Table 2 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 |