Background
Adolescents are often reluctant to seek professional help for mental health problems. In Australia, 12-17 year olds are more likely to approach informal sources (i.e., family and friends) than seek help from GPs, counselors, or mental health professionals [
1‐
3], although family and friends may be approached less frequently by young people with moderate to severe levels of psychological distress [
4‐
6]. While use of health services among adolescents experiencing mental illness has increased over the past two decades, a substantial minority (approximately 30%) do not report accessing any type of service [
7]. Moreover, research among 16-24 year olds indicates that those experiencing substance use disorders may be the least likely to seek treatment [
8]. These findings suggest that despite recent investments in early intervention services in Australia (e.g.,
headspace, a national youth mental health initiative dedicated to improving the wellbeing of young Australians) [
9], many young people may not be receiving appropriate support for emerging mental health and substance use problems.
Improving the mental health literacy of adolescents and the individuals they turn to for support is likely to facilitate help-seeking [
10]. Mental health literacy includes knowledge about disorders that aid in their recognition, management, and prevention, as well as attitudes that support problem recognition and appropriate help-seeking [
11]. In 2006, it was estimated that 1% of the adult population in Australia had received training to improve their mental health literacy skills (Mental Health First Aid) [
12], with more recent estimates indicating that this number has doubled over the last decade [
13]. However, few interventions have focused on teaching adolescents how to help their peers. This is despite evidence that untrained adolescents are likely to have poor mental health literacy, and may lack the knowledge and skills to provide appropriate advice or support to others [
14]. As such, there is likely to be considerable benefit in ensuring that adolescents are able to identify signs of psychological distress in their peers, approach and talk to them about these, address barriers to help-seeking, and help them access appropriate services when necessary [
15]. In particular, there is a need to teach adolescents how to identify and assist with the most common mental health problems that affect their peers. Depressive and alcohol use disorders are of particular concern in this regard, as they typically begin in adolescence or young adulthood [
16,
17], and account for a combined total of 50.5% of the global burden of disease attributed to mental illness [
18].
Initial studies found that while approximately 50-60% of Australian adolescents could correctly identify the symptoms of depression from a vignette [
19,
20], only 20-30% would encourage a peer to seek professional help for depression, with or without concurrent alcohol misuse (i.e., alcohol use disorders [
1,
21]). More recently, studies have found evidence that recognition of depression and attitudes towards treatment may have been improved by campaigns to improve mental health literacy in young people, such as the
beyondblue National Depression Initiative in Australia [
22]. However, no research to date has examined whether there have been corresponding changes in the ways that adolescents intend to support their peers. In addition, few studies have examined adolescents’ ability to recognise signs of alcohol misuse independently, or examined the advice they give to peers experiencing alcohol-related problems.
There is also limited research examining gender differences in adolescents’ intentions towards helping their peers. This is of relevance given that studies have consistently found that females report fewer barriers to seeking help for their own mental health problems [
23‐
27], as well as stronger intentions to seek help from a range of formal and informal sources [
3,
23,
28‐
31]. However, in a pilot study of the program evaluated in the current paper, females reported greater confidence to help a peer experiencing substance use problems than males [
32]. Moreover, in the only study to date examining gender differences in actual helping behaviours by adolescents, females were more likely to suggest and facilitate professional help-seeking as well as to personally help a close other experiencing mental health problems [
33]. Together, this research suggests that adolescent females may be more likely to help their peers than males, for both depression and alcohol misuse.
The current study examined help-seeking for depression and alcohol misuse in a sample of 2464 Australian adolescents. We examined past help-seeking behaviour, confidence and intentions to help a peer, as well as perceived barriers to seeking professional help. We also sought to identify the sources of help that adolescents were most likely to recommend to peers experiencing depression or alcohol problems. Consistent with previous research, we expected that adolescents would be more likely to recommend seeking help from family and friends compared to formal help sources. In addition, it was hypothesised that females would be more likely to have sought help in the past, more likely to have helped a peer seek help, and would demonstrate more confidence and stronger intentions to help their peers, as well as fewer perceived barriers to seeking professional help.
Results
Demographics
In total, 2456 participants completed the baseline survey (1235 female, 1217 male; 4 did not report gender). Participants were 14.9 years old on average (SD = 0.45 years) at the time of the assessment. The average response rate per school was 77.4%. In total, 84.2% of participants were born in Australia; the next most common country of birth was New Zealand (1.9%), followed by the United Kingdom (1.4%), India (1.1%) and China (1.0%). All other countries of birth were reported by less than 1% of participants. The main language spoken at home was English (84.1%), followed by Vietnamese (2.8%), Arabic (2.4%), and Turkish (1.2%).
Help-seeking behaviour
Almost half of the sample (1135 participants; 46.2%) reported seeking help for self-reported symptoms of stress and anxiety, depression, alcohol, drugs, and/or another similar problem. Stress and anxiety was the most common problem, followed by “another similar problem”, depression, and alcohol and other drugs respectively (AOD; Table
2). “Similar problems” included bullying (
n = 298), problems at home (
n = 246), school problems (
n = 26), relationship problems (
n = 166), insomnia (
n = 5), and suicidal thoughts or attempts (
n = 15). The majority of adolescents who had sought help (70-80%) reported doing so within the last 12 months, for each problem type.
Table 2
Main source of help for mental health and substance use problems
Stress/anxiety | 284 | 34.5% | 182 | 22.1% | 40 | 4.9% | 16 | 1.9% | 25 | 3.0% | 276 | 33.5% | 823 | 100% |
Depression | 107 | 24.7% | 122 | 28.2% | 12 | 2.8% | 15 | 3.5% | 5 | 1.2% | 172 | 39.7% | 433 | 100% |
AOD | 7 | 10.0% | 33 | 47.1% | 5 | 7.1% | 6 | 8.6% | 4 | 5.7% | 15 | 21.4% | 70 | 100% |
Other | 195 | 29.1% | 186 | 27.8% | 24 | 3.6% | 24 | 3.6% | 65 | 9.7% | 175 | 26.2% | 669 | 100% |
Parents, friends, and health professionals were the main sources of help, although help-seeking behaviour varied by problem type. For stress and anxiety, more adolescents had sought help from parents and health professionals than from friends. For depression, more adolescents had sought help from health professionals than from parents and friends. For alcohol and other drug-related problems, more adolescents had sought help from friends than from parents or health professionals. Siblings, other relatives, and teachers were used less frequently for support.
Health professionals and teachers were generally perceived as most helpful, although average ratings were low (typically between ‘unhelpful’ and ‘neither helpful nor unhelpful’). Parents and friends were perceived as least helpful, with an average rating between ‘very unhelpful’ and ‘unhelpful’ (Table
3). There were significant differences between helpfulness ratings across the six sources of help for stress/anxiety (H(2) = 48.73,
p < 0.001), depression (H(2) = 23.77,
p < 0.001), and other problems (H(2) = 40.03,
p < 0.001). Dunn-Bonferroni post-hoc tests found that health professionals were rated as significantly more helpful than parents and friends for stress/anxiety, depression, and other problems (all
p values <0.01). Teachers were also rated as significantly more helpful than parents for other similar problems (
p < 0.001). No differences in helpfulness were found in relation to alcohol and other drugs (H(2) = 6.40,
p = 0.269), which is likely due to a lack of statistical power as fewer participants reported these problems.
Table 3
Perceived helpfulness of help sources (1 = very unhelpful to 5 = very helpful)
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD |
Stress/anxiety | 1.62 | .763 | 1.86 | .933 | 2.05 | 1.218 | 1.56 | .727 | 1.88 | .927 | 2.17 | 1.017 |
Depression | 1.81 | .982 | 1.94 | 1.007 | 2.08 | 1.084 | 2.20 | 1.014 | 3.40 | 1.517 | 2.31 | 1.115 |
AOD | 1.57 | .787 | 1.91 | .980 | 2.40 | .894 | 2.00 | 1.095 | 2.25 | .957 | 2.53 | 1.246 |
Other | 1.64 | .742 | 1.85 | .929 | 1.88 | .612 | 1.67 | .637 | 2.26 | 1.108 | 2.17 | .965 |
A further 1257 participants (51.2%) reported encouraging a friend to seek help for stress, anxiety, alcohol, drugs, or another similar problem. Adolescents were more likely to encourage a friend to seek help if they had sought help themselves (71.0% of those who had sought help had encouraged a friend compared to 43.0% of those who had not; X2 = 175.623, p < 0.001).
Mental health literacy and help-seeking intentions
Over half of participants were able to correctly identify depression from the vignettes (Table
4). A further third (31.2%) either identified a different mental health condition, a physical health problem, provided a non-clinical description of the problem (e.g., ‘she’s sad’ or ‘stressed out’), or described a negative event that may have acted as a trigger. Of the remainder, 6.8% responded ‘don’t know’ or said that nothing was wrong (e.g., what Sarah was experiencing was ‘just part of adolescence’), while 2.0% did not answer the question or provided an illegible or judgemental response (e.g., ‘she’s just weak’).
Table 4
Responses to the depression and alcohol misuse vignettes
Depression | 1472 | 59.7% | Alcohol/drug problem | 1287 | 52.3% |
Other mental health condition | 97 | 3.9% | Other mental health condition | 222 | 9.0% |
Non-clinical mood/behavioural descriptors | 325 | 13.2% | Lack of knowledge/poor decision making | 71 | 2.9% |
Alcohol/drugs | 76 | 3.1% | Poor coping/problem management | 165 | 6.7% |
Negative experience trigger | 258 | 10.4% | Peer/social context | 151 | 6.1% |
Physical health problem | 15 | 0.6% | Negative experience trigger | 121 | 4.9% |
Don’t know/unable to identify a problem | 133 | 5.4% | Don’t know/unable to identify a problem | 214 | 8.7% |
Nothing/it’s normal/just adolescence | 34 | 1.4% | Nothing/it’s normal/just adolescence | 109 | 4.4% |
Weak/lazy | 11 | 0.4% | Weak/stupid/attention-seeking | 41 | 1.7% |
Missing | 43 | 1.6% | Missing | 82 | 3.3% |
A slightly smaller proportion correctly identified alcohol misuse from the vignettes. Again, approximately a third (29.6%) provided alternative answers, identifying other mental health conditions, poor decision-making or problem management skills, the influence of peers, or describing a negative triggering event. Of the remainder, 13.1% responded ‘don’t know’ or that nothing was wrong (e.g., Samuel was just being ‘a normal teenager’ or ‘trying to have fun’), while 5.0% did not answer or provided an illegible or judgemental response (e.g., ‘he’s an idiot’).
Most adolescents were at least slightly confident that they could talk to Sarah and Samuel about their concerns, and help them seek professional help (Table
5). Confidence was higher regarding seeking professional help, with approximately 20% of participants ‘very confident’ and only 5% ‘not confident.’
Table 5
Confidence to talk to a peer and help them seek professional help
Talk to Sarah about your concerns? a
| 284 | 11.6% | 905 | 36.8% | 999 | 40.6% | 260 | 10.6% |
Help Sarah seek professional help? a
| 598 | 24.3% | 1165 | 47.4% | 584 | 23. 8% | 95 | 3.9% |
Talk to Samuel about your concerns? b
| 281 | 11.4% | 772 | 31.4% | 939 | 38.2% | 425 | 17.3% |
Help Samuel seek professional help? b
| 466 | 19.0% | 1087 | 44.3% | 683 | 27.8% | 172 | 7.0% |
The majority of participants agreed that both Sarah and Samuel need professional help (Table
6). However, approximately 20% of respondents to each statement neither agreed nor disagreed, while approximately 5% disagreed.
Table 6
Beliefs regarding the need for professional help
Sarah needs professional help a
| 651 | 26.5% | 1213 | 49.4% | 473 | 19.3% | 91 | 3.7% | 20 | 0.8% |
Samuel needs professional help b
| 759 | 30.9% | 1056 | 43.0% | 430 | 17. 5% | 116 | 4.7% | 51 | 2.1% |
When adolescents were asked if they would seek professional help if they had a similar problem, approximately 40% said it was likely in response to both vignettes, 30% were unsure, and 20-30% said it was unlikely (Table
7). Participants who agreed or strongly agreed that Samuel needed professional help were more likely to seek help if they had a similar problem (Chi-squared = 288.88,
p < 0.05). Similarly, participants who agreed or strongly agreed that Sarah needed professional help were more likely to seek help for a similar problem (Chi-squared = 109.21,
p < 0.05).
Table 7
Future help-seeking intentions
If you had a problem like Sarah’s a
| 342 | 13.9% | 667 | 27.7% | 736 | 30.0% | 423 | 17.2% | 275 | 11. 6% |
If you had a problem like Samuel’s b
| 379 | 15. 4% | 728 | 29.6% | 767 | 31.2% | 300 | 12.2% | 235 | 9.5% |
Participants tended to agree with similar barriers to seeking help for depression and alcohol problems (Tables
8 and
9). For both vignettes, the main barriers were self-reliance, followed by embarrassment. A smaller percentage agreed with barriers regarding time and money. The barrier that participants were least likely to agree with was ‘nothing will change the problems that I have.’
Table 8
Barriers to seeking professional help for depression
I would solve my problem myself | 546 | 22.2% | 1149 | 46.6% | 558 | 22.7% | 189 | 7.7% |
I think I should work out my own problems | 573 | 23.3% | 1106 | 44.9% | 593 | 24.1% | 168 | 6.8% |
I’d be too embarrassed to talk to a counsellor | 591 | 24.0% | 809 | 32.8% | 594 | 24.1% | 446 | 18.1% |
Adults can’t understand adolescent problems | 337 | 13.7% | 705 | 28.6% | 783 | 31.8% | 611 | 24.8% |
Even if I wanted to, I wouldn’t have time to see a counsellor | 214 | 8.7% | 580 | 23.5% | 890 | 36.1% | 754 | 30.6% |
A counsellor might make me do what I don’t want to | 469 | 19.0% | 876 | 35.6% | 682 | 27.7% | 411 | 16.7% |
I wouldn’t want my family to know I was seeing a counsellor | 613 | 24.9% | 654 | 26.5% | 593 | 24.1% | 579 | 23.5% |
I couldn’t afford counselling | 294 | 11.9% | 508 | 20.6% | 741 | 30.1% | 896 | 36.4% |
Nothing will change the problems I have | 176 | 7.1% | 334 | 13.6% | 794 | 32.2% | 1132 | 45.9% |
If I go to counselling, I might find out I’m crazy | 213 | 8.6% | 392 | 15.9% | 778 | 31.6% | 1058 | 42.9% |
If I went for help, the counsellor would not keep my secret | 321 | 13.0% | 478 | 19.4% | 616 | 25.0% | 1022 | 41.5% |
Table 9
Barriers to seeking professional help for alcohol misuse
I would solve my problem myself | 523 | 21.2% | 967 | 39.3% | 621 | 25.2% | 295 | 12.0% |
I think I should work out my own problems | 511 | 20.7% | 1051 | 42.7% | 585 | 23.7% | 256 | 10.4% |
I’d be too embarrassed to talk to a counsellor | 445 | 18.1% | 809 | 32.8% | 696 | 28.3% | 452 | 18.3% |
Adults can’t understand adolescent problems | 315 | 12.8% | 573 | 23.3% | 837 | 34.0% | 673 | 27.3% |
Even if I wanted to, I wouldn’t have time to see a counsellor | 213 | 8.6% | 534 | 21.7% | 868 | 35.2% | 790 | 32.1% |
A counsellor might make me do what I don’t want to | 404 | 16.4% | 811 | 32.9% | 668 | 27.1% | 517 | 21.0% |
I wouldn’t want my family to know I was seeing a counsellor | 532 | 21.6% | 698 | 28.3% | 605 | 24.6% | 569 | 23.1% |
I couldn’t afford counselling | 241 | 9.8% | 490 | 19.9% | 731 | 29.7% | 941 | 38.2% |
Nothing will change the problems I have | 139 | 5.6% | 310 | 12.6% | 835 | 33.9% | 1118 | 45.4% |
If I go to counselling, I might find out I’m crazy | 192 | 7.8% | 393 | 16.0% | 778 | 31.6% | 1043 | 42.3% |
If I went for help, the counsellor would not keep my secret | 302 | 12.3% | 548 | 22.2% | 683 | 27.7% | 871 | 35.4% |
Table
10 reports the proportion of adolescents who were very likely or likely to encourage a peer to seek help from each source. Average ratings were calculated for each help source, ranging from 5 (very likely) to 1 (very unlikely). A significant difference between help sources was evident for depression (χ
2 = 3364.37,
p < 0.001), with adolescents most likely to encourage Sarah to seek help from her family (M = 4.19, SD = 0.85), followed by formal sources (M = 3.68, SD = 0.68), peers (M = 3.30, SD = 0.87) and the internet (M = 2.43, SD = 1.00). Similarly, there was a significant difference between help sources for alcohol misuse (χ
2 = 2267.31,
p < 0.001), with adolescents most likely to encourage Samuel to seek help from his family (M = 3.86, SD = 1.02), followed by formal sources (M = 3.66, SD = 0.79), peers (M = 3.13, SD = 0.95) and the internet (M = 2.49, SD = 1.04). Post-hoc tests indicated that all pairwise comparisons between help sources were significant at the
p < 0.001 level, for both vignette conditions.
Table 10
Percentage likely to encourage a peer to seek help from each help source
Her mother | 2124 | 86.2% | School counsellor | 1793 | 72.8% |
School counsellor | 1998 | 81.1% | Mental health professional outside of school | 1757 | 71.3% |
Her father | 1984 | 80.5% | His father | 1745 | 70.8% |
Another relative or family member | 1932 | 78.4% | His mother | 1712 | 69.5% |
Mental health professional outside of school | 1905 | 77.3% | Alcohol and drug worker | 1685 | 68.4% |
Phone help line (e.g., Lifeline, Kids Helpline) | 1632 | 66.2% | Another relative or family member | 1647 | 66.8% |
Doctor/GP | 1468 | 59.6% | Phone help line (e.g., Lifeline, Kids Helpline) | 1487 | 60.4% |
Teacher | 1461 | 59.3% | Doctor/GP | 1475 | 59.9% |
A friend (not related to Sarah) | 1304 | 52.9% | A friend (not related to Samuel) | 1169 | 47.4% |
Her boyfriend or girlfriend | 1132 | 45.9% | His boyfriend or girlfriend | 929 | 37.7% |
Information from a reliable internet website | 732 | 29.7% | Teacher | 890 | 36.1% |
Alcohol and drug worker | 560 | 22.7% | Information from a reliable internet website | 749 | 30.4% |
Information from an internet chat room or blog | 312 | 12.7% | Information from an internet chat room or blog | 359 | 14.6% |
I would not encourage Sarah to seek help from anyone | 175 | 7.1% | I would not encourage Samuel to seek help from anyone | 240 | 9.7% |
Gender differences
Females were significantly more likely to seek help than males (57.8% compared to 37.0%;
χ
2 = 102.486,
p < 0.001), and to have helped a friend seek help in the past (66.9% compared to 44.3%;
χ
2 = 113.615,
p < 0.001). The type of help source also varied by gender for stress and anxiety (
χ
2 = 13.346,
p = 0.020), depression, (
χ
2 = 16.687,
p = 0.005), and another similar problem (
χ
2 = 14.117,
p = 0.015), with females more likely to rely on health professionals as their main source of help. Females were significantly more confident that they could help a peer experiencing symptoms of depression to seek professional help, but significantly less confident that they could help a peer experiencing alcohol misuse. Other differences in confidence were not significant (Table
11).
Table 11
Gender differences in confidence to help a peer
Talk to Sarah about your concerns? a
| 2.48 | .874 | 2.52 | .789 | −1.194 (2.442) | 0.233 |
Help Sarah seek professional help? a
| 2.85 | .836 | 3.01 | .746 | −5.008 (2437) | <0.001 |
Talk to Samuel about your concerns? b
| 2.49 | .950 | 2.26 | .845 | 6.228 (2413) | <0.001 |
Help Samuel seek professional help? b
| 2.77 | .875 | 2.76 | .807 | 0.331 (2404) | 0.741 |
There were significant gender differences in regard to participants’ agreement that the problems described in the vignette warranted professional help. For depression, agreement was higher amongst females (M = 4.04, SD = 0.78) than males (M = 3.90, SD = 0.86;
t = −4.302 [df = 2443],
p < 0.001). Similarly, for alcohol misuse, agreement was higher amongst females (M = 4.06, SD = 0.84) than males (M = 3.89, SD = 1.02;
t = −4.590 [df = 2408],
p < 0.001). While there were no gender differences in the likelihood of seeking help for similar problems, females perceived greater barriers to seeking help than males. This was evident in regard to depression (females M = 2.38, SD = 0.58; males M = 2.30, SD = 0.58;
t = −3.368 [df = 2437],
p = 0.001) as well as alcohol misuse (females M = 2.31, SD = 0.62; males M = 2.23, SD = 0.62;
t = −3.111 [df = 2404],
p = 0.002). Finally, females were more likely to encourage a peer to seek help from formal and internet sources for depression, and from family and formal sources for alcohol misuse. There were no other gender differences in help-seeking intentions (Table
12).
Table 12
Gender differences in likelihood of encouraging a peer to seek help
Depression |
Peer
| 3.29 | 0.92 | 3.31 | 0.81 | −0.669 (2437) | .504 |
Family
| 4.19 | 0.90 | 4.20 | 0.77 | −0.171(2439) | .864 |
Formal
| 3.59 | 0.74 | 3.77 | 0.61 | −6.445(2436) | .000 |
Internet
| 2.36 | 1.01 | 2.49 | 0.98 | −3.283(2436) | .001 |
Alcohol misuse |
Peer
| 3.13 | 0.99 | 3.13 | 0.91 | −0.084(2406) | .933 |
Family
| 3.79 | 1.13 | 3.94 | 0.89 | −3.590(2406) | .000 |
Formal
| 3.51 | 0.85 | 3.81 | 0.69 | −9.563(2406) | .000 |
Internet
| 2.46 | 1.07 | 2.53 | 1.02 | −1.597(2406) | .110 |
Discussion
The current study provides insight into the help-seeking behaviours of Australian adolescents, as well as their beliefs and intentions towards peers experiencing depression and alcohol use problems. Approximately half of the sample had sought help for mental health or substance use problems in the past, with parents, friends, and health professionals the three main sources of support. Our findings contrast with the results of some earlier studies, in which adolescents tended to approach formal help sources less frequently than family and friends [
2,
3], although they are consistent with previous findings amongst adolescents who experience more severe symptoms of psychological distress [
4‐
6]. In particular, we found that health professionals were the primary source of support for adolescents who had sought help for depression. This is not unexpected, given that young people are increasingly seeking professional help for mental health problems [
7], and considering that public recognition of depression and beliefs about treatment has improved over the past two decades, likely due in part to the influence of the
beyondblue Australian National Depression Initiative [
22]. However, it is important to note that while health professionals were consistently rated as more helpful than family or friends, their overall helpfulness rating was low (with an average between ‘unhelpful’ and ‘neither helpful nor unhelpful’). This may be a concern if participants’ have negative past experiences that lead them to be unwilling to seek professional help in the future.
While close to 20% of the sample had sought help for depression, only 3% had sought help for alcohol and other drugs. As the prevalence of substance use disorders amongst 16-24 year olds is approximately double that of affective disorders (Reavley et al., [
8]), many young people may not be seeking help for emerging substance use problems in early adolescence. Moreover, those that did seek help relied primarily on friends for support, with a smaller proportion approaching health professionals or parents. A preference for peers over family has been identified in past research into help-seeking for substance use problems during adolescence, and may increase with the severity of symptoms [
43]. These findings highlight the need for interventions that aim to increase rates of help-seeking for substance use problems specifically, as well as improving general mental health literacy skills.
Just under 60% of the sample correctly identified depression, which is consistent with the results of previous studies examining problem recognition in Australian adolescents [
19,
20]. A slightly smaller percentage (52%) correctly identified alcohol misuse, while 9% incorrectly labelled the problems described in the alcohol vignette as another mental health condition, and a further 13% did not know what was wrong or considered the behaviours described to be ‘normal’ or just part of growing up. In contrast, approximately 4% and 7%, of participants gave similar responses to the depression vignette. While overall rates of correct recognition were similar, these results nevertheless suggest that young people may have more difficulty recognising harmful drinking compared to symptoms of depression, and may be more likely to misidentify alcohol misuse as another mental health problem or minimise it as normal adolescent behaviour. Potentially, this could be one influence contributing to the low rates of help-seeking for alcohol misuse compared to depression.
While the majority of participants agreed that the problems described in both vignettes warranted professional help, one-quarter were undecided or disagreed. However, when participants were asked whether they would seek professional help if they experienced problems similar to those described in the vignettes, fewer than half said they were likely to do so. This is surprising, as previous research suggests that 80-90% of adolescents would seek help if they experienced symptoms of depression, with or without alcohol misuse [
21,
44]. It is possible that there may be additional perceived barriers to help-seeking for alcohol problems that occur in the absence of other mental health symptoms, such as fear of punishment or concerns about the stigma associated with substance use disorders. Indeed, while participants identified similar barriers to seeking help on the BASH for both type of problems, this measure does not assess concerns about punishment, which may be particularly salient amongst underage drinkers. Similarly, it does not assess concerns about stigmatising responses or judgement on behalf of the counsellor, which may be of greater relevance to alcohol misuse given that substance use disorders have been found to be more severely stigmatised than other mental health conditions [
45]. Alternatively, past help-seeking experiences may have influenced adolescents’ future intentions. As health professionals and teachers were the highest rated help sources on helpfulness, yet were still generally considered unhelpful, participants may have been reluctant to seek professional help for future problems based on negative past experiences.
Adolescents reported that they were more likely to encourage their peers to seek help from family members than from other help sources, particularly in regard to depression. The types of formal help that adolescents were most likely to recommend for both types of problem were school counsellors, followed by mental health professionals outside of school. Fewer participants were likely to encourage their peers to seek help from GPs, although they were still recommended by a majority of adolescents. There may be benefits in educating young people about the role of GPs, as there is evidence that many adolescents do not consider them to be an appropriate help source of mental health problems [
46,
47], although GPs may also need additional education about what to do when young people approach them [
48,
49]. Furthermore, it should be noted that close to 10% of the sample said it was likely that they would not encourage a peer to seek help from anyone.
As expected, females were more likely than males to have sought help in the past, and more likely to have helped a friend seek help. Consistent with the findings of Yap and Jorm [
33], they were more likely to rely on professional help than males, and were more likely to report that they would encourage a peer with depression or alcohol misuse to seek help from formal sources. They were also more likely to report they would encourage a peer to seek help from the internet (for depression only) and from family (for alcohol misuse only). A number of unexpected findings emerged, with females significantly more confident that they could help a peer experiencing depressive symptoms seek professional help, but significantly
less confident that they could talk to a peer experiencing alcohol misuse about their concerns. Females also perceived greater barriers to seeking help for both types of problems, which was surprising given that their help-seeking intentions were stronger and their actual help-seeking behaviours were more frequent than in males. The results suggest that there are likely to be barriers over and above those which were assessed that are more influential during adolescence. Alternatively, females may perceive multiple barriers but are still able to overcome them and seek help. Further research should examine in more detail the factors that discourage help-seeking behaviour amongst females, as well as by problem type.
Teaching adolescents how to better support their peers is essential given that many young people continue to be sought out by friends experiencing mental health problems. Indeed, while one third to one half of participants primarily relied on friends for help, more participants reported seeking help for a friend than for their own problems, which is consistent with previous research [
14]. Moreover, despite evidence of poor mental health literacy in regard to problem recognition, the majority of participants were confident that they could approach a peer experiencing symptoms of depression or alcohol misuse, and help them seek professional help. Similar results were reported by Jorm and colleagues [
21], who found that adolescents were more confident than young adults despite demonstrating less sophisticated first-aid knowledge. Teaching young people how to help their peers is necessary to ensure that the advice and support given is appropriate, and may also facilitate help-seeking for their own mental health and substance use problems. In the current study, adolescents who agreed that the problems described in the vignettes warranted professional help also reported that they were more likely to seek help if they experienced similar problems. Similarly, adolescents who had helped a peer in the past were more likely to have sought help themselves.
The current study reported baseline data from trial of
MAKINGtheLINK, a school-based intervention that teaches adolescents how to assist their peers and overcome barriers to accessing professional help. The
MAKINGtheLINK program was designed to address a number of critical gaps in existing early intervention and health promotion activities by teaching school students how to effectively support their peers and overcome perceived barriers to seeking professional help. As peers become increasingly influential during adolescence, young people are ideally positioned to act as ‘gate-keepers’ to mental health services [
50], while equipping them with the knowledge and skills needed to help their peers is likely to facilitate their own help-seeking behaviour. Further analysis of the follow-up data obtained by the
MAKINGtheLINK trial will provide evidence of the effectiveness of the intervention. If deemed effective, the
MAKINGtheLINK program will be the first evidence-informed resource that is able to address critical gaps in knowledge and behaviour of adolescents in relation to help-seeking, and could be a valuable resource that is able to be readily implemented by classroom teachers.
There are a number of limitations with this study to consider. First, data collection was at a single point in time, with participants reporting past help-seeking behaviours only, which may have been affected by recall bias or social desirability effects. While help-seeking intentions measured by the GHSQ-V have been found to be correlated with subsequent behaviours [
41,
51], longitudinal follow-up is required to determine whether the actual attitudes and intentions reported in the current study influence adolescents’ future help-seeking behaviours. In addition, the gender of the peer described in the vignette was fixed and did not vary according to participant gender. This may have influenced adolescents’ help-seeking intentions in relation to their peers, as recipient gender has been found to influence the mental health first aid actions taken by young people [
33]. Finally, the hypothetical situations described in the vignettes may not reflect how adolescents respond to real-life situations. Indeed, Marshall and Dunstan [
52] recently demonstrated that Australian adolescents were less likely to correctly identify depression when a more naturalistic form of presentation (film) was used (specifically, 23% gave correct responses compared to 33.8% in an equivalent vignette from a previous study). More generally, concerns have been raised about current mental health literacy instruments, and it has been argued that more psychometrically robust measures could be developed to assess the components of this construct, which encompasses problem recognition as well as knowledge and beliefs about mental disorders which aid their management or prevention [
53].
Despite their limitations, the results of the current study provide an important addition to the current knowledge regarding help-seeking for mental health and substance misuse problems in Australian adolescents. They suggest that there is still room for considerable improvement in the mental health literacy of Australian adolescents, particularly in regard to problem recognition and treatment beliefs relating to alcohol misuse. Moreover, they highlight the importance of peer training as a means of facilitating early identification and treatment of mental health problems.
Acknowledgements
We are grateful for the financial support provided by the NHMRC, and to the schools, parents and students who have agreed to take part in the trial. We would also like to thank the following individuals for their assistance with running the program in schools: Emma Sandral, Anna Guthrie, Alissa Walsh, Laura Abbey, Nyssa Ferguson, Michael Turner, Shera Blaise, Margaret Chigros, and Erica Gurner.