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Table 2 Barriers and facilitators

From: What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

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