Explaining non‐help‐seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour

Abstract

Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non-help-seeking. Help-seekers and non-help-seekers were interviewed. The findings allowed development of an explanatory model -the cycle of avoidance (COA) -which contributes towards attempts to provide a dynamic understanding of help-seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non-help-seeking in terms of 'barriers' to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises helpseeking as a circular process and offers a model of 'non-help-seeking' in which lay conceptions of mental distress, the social meanings attached to 'help-seeking' and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non-help-seeking in other age groups and conditions, and other illness behaviours.

Beyond Ballistics

“…Notably, as dominant models continue to be emphasized, the empirical development of dynamic models of help seeking has been limited (Pescosolido & Boyer, 1999), though important examples do exist (e.g., Biddle et al, 2007). Furthermore, in accepting interactive subjectivities over time, this approach is complicated by the significant diversity and concurrency of illnessrelated needs, supports, and related processes shifting over the context of an illness experience, as well as the complexity of experiences and identities men bring into the process.…”

“…As Biddle et al (2007) noted, research can benefit from explicitly examining the perceptions and interpretations ("drivers of action") that move individuals away from supports rather than viewing these as barriers to the process. Awareness that perceptions of need and meanings of help can pull men from supports is implicit in existing research on men's help seeking, particularly in research adopting a social constructionist approach accepting health behaviors as performances of masculinity.…”

“…Rather than limiting focus to the initial doctor visit, the dynamic approach examines the illness career, or "pathways" of care guided by lay networks (e.g., friends, clergy), a range of "healers" (e.g., physicians, homeopaths), and remedies (Pescosolido, 1992) as individuals move toward recovery or, if a cure is not possible, enhanced quality of life (Aneshensel, 1999). Emphasizing descriptions rather than explanation, consideration is given to how individuals work with others to recognize and define needs, decide to seek help (or not), evaluate choices, and seek informal and formal support during illness (Biddle, Donovan, Sharp, & Gunnell, 2007;Broadhurst, 2003;Pescosolido, 1992). Integration of subjectivity allows that definitions can evolve over the course of illness and in response to shifting physical and psychological conditions, priorities and expectations (Price, 1996), interpretations, and other labels (Coreil, Bryant, & Henderson, 2001;Liang, Goodman, Tummala-Narra, & Weintraub, 2005).…”

Reconstructing the Temporal-Relational Context: Trans-Action Patterns of Caregivers of an Ill Relative with Alzheimer's Disease

“…This modern orientation of sociology has had repercussions for the evolution of conceptual models of helpseeking processes in health care. Beginning in the 1990s, these models have generally complemented traditional approaches that came under growing criticism for their reliance upon a static and individualistic approach founded on the concept of rational choice (Biddle, Donovan, Sharp, and Gunnell, 2007;Pescosolido, 1992;Shengelia, Tandon, Adams, and Murray, 2005). In contrast, the new models emphasize the dynamics of change and account for historical events and exchanges at the microsocial level (Berkman and Glass, 2000;Messeri, Silverstein and Litwak, 1993;Pescosolido, 1992).…”

Supporting the Process of Help-Seeking by Caregivers of Functionally Dependent Seniors Through eHealth: Protocol for a Multicentric Codesign (Preprint)

“…We find a number of works bearing on modelizations of the process of help seeking [16][17][18][19][20][21][22][23][24]. Nevertheless, there is no consensus on the greater relevance of any one model [25].…”