Help-Negation and Suicidal Ideation: The Role of Depression,Anxiety and Hopelessness

Help-negation is expressed behaviorally by the refusal or avoidance of available help and cognitively by the inverse relationship between self-reported symptoms of psychological distress and help-seeking intentions. The current study examined the association between suicidal ideation and intentions to seek help from friends, family and professional mental health sources in a sample of 302 Australian university students. Participants were 77.5% female and aged from 18–25 years old, with 85.4% aged 21 years or younger. Higher levels of suicidal ideation were related to lower help-seeking intentions for family, friends, and professional mental health care, and higher intentions to seek help from no one. Moderation effects indicated that higher levels of depressive symptoms strengthen the help-negating effect of suicidal ideation for seeking help from friends, family and no one. The results indicate that, even at subclinical levels, suicidal ideation impedes the cognitive help-seeking process at the decision making stage. The results also highlight the importance of improving our understanding of why young people become reluctant to seek help as their levels of suicidal ideation and depressive symptoms increase. Raising awareness that the experience of suicidal ideation and depressive symptoms can promote intentions to avoid help might reduce the help-negation effect when symptoms are first recognized.     

Adolescents’ Suicidal Thinking and Reluctance to Consult General Medical Practitioners

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13–18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.     

Socioeconomic Context, Social Support, and Adolescent Mental Health: A Multilevel Investigation

This study examined whether the impact of contextual-level socioeconomic disadvantage on adolescent mental health is contingent upon individual-level perceptions of social support. Data are from the National Longitudinal Study of Adolescent Health (Add Health), a panel survey of a nationally representative United States sample (analytic N=18,417) of students in 7th through 12th grade. Effects of social support and social context on both internalizing problems (depressive symptoms) and externalizing problems (minor delinquency and violent behavior) are analyzed. Contextual-level socioeconomic disadvantage is positively associated with depressive symptoms, negatively associated with minor delinquency, and not directly associated with violent behavior. High perceived support from family, friends, and other adults offsets poor mental health, but is most protective in areas of low socioeconomic disadvantage. The mental health benefits of perceived social support are dampened in socioeconomically disadvantaged areas, compared to advantaged areas. Results suggest that interventions targeting only individual- or family-level processes within disadvantaged contexts may be inadequate at stemming psychological distress among adolescents. Richard G. Wight, Assistant Research Sociologist, conducts life course mental health research in the UCLA Department of Community Health Sciences. His work emphasizes the intersection of individual- and contextual-level factors that impact health within dyads, families, and neighborhoods. Amanda L. Botticello is a doctoral student in the UCLA Department of Community Health Sciences, where her work addresses the reciprocal relationships between depressive symptoms and problem drinking among adolescents. Carol S. Aneshensel is a Professor of Community Health Sciences at UCLA, where she applies principals of social stratification and life course theory to the analysis of quantitative data to better understand disparities in mental health risks.     

Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers’ to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents’ mental health problems, and building community resources to enable all youth to participate in community life.     

Adolescents' Willingness to Seek Psychological Help: Promoting and Preventing Factors

Although a relatively high percentage of Australian adolescents experience mental health problems, many disturbed adolescents do not receive the help they require, and only a small proportion of adolescents seek professional psychological help. The present study examined adolescents' willingness to seek help and investigated factors that promote and prevent adolescents from seeking help for a mental illness from both formal and informal sources. Secondary school students (254 in number) from schools in Brisbane, Australia completed a questionnaire that examined the relationship between demographic and psychological variables, attitudes toward mental illness, and willingness to seek help for a mental illness. Results suggest that adolescents with greater adaptive functioning, fewer perceived barriers to help seeking, and higher psychological distress were more willing to seek help from formal and informal sources for a mental illness. Greater social support also predicted willingness to seek help from informal sources. Although attitudes toward mental illness did not influence willingness to seek help, less stigmatising attitudes were related to higher knowledge of mental illness, being female, and higher levels of social support. Implications for the present study focus on enhancing the ability of mental health interventions to increase adolescents' willingness to seek psychological help.Received PhD from The University of Queensland     

Stressful Life Events,Cognitive Appraisals,and Psychological Symptoms Among Chinese Adolescents in Hong Kong

Stressful life events, cognitive appraisals of the impact and desirability of these events, and psychological symptoms were assessed in a sample of 745 Chinese adolescents from six secondary schools in Hong Kong. Reporting that an average of eight events were experienced, these adolescents appraised that over half of these events were undesirable and had twice the impact of desirable events on their lives. These events were generally related to interpersonal problems in schools, in family, and with friends. While the appraisal of the subjective impact of these events was highly associated with the simple counting of events when event–symptom relationship was considered, the pessimistic appraisal of events had an independent and noninteractive effect on general and specific psychological symptoms. However, there was some evidence that positive events might moderate the effects of negative events on psychological distress. Implications of cognitive appraisals in coping with life stressors among Chinese adolescents are discussed.     

Young Adolescents' Situational Coping during Adult Intimate Partner Violence

A purposively recruited, ethnically diverse sample (N = 27) of young adolescents and their mothers in domestic violence shelters described adolescents' coping responses during adult intimate partner violence as part of a qualitative study using Life Story methods. Findings revealed competing demands and several responses, including: leaving home, collaborating with family members for safety, calling police, verbally or physically intervening, seeking help outside the family, and palliative responses. Participants provided context-rich accounts of coping and coping goals during violence, including information on help-seeking and police involvement. Implications are discussed for future research and developing interventions to improve safety and psychological outcomes.     

Measuring Barriers to Help-Seeking Behavior in Adolescents

To construct and validate an instrument that would measure barriers to help-seeking behavior in adolescents. Method: A 37-item questionnaire based on prior help-seeking literature was constructed to yield a total score indicating strength of barriers to help-seeking behavior. The instrument was given to a sample of 280 high school students following a pilot study of 65 students. Results: The instrument was found to have good test–retest and internal reliability and adequate validity in the tested population. It shows promise in helping to identify adolescents who may be amenable to, and opposed to, therapeutic intervention, and may aid in understanding which barriers to help seeking are most significant in any given population.     

Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment

Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9?% female, 46.9?% male; racial distribution 79.5?% Caucasian, 11.9?% Hispanic/Latino, and 3.6?% Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14?%) students reporting SI, only 23?% told an adult, 29?% sought adult help, and 15?% did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.     

Facilitating Help Seeking Behavior and Referrals for Mental Health Difficulties in School Aged Boys and Girls: A School-Based Intervention

Although the need for early intervention for mental health difficulties is widely acknowledged, few studies have attempted to explicitly increase actual help seeking behavior for mental health difficulties. Students in intervention classrooms received two one-hour, in-class workshops on distress and help seeking and were compared to students in non-intervention classrooms in a 2-level hierarchical model. More frequent help seeking behavior and more mental health referrals were observed among students in the intervention group than among students in the comparison group. Effects were moderated by the level of distress experienced by students, but not by help seeking attitudes, and could not be accounted for by school staff referrals or website utilization. Results showed that help seeking behavior for mental health difficulties and mental health referrals can be increased with only a moderate investment in time, but that benefits of school-based intervention may be greatest among students with specific needs, such as high levels of distress.

Mothers’ and Fathers’ Autonomy-Relevant Parenting: Longitudinal Links with Adolescents’ Externalizing and Internalizing Behavior

The goal of this study was to advance the understanding of separate and joint effects of mothers’ and fathers’ autonomy-relevant parenting during early and middle adolescence. In a sample of 518 families, adolescents (49 % female; 83 % European American, 16 % African American, 1 % other ethnic groups) reported on their mothers’ and fathers’ psychological control and knowledge about adolescents’ whereabouts, friends, and activities at ages 13 and 16. Mothers and adolescents reported on adolescents’ externalizing and internalizing behaviors at ages 12, 14, 15, and 17. Adolescents perceived their mothers as using more psychological control and having more knowledge than their fathers, but there was moderate concordance between adolescents’ perceptions of their mothers and fathers. More parental psychological control predicted increases in boys’ and girls’ internalizing problems and girls’ externalizing problems. More parental knowledge predicted decreases in boys’ externalizing and internalizing problems. The perceived levels of behavior of mothers and fathers did not interact with one another in predicting adolescent adjustment. The results generalize across early and late adolescence and across mothers’ and adolescents’ reports of behavior problems. Autonomy-relevant mothering and fathering predict changes in behavior problems during early and late adolescence, but only autonomy-relevant fathering accounts for unique variance in adolescent behavior problems.     

Psychological Distress Following Suicidality Among Gay,Lesbian, and Bisexual Youths: Role of Social Relationships

Longitudinal relations between past suicidality and subsequent changes in psychological distress at follow-up were examined among gay, lesbian, and bisexual (GLB) youths, as were psychosocial factors (e.g., self-esteem, social support, negative social relationships) that might mediate or moderate this relation. Past suicide attempters were found to have higher levels of depressive symptoms, anxious symptoms, and conduct problems at a later time than youths who neither attempted nor ideated. Psychosocial factors failed to mediate this relation. The interaction among past suicidality, social support, and negative relationships was associated with subsequent changes in all 3 psychological distress indicators 6 months later. Specifically, high levels of support (either from family or friends) or negative relationships were found to predict increased psychological distress among those with a history of suicide attempts, but not among youths without a history of suicidality. The findings suggest that GLB youths who attempt suicide continue to have elevated levels of psychological distress long after their attempt and they highlight the importance of social relationships in the youths psychological distress at follow-up.Earlier versions of this paper were presented at the biannual meeting of the European Association for Research on Adolescence, Oxford, UK, September 2002; and, at the annual meeting of the American Public Health Association, San Francisco, CA, November 2003.Associate Professor of Psychology, The City University of New York—The City College and Graduate Center. Received PhD in psychology from New York University. Research interests include the relation of identity to health, the intersection of multiple identities, and the relation of violence to health.Doctoral candidate in Social/Personality Psychology and Health Psychology, The City University of New York—Graduate Center. Research interests include the role of social relationships in the preservation of health and well-being.Research Scientist, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute; and Assistant Professor, Department of Psychiatry, Columbia University. Received doctorate in social welfare (DSW) from The City University of New York—Graduate Center. Research and clinical interests include the design and implementation of interventions for gay, lesbian, and bisexual adolescents.     

Sexuality Related Social Support Among Lesbian, Gay, and Bisexual Youth

Lesbian, gay, and bisexual (“LGB”) youth may face significant stressors related to their sexual orientation. Few studies, however, have examined youth’s experiences of support for coping with these stressors. The current study compared LGB youth’s perceptions of support for sexuality stress to their support for other types of problems. The links between sexuality stress, sexuality support, and emotional distress were also examined. Ninety-eight LGB youth (ages 18–21, 33% female) rated support from family, heterosexual friends, and sexual minority friends for dealing with problems related, and not related, to their sexuality. From family and heterosexual friends, support for sexuality stress was less available than support for other stressors. Sexual minority friends provided the highest levels of sexuality support. In regression analyses, higher levels of sexuality support related to decreased emotional distress and buffered against the negative effects of sexuality stress on emotional distress. Sexuality support, although less available than other types of support, may be especially relevant to mental health among LGB youth.     

Economic Hardship and Adolescent Problem Drinking: Family Processes as Mediating Influences

Alcohol is the most commonly used substance among adolescents in the United States, and adolescent drinking is associated with various health risk behaviors. Given the prevalence and consequences of adolescent drinking, understanding family factors that contribute to adolescent drinking is an important area for research. This study used three waves of data to evaluate a family stress model in which economic hardship is indirectly related to adolescent problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing behaviors. Respondents included 300 mothers (71 % Black, 29 % White) and adolescents (51 % male) who were interviewed when adolescents were ages 10, 14, and 16. Structural equation modeling was used to test the hypothesized model and findings supported our hypothesized model. Economic hardship was positively related to maternal psychological distress. Maternal psychological distress was negatively associated with supportive parenting, which in turn was negatively associated with externalizing problems. Externalizing problems were positively associated with problem drinking. In support of our hypothesis regarding indirect effects, economic hardship was indirectly related to problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing problems. The findings from this study highlight the role of family processes in adolescent problem drinking.     

Associations between Social Support from Family,Friends, and Teachers and depressive Symptoms in Adolescents

Approximately 20% of adolescents develop depressive symptoms. Family, friends, and teachers are crucial sources of social support for adolescents, but it is unclear whether social support impacts adolescents directly (principle-effect model) or by moderating the effect of stress (stress-buffer model) and whether each source of social support remains meaningful when their influence is studied simultaneously. To help fill this gap, we followed 1452 Australian students (average age at enrollment?=?13.1, SD?=?0.5; range: 11–16 years; 51.9% female) for 5 years. Based on our findings, each source of support is negatively related to depressive symptoms one year later when studied independently but when combined, only family and teacher support predicted depressive symptoms. Family support in all grades and teacher support in grade 8 to 10 but not in grade 11 directly impacted adolescent depressive symptoms 1 year later. Family support in grades 8 and 11 also buffered against the negative impact of stress on depressive symptoms one year later. Based on the unexpected findings, the most important limitations seem to be that the used instruments do not allow for a separation of different groups of friends (e.g., classmates, same-gender peers, romantic partners), types of social support, and stress. In addition, the high, nonrandom attrition rate with adolescents reporting less social support, more stressful events, a higher frequency of depressive symptoms, and/or being of Torres Strait Islander or Aboriginal background limits the generalizability of our findings. Summarized, our findings demonstrate that adolescents facing stress might benefit more from family support compared to their peers without stressful life events and that friends may have a weaker presence in adolescent lives than expected.     

Mental Health Literacy and Eating-Disordered Behavior: Beliefs of Adolescent Girls Concerning the Treatment of and Treatment-Seeking for Bulimia Nervosa

This research examined the “mental health literacy” of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking for the problem described. Results indicated that primary care practitioners, mothers and close female friends were most highly regarded as potential sources of help. Self-help interventions, including the use of vitamins and minerals, were also highly regarded, whereas participants were less positive about the benefits of mental health specialists and ambivalent about the use of anti-depressant medication. Most participants believed that the problem described would be difficult to treat, and that relapse was likely even given appropriate treatment. An additional finding of note was that among participants with a high level of eating disorder symptoms (n=36, 6.9%), recognition of an eating problem was poor. We conclude that beliefs likely to be conducive to low and/or inappropriate treatment-seeking for eating problems may be common among adolescent girls. In addition, the findings suggest that prevention programs for the eating disorders need to target not only at-risk individuals, but also individuals in their immediate social environment.     

Transactional Relations between Motivational Beliefs and Help Seeking from Teachers and Peers across Adolescence

Adolescents often avoid seeking academic help when needed, making it important to understand the motivational processes that support help seeking behavior. Using expectancy-value theory as a framework, this study examined transactional relations between motivational beliefs (i.e., academic self-concept or academic importance) and seeking help from teachers and peers across adolescence (i.e., from approximately age 12 to 17 years). Data were collected from 1479 adolescents (49% female; 61.9% African American, 31.2% European American, 6.9% other race). Analyses were conducted with cross-lagged panel models using three waves of data from seventh, ninth, and eleventh grade. Results indicated that both academic self-concept and academic importance were associated with increases in teacher help seeking in earlier adolescence, but were associated only with increases in peer help seeking in later adolescence. Help-seeking behavior positively influenced motivational beliefs, with teacher help seeking increasing academic self-concept earlier in adolescence and peer help seeking increasing academic importance later in adolescence. These transactional relations differed by adolescents’ prior achievement and racial background, but not by adolescents’ gender.     

The Dynamic Relationship between Unhealthy Weight Control and Adolescent Friendships: A Social Network Approach

Although adolescence marks a vulnerable stage for peer influence on health behavior, little is known about the longitudinal and dynamic relationship between adolescent friendship and weight control. The current study aims to explain these dynamic processes among a sample of 1156 American adolescents in grades 9–11 (48.6% girls, 23.4% European American, 25.2% African American) from the National Longitudinal Study of Adolescent Health. Stochastic actor-oriented models were fit to examine changes in friendship networks and unhealthy weight control across two waves. The findings support a bidirectional relationship where weight control predicts future friendship seeking and friendship seeking predicts future weight control. The findings also indicate that adolescents prefer friends with similar weight control patterns. Taken together, the results of the current study indicate that adolescent friendships play an integral role in the development of unhealthy weight control and thus can be used to identify adolescents at risk and serve as targets within preventive interventions.     

School Climate & Sexual and Gender Minority Adolescent Mental Health

Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay–Straight Alliance (a Gay–Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14–18 (mean age 15.77) where 53% of participants had a Gay–Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay–Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay–Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay–Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students.