Table 2: Barriers and Facilitators
|
1st author, year, country
|
Study design
|
Sample size
(n=)
|
Age and setting
|
Barriers
|
Facilitators
|
Quality
|
Bates, 2012, Canada
|
Cross sectional survey
|
n=193 students
110 parents
|
11 to 15 years old high school students
|
Students: “nothing will help”, stigma, self-sufficiency, fear of coercion.
Parents: fear of coercion, money constraints, self-sufficiency, perceived impact of adolescent problems and not understanding the child problem.
|
Both: Prior professional help-seeking
|
Medium
|
Boyd, 2011, Australia
|
Cross sectional
|
n=201
|
11 to 18 years old students in rural high school
|
Perceived limited service availability, social proximity and gossip, travel and cost of service, limited knowledge of sources of help, fears confidentiality
|
Not assessed
|
Medium
|
Buttigieg, 2016, Malta
|
Mixed Methods
|
n=494
|
14-15-year-old high school students
|
Need for autonomy, embarrassment, poor mental health literacy, stigma, higher levels of depressive symptoms
|
Not assessed
|
Low
|
Charman, 2010, Australia
|
Qualitative
|
n=20
|
16-26 (mean 17.7 years) members of community groups
|
Confidentiality concerns and stigma
|
Not assessed
|
Medium
|
Chen, 2017, Malasya
|
Cross sectional
|
n=277
|
13-20-year-old high school students
|
Stigma, fear, lack of courage, doubt about counsellor competency
|
Not assessed
|
Medium
|
Cheng, 2013, United Kingdom
|
Cross sectional
|
n=67
|
Parents of Chinese students in language school living in England.
|
Knowledge about help-seeking, language barriers
|
Not assessed
|
Low
|
Cramer, 2017, United States
|
Cross sectional
|
n=396
|
14-17-year-old high school students
|
Stigma, higher levels of emotional difficulties, personnel and service availability
|
Prior help-seeking behaviours
|
Medium
|
Curtis, 2010, New Zealand
|
Mixed Methods
|
n=1896
|
18-24 years old (60.2% under 20) university students
|
Stigma and a perceived need for self-reliance
|
Not assessed
|
Low
|
Czyz, 2013, United States
|
Cross sectional
|
n=157
|
18-22-year-old (77.1% under 20) college students at elevated suicide risk
|
Perception that treatment is no needed, lack of time, self-management and stigma
|
Not assessed
|
Low
|
Dardas, 2017, Jordania
|
Cross sectional
|
N=2349
|
12-17 year-old high school students
|
Higher depressive symptoms, higher levels of stigma
|
Not assessed
|
Medium
|
De Anstiss, 2010, Australia
|
Qualitative
|
n=85
|
13-17 years old, refugee adolescents living in Australia
|
Low priority of mental health, poor mental health literacy, distrust in services, stigma associated with psychological problems and help-seeking
|
Not assessed
|
Medium
|
Doyle, 2017, Ireland
|
Mixed methods
|
n=856
|
15-17-year-old students in post-primary school
|
Dislike of dual role of counsellor/teacher, confidentiality concerns.
|
Not assessed
|
Medium
|
Fukuda, 2016, Brazil
|
Cross sectional
|
n=1,030
|
8-21-year-old school students receiving mental health treatment
|
Fear of stigmatisation and problem denial
|
Not assessed
|
Low
|
Flink, 2013a, The Netherlands
|
Qualitative
|
n=41
|
Mother of teen daughters (aged 12-20) from different ethnic backgrounds
|
Negative attitudes to GP, inaccessible mental health services, denial by daughters.
Minority ethnic groups: fear of negative judgements and gossiping.
|
Good and trustful bond with daughters, good contact with school
|
Medium
|
Flink, 2013b, The Netherlands
|
Qualitative
|
n=50
|
12-20-year-old female adolescents from different ethnic backgrounds
|
Negative attitudes towards health professionals and school services.
Minority groups: fear to parental and fear reactions
|
Not assessed
|
Medium
|
Gonzlaves, 2012, Portugal
|
Qualitative
|
n=39
|
12-17 years old immigrant attending to school, parents, teachers and health professional.
|
Adolescents: reliance on self-support, shyness, fear and language gap
Family: fees, language, legal issues
Professionals: non-recognition of the problem
All: stigma
|
All: strong link with community, mainly teachers and health professionals
|
Medium
|
Gulliver, 2012, Australia
|
Qualitative
|
n=15
|
16-23-year-old elite athletes (66.7% aged under 19).
|
Stigma, lack of mental health literacy, negative past experiences of help-seeking
|
Encouragement from others, stablished relationship with provider, previous positive experiences with mental health services, positive attitudes of others, access to internet.
|
Medium
|
Haavik, 2017, Norway
|
Cross sectional
|
n=1249
|
Adolescents from Norwegian upper schools (mean=17.6)
|
Mental health literacy, delay in making contact, stigma.
|
Increased mental health literacy, awareness of service availability
|
Medium
|
Hasset, 2017, United Kingdom
|
Qualitative
|
n=8
|
16-18-year-old males who entered CAMHS following self-harm or suicidal ideation and where engaged in therapy
|
Want to maintain an independent self.
|
External adult recognising, normalising and initiating help-seeking. Greater insight, maintaining independent self.
|
High
|
Hernan, 2010, Australia
|
Cross sectional
|
n=74
|
14 to 16 years old high school students from rural and metropolitan towns
|
Personal factors related with communication with mental health professionals, problem recognition, shame, confidentiality breach. Logistical factors (transport, money, travel distances, etc.).
|
Not assessed
|
Low
|
Ijadi-Maghsoodi, 2018, United States
|
Qualitative
|
N=76
|
11-18 years old school students
|
Embarrassment, fear of judgement, confidentiality, mental health literacy
|
|
Medium
|
Jennings, 2015, United States
|
Cross sectional
|
n=246
|
18-24 (73.3% aged 18-19) college students
|
Perceived stigma, self-stigma, higher self-reliance
|
Not assessed
|
Low
|
Kahi, 2012, Lebanon
|
Cross sectional
|
n=521
|
17-21 years old student (53,8% aged 17-18) undergoing a preventive medical visit at University centre
|
Confidentiality, embarrassment, doubt about the professionals’ ability to act, knowledge of services, and logistical factors (money, transport, contact).
|
Not assessed
|
Low
|
Labouliere, 2015, United States
|
Cross sectional
|
n=2145
|
14-18-year-old high school students
|
Extreme self-reliance
|
Not assessed
|
Low
|
Linsdey, 2010, United States
|
Mixed-method
|
n=69
|
13 to 18 years old African American boys with high levels of depressive symptoms
|
Shame and distrust of mental health professionals
|
Not assessed
|
Medium
|
Lubman, 2017, Australia
|
Cross sectional
|
n=2456
|
14-15-year-old high school students
|
Self-reliance, embarrassment, time and money
|
Not assessed
|
Medium
|
Lynn, 2014, United Kingdom
|
Cross sectional
|
n=175 adolescents
n=95 parents
|
14-18-year-old adolescent
|
Adolescents: desire of being independent, reduced mental health literacy in parents.
|
Adolescents: Higher perception of problem severity Both: prior professional help-seeking.
|
Low
|
Maioulo, 2019, Australia
|
Cross sectional
|
n=1582
|
16-18 years high school students
|
Not assessed
|
Positive parenting
|
Medium
|
Mariu, 2012, New Zealand
|
Cross sectional
|
n=9699
|
12-18 years old secondary students (years 9 and 10).
|
Not assessed
|
Living with a single parent, living in an over-crowed house, being well known by a teacher
|
Medium
|
Maritnez-Hernaes, 2014, Spain
|
Cross sectional
|
n=105
|
17-21 year old (84.3% aged under 19) participating in longitudinal survey
|
Normalisation of problem, stigma, reliance on self, beliefs of no need of professional help
|
Positive perception of mental health professionals
|
Medium
|
McLean, 2013, United Kingdom
|
Qualitative
|
n=90
|
10-15-year-old secondary school students
|
Stigma
|
Not assessed
|
Medium
|
Murry, 2011, United States
|
Mixed Methods
|
n=163
|
African American mothers of adolescents (mean=14) living in rural Georgia
|
Community stigma towards family, cultural mistrust, cost
|
Welcoming environment of mental health services
|
Medium
|
Nearchou, 2018, Ireland
|
Cross sectional
|
N=722
|
12-16 years old school student
|
Perceived public stigma
|
Not assessed
|
Medium
|
O’Connor, 2014, Australia
|
Cross sectional
|
n=180
|
17-25-year-old (74.16% aged 18-19) college students
|
Not assessed
|
Extraversion, increased perceived benefits of help-seek, low social support and high perceived benefit
|
Low
|
Pisani, 2012, United States
|
Cross sectional
|
n=2,737
|
14-17 years old high school students in rural communities
|
Not assessed
|
Positive attitudes about help-seeking, perceptions responsiveness from adults, school support
|
Medium
|
Recto, 2018, United States
|
Qualitative
|
n=20
|
15-19 years adolescents with perinatal depression
|
Fear of judgement, normalisation of symptoms, lack of trust
|
Not assessed
|
Medium
|
Rughani, 2011, Australia
|
Cross sectional
|
n=778
|
13-18 years old high school students (years 9 to 12) in rural towns
|
Mistrust and do not believe professional help is beneficial
|
Perceived benefits of mental health treatments
|
Medium
|
Samuel, 2014, United States
|
Qualitative
|
n=54
|
15-17-year-old African American males who received mental health treatment services after detention
|
Stigma, ineffective treatment, fear and shame from peers, mistrust of mental health providers
|
Not assessed
|
Medium
|
Sawyer, 2011, Australia
|
Cross sectional
|
n=5,362
|
12-14 years old school students
|
Higher depressive symptoms
|
None found
|
Medium
|
Seamark, 2018, United Kingdom
|
Qualitative
|
n=6
|
17-18-year-old college psychology students
|
Gender roles, cultural expectations, lack of awareness of sources of help, fear of stigma and rejection
|
Not assessed
|
High
|
Sharma, 2017, India
|
Cross sectional
|
n=354
|
13-17-year-old school students
|
Feeling ashamed, uncomfortable
|
Not assessed
|
Low
|
Shechtman, 2018, Israel
|
Cross sectional
|
n=238
|
14-18-year-old school students
|
Self-stigma
|
Not assessed
|
Low
|
Sylwestrzak, 2015, United States
|
Cross sectional
|
n=10,123
|
13-18-year-old adolescents
|
Self-reliance, mental health literacy, fear of stigma, usefulness of treatment
|
Not assessed
|
Low
|
Tharaldsen, 2017, Norway
|
Qualitative
|
n=8
|
17-18-year-old students
|
Limited knowledge, stigma
|
Not assessed
|
Medium
|
Thomas, 2013, Australia
|
Cross sectional
|
n=289
|
18-25-year-old (59.9% aged 18-19) students enrolled in first year psychology classes
|
Not assessed
|
Good symptom recognition, identification of benefits of professional help, openness to treatment for emotional problems
|
Medium
|
Wang, 2018, United States
|
Mixed methods
|
n=19
|
Asian immigrants parents
|
Mental health literacy, structural barriers, cultural barriers (stigma, lack of cultural sensitivity of services)
|
Not assessed
|
Medium
|
Watsford, 2014, Australia
|
Cross sectional
|
n=102
|
12-18-year-old presenting mild to moderate mental health concerns
|
Not assessed
|
Previous experience in mental health services
|
Medium
|
Wilson, 2010a, Australia
|
Cross sectional
|
n=109
|
18-25 years old (78% age 18-19) college students*
|
Higher levels of psychological distress, negative beliefs about treatment
|
Not assessed
|
Medium
|
Wilson, 2010b, Australia
|
Cross sectional
|
n=302
|
18-25 years old (78% age 18-19) university students*
|
Higher level of suicidal ideation and higher depressive symptoms
|
Not assessed
|
Medium
|
Wilson, 2010c, Australia
|
Cross sectional
|
n=590
|
13-18 years old high school students
|
Higher levels of suicidal ideation and general psychological distress.
|
Not assessed
|
Medium
|
Wilson, 2011, Australia
|
Cross sectional
|
n=562
|
18-25 years old (87,7% aged 17-21) students
|
Need for autonomy and independence
|
Not assessed
|
Medium
|
Wilson, 2012, Australia
|
Cross sectional
|
n=1037
|
13-21-year-old adolescents (79% under 19)
|
Need for autonomy
|
Helpfulness of prior mental health care
|
Low
|
Yap, 2011, Australia
|
Cross sectional
|
n=3746 teens
n=2005 parents
|
12-25 years old student (separated data)
|
Stigma and beliefs about helpfulness of mental health care
|
Not assessed
|
Low
|
Yoshioika, 2015, Japan
|
Cross sectional
|
n=311
|
15-19 high school students
|
Concerns about what other people may think
|
Not assessed
|
Low
|
Zhao, 2015, Canada
|
Cross sectional
|
N=115
|
15-16-year-old students
|
Not assessed
|
Secure attachment style, strong relation with peers
|
Medium
|