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Where would young people seek help for mental disorders and what stops them? findings from an austra

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Journal of Affective Disorders 147 (2013) 255–261Contents lists available at SciVerse ScienceDirectJournal of Affective Disorders journal homepage:…
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Journal of Affective Disorders 147 (2013) 255–261Contents lists available at SciVerse ScienceDirectJournal of Affective Disorders journal homepage: www.elsevier.com/locate/jadResearch reportWhere would young people seek help for mental disorders and what stops them? Findings from an Australian national survey Marie Bee Hui Yap a,b,n, Nicola Reavley a,b, Anthony Francis Jorm a,b a bOrygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia Melbourne School of Population Health, University of Melbourne, Australiaa r t i c l e i n f oabstractArticle history: Received 21 August 2012 Received in revised form 12 November 2012 Accepted 12 November 2012 Available online 8 December 2012Background: In order to improve help seeking by young people for mental illness, a better understanding is required of their help-seeking intentions and barriers to their help seeking from various different sources and for different disorders. Methods: Young people’s help-seeking intentions and perceived barriers to help seeking were assessed by a national telephone survey of 3021 youths aged 15–25 years. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. Results: Embarrassment or shyness was the most frequently mentioned barrier to seeking help from most sources. However, different barriers featured prominently depending on the disorder and the helper. Age, sex, and knowing a family member or friend who had received professional help for mental illness predicted some barriers. Limitations: Help-seeking intentions and barriers were assessed with reference to a vignette character and may not reflect actual experience or behaviors. Conclusions: Findings can facilitate the targeting of future efforts to improve young people’s help seeking for mental disorders by highlighting the barriers that are more relevant for specific disorders, sources of help and personal characteristics. & 2012 Elsevier B.V. All rights reserved.Keywords: Treatment Youth Depression Anxiety disorder Barriers1. Introduction Half of all lifetime case-level mental disorders start by age 14 and three quarters by age 24, with affective disorders having the highest lifetime prevalence (29% and 25% for anxiety and depressive disorders respectively; Kessler et al., 2005). Moreover, recent evidence has highlighted that mental disorders are the largest contributors to disability in young people (Mathews et al., 2011). In particular, the long-term sequelae of mental disorders are often exacerbated by delayed help seeking or the lack thereof (de Girolamo et al., 2012; Harris et al., 2005). In order to more effectively target messages to increase appropriate help seeking by young people, a better understanding of what stops young people from seeking help and the predictors of this is required. A recent review revealed that stigma, embarrassment, problems recognizing symptoms (poor mental health literacy), and a preference for self reliance are the most important barriers to help seeking by young people (Gulliver et al., 2010). However, the review, like other more recent studies (Downs and Eisenberg, 2011; n Correspondence to: Population Mental Health Group, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia. Tel.: þ61 4 11989022; fax: þ61 3 9349 5815. E-mail address: mbhy@unimelb.edu.au (M.B.H. Yap).0165-0327/$ - see front matter & 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2012.11.014Evans et al., 2011; Mojtabai et al., 2011; Prins et al., 2011), focused primarily on professional help seeking. Although they are the ideal source of help for mental disorders, professionals are often not the first port of call for young people, who prefer to go to family or friends for help (Rickwood and Braithwaite, 1994; Rickwood et al., 2007). In some cases, these informal sources of help may be the only ones that young people would turn to, hence it is important to examine the barriers that might stop young people from seeking help, even from close others like family and friends, especially if they can become conduits to appropriate professional treatment (Rickwood et al., 2007). Another limitation of extant research on barriers to help seeking is the focus on more prevalent disorders like depression, anxiety or general ‘mental distress’, or an undifferentiated cluster of psychiatric disorders (Gulliver et al., 2010; Mojtabai et al., 2011; Prins et al., 2011). Some recent exceptions have examined suicidal college students (Downs and Eisenberg, 2011) and young women with eating disorders (Evans et al., 2011), and revealed some similarities but also some interesting differences in reported barriers compared with studies that focused on more prevalent or undifferentiated disorders. However, in a 2006 national survey of Australian youth, Jorm et al. (2007) found little differences in barriers for four different vignettes: depression, social phobia, psychosis, and depression with alcohol abuse.256M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261Research examining perceived barriers to help seeking for different disorders is required to clarify whether barriers vary according to the type of disorder. Finally, not many studies have examined predictors of these barriers. Using data from the National Comorbidity Survey Replication of the US general population, Mojtabai et al. (2011) found that age (18–49 versus Z50 years) and severity of mental disorder amongst adults with 12-month DSM-IV disorders significantly predicted structural barriers to help seeking such as inconvenience, cost, and availability. However, attitudinal or evaluative barriers such as stigma or preference for self reliance were not predicted by sociodemographic variables or severity of disorder. Research on predictors of young people’s perceived barriers to help seeking is lacking, hence it remains unclear how efforts to minimize or remove these barriers and increase appropriate help seeking can be most effectively targeted. The current study seeks to address these gaps by examining young people’s help-seeking intentions and their barriers for a range of mental disorders and from various formal and informal sources, using data from a 2011 national survey of Australian youth. To identify subgroups of young people who may need to be targeted in future efforts to improve help seeking, we examined age, sex, psychological distress, and exposure to mental health problems in close family or friends (including whether professional help was received) as potential predictors of help-seeking intentions and their barriers.2. Methods 2.1. Participants The survey involved computer-assisted telephone interviews with 3021 young people aged between 15 and 25 years. The survey was carried out by the survey company Social Research Centre using random-digit dialing of both landlines and mobile phones covering the whole of Australia from January to May, 2011. Up to six calls were made to establish contact. The response rate was 47.9%, defined as completed interviews (3021) out of sample members who could be contacted and were confirmed as in scope (6306). Interviewers ascertained whether there were residents in the household within the age range and, if there were multiple, selected one for interview using the nearest-birthday method.2.3. Potential predictors of help-seeking intentions and barriers Given that age, sex, and personal exposure to mental disorders have been found to be associated with mental health literacy (Jorm et al., 2007; Jorm and Wright, 2008; Yap et al., 2011), young people were asked a range of questions to ascertain this information. Information about respondent sex and age (in years) was collected as part of the interview. To assess their lifetime exposure to mental health problems in family or friends, respondents were asked: ‘‘Has anyone in your family or close circle of friends ever had a problem similar to John’s/ Jenny’s?’’ and ‘‘Have they received professional help or treatment for these problems?’’. Responses were coded such that no experience of a similar problem¼0; having had a similar problem but not received any help¼1; and having had a similar problem and received help¼2. Respondents also reported on their psychological distress in the past 30 days using the interviewer– administered K6 questionnaire (Kessler et al., 2002). Responses were summed to give a score out of 24. 2.4. Content analysis of responses to open-ended questions Responses to where respondents would go for help were coded based on categories identified from the 2006 survey (Jorm et al., 2007), with additional categories formed that were relevant to the different mental disorders studied. Responses were coded with a ‘‘yes’’ or ‘‘no’’ in each category, so that multiple categories were possible. Categories included family, such as parents, spouse, or relative, general practitioner (GP)/doctor, psychologist, psychiatrist, mental health specialist/ service, counselor, helpline, teacher/ lecturer, and friend. Categories of barriers to seeking help were informed by barriers identified in previous research in adolescents (Kuhl et al., 1997; Sheffield et al., 2004; Wright et al., 2006), and included:# structural barriers such as cost, distance to travel, and difficulty in getting an appointment;# stigma-related barriers such as concern that the person might#2.2. Survey interview The interview was based on a case vignette of a young person (John or Jenny) with a mental disorder. On a random basis, respondents were read one of six vignettes—depression, depression with suicidal thoughts, depression with alcohol abuse, social phobia, PTSD, or psychosis (early schizophrenia)—portraying a person aged 15 years (for participants aged 15–17 years) or 21 years (for participants aged 18–25 years) of the same sex as the respondent (Reavley and Jorm, 2011b). All respondents were then asked a series of questions that assessed sociodemographic characteristics, mental health literacy, stigma, exposure to mental disorders, beliefs about interventions, and prevention for the mental disorder in the vignette, psychological distress (using the K6 screening scale; Kessler et al., 2002), and exposure to mental health media campaigns. Here, we report only on help-seeking intentions and perceived barriers. Young people were asked: ‘‘If you had a problem right now like (John/Jenny), would you go for help? Where would you go? What might stop you from seeking help from this (person/ service)?’’.#feel negatively about you, concern about what other people might think of you seeking help from the person, being too embarrassed/shy, and denial/pride; barriers related to treatment or support offered, such as concern that the helper might not be able to help (e.g., what they say might be wrong, lack of empathy or understanding, the problem involves the helper, lack of confidence in the helper’s competence), concern about treatment side effects, not liking the type of treatment expected to be offered, and thinking that nothing can help; and other barriers such as negative feelings/self-perceptions (e.g., fearing trouble, fearing the diagnosis, shame or guilt, lack of confidence, and apprehension about confiding in a stranger), confidentiality/privacy, the illness or symptoms themselves, difficulty talking about the problem, lack of insight about the problem, and wanting to deal with it themselves.2.5. Statistical analysis The data were analyzed using percent frequencies and standard errors of respondents who reported that they would seek help from various formal and informal sources for each of the six vignettes. Given that barriers to help seeking may vary according to the source of help, the data were also analyzed using percent frequencies and standard errors of respondents who reported each barrier for each help source separately for the six vignettes. Patterns of findings will only be discussed if the error bar of a particularM.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261vignette overlaps with the error bar of no more than one other vignette to which it is contrasted. Sample weights were not applied to the above analyses because the data apply only to those intending to seek a particular type of help, not to the whole population. We then conducted binary logistic regressions to explore whether age in years, sex, psychological distress (K6 score), and exposure to mental disorders and professional treatment in family or friends predicted the intention to seek help from various sources and the barriers to help seeking, after controlling for the vignette given. In each regression, the intended source of help or the barrier was the dichotomous dependent variable, and all five predictor variables were entered simultaneously. Age in years and K6 score were continuous variables, vignette had six categories (reference category: depression), sex was dichotomous (reference: males), and exposure to mental disorders had three categories as described above (reference: no disorder). All analyses were performed using Intercooled Stata 12 (StataCorp, 2011). Given the large number of associations evaluated, the po0.01 level was used in order to minimize the chance of Type I errors.257most commonly mentioned source of help in all but the psychosis and depression with alcohol abuse vignettes, where GPs were also frequently mentioned. GP was the most frequently mentioned source of professional help in all but the anxiety disorder vignettes, where counselors were more frequently mentioned. In descending order, the most common barriers (i.e., reported by at least 5% of respondents) to seeking help from any source were: being too embarrassed or shy (27%), concern that the helper might feel negatively about them (11%), no barrier (10%), structural barriers (7%), negative emotions or self-perceptions (7%), concern that the helper might not be able to help (6%), and concern about what others think (5%). Fig. 2 presents percent frequencies of respondents who reported these barriers for each help source, separately for the six vignettes. Overall, embarrassment was most frequently mentioned as a barrier to seeking help from most of the sources, especially by respondents given the depression with alcohol abuse and social phobia vignettes. Regardless of the vignette, structural barriers were more commonly mentioned for formal than for informal sources of help. 3.1. Barriers to seeking help from a GP2.6. Ethics Oral consent was obtained from all respondents before commencing the interview. Respondents aged below 18 years could only commence their interviews after their parents provided oral consent. This study was approved by the University of Melbourne Human Research Ethics Committee.3. Results The 3021 respondents were randomly assigned to one of six vignettes as follows: depression 506, depression with suicidal thoughts 502, depression with alcohol abuse 499, social phobia 507, PTSD 506, and psychosis 501. Fig. 1 shows the percent frequencies and standard errors of young people who reported that they would seek help from five of the most frequently mentioned sources, GP, counselor, mental health professional, family and friend, separately for each vignette. Family was theRespondents given the depression with alcohol abuse vignette were more likely than those given other vignettes (except the psychosis vignette) to report embarrassment as a barrier. Respondents given the psychosis vignette were also more likely to be concerned that the GP might feel negatively about them. Respondents given the depression vignette were more likely to mention structural barriers; whereas those given the social phobia vignette were more likely to report having negative emotions or selfperceptions about seeking help from a GP. 3.2. Barriers to seeking help from a counselor Respondents given the depression with alcohol abuse vignette were more likely to mention embarrassment as a barrier, compared to the psychosis and both anxiety vignettes. Respondents given the psychosis, social phobia, or depression with alcohol abuse vignettes were less likely to report that nothing would stop them from seeking help from a counselor. Whilst none of the respondentsFriend (n = 479) Depression Family (n = 1033)Depression with suicidal thoughts Depression with alcohol abuseMental Health Professional (n = 298)Social Phobia PTSD PsychosisCounsellor (n = 456)GP (n = 704) 0%20%40%60%Fig. 1. Percent frequencies (with standard error bars) of respondents who would seek help from various formal and informal sources for different mental disorder vignettes. Note: n’s refer to the number of respondents who indicated an intention to seek help from each source of help. GP¼ General practitioner/doctor; PTSD ¼posttraumatic stress disorder.258M.B.H. Yap et al. / Journal of Affective Disorders 147 (2013) 255–261What others thinkWhat others think Depression Helper can't helpDepression with suicidal thoughtsNegative emotions/selfperceptionsDepression with alcohol abuseStructural barriersSocial PhobiaNo barriersDepression Depression with suicidal thoughtsHelper can't help Negative emotions/selfperceptionsDepression with alcohol abuseStructural barriersSocial PhobiaNo barriersPTSDPTSD Helper's negative reactionPsychosisPsychosisHelper's negative reaction EmbarrassmentEmbarrassment 0%10%20%30%40%50%0%Proportion of respondents who mentioned each barrier to seeking help from a GPWhat others thinkDepression Depression with suicidal thoughtsHelper can't help Negative emotions/selfperceptionsDepression with alcohol abuseStructural barriersSocial PhobiaNo barriers20%30%40%50%What others think DepressionHelper can't helpDepression with suicidal thoughtsNegative emotions/selfperceptionsDepression with alcohol abuseStructural barriersSocial PhobiaNo barriersPTSD PsychosisHelper's negative reaction10%Proportion of respondents who mentioned each barrier to seeking help from a mental health professionalPTSDHelper's negative reactionPsychosisEmbarrassmentEmbarrassment 0%10%20%30%40%50%0%10%20%30%40%50%Proportion of respondents who mentioned each barrier to seeking help from their familyProportion of respondents who mentioned each barrier to seeking help from a counselorWhat others think Depression Helper can't helpDepression with suicidal thoughtsNegative emotions/selfperceptionsDepression with alcohol abuseStructural barriersSocial PhobiaNo barriersPTSD Helper's negative reactionPsychosisEmbarrassment 0%10%20%30%40%50%Proportion of respondents who mentioned each barrier to seeking help from their friends Fig. 2. Percent frequencies (with standard error bars) of respondents who reported the seven most common barriers for each of the five sources of help, separately for the six vignettes. GP Âź General practitioner/doctor; PTSD Âźpost-traumatic stress disorder.given the PTSD vignette was concerned about what others might think about them seeking help from a counselor; in contrast 15% of respondents given the social phobia vignette were. 3.3. Barriers to seeking help from a mental health professional Respondents given the depression, depression with alcohol abuse, and social phobia vignettes were more likely to feel embarrassed. Respondents given the depression vignette were most likely to report being concerned about the specialist feelingnegative about them; whereas those given the depression with suicidal thoughts vignette were more likely to mention structural barriers. Respondents given the social phobia vignette were more likely to be concerned about what others might think of them seeking help from a specialist. 3.4. Barriers to seeking help from their family Respondents given the social phobia vignette were m
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