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Running Head: FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF
PROFESSIONAL HELP
Factors Influencing Young People’s Choice of Professional Help for Mental Health
Concerns
Sally R. Bradford
University of Canberra
2011
Submitted in partial fulfilment of the requirement for the degree of Bachelor of Science
in Psychology (Honours)
I declare work presented in this thesis is my own work and does not include materials
from published sources without proper acknowledgement.
Sally Bradford
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
Abstract
It is well established that young people have high rates of mental health problems and
low rates of service utilisation. This study investigated whether young people have a
stronger preference for help online, face-to-face, over the phone, or not seeking help.
Further, this study tested whether an intention to seek help online could be predicted by
higher levels of self-stigma, self-reliance and shyness, and lower levels of emotional
competency and mental health literacy. A non-experimental cross-sectional survey
design was used. Participants were 231 students, aged 15–19 years, from three schools
across Canberra, ACT. Results indicated that participants had the strongest preference
for face-to-face help, followed by a preference not to seek help, help online, then help
over the phone. However, preferences did not match behavioural intentions, with
participant‟s highest intention to not seek help at all. In addition, the identified help-
seeking barriers were found to account for 14% of the variance in intentions to seek
help online, and 19% of the variance in an intention not to seek help. Results also
showed that gender differences within help-seeking preferences and the predictor
variables may not be as large as previously identified. The findings suggest that
organisations need to continue providing help face-to-face, whilst trying innovative
methods to promote and provide services online in an attempt to attract the large group
of young people still unwilling to seek help.
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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Acknowledgements
Firstly, I‟d like to thank my supervisor Debra Rickwood for her wealth of
knowledge, encouragement, and unfailing support. I would also like to thank John
Leyshon, Martin Watson, Denis Dickinson, Bernard Walsh and the students of Radford
College, UC Senior Secondary College Lake Ginninderra and UC High School Kaleen
for allowing me into their schools and classrooms. Thank-you also to Lisa Kelly and
headspace ACT for providing a link to my survey on the headspace website. To all my
family and friends, thank-you for your support throughout the years, and this year in
particular. Finally, to the greatest supports in my life, my mum Jenny, and my partner
Jonesy. Mum, thank you for your unfailing financial and emotional support; I know that
I can always turn to you. Jones, you are my best friend and you make me laugh every
day, I love you and cannot thank you enough for all your support.
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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Contents
Abstract ............................................................................................................................. ii
Acknowledgements ......................................................................................................... iii
Contents ........................................................................................................................... iv
List of Tables ................................................................................................................... vi
List of Figures ................................................................................................................. vii
List of Appendices ......................................................................................................... viii
Introduction 1
Factors Affecting Help-Seeking ................................................................................... 3
Gender. ..................................................................................................................... 4
Self-Stigma. .............................................................................................................. 4
Emotional Competence............................................................................................. 6
Mental Health Literacy. ............................................................................................ 7
Self-Reliance. ........................................................................................................... 8
Shyness. .................................................................................................................... 9
Overcoming Barriers .................................................................................................. 10
Face-to-Face Help................................................................................................... 10
Help Over the Phone. ............................................................................................. 11
Help Online. ........................................................................................................... 11
Preferences.................................................................................................................. 15
The Current Study ...................................................................................................... 16
Method ............................................................................................................................ 17
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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Participants ................................................................................................................. 17
Measures ..................................................................................................................... 18
Help-Seeking Intentions. ........................................................................................ 18
Help-Seeking Preferences....................................................................................... 19
Self-Stigma. ............................................................................................................ 19
Emotional Competency. ......................................................................................... 20
Mental Health Literacy. .......................................................................................... 20
Self-Reliance. ......................................................................................................... 22
Shyness. .................................................................................................................. 22
Design and Procedure ................................................................................................. 22
Results ............................................................................................................................ 24
Preferences for Help Sources ..................................................................................... 25
Intentions to Use Each Help Source ........................................................................... 28
Gender Differences in the Predictor Variables ........................................................... 30
Correlations Between the Study Variables ................................................................. 31
Predictive Model of Help-Seeking Intentions ............................................................ 33
Discussion ....................................................................................................................... 36
Limitations of the Study ............................................................................................. 44
Future Research .......................................................................................................... 45
Conclusion .................................................................................................................. 46
References 47
Appendix ........................................................................................................................ 62
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
List of Tables
Table 1 Psychometric Properties of the Study Variables 25
Table 2 Pairwise Contrasts of Help-Seeking Intentions by Help-Seeking
Source 30
Table 3 Summary of the Intercorrelations of the Study Variables 33
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
List of Figures
Figure 1 Hypothesised mediated relationship of gender with help-seeking
intentions 17
Figure 2 Preference for each help source by gender 28
Figure 3 Intentions to use each help-seeking source 29
Figure 4 Hypothesised model predicting intentions to seek help online, face-to-
face and to not to seek help 34
Figure 5 Final path model predicting intentions to seek help online, face-to-face
and to not seek help 36
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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List of Appendices
Appendix A Adolescent Help-Seeking Survey 62
Appendix B University of Canberra Committee for Ethics in Human Research
Letter of Ethical Approval 77
Appendix C ACT Department of Education and Training Letter of Ethical
Approval 74
Appendix D Letter of Invitation to Parents and Guardians 76
Appendix E Research Participant Information Sheet 78
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
The reluctance of young people to seek help for their mental health problems is
well documented. Their lack of service use is concerning since the 16 to 24 year age
group has the highest prevalence rates of 12-month mental disorders (Australian Bureau
of Statistics [ABS], 2007). In addition, this time of life is an important developmental
period which may be adversely affected by these problems. A number of barriers to
help seeking have been identified, some of which may be overcome by providing
services through mediums other than the traditional face-to-face approach. What has
not been identified is whether young people actually prefer these alternate sources, such
as online or phone lines, and the characteristics of those young people who intend to use
each source. By understanding the characteristics of young people who are most likely
to use non face-to-face mediums, organisations may be able to address some of the help
seeking barriers, and tailor their services in order to provide more effective treatments.
The majority of young people aged 16 to 24 years are either dealing with mental
health problems themselves or know someone who is. Mental health problems are
pervasive with the 2007 Australian National Survey of Mental Health and Wellbeing
(NSMHWB) finding that 26.4% of Australians aged 16 to 24 will have a mental health
disorder in any 12-month period (ABS, 2007). In particular, affective disorders are
common with 6.3% of 16 to 24 year olds meeting the criteria for a mood disorder during
any 12-month period. Further, a study of mental disorders and their prevalence rates
among US citizens found that the median age of onset for any disorder was 14 years,
with 75% of all mental disorders having an age of onset by 24 years (Kessler et al.,
2005).
Unfortunately, the high prevalence rates of mental illnesses do not result in high
rates of service utilisation, particularly for males. The 2007 NSMHWB found that only
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HELP
13.2% of males aged 16 to 24 years who identified as having a mental disorder had
sought professional help. The rates are considerably better, but still low for females of
the same age group with only 31.2% seeking help (Slade et al., 2009). These low rates
of service utilisation were also identified by Tanielian et al, (2009) who found that only
25.1% of American adolescents with depression were currently receiving treatment.
Similar concerning results have been found in New Zealand (Oakley Browne, Wells,
Scott, & McGee, 2006), and Canada (Cheung & Dewa, 2007).
In order to receive treatment and support for a mental health problem,
individuals must first seek out help. Help-seeking is the behaviour of actively
communicating with others in order to gain advice, information, treatment, or general
support for a particular problem (Rickwood, Deane, Wilson, & Ciarrochi, 2005). In this
sense, help-seeking is unlike other social interactions as it is intensely personal, often
requiring the help-seeker to disclose very personal thoughts and feelings. Help-seeking
can occur both formally, through professional sources, and informally through social
relationships, and requires a number of steps and responses (Rickwood, et al., 2005).
For example, the individual must first be aware that a problem exists, and realise they
may require outside intervention. They must then be able to express what the issue is to
a source that is both approachable and available.
Appropriate help-seeking behaviours are important protective factors as they are
likely to lead to professional and social supports which will reduce psychological
distress and ultimately improve mental well-being (Wilson, Deane, Ciarrochi, &
Rickwood, 2005). The low rate of adolescents who seek help is therefore concerning
for a number of reasons. Adolescence is a time of change as young people find their
way into new social roles. They are finishing school, gaining work and new financial
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
autonomy, moving out of the family home, and beginning new relationships (Burns &
Field, 2002; Rickwood, White, & Eckersley, 2007). Since mental health problems have
been related to impaired peer relations, low self-esteem, low attention, and difficulties
in school (Strauss, Frame, & Forehand, 1987), even mild issues can cause social,
emotional, and cognitive changes during this pivotal developmental period (Rickwood,
et al., 2005; Sawyer, 2004). In addition to affecting the normal development of young
people, mental health problems have also been associated with increases in smoking and
substance abuse (ABS, 2007). The serious long term consequences that may emerge due
to untreated mental health problems makes it clear that we need to identify and
understand the barriers to help-seeking in order to improve rates of service utilisation.
Factors Affecting Help-Seeking
A wide range of factors have been investigated for their impact on help-seeking.
Particularly strong and consistent evidence has been found for the effects of gender,
self-stigma, emotional competency, mental health literacy, self-reliance and social
competencey. These factors have been identified as they aid or disrupt the skills and
phases required to complete the help seeking process (Srebnik, Cauce, & Baydar, 1996).
Levels of mental health literacy and self-reliance are important as the potential help
seeker must have some understanding of mental health problems in order to recognise
that a problem exists, and then decide that they require outside support (Rickwood,
Deane, & Wilson, 2007). In addition, they need to know who to turn too, what the
process will be (Gould et al., 2004), and believe that it will help (Prochaska &
DiClemente, 1982; Wilson, Deane, & Ciarrochi, 2005). Help-seekers also require
appropriate levels of emotional competency in order to describe their problem and
emotions to others (Rickwood, et al., 2005). Further, social competence and self-stigma
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
are important as young people need to be confident enough to ask others for help
(Wilson & Deane, 2001) and, cannot be too concerned about the potential stigma they
may encounter by doing so (Hickie, Luscombe, Davenport, Burns, & Highet, 2007).
Gender. Women have regularly been identified as being more likely to self-
disclose (Valkenburg, Sumter, & Peter, 2011) and seek help for their mental health
problems than males (ABS, 2007; Angst et al., 2002; Rickwood, 1995). This is most
evident in the 16 to 24 years age group with females being almost two and a half times
more likely to seek help than males (ABS, 2007). The gender difference could be
attributed to the differences in prevalence rates of mental disorders, with approximately
30% of females within the 16 to 24 years group experiencing a 12-month mental health
problem, compared to 23% of males (Slade, et al., 2009). However, it may also be
associated with gender differences which have been identified in levels self-stigma
(Corrigan & Watson, 2007), emotional competency (Ciarrochi, Wilson, Deane, &
Rickwood, 2003), mental health literacy (Burns & Rapee, 2006), and self-reliance
(Rickwood, Deane, et al., 2007).
Self-Stigma. Stigma has been argued to be a strong factor affecting help seeking.
Stigma is a multidimensional construct which is affected by different influences and is
expressed through a range of behaviours (Jorm & Wright, 2008). Generally, stigma has
been defined as a process in which cue elicited stereotypes create attitudes of prejudice
and discrimination (Corrigan, 2004). Specifically, public stigma, personal stigma, and
most recently, self-stigma have been conceptualised as separate constructs. Public
stigma occurs when an individual believes others in the community hold stigmatising
attitudes about mental illnesses (Corrigan, 2004). Personal stigma transpires when an
individual holds those stigmatising views themself (Golberstein, Eisenberg, & Gollust,
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
2009). Self-stigma occurs when an individual internalises their own negative attitudes,
and applies the corresponding stereotypes and prejudices to themself (Eisenberg, Downs,
Golberstein, & Zivin, 2009; Jorm, Barney, et al., 2006).
The empirical literature has shown inconsistencies in the relationship between
stigma and help-seeking, however, these inconsistencies may be a result of the varied
conceptualisations of the construct. Since self-stigma has been defined as separate
construct, a strong relationship with help-seeking behaviours has been identified
(Corrigan, 2004; Eisenberg, et al., 2009). Self-stigma has been suggested as a barrier to
help-seeking because of the strong beliefs people hold about the differences between
people with a mental illness („them‟) and those without („us‟) (Corrigan, 2004; Pinfold
et al., 2003). Corrigan suggests that people who hold these strong „us‟ and „them‟
beliefs will do everything in their power to stop from becoming one of „them‟ and
facing social disapproval. Consequently, these people refuse to seek help.
Self-stigma may be a particularly important factor for young people as they
have been identified as being extremely concerned about their problems becoming
public (Deane, Wilson, & Ciarrochi, 2001). This fear of others becoming aware of their
problems has been identified as a significant reason for students to refuse readily
available services such as their school counsellor. School counsellors‟ offices are often
in a very public place within the school and consequently many young people do not
utilise their services due a lack of confidentiality and anonymity (Rickwood, et al., 2005;
Ybarra & Suman, 2008). Further, students state that they are concerned that the
counsellor will discuss their issues with other teachers. The effects of self-stigma on
help-seeking behaviours may be even stronger for males, who have been identified as
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
having significantly more stigmatising and prejudicial attitudes than females (Corrigan
& Watson, 2007; Schweitzer, Perkoulidis, Krome, Ludlow, & Ryan, 2005).
Emotional Competence. Emotional competency has been identified as a barrier
to help-seeking as potential help-seekers need to identify their feelings and be able to
describe them to others in order to successfully seek help (Rickwood, et al., 2005).
Emotional competence has been defined as the “…ability to perceive emotions, and the
ability to manage self-relevant emotions and to manage others‟ emotions in a socially
acceptable way…” (Ciarrochi & Deane, 2001, p. 234). There are two opinions in how
emotional competence affects help-seeking. Firstly, people low in emotional
competence could have the highest intentions to seek help because they feel less capable
of coping. Conversely, people low in emotional competence may have lower levels of
help-seeking as they have fewer social supports, fewer positive past help-seeking
experiences, and are more embarrassed than those higher in emotional competence
(Ciarrochi, Heaven, & Supavadeeprasit, 2008; Rickwood, et al., 2005). The latter is
supported within the literature with Ciarrochi and Deane (2001) finding that managing
self-relevant emotions was related to a willingness to seek help for suicidal ideation.
This was further supported in Ciarrochi et al. (2003), where higher emotional
competence was found to be associated with higher intentions to seek help in young
people aged 14 to 16 years.
Emotional competence has been found to be generally higher in females
(Ciarrochi & Deane, 2001; Ciarrochi, et al., 2003) and connected to self-stigma. For
example, Ciarrochi, Chan, and Bajgar (2001) found that females had greater skill at
perceiving emotions, regulating others‟ emotions, and utilising emotions, than males.
Further, females appear to be more willing to use emotional labels (Burns & Rapee,
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
2006). Females have also been identified as believing that emotional outlets such as
laughing, crying, and shouting are of greater benefit for emotional problems, than males
believe they are (Angst, et al., 2002). As low emotional competency has also been
associated with a fear of embarrassment (Rickwood, et al., 2005), it is likely that low
emotional competency would be related to higher levels of self-stigma.
Mental Health Literacy. Mental health literacy has been identified as an
important factor in help seeking. „Mental health literacy‟ refers to the “knowledge and
beliefs about mental disorders which aid their recognition, management or prevention”
(Jorm et al., 1997). It encompasses the ability to “recognise specific disorders, knowing
how to seek mental health information, knowledge of the risk factors and causes of self-
treatments and of professional help available, and attitudes that promote recognition and
appropriate help-seeking” (Jorm, et al., 1997). Mental health literacy is important as
the information and knowledge that individuals have on mental health problems can
have a significant impact on the way that they identify and come to terms with their
symptoms (Burns & Rapee, 2006), seek help and stay in control of their treatment
(Rickwood, Deane, et al., 2007), and cope with the changes in their life (Jorm, Barney,
et al., 2006; Korp, 2006).
Mental health literacy tends to be higher in females and has been associated with
lower levels of self-stigma. For example, females have been found to have greater
awareness of available help sources such as beyondblue (Jorm, 2009). Males have also
been identified as being less likely to correctly recognise symptoms of psychosis
(Cotton, Wright, Harris, Jorm, & McGorry, 2006). This was most pronounced for
males aged 18 to 25 years. The connection between mental health literacy and self-
stigma has emerged due to the argument that increasing individual knowledge around
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
mental health problems will decrease feelings of stigma and increase help seeking
behaviours (Burns, Durkin, & Nicholas, 2009; Jorm, Barney, et al., 2006; Wilson &
Deane, 2001).
Self-Reliance. Higher levels of self-reliance have been identified as a barrier to
help seeking due to the belief that one should be able to cope with their problems alone
(Wilson, Deane, & Ciarrochi, 2005). As teenagers progress through their adolescent
years there is a natural transition from relying on parents, to self-reliance and autonomy
(Rickwood, Deane, et al., 2007; Steinberg & Silverberg, 1986; Wilson, Deane, &
Ciarrochi, 2005). Therefore, as young people move through this developmental period
they are likely to increase their belief that they should be able to cope alone, and
consequently are less likely to seek help. For example, in a study conducted by Gould
et al. (2004), 33.1% of participants stated they did not seek help as they wanted to solve
their problems themselves. Similar beliefs were identified by Wilson, Deane and
Ciarrochi (2005), who found that adolescents admired others‟ abilities to cope without
counselling, and felt that counselling should be used as a last resort. Further, Ortega
and Alegria (2002) found that adolescents with significant mental health problems who
held self-reliant attitudes, were 54% to 58% less likely to use services than adolescents
without self-reliant attitudes.
Empirical research has not directly identified an overall gender difference in
self-reliance, however, males have been shown to be significantly more likely to hold
the belief that depression should be dealt with alone (Jorm, Kelly, et al., 2006). This
gender difference may be attributed to the socially developed belief that help seeking is
un-masculine and reflects personal weakness (Jorm, Kelly, et al., 2006). Further, self-
reliance may also be associated with self-stigma, with highly self-reliant 14 to 16 year
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
olds holding negative views about depression (Jorm, Kelly, et al., 2006). Additional
evidence for the relationship between self-stigma and self-reliance was provided by
Ortega and Alegria (2002) who found that highly self-reliant Peurto Rican adults were
much less comfortable with their family or others knowing they were seeking treatment.
Shyness. Shyness is an aspect of social competence that has been identified as a
contributing factor in help-seeking (Rickwood, et al., 2005). Cognitively, shyness is the
“discomfort or inhibition in interpersonal situations that interferes with pursuing
ones...goals” (Henderson & Zimbardo, 1998, p. 497). Shy people are often withdrawn,
fearful, and hesitant to interact because they see themselves as awkward, unfriendly and
incompetent (Greenberger, Josselson, Knerr, & Knerr, 1974; Henderson & Zimbardo,
1998; Shiner & Caspi, 2003). These negative views cause shy people to have excessive
self-focus and a preoccupation with others‟ evaluations, and possible rejection of them
(Bruch, Gorsky, Collins, & Berger, 1989; Bruch, Hamer, & Heimberg, 1995; Rivet
Amico, Bruch, Haase, & Sturmer, 2004). This is particularly the case in unpredictable
or unknown situations, such as asking people for help (Carducci, 1999; Greenberger, et
al., 1974; Zimbardo, 1977). In-fact, one study found that the most commonly reported
triggers for shyness by American university students were „strangers‟ and „those in
authority‟ (Zimbardo, 1977, p. 36).
Gender differences do not appear to exist in levels of shyness, and the
relationship between self-stigma and shyness is questionable due to limited empirical
evidence. Unlike the other barriers associated with help-seeking, gender differences
have not been identified in levels of shyness (Bruch, et al., 1989; Crozier, 2005; Miller,
1995). Although the relationship between self-stigma and shyness is yet to be
empirically tested, it is likely that shyness is related to greater concerns of self-stigma as
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
shy people tend to be overly concerned with others‟ evaluations of them (Bruch, et al.,
1989).
Overcoming Barriers
By understanding what influences certain groups of people to seek help,
organisations may be able to match appropriate supports to the appropriate group rather
than providing a homogenous service to the entire heterogeneous population, with the
assumption that “one size fits all” (Kelly, Jorm, & Wright, 2007). Matching appropriate
services to the groups of young people who are most likely to benefit from them may
result in higher help-seeking behaviours and reduced distress (Deane, et al., 2001).
Many studies have found that adolescents are most willing to seek help from
informal sources such as their family and friends (Rickwood, et al., 2005; Ryan,
Shochet, & Stallman, 2010; Wilson, Deane, Ciarrochi, et al., 2005), however peers may
not be the most appropriate source of help. For example, Gould et al. (2004) found that
students who had contact with a suicidal peer were significantly more likely to be
depressed, have a substance abuse problem, or be seriously suicidal themselves, than an
adolescent not in contact with a suicidal peer. In addition, Rickwood (1995) found that
participants who shared their problems with family or friends did not experience a
reduction in psychological distress. It was argued that sharing a problem with non-
professionals where the conversation focuses on all the possible negative ramifications
may, in-fact, increase distress. For these reasons it is suggested that professionals are
the most appropriate source of help for young people with a mental health problem.
Face-to-Face Help. Traditional approaches to mental health care rely on face-
to-face service delivery. This approach has a number of benefits. For example, face-to-
face help is likely to benefit those help-seekers who rely on the reassuring non-verbal
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
and visual cues that are fundamental to the traditional counselling process (Reynolds Jr,
Stiles, & Grohol, 2006; Rochlen, Zack, & Speyer, 2004; Ybarra & Suman, 2008). Face-
to-face help may also be preferred by those people who lack human contact in their
usual day-to-day activities. Further, face-to-face help is likely to be preferred by those
who are concerned about the quality of online or phone line information, or the
credentials of those therapists providing it (Barak, Klein, & Proudfoot, 2009; Eysenbach,
Powell, Kuss, & Sa, 2002; Kiley, 2002). However, the barriers of self-stigma,
emotional competency, mental health literacy, self-reliance, and shyness may be
maximally evident when utilising face-to-face approaches.
Help Over the Phone. Crisis lines and counselling over the phone may be
beneficial for those help-seekers who prefer to talk through their problems with another
human being, whilst remaining anonymous. Like face-to-face help, phone lines allow
for verbal cues, however, non-verbal body language cannot be observed. The lack of
non-verbals may then contribute to an incomplete understanding of the situation by
either party (S. A. King, Engi, & Poulos, 1998; Oravec, 2000). Whilst phone lines are
more anonymous than face-to-face services, this is not to the extent of online services as
others may overhear the conversation or see the phone bills (Oravec, 2000). Phone
lines are however, likely to be more cost effective and easier to access than face-to-face
therapy (J. Wright, 2002).
Help Online. Online therapy offers a number of unique benefits which may
address some of the identified help-seeking barriers. A significant benefit is the
potential to reach more males. Studies have shown that the „gender divide‟ apparent in
other sources of help is reduced in online sources, with males accessing help (Gould,
Munfakh, Lubell, Kleinman, & Parker, 2002), and self-disclosing at similar levels to
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
females (Valkenburg, et al., 2011). As well as potentially reaching more males, the
internet also allows users to remain anonymous, search for information on mental
disorders and treatments, express their emotions in their own time, and solve their own
problems.
Online therapy is difficult to define due to the internet‟s capacity to use many
mediums (Barak, et al., 2009). Richlen, Zack and Speyer (2004), have defined online
therapy as “any type of professional therapeutic interaction that makes use of the
internet to connect to qualified mental health professionals”. Whilst covering some
aspects of online therapy, this definition fails to include other available mediums such
as self-guided automated web sites. Online therapy can occur either asynchronously or
synchronously, through guided or self-guided options, be public or private, and occur in
either individual or group circumstances (Barak & Bloch, 2006; Barak, et al., 2009;
Luce, Winzelberg, Zabinski, & Osborne, 2003; Oravec, 2000). The automatic feedback
provided by self-guided therapy websites can vary by being either personal, normative
or ipsative (changes since the last assessment) (de Vries & Brug, 1999). Asynchronous
means that the communication does not occur in „real-time‟ but when it suits both
parties, such as via email (Rochlen, et al., 2004). Communication that occurs
synchronously is in „real time‟ using mediums such as chat rooms or instant messaging.
Guided counselling occurs when there is a counsellor guiding the help-seeker through
some type of therapy, whereas self-guided therapy occurs when the help-seeker is using
an automated website or computer program which simulates human communication
(Sofka, 1997). There are currently a number of sites which offer self-guided therapy
options by combining health information and interactive learning or counselling
activities (Kerr, Murray, Stevenson, Gore, & Nazareth, 2006). Some examples of sites
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
already available include; „www.blackdoginstitute.com‟ (Barnes et al., 2009),
„www.moodgym.org‟ (Christensen, Griffiths, & Jorm, 2004),
„www.gamblingtherapy.org‟ (Anthony, 2005), and „http://au.reachout.com‟ (Burns,
Ellis, Mackenzie, & Stephens-Reicher, 2009). The „Beacon‟ website run by the
Australian National University is also a useful portal which provides links to alternative
self-help programs and their empirical evidence.
As confidentiality is a great concern for young people, the internet is likely to be
advantageous as it allows users to receive help whilst remaining completely anonymous
to services (Oh, Jorm, & Wright, 2009; Oravec, 2000; Ryan, et al., 2010), families
and/or friends (R. King et al., 2006). Remaining anonymous may increase the
likelihood that young people will ask questions they are too embarrassed to ask others,
and at a pace they can set themselves (Korp, 2006). For example, in an online
intervention on body image, many participants stated they felt that they were able to be
more honest as they were less concerned about the judgement of others (Zabinski et al.,
2001). The anonymity of the internet is also likely to reduce young people‟s fears
around stigma, particularly when they are dealing with highly stigmatised issues such as
suicide (Ybarra & Suman, 2008). Therefore, online therapy may be particularly useful
for those young people high in self-stigma and shyness, as their fears around other‟s
judgements of them may be reduced.
Online services allows adolescents to increase their autonomy from parents and
be more self-reliant by providing an easily accessible point to start the help-seeking
process (Luce, et al., 2003; Oravec, 2000; Rickwood, Deane, et al., 2007; Rochlen, et al.,
2004; J. Wright, 2002). Whilst some young people may not have links to traditional
sources of help such as school, work, or doctors, most will have some access to the
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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internet (Becker, Mayer, Nagenborg, El-Faddagh, & Schmidt, 2004; Rickwood, Deane,
et al., 2007). For example, a study conducted by Blanchard, Metcalf, Degney, Herman
and Burns (2008), found that 43% of 13 to 25 year olds had access to the internet at
home, 30.2% had access through a local library, and 17.7% had access at school.
Another study found that of participants connected with „headspace‟; an Australian
service providing mental health support and information to young people (headspace,
2011), only 5% were not current internet users (McGorry et al., 2007).
Online therapy may be beneficial to young people who have limited mental
health literacy. The internet allows for almost unlimited amounts of additional
information such as fact sheets on illnesses to be transferred and accessed between
parties (Kerr, et al., 2006; Oravec, 2000; Rochlen, et al., 2004). The ability to access
this information readily allows help-seekers to research what their symptoms mean, and
what treatments are available.
Further, online therapy may help young people who are shy and/or, low in
emotional competence by providing help-seekers with a „zone of reflection‟, where they
can take the time to decide what they would like to say (Lange et al., 2003; Rochlen, et
al., 2004; Wolak, Mitchell, & Finkelhor, 2002). In addition, online therapy often allows
help-seekers to progress at their own pace (Proudfoot et al., 2007). Having this time to
respond appropriately, and controlling the pace, may make online therapy less
confronting to young people than the more traditional face-to-face or phone line
services (Henderson & Zimbardo, 1998).
As well as having the potential to overcome a number of help-seeking barriers,
most importantly, online therapy has been shown to be effective. To date, trials have
found positive results for interventions focusing on body image and dissatisfaction
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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(Heinicke, Paxton, McLean, & Wertheim, 2007; Luce, et al., 2003; Zabinski, Wilfley,
Calfas, Winzelberg, & Taylor, 2004; Zabinski, et al., 2001), and reducing symptoms in
post-traumatic stress disorder (Lange, et al., 2003) and depression (Christensen, et al.,
2004). There have also been encouraging results in interventions aimed at reducing
alcohol and cannabis use (Bewick, Trusler, Mulhern, Barkham, & Hill, 2008; Newton,
Teesson, Vogl, & Andrews, 2009).
Preferences
Due to the low numbers of young people who seek professional help for their
mental health problems, organisations have been trying to understand and overcome the
barriers to young people accessing their services. One of the recent ways they have
been attempting to reach young people is by providing help online. The change in
service delivery has occurred under the assumption that young people would prefer to
access services over the internet. Although research has shown that providing therapy
and counselling online has had positive outcomes (Cook & Doyle, 2002; Heinicke, et al.,
2007), a review of the literature has found no study demonstrating that young people
actually prefer this source of help over that of face-to-face or phone line services. It
seems that the belief that young people hold this preference is, to date, an assumption.
One of the few studies examining this area asked young people if they would use a self-
guided online program or book if it existed (Farrand, Perry, Lee, & Parker, 2006).
Participants could however, only answer yes or no, and although 73% stated they may
use a self-guided option if it existed, this did not indicate that it was actually their
preferred help source. Further, whilst studies by Burns, Davenport, Durkin, Luscombe
and Hickie (2010) and Gould et al. (2002) found that approximately one fifth of
adolescents aged 12-17 had used the internet in the past for a mental health or substance
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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abuse problem, neither of these studies indicated whether the internet was preferred by
these young people or if it was used because they lacked an alternative. Consequently,
at this point in time it is an untested assumption that young people actually prefer online
mental health care over the more traditional forms of delivery.
The Current Study
The aim of this study was to assess whether young people do have a preference
for online therapy over other more traditional types of services, what their actual help-
seeking intentions are, and the factors which contribute to this intention. Based on
previous research indicating the differences between males and females on how they
deal with emotional problems, it was firstly hypothesised that overall girls would have a
higher intention to seek help and would be more likely to prefer face-to-face or phone
line services, whilst boys would have a lower intention to seek help and would have a
greater preference for the more anonymous online help. In addition, it was
hypothesised that intentions to seek help online would be directly related to higher
levels of potential self-stigma. Thirdly, it was hypothesised that higher levels of
potential self-stigma would be related to higher levels of self-reliance and shyness, and
lower levels of mental health literacy and emotional competency. Finally, it was
hypothesised that boy‟s greater intention to seek help online would be explained by
their lower levels of mental health literacy and emotional competency, and higher levels
of self-reliance. Gender differences in shyness were not anticipated. Figure 1 shows the
hypothesised relationship between gender, emotional competency, mental health
literacy, self-reliance, shyness, self-stigma and help-seeking intentions.
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Figure 1. Hypothesised mediated relationship of gender with help-seeking intentions.
Method
Participants
Participants were 231 students attending three schools in Canberra during April
and May, 2011. There were 139 females (60.2%) and 92 males (39.8%) with ages
ranging from 15 to 19 years ( ). The students were evenly spread
between public and private schools with 69 of the participants attending the University
of Canberra Secondary School Lake Ginninderra (UCSSLG) and 31 attending the
University of Canberra Kaleen High (UC Kaleen), giving a total 43.3% of participants
from public schools. The remaining 131 participants (56.7%) were attending Radford
College which is an independent Anglican college. Across the three schools there were
59 students in year ten (25.5%), 94 in year eleven (40.7%), and 78 in year twelve
(33.8%).
Gender
Emotional Competence
Self-Reliance
Shyness
Self-Stigma
Mental Health Literacy
Seek Help Online
Seek Help Face-to-Face
Seek Help over the Phone
Would Not Seek Help
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Measures
Participants were asked to complete a series of self-report measures combined
into a questionnaire labelled the “Adolescent Help Seeking Questionnaire” (see
Appendix A). This firstly asked demographic questions such as age, gender and the
school attended, and then assessed help-seeking intentions, help-seeking preferences,
self-stigma, shyness, self-reliance, emotional competency, and mental health literacy.
Help-Seeking Intentions. The „General Help Seeking Questionnaire‟ (GHSQ)
(Rickwood, et al., 2005; Wilson, Deane, Ciarrochi, et al., 2005) was adapted to assess
intentions to use each source of help. Participants were asked to read a vignette
describing depression, which was adapted from Jorm and Wright (2008) so that
participants imagined themselves feeling depressed. Depression was chosen as the
mental health problem as this is the most commonly experienced mental health problem
for this age group (ABS, 2007). Participants were then asked to identify how likely it is
that they would seek help from each of the sources if they were feeling as the vignette
described.
The various sources of help were chosen to reflect variation in type of
communication and level of anonymity comprising of online, phone line, face-to-face
and no help. The online options were split into self-guided “...from a website” and
guided options, with the guided options also being split into an asynchronous source
“…email with a professional”, and a synchronous source “… instant chat with a
professional”. The various face-to-face options were as follows: “Youth worker”,
“Private psychologist”, “School counsellor”, “Other counsellor”, and “Health
Practitioner/GP”. For each of the options participants were asked to rate how likely it
is they would use that source from 1 (Extremely Unlikely) through to 7 (Extremely
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Likely). The responses for each of the categories were averaged to obtain a total help-
seeking intention for each of the four categories of phone, online, face-to-face, and no
one.
In previous studies the GHSQ has been used by averaging all the help-seeking
options in order to create a single score of help-seeking intentions. When the measure
was used in this way, a Cronbachs‟ alpha of .70 and a three week test-retest validity
of .86 for non-suicidal issues was identified in a sample of Australian adolescents
(Wilson, Deane, Ciarrochi, et al., 2005). The measure was also shown to be valid with
positive and significant correlations between scores on the intention to seek help and
actual help-seeking behaviours.
Help-Seeking Preferences. To assess help-seeking preferences, participants
were asked to choose overall whether they would prefer to have help: “over the phone”,
“online” “face-to-face”, or “I would not seek help”. An open-ended question also asked
why they would prefer that type of help source.
Self-Stigma. Self-stigma was assessed using the „Self-Stigma of Depression
Scale‟ (SSDS) (Barney, Griffiths, Christensen, & Jorm, 2010). Participants were asked
to imagine they had the problem stated in the depression vignette when answering each
item. The scale is composed of 16 items which assess four factors of Shame, Self-
Blame, Help-Seeking Inhibition and Social Inadequacy. An example item is, “I would
see myself as weak if I took antidepressants”. The items are rated on a 5-point Likert
scale ranging from 1 (Strongly Disagree) through to 5 (Strongly Agree). Item C3 was
reverse scored and then all items averaged to obtain a total self-stigma score, with
higher scores indicating higher self-stigma.
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The scale is yet to be tested on adolescents, however, it has been shown to have
high internal consistency with a Cronbach‟s alpha of .87 for the total SSDS, .83 for
Shame, .78 for Self-Blame, .79 for Help-Seeking Inhibitions, and .79 for Social
Inadequacy in Australian adults (Barney, et al., 2010). Initial uses of the test have also
shown good test-retest reliability with no significant differences in scores at a two
month follow up (Barney, et al., 2010).
Emotional Competency. An adapted version of the „Toronto Alexithymia
Scale‟ (TAS-20) (Bagby, Parker, & Taylor, 1994) was used to measure emotional
competency. The adapted version of the scale has 12 items and has previously been
used with Australian adolescents (Heaven, Ciarrochi, & Hurrell, 2010). The scale
assesses difficulty in identifying feelings (“I have feelings that I can‟t quite identify”)
and difficulty in describing feelings (“It is difficult for me to find the right words for my
feelings”), however, factor analysis indicates a single dimension exists (Heaven, et al.,
2010). Items are responded to on a 5-point Likert scale from 1 (Strongly Agree)
through to 5 (Strongly Disagree). Item F4 is reverse scored and then all items averaged
to obtain a total emotional competency score with higher scores indicating higher
emotional competency.
The scale has good internal consistency in Australian adolescent populations
with a Cronbach‟s alpha of .87 (Heaven, et al., 2010). Criterion validity was also found
with positive correlations between emotional competency and social support, negative
affect, and positive affect (Heaven, et al., 2010).
Mental Health Literacy. Mental health literacy was assessed by adapting
methods used in previous studies where participants were asked to respond to vignettes
(Burns & Rapee, 2006; Cotton, et al., 2006; Farrer, Leach, Griffiths, Christensen, &
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Jorm, 2008). In the current study, three vignettes were chosen describing someone with
Social Phobia/Anxiety, Schizophrenia, and Depression with Substance Misuse as these
are have been used in previous studies assessing mental health literacy (Burns & Rapee,
2006; Jorm & Wright, 2008). The vignettes were adapted from those used by Burns and
Rapee (2006) and Jorm and Wright (2008) by changing the names and identifying terms
so that they were not gender specific. For each vignette, participants were asked to
indicate how worried they would be, from 1 (Not at all Worried) through to 4
(Extremely Worried) about the emotional well-being of the person described in the
vignette if that person were their friend. Participants were also asked what they thought
was the matter and whether they thought the person needs help for their problem.
To compute a score for mental health literacy, zero points were awarded if the
participant was not at all worried, one point was awarded if they were a little bit
worried, and two points awarded if they were either quite worried or extremely worried.
Points were also awarded for a correct or partly correct diagnosis for each vignette.
Diagnoses were considered partly correct if they only stated half of the disorder. For
example a diagnosis of “Phobia” or “Depression” received one point, where “Social
Phobia” or “Depression with Substance Misuse” received two points. Points were also
awarded based on the belief that the disorder required help, where answers of „no‟
received zero, „maybe‟ received one, and „yes‟ received two. Scores for the three
questions of how worried they were, diagnosis, and belief that it required help were
summed to give a score out of six. The total scores for the three vignettes were
averaged to obtain a total mental health literacy score out of six, with higher scores
indicating better mental health literacy.
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Self-Reliance. Self-reliance was assessed using the self-reliance subscale of the
„Psychosocial Maturity Inventory Form D‟, for the 11th
grade (Greenberger, et al., 1974).
The scale is composed of 10 items rated on a 4-point scale from 1 (Strongly Agree) to 4
(Strongly Disagree) with all items averaged to attain a total self-reliance score. Higher
scores indicate higher self-reliance. An example item is “In a group I prefer to let other
people make the decisions”.
The scale has good internal consistency with an alpha of .82 in American
adolescent populations, and has also been found to have concurrent validity with teacher
ratings of self-reliance (Greenberger, et al., 1974).
Shyness. Shyness was assessed using the „Revised Cheek and Buss Shyness
Scale‟ (CBSS-R) (Crozier, 2005). The scale has 14 items asking participants to respond
to statements such as “I feel tense when I am with people I don‟t know well”.
Participants were asked to rate how characteristic each statement is of them on a 5-point
scale ranging from 1 (Very Unlike Me) through to 5 (Very Like Me). Items D3, D6, D9
and D12 were reverse scored and then all items averaged to obtain a total shyness score
with higher scores indicating higher levels of shyness.
The scale has high internal consistency with a Cronbach alpha of .86 in
American university students. There is limited evidence for the test-retest reliability of
the CBSS-R, however, a 90 day test-retest reliability of .74 was found for a 9 item
version of the test (Cheek & Buss, 1981).
Design and Procedure
The research was approved by the University of Canberra (UC) Committee for
Ethics in Human Research (Project No. CEHR 11-55), and the ACT Department of
Education and Training (Ref No. 2011/00468-3) (see Appendix B and C). It was also
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peer reviewed by two UC psychology lecturers. In order to obtain participants from a
wide socioeconomic range, letters of interest in participating in the research were sent to
principals of a public high school and college, and a private college in Canberra. The
participating school principals gave approval for the students in their schools to
participate.
A non-experimental cross-sectional survey design was employed for the study.
A convenience sampling technique was used where all students at school on the day of
testing in years 10 at UC Kaleen, and years 10, 11 and 12 at Radford College were
given the option to participate. At UCSSLG all students who were enrolled in
Psychology or Sociology and were at school on the day of testing were given the
opportunity to participate. Letters were sent to all students‟ parents informing them of
the study and providing them with the option to have their child „opt out‟ if they did not
want them to participate (see Appendix D). If the letter was not returned consent was
assumed. Students at UC Kaleen and UCSSLG completed the survey in class time
using either the pen and paper formats, or online through a web-link. Students at
Radford College were emailed a link to the survey and completed it in their own time. A
sample size of between 200-300 students was aimed for, which would allow for any
medium sized effects to be detected at a power of .80, for five predictors in a multiple
regression analysis (Cohen, 1992). Out of a total 302 students who were informed of
the study, 231 completed it, resulting in a return rate of 76.49%.
Participation in the study involved completing the „Adolescent Help-Seeking
Questionnaire‟ which took between 20 and 30 minutes. The first page of the survey
informed participants about the study and made it clear that responses were confidential
and that participation was voluntary. It also provided details on where to go for more
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information, where to go to make a complaint about the research, and where to obtain a
summary of the final results (see Appendix E). Consent was assumed if they survey was
completed.
Results
Data were analysed using PASW Statistics 18 with alpha set at .05 unless
otherwise specified. All data were first carefully screened. There was less than 5%
missing data over all items, indicating the data can be assumed „missing at random‟
(Tabachnick & Fidell, 2007), listwise deletion was therefore used. The psychometric
properties of each variable used in the study are presented in Table 1. This reveals that
all scales attained adequate internal consistency according to Cronbach‟s alpha. The
lowest alpha scores were for the subscales of the self-stigma measure. Skewness scores
showed no major deviations from normality.
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Table 1
Psychometric Properties of the Study Variables
Range
Variable No. of Items M SD α Potential Actual Skew Kurt
Help Seeking Sources
Online 3 3.01 1.49 .81 1-7 1.00-6.33 .36 -.90
Face-to-face 4 3.46 1.51 .86 1-7 1.00-6.80 -.01 -1.02
Phone 2 2.25 1.35 .88 1-7 1.00-7.00 1.22 1.32
No Help 1 3.95 1.99 1-7 1.00-7.00 .02 1.22
Self-Stigma 16 3.05 .67 .84 1-5 1.63-4.75 -.32 .12
Shame 4 3.12 .80 .71 1-5 1.00-4.75 -.54 .08
Self-Blame 4 3.71 .67 .63 1-5 1.50-5.00 -.49 .65
Help-Seeking Inhibitions
4 3.31 .82 .65 1-5 1.25-5.00 -.25 -.42
Social Inadequacy
4 3.52 .73 .60 1-5 1.25-5.00 -.40 .15
Emotional Competency
12 3.18 .77 .87 1-5 1.42-5.00 .04 .60
Mental Health Literacy
9 4.50 .84 .61 0-6 1.17-6.00 -1.20 2.71
Self-Reliance 10 3.00 .46 .81 1-4 1.30-4.00 -.37 .25
Shyness 14 2.82 .67 .85 1-5 1.57-4.54 .25 .81
Note. Standard Error for all variables is .16.
Preferences for Help Sources
When participants were forced to choose between the options of online, face-to-
face, phone line, or no help it was clear that face-to-face help was the preferred option
for both genders. Overall, 58.9% of participants preferred face-to-face help, 23.8%
stated they would not seek help, 16% preferred online help, and 1.3% stated they would
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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seek help over the phone. There were 35% of participants who supplied a qualitative
response as to why a certain help source was their preferred option. The commonly
stated reasons for face-to-face help were because it is more personal, body language can
be assessed, it is a trusting environment, the help-seeker knows who they are talking to
and the service provider‟s qualifications, and there is customised feedback. The reasons
for not wanting to seek help were because the potential help seekers were too scared or
did not like talking about themselves. The participants who preferred online sources
stated that they preferred the anonymity of the internet, that information was easily
accessible, and that there are often people in chat rooms who have been through the
same thing. One insightful participant noted:
“I tried to use to internet last year but could not find anything useful so I just
talked to trusted adults and friends, I tried the internet because it seemed
better, less personal, less intrusive. But I was unsuccessful because I didn't
really know what I was looking for. I find it hard talking to people I don't
really know, the fear of judgement or gossip is large. The internet is a lot
faster, easier, less organisation, and less pressure.”
In order to determine whether gender or grade affected the preferences for
sources of help, a Pearson‟s Chi-square test of contingencies was used. As only three
participants chose „Over the phone’ as their desired preference, these scores were
recoded as missing so as not to violate the assumption that each cell has an expected
frequency of at least five. This resulted in a sample size of 228 for this analysis. The
assumption of minimum cell frequencies was also violated when the cells were further
split by school grade so the analysis was run only comparing the preferences between
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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genders. The Chi-square test was statistically significant, ( )
, with a small to medium effect size, Cramer‟s
To determine where the significant difference in preferences lay, separate
Chi-square tests were used. The association between gender and help-seeking
preference was small but statistically significant when comparing preferences for online
and face-to-face help, ( ) Cramer‟s . Odds
ratios revealed that males were 1.66 times more likely to prefer online sources over
face-to-face sources than females. There was also a significant, small to moderate
association between gender and the help-seeking preferences of face-to-face help and
not seeking help, ( ) Cramer‟s . Odds ratios
showed that females were 1.58 times more likely to prefer help face-to-face than not
seek help, compared to males. The association between gender and the preferences of
online help and not seeking help were non-significant, ( ) ,
indicating that males and females were just as likely to have a preference for either of
these sources. The preferences by gender are shown in Figure 2.
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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Figure 2. Preference for each help source by gender.
Intentions to Use Each Help Source
To examine the gender and grade differences in intentions to seek help by each
help source a 2 (gender) x 3(grade) x 4 (help seeking preference) mixed analysis of
variance with a repeated measure on the last factor was performed. A visual inspection
of each distribution‟s histograms, Q-plots and bar graphs indicated that all distributions
were relatively normal. In addition, the skewness and kurtosis scores of each
distribution were close to zero. Homogeneity of variance was met as Levene‟s test was
non-significant and the Fmax statistic was smaller than the recommended maximum of
10 (Tabachnick & Fidell, 2007). Homogeneity of intercorrelations was met as Box‟s M
was non-significant. Mauchly‟s test indicated that the sphericity assumption was
violated, consequently the Huynh-Feldt correction was employed (Tabachnick & Fidell,
2007).
0
10
20
30
40
50
60
70
80
Online Face-to-Face Phone I would notseek help
Pe
rce
nt
Help Source
Male
Female
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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The only statistically significant effect revealed by the analysis was a large main
effect for help-seeking intentions, ( ) , partial . A
series of pairwise comparisons using a Bonferroni adjustment found that the intention to
use each help-seeking source was significantly different from the intention to use any
other source. Figure 3 shows that the highest intention was to not seek help, followed
by seeking help face-to-face, then online help, with phone help being the least likely
source of help. Table 2 displays the significance values for each contrast. Means and
standard deviations of each help-seeking source are presented in Table 1. There were
no significant effects for gender ( ) ; grade, ( )
, or the gender by grade interaction, ( ) .
Figure 3. Intentions to use each help-seeking source.
Note. Error bars represent 95% confidence intervals.
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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Table 2 Pairwise Contrasts of Help-Seeking Intentions by Help-Seeking Source
Mean Difference
95% Confidence Interval
Help Seeking Source p Lower Bound
Upper Bound
I would not seek help
Face-to-Face
.56 .037* .02 1.09
Online .98 .000** .49 1.45
Phone 1.69 .000** 1.20 2.18
Face-to-Face
Online .41 .003* .10 .72
Phone 1.13 .000** .86 1.41
Online Phone .72 .000** .46 .99
Note. *p < .05. **p < .01.
Gender Differences in the Predictor Variables
Independent sample t tests were used to compare the average scores between
males and females for each predictor variable. Normality was assumed after inspecting
histograms, Q-plots and skewness scores. Levene‟s test was significant for the self-
reliance and shyness variables, and therefore equal variances could not be assumed.
Equal variance could be assumed in the remaining variables. The t test indicated a
moderate, statistically significant difference between males and females for self-stigma,
( ) with males ( ) scoring lower
than females ( ). There was also a statistically significant, moderate
to large difference in scores for mental health literacy, with females (
) scoring higher than males ( ), ( )
The t tests for shyness, ( ) self-reliance, ( )
and emotional competency, ( ) were all non-
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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significant showing no difference in scores between males and females for these
variables.
Correlations Between the Study Variables
To assess the size and direction of the linear relationships between the study
variables, bivariate Pearson‟s product-movement correlation coefficients (r) were
computed and are presented in Table 3. The assumptions of normality, linearity and
homoscedasticity were assessed, and found to be supported. Specifically, a visual
inspection of the histograms, Q plots, and skewness scores for each variable confirmed
that all variables were normally distributed. Similarly, visually inspecting scatterplots
of each variable against the other variables confirmed that the relationships were linear
and homoscedastic.
In terms of intercorrelations among the help-seeking variables, the three help-
seeking sources of online, face-to-face and phone help were all moderately
intercorrelated. The relationships showed that as the likelihood of using a particular help
source increased, the likelihood of using either of the other two sources also increased.
There were weak to moderate negative correlations between each of the three sources of
online, phone and face-to-face help with not seeking help. As the likelihood of using
any of the three sources increased, the likelihood of not seeking help decreased.
The help-seeking variables were generally not significantly related to their
predictors in the ways that were hypothesised. Both online, and face-to-face, intentions
were only weakly related to mental health literacy, with higher mental health literacy
related to an increased intention to use each source. Neither online nor face-to-face
intentions were significantly related to any other predictor variable. Help-seeking
intentions to use phone lines were not significantly related to any of the predictor
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
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variables. Only an intention to not seek help showed significant associations with most
of the predictors, but the relationships were weak. An increased intention to not seek
help was weakly related to increased self-stigma and shyness, and decreased emotional
competency and self-reliance. There was no significant association between an
intention to not seek help and mental health literacy.
Examination of intercorrelations among the predictor variables revealed that
self-stigma was related to most of the other predictor variables in the hypothesised
directions, although the relationships were relatively weak. With increasing levels in
self-stigma, levels of emotional competency and mental health literacy decreased and
shyness levels increased. Unexpectedly, however, self-stigma scores increased as self-
reliance scores decreased. There were also significant relationships between emotional
competency scores with self-reliance and shyness. As emotional competency scores
increased self-reliance ratings also increased and shyness levels decreased. Further,
higher levels of mental health literacy were related to higher levels of self-reliance and
higher self-reliance was related to lower levels of shyness. There were non-significant
relationships between mental health literacy and emotional competency, and mental
health literacy and shyness.
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Table 3
Summary of the Intercorrelations of the Study Variables
Measure 1 2 3 4 5 6 7 8 9
1. Online - .38** .47** -.14* .10 .12 .13* -.02 .01
2. Face-to face - .45** -.40** -.01 .03 .21** .07 -.07
3. Phone - -.25** .03 .02 .07 -.04 -.03
4. No Help - .20** -.22** -.12 -.18** .15*
5. Self-Stigma - -.26** -.16* -.18** .21**
6. Emotional Competency
- .08 .44** -.27**
7. Mental Health Literacy - .19* .04
8. Self-Reliance - -.43**
9. Shyness -
Note. N = 230. *p < .05. **p < .01.
Predictive Model of Help-Seeking Intentions
A path analysis was conducted to test the goodness of fit of the data to the initial
hypothesised model (Presented in Figure 1), predicting intentions to use each of the
help-seeking sources. However, as shown in Figure 4, the tested path analysis did not
include phone help as this preference was negligible. Note that a multiple regression
analysis was not conducted due to the lack of significant bivariate correlations between
the dependent variables and the predictor variables. Consequently, the multivariate
regression analysis would provide no useful information. Rather, the path analysis was
conducted to reveal the indirect effects and enable prediction of multiple dependant
variables. The path analysis was performed using AMOS 18 (Arbuckle, 1983-2005) to
enable the simultaneous estimation of multiple dependent relationships. The sample
34
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
size of 231 met the minimum requirement of 200 in order to ensure high statistical
power (Kline, 1998). Testing for multivariate outliers, normality and homogeneity of
variance did not reveal any serious violation of assumptions.
The hypothesised model presented in Figure 4 did not fit the data, χ2
= 233.861,
df = 26, p < .001, GFI = .807, AGFI = .666, TLI = -.077, RMSEA = .186. This model
explained less than 1% of the variance in intentions to use face-to-face help, 1% of the
variance in online help and 3% of the variance in intentions to seek no help.
Figure 4. Hypothesised model predicting intentions to seek help online, face-to-face and to not seek help.
The model was subsequently modified by dropping non-significant paths and the
examination of modification indices was used to obtain a better fitting model. Further,
at each stage of model respecification, the best-fitting model was assessed using the
Akiake Information Criterion (AIC) and more stringent Consistent Akiake Information
Criterion (CAIC), which Williams and Holahan (1994) suggest are the best indicators of
model-parsimony. Based on the recommendation of Holmes-Smith, Coote, and
Gender
Emotional Competence
Self-Reliance
Shyness
Self-Stigma
Mental Health Literacy
Seek Help Online
Seek Help Face-to-Face
Would Not Seek Help
35
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
Cunningham (2004) that the model with the smallest AIC/CIAC is the best fitting model,
Figure 5 illustrates the model which was shown to best fit the data, χ2
= 36.236, df = 24,
p = .052, GFI = .966, AGFI = .937, TLI = .931, RMSEA = .047, AIC = 78.236, CAIC =
171.526, along with standardised parameter estimates. All paths presented were
significant at p < .05. This model explained 5% of the variance in intentions to use face-
to-face help, 14% of the variance in online help and 19% of the variance in intentions to
seek no help. All the parameters attaining significance in this multivariate model were
consistent with their bivariate correlations.
In the multivariate model, the only direct predictor of online intentions was a
moderately strong intention for face-to-face help. The only direct predictor of face-to-
face help-seeking intentions was a weak relationship with mental health literacy.
Intention to not seek help was directly predicted by a moderately strong negative
relationship with intentions to seek face-to-face help and a weaker association with self-
stigma. In turn, greater self-stigma was predicted by relatively weak relationships with
emotional competence (less competence), gender (being female) and higher shyness.
Mental health literacy was only predicted by gender, with girls having greater literacy.
Self-reliance was not directly or indirectly related to any of the help-seeking
intentions, but was shown to be predicted by mental health literacy, emotional
competence and shyness. Emotional competence was only indirectly related to help-
seeking intentions through self-stigma, and was predicted by shyness. As noted, gender
was indirectly related to help-seeking intentions via girls having greater mental health
literacy and higher levels of self-stigma.
36
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
Figure 5. Final path model predicting intentions to seek help online, face-to-face and to not seek help.
Discussion
The aim of this study was to determine whether young people do have a
preference for online therapy over the more traditional service types, what their actual
help-seeking intentions are, and the factors which contribute to these intentions.
Overall, it appears that young people still hold a majority preference for help face-to-
face, however, the highest intention was to not seek help at all, and this was also a
strong preference. Contrary to the hypothesis, there were no gender differences in
intentions to seek help; however the hypothesis was supported in that females had a
stronger preference for face-to-face help, whilst males had a stronger preference for
online help. In support of the hypothesis, higher levels of self-stigma were related to
higher levels of shyness and lower levels of emotional competency, although no
significant relationships were identified between self-stigma and mental health literacy,
Gender (Female)
Shyness
Mental Health Literacy
Self-Reliance Emotional Competency
Self-stigma
Online
.34
.21
-.27
.33
.18
.13
.22
-.34
-.23
R2 = .12
R2 = .08
R2 = .13
R2 = .32
R2 = .14
Face-to-Face
R2 = .05
.38
Would Not Seek Help
R2 = .19
.18
-.40
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
or self-stigma and self-reliance. As hypothesised, males were found to have lower
mental health literacy scores than females, however no gender differences were
identified in levels of emotional competency or self-reliance. The path model indicated
that the predictive ability of most of the identified barriers in predicting an intention to
seek help online were low, however there were some improvements in predicting
intentions to not seek help at all.
Results revealed that when young people aged 15-19 years are forced to choose
a preferred help source between online, face-to-face, phone, and not seeking help,
almost two-thirds of this study‟s participants preferred to seek help through face-to-face
interaction, whilst almost a quarter preferred to not seek help at all. The main reasons
stated by young people as to why they preferred face-to-face formats were because they
were more personal, their feedback was customised to their situation, and they knew
who they were speaking too. The 16% of participants who preferred online formats
stated that they appreciated the anonymity of the internet, the ease of accessing
information, and using chat rooms to talk to people who had been through the same
thing. These responses show that young people who prefer help face-to-face and online
have some similarities in their reasons for that preference, in that both groups of young
people prefer these sources as they can talk to others about their problems; the online
group simply prefer to do it anonymously. In contrast to the young people who would
prefer to seek help either online or face-to-face, a common response from the quarter of
participants who preferred to not seek help at all, was that they did not like talking about
themselves or their problems to others. Therefore, a major distinction in the groups of
young people and their preferences appears not to just be between each preferred source
38
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
of help, but rather, between young people who are willing to seek help, either online or
face-to-face, and those who would not seek help at all.
The stronger preference for face-to-face help, over that of online or phone help,
could be explained by the „mere exposure effect‟ of attitude formation (Zajonc, 1968).
The mere exposure effect is the tendency to develop more positive feelings toward
people and objects the more we are exposed to them (Zajonc, 1968), and has been found
to be a highly robust and reliable phenomenon (Bornstein, 1989). Applying this theory,
it could be argued that the traditional face-to-face approach is the preferred method by
the majority of participants simply because face-to-face help is better established, and
young people are more familiar with the potential process, where-as online help is new
and unfamiliar. Encouragingly, advertising campaigns have been shown to increase
awareness around a number of mental health problems such as depression (Phoenix-
Research, 2006), therefore, based on the mere exposure effect (Zajonc, 1968), a
campaign introducing sources such as „http://au.reachout.com‟ (Burns, Ellis, et al., 2009)
and „www.moodgym.org‟ (Christensen, et al., 2004) may result in an increase in
preferences for help online, and possibly, an increase in overall service utilisation.
The gender differences in intentions and preferences to seek help were mixed.
Contrary to the hypothesis, the analysis of variance indicated that there were no
differences between males and females in the intention of using each help source. In
contrast, the Chi-square test indicated that there were gender differences in relative
preferences when a forced choice was measured. As hypothesised, the Chi-square test
showed that a higher percentage of females than males would prefer to seek help face-
to-face, whilst a higher percentage of males than females would prefer to not seek help
at all, or seek help online. Although these findings are in line with the hypothesis, the
39
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
odds ratios were compared by using percentages, not actual help seeking numbers. As
these results, and those of previous studies (ABS, 2007; Angst, et al., 2002), indicate
that there are more females seeking help in the first place, it is likely that there are still
more females overall, using online sources than males. However, as Gould et al. (2002)
suggested, the „gender divide‟ which is highly visible in face-to-face formats appears to
be reduced in online sources of help. This is an encouraging sign and in the future we
may see the divide continue to reduce as males become increasingly aware of
alternative help-seeking options. Whilst the „gender divide‟ appears to be reduced in
online formats, it is also necessary to note that the largest percentage of males still
preferred face-to-face and not seeking help, over that of online help.
The relationships between the predictor variables were somewhat as
hypothesised. As hypothesised, higher levels of self-stigma were related to lower levels
of emotional competency and higher ratings of shyness. Contrary to the hypothesis
however, no significant relationships were identified between self-stigma and mental
health literacy, or self-stigma and self-reliance. Whilst the results of the current study
do not provide support for previous research indicating that increased knowledge about
mental illnesses can reduce stigma (Burns, Durkin, et al., 2009), it does provide support
for the argument put forward by Jorm and Barney et al. (2006) that the two do not
always go together. The current results suggest that simply having an understanding of
various mental health disorders, and knowledge of whether outside support should be
obtained, does not reduce self-stigma. The lack of a significant relationship between
self-stigma and self-reliance does not provide support for the previous findings of Jorm
and Kelly et al. (2006) or Ortega and Alegria (2002), however this may be due to how
self-reliance was measured in these previous studies. Both of these previous studies
40
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
simply used a dichotomous question asking participants whether they believed in
dealing with depression or emotional problems alone. It is likely that this dichotomous
question does not cover all the dimensions of self-reliance that are tested in the measure
used in the current study.
The gender differences within the predictor variables were also somewhat mixed.
In support of the hypothesis and findings by Jorm (2009) and Cotton et al. (2006),
mental health literacy was found to be higher in females. Additionally, as hypothesised,
there were no gender differences in levels of shyness. In contrast to findings by
Corrigan and Watson (2007), males in this study were actually found to have lower self-
stigma scores than females. Furthermore, contrary to the hypothesis and previous
research, no gender differences were identified in levels of emotional competency
(Ciarrochi, et al., 2001; Ciarrochi, et al., 2003) or self-reliance (Jorm, Kelly, et al.,
2006). The unexpected lack of gender differences could be attributed to differences in
samples. For example, the research by Corrigan and Watson (2007) was conducted in
America, with a participant age range of 18-95 years. Alternatively, the lack of gender
differences may suggest that there is a shift occurring in the ability of younger men to
communicate their emotions and their stigmatising beliefs around mental illnesses. This
shift may be occurring due to Australian national advertising campaigns, such as the
beyondblue campaign launched in 2006, which aims to raise awareness around
depression, anxiety and substance abuse problems (beyondblue, 2006). This campaign
has now been running for a number of years and has used various high profile males to
talk openly about their own mental health problems. It is possible that we are now
seeing positive results of the campaign with young males becoming more comfortable
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
talking about their emotions, and having reduced stigmatising attitudes than evident in
previous studies.
In the current study, three-quarters of the sample stated they would prefer to
seek help either face-to-face or online, however, the majority of these young people also
stated that they were most likely to not seek help at all. The variation between young
people‟s preferences for certain sources of help and their actual help-seeking intentions,
indicates that there are barriers standing in the way of young people fulfilling their
preference to seek help. The predictive model provides support for self-stigma,
emotional competency, mental health literacy, and shyness in being direct or indirect
barriers to help-seeking, however, the ability of these barriers in predicting intentions to
seek help online, were low.
The path model accounted for 5% of the variance in an intention to seek help
face-to-face with mental health literacy being a direct predictor, and gender being an
indirect predictor through the effect of mental-health literacy. The connection between
mental health literacy and help seeking intentions for face-to-face formats is
encouraging as a number of interventions have shown that mental health literacy can be
improved (Kelly, et al., 2007; A. Wright, McGorry, Harris, Jorm, & Pennell, 2006). For
example, an intervention conducted by Esters, Cooker and Ittenbach (1998) which
provided information on help sources, the reality of stigma, and the symptomology,
treatment, and prognosis of a variety of mental illnesses, resulted in participants being
more favourable to seeking help from professional sources in the future. Encouragingly,
this improvement still remained at a 12 week follow up. The relationship between
higher mental health literacy and intentions to seek help face-to-face, may also provide
42
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
further support for the argument that young people are more likely to prefer help
sources they already have knowledge about (Zajonc, 1968).
An intention to seek help online was only directly predicted by an intention to
seek help face-to-face, although, the predictive model was able to account for 14% of
the variance in this intention. Of the three tested help sources the model could best
predict an intention to not seek help, accounting for 19% of the variance. This was
through the direct relationships of a low intention to seek help face-to-face and higher
self-stigma attitudes, and, the indirect relationship of lower mental health literacy, lower
emotional competency, increased shyness and being female. The increased ability of
the identified barriers of self-stigma, emotional competency and shyness in predicting
an intention to not seek help at all, over an intention to seek help online, suggests that
whilst online help may theoretically accommodate these barriers it either does not
accommodate them to a significant extent, or, young people who are challenged by
these barriers are not willing to try online help in the first place in order to see that it
does accommodate them. If the latter is the case, there are some concerning
implications as this suggests that simply providing help through different means is not
going to increase the likelihood that young people facing these barriers will actually use
these new sources. These particular young people may need more than just an increased
perceptual awareness of the available sources to increase their behavioural intentions
(Ajzen, 1989; Katz, 1960; Zajonc, 1968).
The functional approach to attitude change suggests that attitudes are formed
based on the degree to which they satisfy different psychological needs, and in this
sense, this theory is an active, rather than passive approach (Katz, 1960). Katz suggests
that one of the ways we form attitudes is through an adjustment function were positive
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FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
attitudes form in the process of achieving a particular goal. Based on this theory, it
would seem that young people who are faced with particular barriers actually need to
experience help-seeking through the various avenues to determine for themselves
whether or not it does address their individual barrier/s or concerns, thereby determining
whether that source has addressed their psychological requirement (Katz, 1960). This
opportunity could be provided through a whole school intervention which introduces
young people to alternative help-seeking sources, and allows students to trial them,
before they are even needed. An intervention such as this would allow young people to
decide which sources of help address their individual concerns, possibly changing their
attitude to that source and thereby increasing their intention to seek help when needed in
the future.
The relatively low predictive abilities of self-stigma, emotional competency,
mental health literacy, self-reliance and shyness in predicting an intention to seek help
online, also indicate that other variables are likely predictors of this intention. For
example, an increased intention to seek help online may be more evident for young
people faced with speech or hearing difficulties (Blanchard, et al., 2008), restrictions in
mobility due to physical conditions or location (Rochlen, et al., 2004) or concerns
around the cost and time required to seek help face-to-face (Evans et al., 2011; Ho, Hunt,
& Li, 2008). Further, intentions to seek help online, may be better predicted simply by
the level of knowledge young people have about where they can go for help online. For
example, Jorm (2009) found that that recall of mental health organisations by 12-25
year olds varied dramatically, with the highest recollection being for beyondblue,
recalled by only one-third of the sample. Since such low percentages of young people
were able to identify mental health organisations in the study by Jorm, it is likely that
44
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
the participants in the current study could not identify where they would go for help
online, and therefore, rated their intentions to use it as low regardless as to whether or
not they thought it may accommodate their reasons for not seeking help.
Overall, the findings of the current study show that the highest intentions of
young people are to not seek help at all, even if clearly symptomatic. Further, one in
four young people actually prefer to not seek help, generally because they do not like
talking about themselves. Whilst there are online sources available such as
„reachout.com‟, and „moodgym‟, which allow young people to find information, read
other‟s stories and complete cognitive-behavioural based exercises without disclosing or
interacting with others (Barak, et al., 2009), it is likely that young people are unaware of
them (Jorm, 2009). This suggests that organisations need to continue using innovative
methods to both promote and provide services to ensure all young people are not only
aware of them, but their needs are catered for. Finally, organisations need to remain
aware that at this point in time the majority of young people still prefer face-to-face
approaches and their needs and preferences should not be forgone in order to provide
new services online.
Limitations of the Study
One of the aims of this study was to bring together a number of previously
identified barriers to help-seeking in order to determine whether combined, they could
explain intentions to use various sources of help. Whilst testing all these barriers
together provided a multivariate approach to understand the complex barriers faced by
young people, it required a lengthy survey. Although there were very few missing data,
the length of the survey may have affected how carefully the participants answered each
question. Further, whilst the sample had a relatively equal spread of participants across
45
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
the public and private schools, and year groups, all participants were from Canberra.
This limits the generalisability to the wider Australian population as the higher average
weekly income of Canberrans (ACT Department of Treasury, Economics Branch [ACT
Treasury], 2011), potentially results in this sample having better access to information
technologies than other young people around Australia. In addition, although the
sample was large enough to ensure high statistical power for a path analysis (Kline,
1998), it was not large enough to test all hypotheses of interest such as determining
whether school-grade level had an impact on help-seeking preferences. Finally, because
the study was of a cross-sectional nature the relationships devised from the path model
cannot be conferred to be directional or causal. While these relationships were the best
statistical fit, their causal direction is untested.
Future Research
To further understand the causal nature of the barriers identified in the current
study a longitudinal approach is required. Future studies should also use a longitudinal
approach based on the mere exposure theory (Zajonc, 1968) to test whether promoting
various help-seeking sources can in-fact, alter attitudes and intentions to seek help for
those sources. Since the barriers identified in this study were unable to account for any
more than 14% of the intentions to seek help online, it would also be useful to
investigate the reasons for this further. A study based on the functional approach to
attitude formation (Katz, 1960), which implements a whole school program introducing
young people to online sources, and allowing them the freedom to investigate how they
work and what is required of them as help-seekers, then retesting preferences and the
barriers of self-stigma, emotional competency, mental health literacy, self-reliance and
shyness may help in understanding whether or not these barriers are accommodated by
46
FACTORS INFLUENCING YOUNG PEOPLE‟S CHOICE OF PROFESSIONAL
HELP
online sources. Further, a study using focus groups of young people who prefer online
help may aid in identifying other reasons why they prefer this source and the types of
young people who are likely to be attracted to online help. These young people‟s
stories and experiences could also be used to encourage others to seek help.
Understanding the types of young people who use each help source will assist
organisations to effectively promote their services to the groups of young people most
likely to benefit from them.
Conclusion
In summary, the results of this study show that young people aged 15-19 from
Canberra, still prefer traditional face-to-face mental health service delivery, although, a
small group would prefer online help. Unfortunately, one in four participants still
preferred to not seek help at all. Of particular interest is the overwhelming lack of
preference for phone help. Further, the highest overall intention is actually to not seek
help at all. This suggests that whilst organisations should continue to provide face-to-
face services to cater for the large group of young people who still prefer this traditional
method, they should continue to use innovative methods to provide and promote their
services, in a constant attempt to attract those young people who are still unwilling to
seek help.
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Appendix A
Adolescent Help Seeking Survey
Instructions
This survey asks about:
The types of services you would likely seek help from for emotional problems
How you would feel about having some emotional problems
Some personality traits
Your understanding of various mental health concerns
This is an anonymous survey – do not write your name anywhere. For each question, circle only ONE of the options provided. There are also spaces to add other responses which aren‟t listed.
You are free to stop the survey at anytime.
Section A
First, just a few questions about you:
Please tick the appropriate box.
A1. Age: 15 16 17 18 19+
A2. Gender: Male
Female
A3. School:
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Section B
Please read the following scenario:
You have been feeling unusually sad and miserable for the last few weeks. You are tired all the time and have trouble sleeping at night. You don’t feel like eating and have lost weight. You can’t keep your mind on your studies and your marks have dropped. You put off making decisions and even day-to-day tasks seem too much for you.
Below is a list of people who you might seek help or advice from if you were experiencing the above problems. Please circle the number that shows how likely it is that you would want to seek help from each of these sources as your first point of contact if you were experiencing the above problems..
If I was feeling that way I would seek help from…
Extremely Unlikely
Extremely Likely
B1 Phone Line Help
A Crisis line (e.g. Lifeline or Kids helpline
1 2 3 4 5 6 7
B Other counsellor over the phone 1 2 3 4 5 6 7
B2 Online Help
A Help from a website (e.g. ReachOut, Beyondblue, MoodGym)
1 2 3 4 5 6 7
B Help through email with a professional (delayed feedback)
1 2 3 4 5 6 7
C Help through instant chat with a professional (instant feedback)
1 2 3 4 5 6 7
B3 Face to Face
A Help face to face with a youth worker
1 2 3 4 5 6 7
B Help face to face with a private psychologist
1 2 3 4 5 6 7
C Help face to face with a school counsellor
1 2 3 4 5 6 7
D Help face to face with a counsellor not associated with the school
1 2 3 4 5 6 7
E Help face to face with a GP / Health practitioner
1 2 3 4 5 6 7
B4 No Help
A I would not seek help 1 2 3 4 5 6 7
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B5)
Overall, if you felt like what is described in the scenario would you prefer to have help: (please tick one box)
Over the phone
Online
Face to Face
I would not seek help
B6)
If you have a strong preference for a certain help source (or have sought help when feeling down before) please state what it is and why you prefer it.
Source:
Why I prefer it:
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Section C
Please read the scenario again:
You have been feeling unusually sad and miserable for the last few weeks. You are tired all the time and have trouble sleeping at night. You don’t feel like eating and have lost weight. You can’t keep your mind on your studies and your marks have dropped. You put off making decisions and even day-to-day tasks seem too much for you.
Below is a list of statements about how you might feel if you had a problem like the one described.
Please circle the number that indicates how strongly you agree or disagree with each statement.
If I was feeling that way… Strongly Disagree Disagree
Neither Agree or Disagree Agree
Strongly Agree
C1 I would feel embarrassed 1 2 3 4 5
C2 I would think I should be able to „pull myself together‟
1 2 3 4 5
C3 I would feel like I was good company
1 2 3 4 5
C4 I wouldn‟t want people to know that I wasn‟t coping
1 2 3 4 5
C5 I would feel ashamed 1 2 3 4 5
C6 I would think I should be able to cope with things
1 2 3 4 5
C7 I would feel like a burden to other people
1 2 3 4 5
C8 I would see myself as weak if I took antidepressants
1 2 3 4 5
C9 I would feel disappointed in myself
1 2 3 4 5
C10 I would think I should be stronger 1 2 3 4 5
C11 I would feel inadequate around others
1 2 3 4 5
C12 I would feel embarrassed about seeking professional help
1 2 3 4 5
C13 I would feel inferior to other people
1 2 3 4 5
C14 I would think I only had myself to blame
1 2 3 4 5
C15 I would feel I couldn‟t contribute much socially
1 2 3 4 5
C16 I would feel embarrassed if others knew I was seeking professional help
1 2 3 4 5
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Section D
For the following questions please read each item carefully and decide to what extent it is characteristic of your feelings and behaviour.
Circle the number that indicates how characteristic it is of your feelings and behaviour.
Very Very Unlike Me Unlike Me Neutral Like Me Like Me
D1 I feel tense when I am with people I don‟t know well
1 2 3 4 5
D2 I am socially somewhat awkward
1 2 3 4 5
D3 I do not find it difficult to ask other people for information
1 2 3 4 5
D4 I am often uncomfortable at parties and other social functions
1 2 3 4 5
D5 When in groups of people I have trouble thinking of the right thing to talk about
1 2 3 4 5
D6 It does not take me long to overcome my shyness in a new situation
1 2 3 4 5
D7 It is hard for me to act natural when I am meeting new people
1 2 3 4 5
D8 I feel nervous when speaking to someone in authority
1 2 3 4 5
D9 I have no doubts about my social competence
1 2 3 4 5
D10
I have trouble looking someone right in the eye
1 2 3 4 5
D11
I feel uncomfortable in social situations
1 2 3 4 5
D12
I do not find it hard to talk to strangers
1 2 3 4 5
D13
I am more shy with members of the opposite sex
1 2 3 4 5
D14
During conversations with new people, I worry about saying something foolish
1 2 3 4 5
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Section E
For the following questions please read each item carefully and decide to what extent you agree or disagree with each statement.
Circle the number that indicates how much you agree with each statement.
Strongly Disagree Disagree Agree
Strongly Agree
E1
It‟s not practical to decide what kind of a job you want because that depends so much on other people.
4 3 2 1
E2 In a group I prefer to let other people make the decisions.
4 3 2 1
E3
You can‟t be expected to make a success of yourself if you had a bad childhood.
4 3 2 1
E4 Luck decides most of the things that happen to me.
4 3 2 1
E5 The main reason I‟m not more successful is that I have bad luck.
4 3 2 1
E6 Someone often has to tell me what to do.
4 3 2 1
E7
When things go well for me, it is usually not because of anything I did myself.
4 3 2 1
E8 I feel very uncomfortable if I disagree with what my friends think.
4 3 2 1
E9
It is best to agree with others, rather than say what you really think, if it will keep the peace.
4 3 2 1
E10
I don‟t know whether I like my new clothes until I find out what my friends think of them.
4 3 2 1
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Section F
For the following questions please read each item carefully and decide to what extent you agree or disagree with each statement.
Circle the number that indicates how much you agree with each statement.
Strongly Disagree Disagree
Neither Agree or Disagree Agree
Strongly Agree
F1 I am often confused about what emotion I am feeling
5 4 3 2 1
F2 It is difficult for me to find the right words for my feelings
5 4 3 2 1
F3 I have physical sensations that even doctors do not understand
5 4 3 2 1
F4 I am able to describe my feelings easily
5 4 3 2 1
F5 When I am upset, I do not know if I am sad, frightened or angry
5 4 3 2 1
F6 I am often puzzled by sensations in my body
5 4 3 2 1
F7 I have feelings that I cannot quite identify
5 4 3 2 1
F8 I find it hard to describe how I feel about people
5 4 3 2 1
F9 People tell me to describe my feelings more
5 4 3 2 1
F10 I often do not know why I am angry
5 4 3 2 1
F11 It is difficult for me to reveal my innermost feelings, even to close friends
5 4 3 2 1
F12 I am often confused about what emotion I am feeling
5 4 3 2 1
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Section G
For the following questions please read the brief description provided in the box and decide whether each person has a serious problem, and if so, what they should do about it. There are no right or wrong answers – we just want to get some different points of few about what different people would think and do.
Sam is 17 years old and is living at home. Since starting at a new school last year Sam has become even more shy than usual and has made only one friend. Sam would really like to make more friends but is scared of saying or doing something embarrassing. Although Sam‟s grades are ok, Sam rarely speaks in class and becomes increasingly nervous, trembles, blushes and feels like vomiting if required to speak in front of the class. Sam never answers the phone and refuses to attend social gatherings. Sam knows the fears are unreasonable but just can‟t seem to control them, and this is really upsetting.
G1. If Sam was your friend, how worried would you be about their overall emotional well-being? (Please circle the appropriate response)
a) I would not be at all worried about their emotional well-being.
b) I would be a little bit worried about their emotional well-being.
c) I would be quite worried about their emotional well-being.
d) I would be extremely worried about their emotional well-being.
G2. In five words or less, what do you think is the matter with Sam?
G3. Do you think Sam needs help for the problem? (Please Circle)
No Don‟t Know Yes
If “Yes”, from whom?:
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Leigh is 18-years old and lives at home. Leigh has been attending school irregularly over the past year and has recently stopped attending altogether. Over the past 6 months Leigh has stopped seeing any friends and begun spending a lot of time in the bedroom and refusing to eat with the rest of the family or have a shower. Even though Leigh‟s parents know there is no one else in the bedroom, they have heard Leigh shouting and arguing as if someone else was there. When they try and encourage Leigh to go out, Leigh whispers that they can‟t leave home because the neighbour is spying on them. They know Leigh is not taking drugs as Leigh never leaves the house or sees anyone to get them.
G4. If Leigh was your friend, how worried would you be about their overall emotional well-being? (Please circle the appropriate response)
e) I would not be at all worried about their emotional well-being.
f) I would be a little bit worried about their emotional well-being.
g) I would be quite worried about their emotional well-being.
h) I would be extremely worried about their emotional well-being.
G5. In five words or less, what do you think is the matter with Leigh?
G6. Do you think Leigh needs help for the problem? (Please Circle)
No Don‟t Know Yes
If “Yes”, from whom?:
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Taylor is in year 12. Taylor‟s friends have been planning to go away together on a cruise for schoolies week and have been planning it for some time. Lately however, Taylor has not seemed interested in the trip, in-fact Taylor has not seemed interested in anything for a couple of months. Taylor has lost their characteristic spark and energy, and regularly appeared to be sad and tearful. Taylor has also been drinking increasingly more alcohol over the past year, and recently forgot to confirm the trip with the travel agent on the allocated day, due to a hangover. Taylor was very upset about this saying things like “I‟m useless”, and “good for nothing”, and that “I might as well just be dead because no one would care if I wasn‟t here anymore”.
G7. If Taylor was your friend, how worried would you be about their overall emotional well-being? (Please circle the appropriate response)
i) I would not be at all worried about their emotional well-being.
j) I would be a little bit worried about their emotional well-being.
k) I would be quite worried about their emotional well-being.
l) I would be extremely worried about their emotional well-being.
G8. In five words or less, what do you think is the matter with Taylor?
G9. Do you think Taylor needs help for the problem? (Please Circle)
No Don‟t Know Yes
If “Yes”, from whom?:
Thank you for completing this survey.
If anything in this survey has caused you distress, please contact your
school counsellor or Lifeline (13 11 14).
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Appendix B
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Appendix C
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Appendix D
Dear Parent(s)/ Guardian(s)
Re: Invitation for your child to participate in a research survey on “Factors
influencing young people’s choice of professional help for their mental health
concerns”
We are seeking permission for your child to participate in a study relating to adolescent
preferences for mental health concerns.
The purpose of the study is:
1. To investigate whether there is a preference for types of help for mental health
problems (whether there is a preference form online, phone line or face-to-face
services).
2. To identify the characteristics of young people who prefer online services so that
services can ensure they are providing appropriate support to all young people.
The ACT Department of Education & Training and the University of Canberra
Committee for Ethics in Human Research have both approved this study. The principal
researcher is conducting this project as part of 4th year thesis requirements to attain a
Bachelor of Science (Psychology) Honours degree at the University of
Canberra.
Participation will entail:
1. Completing a 20 to 30 minute anonymous survey consisting of a general help
seeking questionnaire, a self-stigma for depression scale, a self-reliance scale, a
scale of emotional competence, a shyness scale and questions relating to their
mental health literacy. Your child will not be asked about their current mental
health.
2. Your child will complete this survey during one in-class session, or during their
own time using an online version.
This study will be anonymous and completely confidential. No individual information
will be identifiable to the researcher and group data will be stored securely according to
University of Canberra guidelines.
Participation in this study is voluntary and no child will be approached to participate
unless parental approval is received. If parental consent is given, then your child will be
asked separately whether they would like to participate. It will be explained that
participants are free to stop the survey at anytime or skip any sections they would prefer
not to answer.
If you would like any more information please contact the project‟s supervisor
Professor Debra Rickwood. Ph: 6201 2701 or email at
Debra.Rickwood@canberra.edu.au
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Factors influencing young people’s choice of professional help for mental health
concerns
If you DO NOT wish your child to participate please tick the box and return this
consent form to the school by_____
(If you do not complete this consent form it will be assumed that you have provided
your consent.)
I have read and understood the purpose and requirements of this study on my child.
I do not wish my child to participate in this study.
Parent/ Guardian Name:_____________________________________
Child‟s Name:_____________________________________________
Signature:________________________________________________
Date: ____________________________________________________
A summary of the findings of this research will be provided to your school by the
end of the year.
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Appendix E
RESEARCH PARTICIPANT INFORMATION SHEET:
Factors affecting young people’s choice of professional help for mental
health concerns Project Aim To identify which factors contribute to young people‟s choice of professional help when
they are concerned about a mental health problem. Of interest is whether young people
prefer online, phone line or face-to-face services as these all vary in their levels of
anonymity and type of communication. The factors of interest include self-stigma,
mental health literacy, emotional competence, shyness, and self-reliance.
Benefits of Project
It is anticipated that by understanding the factors that contribute to young peoples‟
preference for a type of mental health service, services will be able to tailor their
interventions to address all young people.
Participation
Participation will entail completing a 20-30 minute survey addressing the factors of
interest.
Participating in this study is voluntary and you are free to withdraw at any time, without
penalty. You may also avoid answering questions that you do not wish to answer.
Confidentiality and Anonymity
All responses will be treated confidentially and no identifying information will be
reported. Data will be secured, stored and disposed of according to University of
Canberra guidelines. Only collated data will be reported. No individual data or details
will be disclosed.
This study is being conducted by the principal researcher in order to meet part of the
requirements for a Honours Degree in Psychology at the University of Canberra. The
ACT Department of Education & Training and the University of Canberra Committee
for Ethics in Human Research (Approval no. CEHR 11-55), have both approved this
study.
Access to a summary of the results will be available through the School Principal on
completion of analysis. For any further inquiries or information please contact the
research supervisor, Professor Debra Rickwood (debra.rickwood@canberra.edu.au)
If you wish to participate in this study, please begin
If you do not wish to participate in this research please leave the survey blank
and it will be collected at the end.
If at anytime you feel distressed as a result of the questionnaire please contact the
school counsellor or ring Lifeline on Ph: 13 11 14
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