What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

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Abstract

Background

Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap.

Methods

Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10–19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis.

Results

Ninety studies meet the inclusion criteria for this review for barrier and facilitators ( n = 54) and interventions ( n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements.

Conclusion

Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.

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Most cited references 136

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The age of adolescence

Susan Sawyer, Peter S Azzopardi, Dakshitha Wickremarathne … (2018)

Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review

Amelia Gulliver, Kathleen Griffiths, Helen Christensen (2010)

Background Adolescents and young adults frequently experience mental disorders, yet tend not to seek help. This systematic review aims to summarise reported barriers and facilitators of help-seeking in young people using both qualitative research from surveys, focus groups, and interviews and quantitative data from published surveys. It extends previous reviews through its systematic research methodology and by the inclusion of published studies describing what young people themselves perceive are the barriers and facilitators to help-seeking for common mental health problems. Methods Twenty two published studies of perceived barriers or facilitators in adolescents or young adults were identified through searches of PubMed, PsycInfo, and the Cochrane database. A thematic analysis was undertaken on the results reported in the qualitative literature and quantitative literature. Results Fifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. Facilitators were comparatively under-researched. However, there was evidence that young people perceived positive past experiences, and social support and encouragement from others as aids to the help-seeking process. Conclusions Strategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance.

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Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study

Wichor M. Bramer, Melissa Rethlefsen, Jos Kleijnen … (2017)

Background Within systematic reviews, when searching for relevant references, it is advisable to use multiple databases. However, searching databases is laborious and time-consuming, as syntax of search strategies are database specific. We aimed to determine the optimal combination of databases needed to conduct efficient searches in systematic reviews and whether the current practice in published reviews is appropriate. While previous studies determined the coverage of databases, we analyzed the actual retrieval from the original searches for systematic reviews. Methods Since May 2013, the first author prospectively recorded results from systematic review searches that he performed at his institution. PubMed was used to identify systematic reviews published using our search strategy results. For each published systematic review, we extracted the references of the included studies. Using the prospectively recorded results and the studies included in the publications, we calculated recall, precision, and number needed to read for single databases and databases in combination. We assessed the frequency at which databases and combinations would achieve varying levels of recall (i.e., 95%). For a sample of 200 recently published systematic reviews, we calculated how many had used enough databases to ensure 95% recall. Results A total of 58 published systematic reviews were included, totaling 1746 relevant references identified by our database searches, while 84 included references had been retrieved by other search methods. Sixteen percent of the included references (291 articles) were only found in a single database; Embase produced the most unique references (n = 132). The combination of Embase, MEDLINE, Web of Science Core Collection, and Google Scholar performed best, achieving an overall recall of 98.3 and 100% recall in 72% of systematic reviews. We estimate that 60% of published systematic reviews do not retrieve 95% of all available relevant references as many fail to search important databases. Other specialized databases, such as CINAHL or PsycINFO, add unique references to some reviews where the topic of the review is related to the focus of the database. Conclusions Optimal searches in systematic reviews should search at least Embase, MEDLINE, Web of Science, and Google Scholar as a minimum requirement to guarantee adequate and efficient coverage. Electronic supplementary material The online version of this article (10.1186/s13643-017-0644-y) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Antonia Aguirre Velasco: Antonia.aguirre.v@gmail.com

Ignacio Silva Santa Cruz: Ignacio.silva.sc@gmail.com

Jo Billings: j.billings@ucl.ac.uk

Magdalena Jimenez: mmjimen1@uc.cl

Sarah Rowe:

ORCID: http://orcid.org/0000-0003-1072-6182

s.rowe@ucl.ac.uk

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 11 June 2020

Publication date PMC-release: 11 June 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 293

Affiliations

[1 ]Child and Adolescent Mental Health Service, Children’s Hospital Dr. Roberto del Río, Santiago, Chile

[2 ]GRID grid.443909.3, ISNI 0000 0004 0385 4466, Public Health School, Faculty of Medicine, , University of Chile, ; Santiago, Chile

[3 ]GRID grid.83440.3b, ISNI 0000000121901201, División of Psychiatry, , University College London, ; London, UK

[4 ]Camden and Islington Mental Health Foundation Trust, London, UK

Author information

Sarah Rowe http://orcid.org/0000-0003-1072-6182

Article

Publisher ID: 2659

DOI: 10.1186/s12888-020-02659-0

PMC ID: 7291482

PubMed ID: 32527236

SO-VID: cd452b85-72fb-45d3-bab8-88d46dc54f48

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 23 September 2019

Date accepted : 11 May 2020

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: help-seeking,adolescent,mental health,barriers,facilitators,interventions,systematic review

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: help-seeking, adolescent, mental health, barriers, facilitators, interventions, systematic review