Background
Methods
Inclusion | Exclusion |
---|---|
- Focused on help-seeking barriers, facilitators and interventions - Includes formal and informal sources of help - Help-seeking for depression, anxiety, suicidal ideation, emotional distress - Age range: 10 to 19 years - Studies published in English Spanish and French - All study designs | - Not focused on help-seeking for mental health problems - Help-seeking for anorexia, schizophrenia and other mental health problems not described in the inclusion criteria - Participants above or over 10 to 19 years age range - Published in other languages - Published before 2010 if referring to help-seeking barriers and facilitators |
Results
Question 1: help-seeking barriers and facilitators
1st author, year, country | Study design | Sample size (n=) | Age and setting | Barriers | Facilitators | Quality |
---|---|---|---|---|---|---|
Bates, 2012, Canada | Cross sectional survey | n = 193 students 110 parents | 11 to 15 years old high school students | Students: “nothing will help”, stigma, self-sufficiency, fear of coercion. Parents: fear of coercion, money constraints, self-sufficiency, perceived impact of adolescent problems and not understanding the child problem. | Both: Prior professional help-seeking | Medium |
Boyd, 2011, Australia | Cross sectional | n = 201 | 11 to 18 years old students in rural high school | Perceived limited service availability, social proximity and gossip, travel and cost of service, limited knowledge of sources of help, fears confidentiality | Not assessed | Medium |
Buttigieg, 2016, Malta | Mixed Methods | n = 494 | 14–15-year-old high school students | Need for autonomy, embarrassment, poor mental health literacy, stigma, higher levels of depressive symptoms | Not assessed | Low |
Charman, 2010, Australia | Qualitative | n = 20 | 16–26 (mean 17.7 years) members of community groups | Confidentiality concerns and stigma | Not assessed | Medium |
Chen, 2017, Malasya | Cross sectional | n = 277 | 13–20-year-old high school students | Stigma, fear, lack of courage, doubt about counsellor competency | Not assessed | Medium |
Cheng, 2013, United Kingdom | Cross sectional | n = 67 | Parents of Chinese students in language school living in England. | Knowledge about help-seeking, language barriers | Not assessed | Low |
Cramer, 2017, United States | Cross sectional | n = 396 | 14–17-year-old high school students | Stigma, higher levels of emotional difficulties, personnel and service availability | Prior help-seeking behaviours | Medium |
Curtis, 2010, New Zealand | Mixed Methods | n = 1896 | 18–24 years old (60.2% under 20) university students | Stigma and a perceived need for self-reliance | Not assessed | Low |
Czyz, 2013, United States | Cross sectional | n = 157 | 18–22-year-old (77.1% under 20) college students at elevated suicide risk | Perception that treatment is no needed, lack of time, self-management and stigma | Not assessed | Low |
Dardas, 2017, Jordania | Cross sectional | N = 2349 | 12–17 year-old high school students | Higher depressive symptoms, higher levels of stigma | Not assessed | Medium |
De Anstiss, 2010, Australia | Qualitative | n = 85 | 13–17 years old, refugee adolescents living in Australia | Low priority of mental health, poor mental health literacy, distrust in services, stigma associated with psychological problems and help-seeking | Not assessed | Medium |
Doyle, 2017, Ireland | Mixed methods | n = 856 | 15–17-year-old students in post-primary school | Dislike of dual role of counsellor/teacher, confidentiality concerns. | Not assessed | Medium |
Fukuda, 2016, Brazil | Cross sectional | n = 1030 | 8–21-year-old school students receiving mental health treatment | Fear of stigmatisation and problem denial | Not assessed | Low |
Flink, 2013a, The Netherlands | Qualitative | n = 41 | Mother of teen daughters (aged 12–20) from different ethnic backgrounds | Negative attitudes to GP, inaccessible mental health services, denial by daughters. Minority ethnic groups: fear of negative judgements and gossiping. | Good and trustful bond with daughters, good contact with school | Medium |
Flink, 2013b, The Netherlands | Qualitative | n = 50 | 12–20-year-old female adolescents from different ethnic backgrounds | Negative attitudes towards health professionals and school services. Minority groups: fear to parental and fear reactions | Not assessed | Medium |
Gonzlaves, 2012, Portugal | Qualitative | n = 39 | 12–17 years old immigrant attending to school, parents, teachers and health professional. | Adolescents: reliance on self-support, shyness, fear and language gap Family: fees, language, legal issues Professionals: non-recognition of the problem All: stigma | All: strong link with community, mainly teachers and health professionals | Medium |
Gulliver, 2012, Australia | Qualitative | n = 15 | 16–23-year-old elite athletes (66.7% aged under 19). | Stigma, lack of mental health literacy, negative past experiences of help-seeking | Encouragement from others, stablished relationship with provider, previous positive experiences with mental health services, positive attitudes of others, access to internet. | Medium |
Haavik, 2017, Norway | Cross sectional | n = 1249 | Adolescents from Norwegian upper schools (mean = 17.6) | Mental health literacy, delay in making contact, stigma. | Increased mental health literacy, awareness of service availability | Medium |
Hasset, 2017, United Kingdom | Qualitative | n = 8 | 16–18-year-old males who entered CAMHS following self-harm or suicidal ideation and where engaged in therapy | Want to maintain an independent self. | External adult recognising, normalising and initiating help-seeking. Greater insight, maintaining independent self. | High |
Hernan, 2010, Australia | Cross sectional | n = 74 | 14 to 16 years old high school students from rural and metropolitan towns | Personal factors related with communication with mental health professionals, problem recognition, shame, confidentiality breach. Logistical factors (transport, money, travel distances, etc.). | Not assessed | Low |
Ijadi-Maghsoodi, 2018, United States | Qualitative | N = 76 | 11–18 years old school students | Embarrassment, fear of judgement, confidentiality, mental health literacy | Medium | |
Jennings, 2015, United States | Cross sectional | n = 246 | 18–24 (73.3% aged 18–19) college students | Perceived stigma, self-stigma, higher self-reliance | Not assessed | Low |
Kahi, 2012, Lebanon | Cross sectional | n = 521 | 17–21 years old student (53,8% aged 17–18) undergoing a preventive medical visit at University centre | Confidentiality, embarrassment, doubt about the professionals’ ability to act, knowledge of services, and logistical factors (money, transport, contact). | Not assessed | Low |
Labouliere, 2015, United States | Cross sectional | n = 2145 | 14–18-year-old high school students | Extreme self-reliance | Not assessed | Low |
Linsdey, 2010, United States | Mixed-method | n = 69 | 13 to 18 years old African American boys with high levels of depressive symptoms | Shame and distrust of mental health professionals | Not assessed | Medium |
Lubman, 2017, Australia | Cross sectional | n = 2456 | 14–15-year-old high school students | Self-reliance, embarrassment, time and money | Not assessed | Medium |
Lynn, 2014, United Kingdom | Cross sectional | n = 175 adolescents n = 95 parents | 14–18-year-old adolescent | Adolescents: desire of being independent, reduced mental health literacy in parents. | Adolescents: Higher perception of problem severityBoth: prior professional help-seeking. | Low |
Maioulo, 2019, Australia | Cross sectional | n = 1582 | 16–18 years high school students | Not assessed | Positive parenting | Medium |
Mariu, 2012, New Zealand | Cross sectional | n = 9699 | 12–18 years old secondary students (years 9 and 10). | Not assessed | Living with a single parent, living in an over-crowed house, being well known by a teacher | Medium |
Maritnez-Hernaes, 2014, Spain | Cross sectional | n = 105 | 17–21 year old (84.3% aged under 19) participating in longitudinal survey | Normalisation of problem, stigma, reliance on self, beliefs of no need of professional help | Positive perception of mental health professionals | Medium |
McLean, 2013, United Kingdom | Qualitative | n = 90 | 10–15-year-old secondary school students | Stigma | Not assessed | Medium |
Murry, 2011, United States | Mixed Methods | n = 163 | African American mothers of adolescents (mean = 14) living in rural Georgia | Community stigma towards family, cultural mistrust, cost | Welcoming environment of mental health services | Medium |
Nearchou, 2018, Ireland | Cross sectional | N = 722 | 12–16 years old school student | Perceived public stigma | Not assessed | Medium |
O’Connor, 2014, Australia | Cross sectional | n = 180 | 17–25-year-old (74.16% aged 18–19) college students | Not assessed | Extraversion, increased perceived benefits of help-seek, low social support and high perceived benefit | Low |
Pisani, 2012, United States | Cross sectional | n = 2737 | 14–17 years old high school students in rural communities | Not assessed | Positive attitudes about help-seeking, perceptions responsiveness from adults, school support | Medium |
Recto, 2018, United States | Qualitative | n = 20 | 15–19 years adolescents with perinatal depression | Fear of judgement, normalisation of symptoms, lack of trust | Not assessed | Medium |
Rughani, 2011, Australia | Cross sectional | n = 778 | 13–18 years old high school students (years 9 to 12) in rural towns | Mistrust and do not believe professional help is beneficial | Perceived benefits of mental health treatments | Medium |
Samuel, 2014, United States | Qualitative | n = 54 | 15–17-year-old African American males who received mental health treatment services after detention | Stigma, ineffective treatment, fear and shame from peers, mistrust of mental health providers | Not assessed | Medium |
Sawyer, 2011, Australia | Cross sectional | n = 5362 | 12–14 years old school students | Higher depressive symptoms | None found | Medium |
Seamark, 2018, United Kingdom | Qualitative | n = 6 | 17–18-year-old college psychology students | Gender roles, cultural expectations, lack of awareness of sources of help, fear of stigma and rejection | Not assessed | High |
Sharma, 2017, India | Cross sectional | n = 354 | 13–17-year-old school students | Feeling ashamed, uncomfortable | Not assessed | Low |
Shechtman, 2018, Israel | Cross sectional | n = 238 | 14–18-year-old school students | Self-stigma | Not assessed | Low |
Sylwestrzak, 2015, United States | Cross sectional | n = 10,123 | 13–18-year-old adolescents | Self-reliance, mental health literacy, fear of stigma, usefulness of treatment | Not assessed | Low |
Tharaldsen, 2017, Norway | Qualitative | n = 8 | 17–18-year-old students | Limited knowledge, stigma | Not assessed | Medium |
Thomas, 2013, Australia | Cross sectional | n = 289 | 18–25-year-old (59.9% aged 18–19) students enrolled in first year psychology classes | Not assessed | Good symptom recognition, identification of benefits of professional help, openness to treatment for emotional problems | Medium |
Wang, 2018, United States | Mixed methods | n = 19 | Asian immigrants parents | Mental health literacy, structural barriers, cultural barriers (stigma, lack of cultural sensitivity of services) | Not assessed | Medium |
Watsford, 2014, Australia | Cross sectional | n = 102 | 12–18-year-old presenting mild to moderate mental health concerns | Not assessed | Previous experience in mental health services | Medium |
Wilson, 2010a, Australia | Cross sectional | n = 109 | 18–25 years old (78% age 18–19) college students* | Higher levels of psychological distress, negative beliefs about treatment | Not assessed | Medium |
Wilson, 2010b, Australia | Cross sectional | n = 302 | 18–25 years old (78% age 18–19) university students* | Higher level of suicidal ideation and higher depressive symptoms | Not assessed | Medium |
Wilson, 2010c, Australia | Cross sectional | n = 590 | 13–18 years old high school students | Higher levels of suicidal ideation and general psychological distress. | Not assessed | Medium |
Wilson, 2011, Australia | Cross sectional | n = 562 | 18–25 years old (87,7% aged 17–21) students | Need for autonomy and independence | Not assessed | Medium |
Wilson, 2012, Australia | Cross sectional | n = 1037 | 13–21-year-old adolescents (79% under 19) | Need for autonomy | Helpfulness of prior mental health care | Low |
Yap, 2011, Australia | Cross sectional | n = 3746 teens n = 2005 parents | 12–25 years old student (separated data) | Stigma and beliefs about helpfulness of mental health care | Not assessed | Low |
Yoshioika, 2015, Japan | Cross sectional | n = 311 | 15–19 high school students | Concerns about what other people may think | Not assessed | Low |
Zhao, 2015, Canada | Cross sectional | N = 115 | 15–16-year-old students | Not assessed | Secure attachment style, strong relation with peers | Medium |
Help-seeking barriers
Stigma
Family beliefs
Mental health literacy
Autonomy
Other help-seeking barriers
Help-seeking facilitators
Secondary outcomes
Question 2: help-seeking interventions
1st Author, year, country | Sample size | Inclusion criteria | Design | Setting and intervention | Comparison group | Primary outcome | Measures | Results and effect size | Quality |
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Psychoeducation-mental health | |||||||||
Berridge, 2011, Australia | 182 | 10th grade students (aged 14–16) | Post-test design Feasibility trial | MAKINGthe LINK. School-based. Five class room activities provided by teachers who received specialised training. | No control group | Acceptability and feasibility of the programme | A 16-item programme satisfaction survey. | -Not relevant | n/a1 |
Casañas, 2019, Spain | . | 13–14 year old high school student | Clustered RCT2. Study protocol | EspaiJOVE, 14 h of psychoeducation and activities with the scholar community. | Waiting list | Help seeking behaviours | General Help-Seeking Questionnaire (GHSQ) | -Not relevant | n/a |
Lubman, 2016, Australia | – | year-9 students (aged 14–15) | Cluster RCT Study protocol | MAKINGthe LINK. Five class room activities provided by teachers who received a training. | Waiting list | Help seeking behaviours | General Help Seeking Questionnaire (GSHQ-V) | -Not assessed | n/a |
Perry, 2014, Australia | 208 | 9th or 10th grade students (aged 13–16) | Cluster RCT. Feasibility trial | HeadStrong, school based intervention with educational practical modules during 5 to 8 weeks. | Regular Health and Physical Education classes | Attitudes towards help-seeking | Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) | -Not relevant | Medium |
Sharpe, 2016, United Kingdom | 6551 | Year 7 school student (aged 11–12) | Hierarchical cluster RCT. | Student booklet designed fomenting help-seeking and self-management support. | Waiting list | Help-seeking behaviour | Four-point scale developed by authors | There was no difference in help-seeking behaviour Odds ratio (95% C.I) 1.01 (0.95–1.07) | Medium |
Psychoeducation-depression | |||||||||
Joyce, 2011, Australia | 32 | Secondary students (aged 14–16) | Post-intervention design. Pilot study | School based. Information sheet based on evolutionary perspective | Informative sheet about depression | Piloting the sheet. | Linkert scale (5 points) | -Not relevant | n/a |
King, 2011, United States. | 416 | 9th to 12th grade high school students | Quasi experimental design | Surviving the Teens is school based programme. Four 50 min session focused on psychoeducation. | No control group | Help seeking attitudes and behaviour | Instrument developed for the study evaluating self-efficacy and help-seeking behaviours. | Increased help-seeking behaviours after intervention and maintained in follow-up (3 months). (t = 4.634/ p < .001) | Medium |
Robinson, 2010, Australia | 246 | Boys school students (aged 14–16) | Pre-test, post-test design | School-based developed in one-off, 2-h workshop focused on depression definition, coping skills and help-seeking. | Waiting list | Help-seeking behaviours | Evaluation of Mental Health First Aid training | Intervention group was more likely to seek for help Adjusted odds ratio (95% C.I.)= 3.48 (1.93, 6.29) p < 0.0001 | Medium |
Ruble, 2013, United States | 593 | High school students | Pre-test and post-test design | School-based, 3 h curriculum designed to educate students, teachers, and parents about depression and help-seeking. | No intervention | Attitudes towards treatment seeking | Adolescent Depression Knowledge Questionnaire (ADKQ) | Significant increase in the intention to seek help from other t = 13.658/ p < 0.0001. | Medium |
Strunk, 2014, United States | 158 | Emotionally troubled teens in 9th and 12th grade | Pre- test and Post-test design | Surviving the Teens is school based programme. Four 50 min session focused on psychoeducation. | No control group | Help-seeking behaviours | Survey developed by authors. | Paired t-test showed a significant increase at posttest (p < 0.0005) but not at 3 months follow-up (p = 0.014). | Medium |
Beaudry, 2019, United States | 481 | High school students | RCT. | Interactive classroom curriculum and focus group with parent, students and teachers. | Waiting list | Help seeking behaviours related to depression | Adolescent Depression Knowledge Questionnaire (ADKQ) | -Not available due to data collection issues | Medium |
Howard, 2019, Australia | 327 | 16–19 year old students | Three-arm, pre-posttest, double-blind RCT. | Psychoeducation of biological and psychosocial conditions and causes of depression | Neutral information about depression | Help-seeking intentions | General Help-Seeking Questionnaire (GHSQ) | -Small but significant increase in help-seeking (p = 0.015) | Medium |
Psychoeducation-stigma | |||||||||
Calear, 2017, Australia | – | 11 and 12 grade male students (15–18 years of age) | Two arm cluster RCT.Study protocol | Silence is Deadly. School based, focused in males. Included classroom presentation (1 h), and supporting website and social media messages. | Waiting list | Help seeking intentions | General Help-Seeking Questionnaire (GHSQ) | -Not assessed | n/a |
Hart, 2016, Australia | 241 | High school students (aged 15–17) | Pre-test, post-test design Feasibility trial | Teen Mental Health First Aid program. School based, 3 sessions, delivered to students, parents and teachers. | No control group | Help seeking intentions | Survey questionnaire developed for the study to measure help-seeking. | -Not relevant | Medium |
Rickwood, 2004, Australia | 457 | School students (aged 14–18) | Solomon four-group design (pre-and post-intervention). | School based, interactive presentation by former mental health patients. | No intervention | Help-seeking intentions | General Intentions to Seek Help Questionnaire | Significant effect of the intervention Wilks’ Λ = .942 F (4,417) = 6.428p < 0.001 | Medium |
Saporito, 2013, United States | 156 | Adolescents from Public High School | RCT. | School based Interactive 1 h session, providing basic mental health and video with case example. | Educational presentation with content unrelated to mental health. | Reduction of Stigma towards help-seeking | Short for of Attitudes toward Seeking Professional Psychological Help (ATSPPH) | Increased willingness to seek for help in students with past treatment history F(1, 146) =6.64, p = .01ηp2 = .04 | Medium |
12. Yang, 2018, United States | 14 | High school students “at risk” of mental health conditions. | Quasi-experimental Pilot study | InSciEd-oOut. School based, 20-day anti-stigma classroom activities | No control group | Help-seeking behavioural intentions | General Help-Seeking Questionnaire Vignette Version. | Not assessed | n/a |
30. Young, 2013, Canada | 254 | High school students (aged 14–18) | Pre and Post intervention survey design | School based, combining classroom sessions and talk with person with schizophrenia | No control group | Self-stigma in help-seeking | Self-Stigma of Seeking Help scale | Significant reduction in self-stigma to seeking help after the intervention (p < 0.05) | Medium |
Psychoeducation- suicide + self-harm | |||||||||
Aseltine, 2004, United States | 2100 | Students in high schools | Cluster RCT | SOS programme, school based interactive intervention based on teaching materials and discussion guide, plus a screening instrument. | Health and social studies classes | Help-seeking behaviour | Questionnaire developed by the authors | Not significant effect of the program in help-seeking β = 0.255 p > 0.05 | Medium |
Aseltine, 2007, United States | 3837 | Students in high schools in Hartford and in Columbus. | Cluster RCT | SOS programme, school based interactive intervention based on teaching materials and discussion guide, plus a screening instrument. | Health and social studies classes | Help-seeking behaviour | Questionnaire developed by the authors | Not significant effect of the program in help-seeking β = −0.01 p > 0.05 | Medium |
Freedenthal, 2010, United States. | 142 staff 146 student | Staff and students in High school in Denver area. | Pre and Post intervention survey Pilot study | Yellow-ribbon. School based, 25 min training, card with hotline numbers and t-shirt with mental health messages. | No intervention | Help seeking behaviours | Self-reported survey developed by authors | Not relevant | n/a |
Kalafat, 1994, United States | 253 | 10th grade high school students | Solomon four-group design | School based suicide awareness program. 3 psychoeducation sessions. | Physical education classes | Help seeking attitudes | Likert scale developed by the authors. | Significant effect of the intervention F (14,225) =1.87 p < .03 | Medium |
Schimidt, 2015, United States | 5949 | High school students (aged 10–18) | Pre and Post intervention design. Feasibility trial | Yellow-ribbon. School based, 25 min training, card with hotline numbers and t-shirt with mental health messages. | No control group | Help Seeking | 9 item scale developed for the study | -Not relevant | n/a |
Outreach interventions | |||||||||
Deane, 2007, Australia | 506 | 9th and 10th grade high school students | Post-test design | The Building Bridges to General Practice, school based. GP deliver one session to improve students perception. | No intervention | Help seeking intentions | Adapted version from the General Help Seeking Questionnaire (GHSQ) | Increased help-seeking intentions at follow-up F(2,217) = 3.04/ p < 0.05. | Medium |
Rughani, 2011, Australia | 260 | Year 11 high school students | RCT | Promoting Access to support seeking. School based, two 50 min sessions for building relationships with mental health professionals. | Alternative presentation | Help-seeking intentions | Items adapted from the General Help-Seeking questionnaire (GHSQ) | Short term improvement of help-seeking intentions F (14,225) =1.87 p < .03 | Medium |
Wilson, 2008, Australia | 291 | Year 11 students from 3 high schools in New South Wales | Quasi-experimental Nested design | The Building Bridges to General Practice, school based. GP deliver one session to improve students perception. | No intervention (year 10 students) | Help-seeking intentions | General Help Seeking Questionnaire (GHSQ) | Increased help-seeking intentions for psychological problems after the intervention F(2,598) = 4.31p < 0.01 | High |
Multimedia/Online interventions | |||||||||
Conrad, 2014, Germany | 532 | High school Students without history of mental health care | Quasi-experimental | Film festival aiming to give a podium to the topic mental health. | No control group | Help seeking attitudes | Seven items Linkert scale developed by authors | Not significant change in help-seeking t = 0.414 | Medium |
Nicholas, 2004, Australia | 243 | High school students aged 13 to 18. | Post-test design Feasibility trial | School based, classroom presentations of ReachOUT! Website. | No control group | Help-seeking behavioursintentions and the use if the website. | Questionnaire developed by authors | Not relevant | n/a |
Rowe, 2018, United Kingdom | 23 | Teens (aged 12–18) who had self-armed (last 12 months) and basic English speaker. | Two group parallel arm, single blind RCT.Feasibility trial. | My self-help tool. School based, web-personalised decision aid intervention designed to help identify help-seeking alternatives for self-harm. | General information about mood and feelings. | Help seeking intentions | General Help-Seeking Questionnaire (GHSQ). | Not relevant | n/a |
Santor, 2007a, Canada | 388 | Grade 8th high school students | Pre-post test design | School based help seeking workshop + Information website called “YooMagazine” | No intervention | Help-seeking attitudes | The Help Seeking Attitude Questionnaire | Positive effect of the intervention β = 0.108, F(1,1037) = 3.85 p < 0.04. | Medium |
Santor, 2007b, Canada | 455 | Grade 7th to 12th students | Pre and Post intervention survey design Feasibility trial | Information website called “YooMagazine” | No control group | Help-seeking behaviours | Help-seeking indicators (e.g: visits to school mental health) | Not relevant | n/a |
Wiljer, 2016, Canada. | – | Youth (16–29) college students | Two arm RCT.Study protocol | Thought Spot. College based, web and mobile platform | Usual care | Self-efficacy for mental health help-seeking | General Help-Seeking Questionnaire (GHSQ) | Not assessed | n/a |
Peer leader training interventions | |||||||||
Calear, 2016, Australia | – | 7 to 10 grade students (aged 12–15) | Two arm cluster RCT. Study protocol | The sources of Strength. School based, during 1 year (approx.) includes staff and peer leaders training and school messaging. | Waiting list (24 months). | Help seeking intentions | An adapted version of General Help -Seeking Questionnaire(GHSQ) | Not relevant | n/a |
O’reilly, 2016, Ireland | 30 | Teens aged 15–17 with interest in mental health, speaking skills. | Pre and Post intervention survey design Feasibility trial | School based, four 3 h workshop training peer leaders. | No control group | Stigma for help-seeking behaviours | Perception of Stigmatisation by Others FOR Seeking Help Scale (PSOSH) | Not relevant | n/a |
Parihk, 2018, United States | 878 | High school students | Quasi-experiment | P2P. School based, peer leaders develop a school public awareness campaign | No control group | Help seeking intentions | Adapted version of the P2P Depression Awareness Questionnaire | 78% of students will seek for help after the intervention p < 0.001 | Medium |
Wyman, 2010, United States | 2675 | High school students (aged 14 to 18) | RCT. | The sources of Strength. School based, during 1 year (approx.) includes staff and peer leaders training and school awareness campaign. | Waiting list | Acceptability of seeking help | Help Seeking from Adults scale created by authors | Positive effects on help-seeking from adults Mean differences (95%CI) =0.58 (0.24, 0.91). p = 0.04 | Medium |