Introduction
Methods
Literature search
Eligibility criteria
Study selection
Data extraction
Quality rating
Data synthesis
Results
Study description
References | Number of participants reporting barriers/facilitators | Age (range) | Country | Ethnicity | Females (%) | Area of living | Setting | Focus of the study | Mental health assessment | Source of professional help | Service use | Barrier/facilitator measure—details | Quality assessment |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Boyd et al. [26] | 201 | 11–18 | Australia | No information | 63% | Rural | School | Anxiety and Depression | CES-D SASa | Any professional help | No information | Open-ended question about barriers to seeking professional help | 17 (high) |
Chandra and Minkovitz [32] | 274 | 13–14 | USA | 46% white, 27.4% black, 9.5% Asian, 4.7% Hispanic and 9% multiracial | 50% | Suburban | School | Emotional concerns | Not assessed | Mental health services | 15.9% received psychological services or counselling (past year) | Ten barriers to help-seeking and ‘no barriers’ option | 17 (high) |
Cigularov et al. [33] | 854 | 14–18 | USA | 78.3% Caucasian, 10.2% Hispanic, 2% Asian/Pacific, 1.7% Native American, 0.8% African American, 6.6% Other | 47% | No information | School | Depression and suicidality | Not assessed | Any professional help | No information | 26 barriers to help-seeking; 6-point Likert scale | 18 (high) |
D’Amico et al. [29] | 2883 | 14–18 | USA | 69% Caucasian, 13% Hispanic, 5% Asian American/Pacific Islander, 2% American Indian/Alaskan Native, 1% African American, 10% ‘other’ | 50% | No information | School | Alcohol related problems and concerns | Adapted questionnaire to assess drinking habits (6.7% ‘heavy drinkers’ and 21% ‘problem drinkers’) | Alcohol related services | No information | 14 facilitative factors; 5-point Likert scale | 16 (moderate) |
Freedenthal and Stiffman [27] | 101 (out of 356 screened for suicidal thoughts)b | 15–21 | USA | American Indians | 72% | 51.5% lived on the reservation, 48.5% in urban areas | Participant home | Suicidality | Questions about suicidality (100% ever thought of/attempted suicide; 59.4% suicidal thoughts, 24% multiple suicide attempts, 10% one suicide attempt, 6% number of attempts not given), YSR | Any professional help | 40.59% saw a MH professional; 12.87% consulted a school counsellor or teacher. | Open-ended question about barriers to seeking professional help with suicidal thoughts or behaviour. | 17 (high) |
Gould et al. [34] | 519 | 13–19 | USA | 78% white, 3% African American, 13% Hispanic, 1% Asian, 4% other | 50% | Urban and rural | School | Feeling very upset, stressed or angry | BHS (10% above threshold) CIS (28% above threshold) | Any professional help including hotlines | Hotline/substance programme/other health professional: 1.7–3.1 (last year), 2.1–3.3 (ever): School counsellor/ MH professional: 21.1–22-3(last year), 29.5–29.8 (ever) | 16 barriers to help-seeking | 17 (high) |
Gould et al. [35] | 24 (out of 317 identified ‘at risk’ and who did not seek help after referral at baseline)b | 13–19 | USA | 58.3% white, 20.8% Hispanic, 12.5% Asian, 8.3% other | 54% | No information | School | Suicidality | SIQ-JR (33% serious suicidal ideation), seven questions about suicide attempt history (25% past suicidal attempts), BDI-IA (58.3% depression), DUSI, CIS (37.5%)c | Mental health services | None | HUQ | 17 (high) |
Guo et al. [36] | 865 Latin American | M = 12.6, SD = 1.96 | USA | Latin American | 51% | No information | School | Internalising and externalising problems | SDQ (20.3% elevated symptoms) and CIS | SBMHS | 12.9% referred to SBMHS (past academic year) | Nine reasons for not seeking help | 15 (moderate) |
936 Asian American | Asian American | SDQ (13.9% elevated symptoms) CIS | 3.2% referred to SBMHS (past academic year). | ||||||||||
Guterman et al. [37] | 858 Arab | 14–17 | Israel | 46.7% Arab and 53.3% Jewish | 57.9% | No information | School | Emotional distress—exposure to community violence | Adapted version of My ETV (87% witnessed ≥ 1 act of community violence (past year) | Any Professional Help | 11.5% sought help from MH professional, 10% from youth group or religious leader, 9.2% from teacher and 8.7% from medical professional | 16 reasons for not seeking help | 18 (high) |
977 Jewish | 14-17 | 54.5% | Adapted version of My ETV (92.5% witnessed ≥ 1 act of community violence (past year) | 4.1% sought help from MH professional, 3.5% from youth group or religious leader, 2.7% from teacher and 2.1% from medical professional | |||||||||
Haavik et al. [38] | 1249 | M = 17.6, SD = 1.15 | Norway | No information | 56% | Rural and urban | School | MH in general | Not assessed | MH Services | School-based MH services: 11–29.8%, Specialist MH services: 9.7–10.5%, Youth health station/GP: 16.2–32.9% | Nine barriers to help-seeking; 5-point Likert scale | 18 (high) |
Khairani et al. [39] | 21 (out of 215 screened for depression symptoms)b | 13–20 | Malaysia | 99.1% Malays, 0.9% Indians | 57% | Rural | Primary care clinic | Depression | Structured self-report questionnaire with ten questions on depressive symptoms based on the DSM-IV (100% met criteria for depression) | Medical professionals | 9.5% of those reporting significant depressive symptoms had sought medical help for these | No details about the barrier measure | 15 (moderate) |
Kuhl et al. [40] | 280 | 14–17 | USA | 84% Caucasian, 9.8% Asian American, 4% Hispanic, 0.4% African American, 2.1% no ethnicity specified. | 50% | No information | School | MH in general | 50-item measure of physical and psychiatric symptoms developed by Dubowa | Any professional help | 30% of participants were currently or previously in therapy | BASH | 16 (moderate) |
Lubman et al. [41] | 2456 | 14–15 | Australia | 84.2% born in Australia; 1.9% in New Zealand, 1.4% in the United Kingdom, 1.1% in India and 1.0% in China | 50% | Rural and urban | School | Depression and alcohol abuse; any professional help | Not assessed | Any professional help | 30% sought help for MH problems from teachers or health professionals | BASH-B | 20 (high) |
Meredith et al. [24] | 184 depressedb 184 non-depressedb | 13–17 | USA | 14.2% White, 32.7% Black, 49.3% Hispanic, 3.8% Other | 78% | No information | Primary care clinic | Depression | DISC—depression module (100% of ‘depressed’ and 0% of ‘non depressed’ sample met the diagnostic criteria for depressive disorder in last 6 months) | Any professional help | 55% reported receiving depression counselling (6 months after depression was identified) No information | Seven barriers; 5-point Likert scale | 20 (high) |
Muthupalani-appen et al. [42] | 131 smokers 268 non-smokers | 13–17 | Malaysia | No information | No information | No information | School | Emotional and behavioural problems | YSRa | Primary care providers | 5.3% sought help No information | 16 reasons for not seeking help | 15 (moderate) |
Samargia et al. [43] | 497 (those who reported having foregone mental health care from 878 screened) | 16 | USA | 86.9% White, 0.9% African American, 3.2% Native American, 6.1% multiracial, 1.7% Asian, 1.1% Hispanic | 65% | Rural and urban | School and community centres | Psychological or emotional problems | DHS and DHHSa | Mental health services | 100% | 11 reasons for not seeking help | 17 (high) |
Sharma et al. [44] | 354 | 13–17 | India | No information | 48% | Urban | School | Depression | Not assessed | Any professional help | No information | No details about the barrier measure | 9 (low) |
Sheffield et al. [45] | 254 | 15–17 | Australia | 89.7% Australian and 10.3% from other countries (mainly Asia, Europe, and the United Kingdom) | 51% | No information | School | MH in general | The DASS-21a | Any professional help | 9.1% sought help for a mental illness; 31.2% for a personal, emotional or behavioural problem (past 12 months) | Nine barriers to help-seeking | 17 (high) |
Sylwestrzak et al. [46] | 10,123 | 13–18 | USA | 65.6% non-Hispanic whites, 15.1% non-His- panic blacks, and 14.4% Hispanics | 49% | Rural and urban | Household and school | Emotional and behavioural problems and coping with stress | As a part of NCS-A Study they were asked about MH symptomsa | Any professional help | > 63% reported seeking treatment to manage and cope with emotions; 11.6% to help with controlling problem behaviours and 6.9% to help cope with stress | 14 reasons for not seeking help | 14 (moderate) |
Wilson and Deane [47] | 1037 | 13–21 | Australia | 95% Australian, remaining 5% European, Asian, North or South American, Middle Eastern, and ‘other’ | 59% | Urban | School and youth community groups | Psychological problems | Not assessed | MH Services | No information | BASH-B | 18 (high) |
Wilson et al. [28] | 1184 | 11–17 | Australia | No information | 50% | Urban | School | Depression | CES-D (10.5% with moderate–severe depression symptoms) | MH Services | No information | Open-ended question about perceived barriers to seeking professional help | 16 (moderate) |
Wilson et al. [30] | 173 (trial) | 14–16 | Australia | 88% Australian, 6% European, 2% Asian | 58% | No information | School | Psychological problems | Not assessed | Help-seeking with GPs | 6.9–8.1% had ≥ 1 consultation with GP about psychological health | BETS | 18 (high) |
118 (comparison group) | 86% Australian, 9% European, 2% Aboriginal | 60% | 1.7–4.2% had ≥ 1 consultation with GP about psychological health | ||||||||||
Wu et al. [48] | 119 | 7–13 | USA | 82% White, 12% African American, 3% Asian, 3% other | 50% | No information | Community mental health centres | Paediatric anxiety | MASC, CAIS-C/P, CDI, PARS, ADIS-IV-C/P (66% GAD, 43% Social Phobia, 41% ADHD, 39% Separation Anxiety, 29% Specific Phobia) | MH Services | 100% | TAQ-CA | 20 (high) |
References | Number of participants reporting barriers/facilitators | Age (range) | Country | Ethnicity | Females (%) | Area of living | Setting | Focus of the study | Mental health assessment | Source of professional help | Service use | Barrier/facilitator measure—details | Quality Assessment |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Balle Tharaldsen et al. [49] | 8 | 17–18 | Norway | 88.5% Norwegian, 12.5% immigrant background. | 75% | No information | School | MH in general | No previous MH problemsb | Any professional help | 0% current, 25% previous contact with professional help. | Interviews | 17 (high) |
Becker et al. [50] | 13 | 12–17 | USA | Majority Caucasian | 38% | No information | Community—outreach and support programmes for military families | MH in general | Not assessed | MH services | No information | Interviews and focus groups | 16 (high) |
Breland-Noble et al. [51] | 29 | 11–17 | USA | African American | No information | Rural, urban and suburban | No information. | Depression | Not assessed | Any professional help | No information | Interviews and focus groups | 12 (moderate) |
Bullock et al. [52] | 15 | 14–18 | Canada | 100% Canadian with heterogeneous ethnicities (i.e. mixed European, Aboriginal). One youth was a 2nd generation migrant. | 87% | No information | The Depressive Disorders (outpatient) Program of a psychiatric hospital | Suicidality | K-SADS-PL, SCID-II (53% depressive disorder, 33% cluster B personality disorder) questions about suicidality (60% lifetime suicide attempt, 40% multiple attempts) | Any professional help | 100% | Interviews | 12 (moderate) |
Bussing et al. [31] | 148 | 14–19 | USA | No information | 59% | Rural and urban | School | ADHD | Screening questions with parents and CASA (74% ADHD high risk). | Psychiatric/medical and psychological help | 57% had a previous ADHD treatment | Open-ended survey questions | 14 (moderate) |
Chandra and Minkovitz [53] | 57 | 13–14 | USA | 30% African American | 74% | Suburban | School | MH in general | Not assessed | MH services | 38.6% within and 10.5% outside the school | Interviews | 16 (high) |
Clark et al. [54] | 29 | 12–18 | Australia | No information | 0% | Rural and urban | School and MH Clinic | Clinical anxiety | 28% history of anxiety diagnosisb | Any professional help | 28% had previously sought professional help | Interviews and focus groups | 17 (high) |
De Anstiss and Ziaian [55] | 85 | 13–17 | Australia | 100% refugees of mixed ethnic backgrounds | 56% | No information | Community—refugee centres, programmes, schools | MH in general | Not assessed | MH services | Not clear | Focus groups | 15 (moderate) |
Del Mauro and Jackson Williams [56] | 31 | 7–18 | USA | 87.1% Caucasian, 3.2% African American, 3.2% Asian, 3.2% Hispanic, 3.2% not reported | 71% | Rural and urban | Community | MH in general | Not assessed | Psychological help | 19.4% ≥ 1 therapy session | Focus groups | 15 (moderate) |
Doyle et al. [57] | 35 | 16–17 | Ireland | No information | 66% | Urban | School | MH in general | Not assessed | Help-seeking in schools | No information | Focus groups | 12 (moderate) |
Fleming, Dixon and Merry [58] | 39 | 13–16 | New Zealand | 49% Maori, 38% Pacific Islands, 10% New Zealand European | 26% | No information | School—alternative schooling programmes for students excluded or alienated from mainstream education | Depression | Not assessed | Health providers and computer-based help | No information | Focus groups | 16 (high) |
Fornos et al. [59] | 65 | 13–18 | USA | 89% Mexican–American | No information | Urban | School | Depression | Not assessed | Any professional help | No information | Focus groups | 10 (low) |
2954 (out of 6020 screened)c | 15–16 | UK | 82% White, 12% Asian, 3% Black and 3% Other | 54% | No information | School | Self-harm and suicidality | Questions about self-harm (10% lifetime self-harm) and scales to measure depression, impulsivity, anxiety and self-esteema | Any professional help | No information | Open-ended survey questions | 13 (moderate) | |
332 who did not seek help before self-harm (out of 593 with a lifetime history of self-harm)c 412 who did not seek help after self-harm (out of 593 with a lifetime history of self-harm)c | 15–16 | UK | 88% White | Around 75% | No information | School | Self-harm | Questions about self-harm (100% lifetime history of self-harm) and scales to measure depression, impulsivity, anxiety and self-esteema | Any professional help | 14% got help before the episode of self-harm 1.4% got help after the episode of self-harm | Open-ended survey questions | 13 (moderate) | |
Francis et al. [60] | 52 | 14–16 | Australia | No information | 71% | Rural | School | MH in general | Not assessed | Any professional help | No information | Focus groups | 16 (high) |
Gonçalves et al. [61] | 16 | 12–17 | Portugal | 25% Portuguese (African descendent)25% Cape Verde, 18.8% Brasil, 18.8% Angola, 12.5% Other | 31% | No information | School | MH in general | Not assessed | Any professional help | 31.3% had previous psychologist visit | Focus groups | 14 (moderate) |
Gronholm et al. [62] | 29c | 12.2–18.6 | UK | 65.5% White, 31% Black, 3.4% Asian | 65.50% | Urban | School | Inter-/externalising disorder and risk of developing psychotic disorder | SDQ (100% borderline or clinical level of inter-/externalising disorder PLE (100% ≥ 1 ‘yes’ response to question regarding psychotic-like experiences) | Any professional help | No information | Interviews | 18 (high) |
Hassett and Isbister [63] | 8c | 16–18 | UK | No information | 0% | No information | Clinic—CAMHS | Self-harm and suicidality | ≥ 2 episodes of self-harm (past 12 months)b | MH services | 100% | Interviews | 17 (high) |
Huggins et al. [64] | 6 | 18 | USA | No information | No information | Rural and urban | School | MH in general | Not assessed | School-based mental health services | No information | Interviews | 17 (high) |
Kendal et al. [65] | 23 | 11–16 | UK | No information | 65% | Urban | School | Emotional difficulties | Not assessed | School-based pastoral support | 39% had used the MH service in school | Interviews | 15 (moderate) |
Klineberg et al. [66] | 30 | 15–16 | UK | 40% Asian, 23% Black, 20% Mixed ethnicity, 13% White British and White Other | 80% | Urban | School | Self-harm | Adapted version of A-Cope (33% never self-harmed, 30% self-harmed once, 37% more than once) | Any professional help | No information | Interviews | 16 (high) |
Leavey, Rothi and Paul [67] | 48 | 14–15 | UK | No information | 50% | Urban | School | Emotional and mental health problems | Not assessed | Primary care providers | No information | Focus groups | 11 (low) |
Lindsey, et al. [68] | 16 | 11–14 | USA | 100% African American | 50% | Urban | School | MH in general | Not assessed | MH services | 44% received school-based counselling | Focus groups | 17 (high) |
18c | 14–18 | USA | 100% African American | 0% | Urban | Community based mental health centres and after-school programs for youth | Depression | CES-D (100% elevated levels of depression symptoms) | MH services | 55% of them were in treatment | Interviews | 16 (high) | |
Mcandrew and Warne [69] | 7c | 13–17 | UK | 100% White British | 100% | No information | n/a | Self-harm and suicidality | 100% experienced self-harm and/or suicidal behaviourb | Any professional help | No information | Interviews | 13 (moderate) |
Meredith et al. [24] | 16c | 13–17 | USA | No information | No information | No information | Primary care clinic | Depression | Diagnostic Interview Schedule for Children—depression module (100% met criteria for depression) | Any professional help | Not clear | Interviews | 10 (low) |
Mueller and Abrutyn [70] | 10 | No information | USA | Upper middle class community | No information | Suburban | Community | Suicidality | Not assessed | Any professional help | No information | Interviews and focus groups | 11 (low) |
Pailler et al. [71] | 60 | 12–18 | USA | 65% African American, 27% White, 8% multiracial | 52% | Urban | Tertiary care children’s hospital | Depression | Not assessed | MH services | No information | Interviews | 18 (high) |
Prior [72] | 8 | 13–17 | UK (Scotland) | No information | 75% | No information | School | MH in general | Not assessed | School counselling | 100% received school counselling | Interviews | 15 (moderate) |
Timlin-Scalera et al. [73] | 26 | 14–18 | USA | 100% White | 15% | Suburban | School | MH in general | Not assessed | Any professional help | Not clear | Interviews | 17 (high) |
Wilson and Deane [74] | 23 | 14–17 | Australia | 91% Australians of European descent, 4% Aboriginal, 4% Pakistani | 52% | Urban | School | MH in general | Not assessed | Any professional help | No information | Focus groups | 16 (high) |
Wisdom et al. [75] | 22 | 14–19 | USA | 90% White (non-Hispanic), other people with African, Hispanic, and Asian heritage | 59% | No information | School and MH Clinic | Depression | Assessed by primary care providersa | Primary care providers | Not clear | Interviews and focus groups | 16 (high) |