data revealed that family members, including parents, spouse, or relatives, are the most frequently nominated source of help by young people in the context of mental health problems. Notably, this was true except for the psychosis and depression with alcohol abuse vignettes, where GPs were also frequently mentioned. The severity of the illness (psychosis vignette) and the personal shame and possibility of getting into trouble, especially with parents, for having co-morbid alcohol problems may partly account for these findings. While it is important that parents maintain a firm stance against alcohol misuse by their adolescent children, experts recommend calm discussion and open parent–child communication about alcohol use (Parenting Strategies Program, 2010; Ryan et al., 2011),
259
which may help increase the likelihood of young people seeking help earlier from their family for developing alcohol problems. Also consistent with past research (Jorm et al., 2007), GPs were generally the most commonly nominated source of professional help, especially for psychosis and the three depression vignettes. Extending findings by Jorm et al. (2007), our study found that counselors were also a commonly nominated source of professional help for both social phobia and PTSD. 4.2. Barriers to seeking help from various sources for different disorders Overall, it is concerning that only 10% of the respondents said that nothing would stop them from seeking help. This is consistent with the relatively lower rates of or delayed help seeking for mental disorders, especially social phobia (Reavley and Jorm, 2011b; Rickwood et al., 2007). When young people were asked to nominate what might stop them from seeking help, stigmarelated barriers such as embarrassment and concern that the helper might feel negatively about them emerged as the most common barriers. These findings are consistent with evidence to date (Gulliver et al., 2010; Jorm et al., 2007), but add to the evidence base by examining how these and other frequently mentioned barriers may differ depending on the helper and the type of disorder. A few key patterns of findings are highlighted here, summarized for each of the five most common sources of help. 4.3. Barriers to seeking help from a GP If young people do seek professional help for depression with alcohol abuse, they are more likely to turn to GPs. However, rates of help seeking for this disorder may remain low partly because embarrassment or shyness is such a prominent barrier. This finding highlights related evidence that confidentiality is of utmost importance to young people accessing services for substance-related problems, due to the shame attached and the corresponding fear of judgment (Rickwood et al., 2007). Respondents given the psychosis vignette were particularly concerned that the GP, as well as the counselor, family and friends, might react negatively towards them. Interestingly, this barrier is less prominent for help seeking from mental health professionals. One possible reason is that young people perceive these professionals as specialists in treating more severe disorders and are hence more familiar with and accepting of them. It is notable that structural barriers featured more prominently for depression than for most other disorders, despite ongoing campaigns by beyondblue: the national depression initiative to improve help seeking for depression, often with GPs as the first point of contact (Hickie, 2004; Jorm et al., 2005). Nonetheless, a recent report observed that awareness of beyondblue may not necessarily improve depression literacy or help seeking (Yap et al., 2012). The self stigma-related barrier of having negative emotions (e.g. fear, guilt, shame) or self-perceptions (e.g. lack of confidence) was a prominent barrier for respondents given the social phobia vignette. Given that social anxiety is inherent in social phobia, and is often perceived as a personal weakness rather than an illness by young people (Yap et al., 2011), young people with social phobia are likely to find professional help seeking, even from GPs, particularly challenging. 4.4. Barriers to seeking help from a counselor Respondents given the depression with alcohol abuse vignette were particularly likely to mention embarrassment as a barrier to seeking help from a counselor. Respondents given the psychosis,
260
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
depression with alcohol abuse, and social phobia vignettes were less likely to perceive no barriers to help seeking from a counselor. This is unsurprising given the high levels of stigma attached to these disorders; concurrent with evidence indicating that psychosis and depression with alcohol abuse are seen as ‘dangerous or unpredictable’, and social phobia is seen as a personal weakness rather than an illness (Jorm and Wright, 2008). Concern about what others think distinguished between respondents given the social phobia vignette and those given the PTSD vignette: whilst the former group mentioned this barrier more than respondents given other vignettes, the latter group did not mention it at all. The finding involving social phobia may be due to young people’s perception that social phobia is not a real illness and hence does not warrant professional help (Yap et al., 2011), and its association with higher levels of perceived stigma (Jorm and Wright, 2008), which might increase young people’s concern that others might view them negatively if they sought help. In contrast, perhaps because PTSD could be attributed to an external cause (Reavley and Jorm, 2011b), professional help may seem more justified and less likely to be frowned upon by others. 4.5. Barriers to seeking help from a mental health professional Respondents were more likely to feel embarrassed about seeking help from a mental health professional and more concerned about the specialist feeling negative about them if they were given the depression vignette. Young people might view mental health professionals as specializing in severe mental disorders. For this reason, they might think that depression is too benign for seeking help from specialists. Given that the first line of treatment for depression is cognitive behavior therapy which is mostly offered by mental health professionals, it is important for future efforts to address this barrier. Although a range of common barriers such as structural barriers, negative emotions or self perceptions, or concern about the specialist’s negative reaction or ability to help was not frequently mentioned by respondents given the depression with alcohol abuse vignette, embarrassment remained a prominent barrier to their help seeking from mental health professionals. When it comes to help seeking from specialists for depression with suicidal thoughts, structural barriers featured prominently. This likely reflects the structure of the health care system whereby a GP referral is required for specialist consultations, which creates an additional hurdle for young people, especially in a crisis situation involving suicidality. Respondents given the social phobia vignette were more likely to be concerned about what others might think of them seeking help from specialists, probably for similar reasons to them seeking help from counselors. 4.6. Barriers to seeking help from their family Although more than 40% of respondents reported the intention to seek help from their family (the main source of intended help) for social phobia, over 40% of these also said that they might be too embarrassed to do so. This may be partly due to concern about their family’s negative reactions, such as dismissive or trivializing responses, since social phobia is perceived by the general community as a personal weakness that is within the control of the person (Reavley and Jorm, 2011a). 4.7. Barriers to seeking help from their friends Young people with the intention to seek help from friends for psychosis may be hindered by concern about their ability to help, empathize, or understand. This is probably due to the severity of the disorder, and in fact accurately reflects the inadequate ability
of young people (respondents’ peers) to accurately recognize psychosis in a vignette (Yap et al., 2012). Overall, barriers to help seeking from informal sources like family and friends seem to be more similar than different across vignettes. 4.8. Predictors of help-seeking intentions and their barriers The same characteristics predicted intentions to seek help from formal versus informal sources, but in opposite directions. Specifically, younger and male respondents were more likely to seek help from informal sources, and younger respondents were less likely to seek help from formal sources. This is consistent with extant evidence that adolescents and males have less than optimal help-seeking intentions (Jorm et al., 2007; Reavley and Jorm, 2011b). Consistent with previous findings (Jorm et al., 2007), respondents exposed to professional help seeking by a family member or friend were more likely to report the intention to seek similar (formal) help for themselves and less likely to turn to informal sources of help. These young people may have become more aware of professional sources of help and pathways to treatment through their family or friends, and potentially more open to seeking help from these sources rather than their informal support network. Age emerged as a significant predictor of two barriers: embarrassment and structural barriers. Firstly, younger respondents were more likely to report feeling too embarrassed or shy about seeking help from both formal and informal sources. This is consistent with extant evidence that adolescents have poorer mental health literacy (Jorm et al., 2007; Reavley and Jorm, 2011b) and are more likely to view mental illness as a personal weakness rather than a sickness, compared to young adults (Jorm and Wright, 2008). Secondly, older respondents were more likely to perceive structural barriers to seeking help from formal sources. This may be because unlike younger respondents who could still depend on their parents to provide support for the help seeking process, young adults have to rely on their own resources to get to their source of help. Female respondents were more likely to report that concern about the helper feeling negatively about them might stop them from seeking help from formal sources. This is consistent with some research evidence suggesting that females are more sensitive to social rejection (Stroud et al., 2002). Finally, it is unfortunate that knowing a family member or friend who had received professional help for mental illness increased rather than decreased the likelihood that young people would be concerned about what others might think of them seeking professional help. Hence, although knowing someone who had received help may strengthen young people’s intention to seek help from a GP (Jorm et al., 2007), it may also heighten their sensitivity to what others might think of them, perhaps due to a vicarious experience of stigma associated with the family member or friend’s illness and treatment history.
5. Strengths and limitations This national survey is the first of its kind to examine predictors of young people’s barriers to seek help for six different mental disorders, from different formal and informal sources. Nonetheless, its findings should be interpreted in light of the study limitations. Firstly, we only assessed help seeking intentions and barriers with reference to a vignette character; hence it is unclear how closely these reflect actual experience or behaviors. Relatedly, it was not possible to assess whether the selfreported intentions and barriers accurately reflect these respondents’ actual behaviors if they do develop mental health problems. Nonetheless, a recent report found that young people’s
M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261
help-seeking intentions did prospectively predict some of their actual help-seeking behaviors two years later (Reavley et al., 2011). 6. Implications and conclusions Findings from this study indicate that different barriers feature prominently in young people’s help seeking depending on the source of help and the type of disorder. Importantly, findings can facilitate the targeting of future efforts to improve young people’s help seeking for mental disorders by highlighting the barriers that are more relevant for seeking help from particular formal or informal sources for specific disorders, and some respondent characteristics which predict these barriers. Role of funding source Funding for this study was provided by the National Health and Medical Research Council and the Department of Health and Ageing. The funding source had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Conflict of interest No conflict declared.
Acknowledgments Funding for this study was provided by the Department of Health and Ageing and the National Health and Medical Research Council. The authors thank Miss Alicia Holborn, Miss Fiona Blee, and Miss Pamela Pilkington for their assistance with the coding of responses to some open-ended questions in the survey.
References de Girolamo, G., Dagani, J., Purcell, R., Cocchi, A., McGorry, P.D., 2012. Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiology and Psychiatric Sciences 21, 47–57. Downs, M.F., Eisenberg, D., 2011. Help seeking and treatment use among suicidal college students. Journal of American College Health 60, 104–114. Evans, E.J., Hay, P.J., Mond, J., Paxton, S.J., Quirk, F., Rodgers, B., Jhajj, A.K., Sawoniewska, M.A., 2011. Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey. Eating Disorders 19, 270–285. Gulliver, A., Griffiths, K., Christensen, H., 2010. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10, 113. Harris, M.G., Henry, L.P., Harrigan, S.M., Purcell, R., Schwartz, O.S., Farrelly, S.E., Prosser, A.L., Jackson, H.J., McGorry, P.D., 2005. The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophrenia Research 79, 85–93. Hickie, I., 2004. Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative. Australasian Psychiatry, S38–S46. Jorm, A., Wright, A., Morgan, A., 2007. Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents. The Medical Journal of Australia 187, 556–560.
261
Jorm, A.F., Christensen, H., Griffiths, K.M., 2005. The impact of beyondblue: the national depression initiative on the Australian public’s recognition of depression and beliefs about treatments. Australian and New Zealand Journal of Psychiatry 39, 248–254. Jorm, A.F., Wright, A., 2008. Influences on young people’s stigmatising attitudes towards peers with mental disorders: national survey of young Australians and their parents. British Journal of Psychiatry 192, 144–149. Kessler, R.C., Andrews, G., Colpe, L.J., Hiripi, E., Mroczek, D.K., Normand, L.T., Walters, E.E., Zaslavsky, A.M., 2002. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32, 959–976. Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E., 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602. Kuhl, J., Jarkon-Horlick, L., Morrissey, R., 1997. Measuring barriers to help-seeking behavior in adolescents. Journal of Youth and Adolescence 26, 637–650. Mathews, R.R., Hall, W.D., Vos, T., Patton, G.C., Degenhardt, L., 2011. What are the major drivers of prevalent disability burden in young Australians? Medical Journal of Australia 194, 232–235. Mojtabai, R., Olfson, M., Sampson, N.A., Jin, R., Druss, B., Wang, P.S., Wells, K.B., Pincus, H.A., Kessler, R.C., 2011. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological Medicine 41, 1751–1761. Parenting Strategies Program, 2010. Parenting Guidelines for Adolescent Alcohol Use. Orygen Youth Health Research Centre, University of Melbourne, Melbourne. Prins, M., Meadows, G., Bobevski, I., Graham, A., Verhaak, P., van der Meer, K., Penninx, B., Bensing, J., 2011. Perceived need for mental health care and barriers to care in the Netherlands and Australia. Social Psychiatry and Psychiatric Epidemiology 46, 1033–1044. Reavley, N., Yap, M.B.H., Wright, A., Jorm, A.F., 2011. Actions taken by young people to deal with mental disorders: findings from an Australian national survey of youth. Early Intervention in Psychiatry 5, 335–342. Reavley, N.J., Jorm, A.F., 2011a. Recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian National Survey of Mental Health Literacy and Stigma. Australian and New Zealand Journal of Psychiatry 45, 947–956. Reavley, N.J., Jorm, A.F., 2011b. Young people’s recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey. Australian and New Zealand Journal of Psychiatry 45, 890–898. Rickwood, D., Braithwaite, V., 1994. Social-psychological factors affecting helpseeking for emotional problems. Social Science and Medicine 39, 563–572. Rickwood, D., Deane, F., Wilson, C., 2007. When and how do young people seek professional help for mental health problems? Medical Journal of Australia 187, S35–S39. Ryan, S.M., Jorm, A.F., Kelly, C., Hart, L., Morgan, A.J., Lubman, D.I., 2011. Parenting to reduce adolescent alcohol consumption: a Delphi consensus study. BMC Public Health 11, 13. Sheffield, J.K., Fiorenza, E., Sofronoff, K., 2004. Adolescents’ willingness to seek psychological help: promoting and preventing factors. Journal of Youth and Adolescence 33, 495–507. StataCorp, Stata Statistical Software: release 12. College Station, TX: StataCorp LP, (2011). Stroud, L.R., Salovey, P., Epel, E.S., 2002. Sex differences in stress responses: social rejection versus achievement stress. Biological Psychiatry 52, 318–327. Wright, A., McGorry, P.D., Harris, M.G., Jorm, A.F., Pennell, K., 2006. Development and evaluation of a youth mental health community awareness campaign— the Compass Strategy. BMC Public Health 6, 215. Yap, M.B., Reavley, N.J., Jorm, A.F., 2012. Associations between awareness of beyondblue and mental health literacy in Australian youth: results from a national survey. Australian and New Zealand Journal of Psychiatry 46, 541–552. Yap, M.B.H., Wright, A., Jorm, A., 2011. The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Social Psychiatry and Psychiatric Epidemiology 46, 1257–1265.