Intentions and barriers to help-seeking in children and adolescents differing in depression severity: Cross-sectional results from a school-based mental health project

Abstract

Background: Mental health problems, such as depression, have a high prevalence in children and adolescents (C&A). However, the majority of C&A suffering from depression do not seek professional help. In addition to general barriers, the specific psychopathology related to depressive symptoms may decrease their intentions to seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between C&A with different levels of depressive symptoms. Methods:This cross-sectional study is part of a large-scale, multi-center project. Participants were N = 9,509 C&A who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, C&A were allocated to the following three subgroups: a) without depressive symptoms, b) with subclinical symptoms, c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior (AHSQ), help-seeking intentions (GHSQ) and perceived barriers (Barriers questionnaire) between those different subgroups. A qualitative content analysis examined text answers on other perceived barriers to help-seeking. Results:Participants were mostly female (n = 5,575, 58.6%) and 12 to 24 yearsold (M =15.09, SD = 2.37). Participants with different levels of depressive symptoms differed significantly in help-seeking behavior, intentions and perceived barriers. Specifically, participants with clinical depressive symptoms reported more previous help-seeking, but lower intentions to seek help compared to participants without symptoms (all p < .05). Participants with subclinical depressive symptoms reported a similar frequency of previous help-seeking, but higher intentions to seek help compared to participants without symptoms (all p <.05). Perception of barriers was different across subgroups: participants with clinical and subclinical depressive symptoms perceived the majority of barriers such as stigma, difficulties in accessibility, and family-related barriers as more relevant than participants without depressive symptoms. Across all subgroups, participants frequently mentioned intrapersonal reasons, a high need for autonomy, and a lack of mental health literacy as barriers to help-seeking. Conclusions: C&A with higher levels of depressive symptoms are more reluctant to seek professional help and perceive higher barriers. This underlines the need for effective and low-threshold interventions to tackle barriers, increase help-seeking, and lower depressive symptoms in C&A differing in depression severity. Trial Registration: DRKS00014685