Why Teens Don’t Talk: Understanding the Role of Stigma Within Barriers to Help Seeking

Abstract

The stigma of mental illness, among a larger set of barriers to help seeking, has been understudied among teens. These barriers and the sources of support were examined through an online survey with 1,428 U.S. 13- to 17-year-olds. Data were analyzed using Q, with indexing and Z tests calculated for significant group differences. Parents were cited as the top support source for depression compared with mental health professionals. Nonstigma barriers were the top barriers for teens, including discomfort with difficult emotions and being misunderstood when reaching out for support. Stigma barriers were significantly higher for Hispanic and LGBTQ+ teens, and stigma-adjacent barriers were significantly higher among Black/African American teens. Results are discussed in terms of the differential support that teens need to navigate emotional challenges and for further understanding barriers to help seeking that are not weighed heavily by stigma, as in past studies.

Stigma has long been a focus of research in mental health because of its role as a barrier to help seeking, preventing those in need from reaching out for support (1–3). Stigma traditionally refers to the negative views held by society and internalized about people with mental illness, resulting in shame (4, 5). The implications of stigma have been well documented and are significant for help seeking. For example, those who carry stigma attitudes related to people who die by suicide are less likely to seek help from mental health professionals and more likely to have poorer attitudes about help seeking (6).

A large portion of the literature has focused on adults (3) and people with serious mental disorders (2, 7). Differentiating types of stigma (8) and its wide-ranging effects, from help seeking and self-efficacy to housing and employment (9), has largely focused on adults. A significant effort has been made to identify stigma-related effects—specifically fear, dangerousness, weakness, negative social judgment, shame and embarrassment, and disclosure and confidentiality concerns—on help-seeking behaviors (3, 10).

Defining Teen Stigma and Its Relationship to Help-Seeking Behaviors

The Substance Abuse and Mental Health Services Administration (SAMHSA)’s recent report shows a breadth of barriers to help seeking among teens, including stigma-related and nonstigma barriers (11). Among those who thought they should have treatment for mental health conditions, the top reasons that teens cite for not receiving treatment included thinking that they should have been able to handle their difficult emotions or behavior on their own (81%); worrying about what people would think or say if they got treatment (53%); worrying that information would not be kept private (50%); not knowing how or where to get treatment (47%); and thinking that treatment would not help them (43%). With a growing trend of teens reporting mental health challenges, such as an increase in persistent feelings of sadness or hopelessness (28% in 2011 to 42% in 2021) (12), it is important to further explore how stigma might appear among this age group. Past research has identified stigma as a main barrier to help seeking among teens (13–15), but these studies have looked at specific mental health conditions (e.g., depression), and studies have used differing definitions of stigma (3, 16). Studies also have shown differential effects of stigma by race-ethnicity, culture, and gender. For example, a study on middle school students’ perceptions of mental illness found that boys, Latina/o teens, and Black teens reported greater stigma-related beliefs than girls and White teens (17).

There are significant shifts in discussing mental health challenges openly, particularly from earlier generations when compared with current teens. Attitudes and actions about caring for mental health challenges seem to be improving for younger generations, as about a third (35%) of Generation Z participants reported receiving treatment or therapy for mental health conditions, compared with 26% of Generation X participants, and 22% of baby boomers (18). The rise of social media and its role in teens’ lives has created a platform for more open discussions of mental health and stigma-free messaging (19, 20). It is also likely that the COVID-19 pandemic had differential and beneficial effects on teens’ perceptions of mental health conditions and treatment (21). During their childhood, mental health and substance misuse awareness and treatment quickly became regular topics on mainstream and social media, which was significantly different from the experiences of their older contemporaries. Additionally, during this time, children and teens were homebound and had significantly more contact with their immediate families. Given these generational shifts and the potential COVID-19–related effects, the authors of this study sought to identify the main barriers to help seeking among teens ages 13–17 years old; the person(s) to whom they would turn if seeking help for depression; and the differences among those who identify as Hispanic, Black/African American, Asian, and lesbian, gay, bisexual, transgender, queer or questioning, plus others (LGBTQ+).

Study Methods

The present research study received approval from the Biomedical Research Alliance of New York (BRANY) Institutional Review Board for a quantitative survey of teens ages 13–17. A sample of teens were recruited through Dynata and Prodege, proprietary online research panels. Consent and survey data were collected digitally by means of Unicom; parental consent was provided initially, and resulting eligible teens provided assent to gain access to the online survey (Figure 1). For the teens to participate, their parents answered an initial set of demographic questions and then provided the survey to their teens to opt in or out. Eligibility criteria included parents (who were at least 25 years old, to rule out very young parents as outliers) having a teen between the ages of 13 and 17 in their household; and participants, ages 13–17 years, in eighth through 12th grade. Quotas for age, gender identity, and race-ethnicity were set to allow for a nationally representative sample, matched to the U.S. Census data for ages 13–17. Boosts were included to reach sizable samples for Hispanic, Black/African American, Asian, and LGBTQ+ respondents. Data were cleaned and analyzed using Q, a market research data analysis platform.

FIGURE 1.

Consolidated Standards of Reporting Trials (CONSORT) flow chart

Participants (N=1,428) were evenly split between those who identified as girls (49%), as boys (49%), and as transgender or nonbinary (2%). Race-ethnicity was distributed as follows: 60% non-Hispanic White, 21% Hispanic, 13% Black/African American, 8% Asian, 4% multiracial, 2% Native American/Alaskan Native, 1% self-described, and <1% Middle Eastern; 14% of the sample identified as LGBTQ+ or unsure. The subgroup analyses presented in this article focus on race-ethnicity and LGBTQ+ status, which showed the most significant and relevant results.

The survey, titled Teen Help Seeking Behavior Exploration, was administered in fall 2023. The survey contained 21 total possible items; conditional logic was used to show and hide questions and responses on the basis of the participants’ earlier responses. On average, the survey required 25 minutes to complete. Main categories of questions were barriers to help seeking when experiencing uncomfortable emotions, sources of stress, sources of and likelihood of using support, attitudes and opinions about caring for one’s mental health, and ways in which participants care for their mental health.

Methodology for Coding Barriers

As outlined by previous definitions of stigma regarding mental health (5, 22) and the current discourse of mental health among teens and young adults (10), barriers that were historically considered as “stigma” derived from the mental illness literature (3) may not apply to younger generations. Therefore, categories of barriers were developed to disentangle stigma-related barriers from other types of barriers to help seeking (Figure 2). Barriers classified as “stigma” were those that most closely matched previous definitions of stigma, specifically those based on feelings of shame, embarrassment, guilt, and fear of being seen as abnormal (5). The second category (“stigma-adjacent”) included barriers to help seeking and fears that might be related to shame-based stigma but might also be related to normative developmental concerns that teens experience. Examples include fear about being judged by others, potentially having their reputation damaged, being seen as weak or not mentally strong, and disclosure or confidentiality concerns. The third category (“nonstigma barriers”) are barriers to help seeking that differ from stigma, such as social, economic, knowledge, and societal barriers, that may prevent teens from talking about their concerns about mental health conditions and getting the help that they need. Examples include not knowing who to talk to, not knowing what a mental health condition looks like, not trusting mental health professionals, and not being able to afford a mental health professional.

FIGURE 2.

Categories of barriers to teen help-seeking behaviors

Results

Teens’ Sources of Support

Participants reported the likelihood that they would seek support from various people or places for feelings of sadness and depression. For analyses, positive and negative valenced responses were combined; the response choices were definitely would, probably would, probably would not, and definitely would not (Table 1). For the full sample, participants cited parents as the top source of support when managing feelings of sadness and depression (87% reported that they definitely would or probably would select their parents), and 82% selected friends. Out-of-school mental health professionals (54%), school guidance counselors (53%), and school psychologists (53%) were selected by roughly half of teens. Forty-four percent of participants reported using online resources (42% selected online friends, and 30% selected an online community).

TABLE 1.

Help seeking for depression and sadness by support type: sample group comparison to total students^a

Support providers	Total		Hispanic			Black/African American			Asian			LGBTQ+
	N	%	N	%	Index level	N	%	Index level	N	%	Index level	N	%	Index level
Your parent(s)	1,245	87	266	87	ns	221	88	ns	215	86	ns	159	79	ns
Friends in real life	1,169	82	259	85	ns	202	81	ns	192	77	ns	161	80	ns
Your sibling(s)/cousin(s)	941	66	218	71	ns	187	75	ns	148	59	ns	125	62	ns
Other family members	868	61	198	65	ns	164	66	ns	124	50	ns	121	60	ns
Someone you are dating	783	55	186	61	ns	141	56	ns	98	39	<80	127	63	ns
Health care provider(s)	776	54	179	58	ns	140	56	ns	112	45	ns	115	57	ns
Out-of-school mental health professionals	761	53	172	56	ns	155	62	ns	108	43	ns	138	68	>120
School guidance counselors	754	53	175	57	ns	155	62	ns	121	48	ns	107	53	ns
School psychologists	728	51	174	57	ns	154	62	>120	114	46	ns	107	53	ns
Resources you find online	629	44	174	57	>120	102	41	ns	114	46	ns	107	53	>120
Teachers	612	43	146	48	ns	129	52	>120	96	38	ns	83	41	ns
Online friends	593	42	167	55	>120	102	41	ns	85	34	ns	110	54	>120
Your own religious group	533	37	139	45	>120	121	48	>120	70	28	<80	53	26	<80
Coaches	515	36	140	46	>120	98	39	ns	72	29	<80	60	30	ns
Principals or other school leaders	436	31	120	39	>120	89	36	ns	48	19	<80	51	25	ns
Online community	423	30	125	41	>120	84	34	ns	65	26	ns	76	38	>120
Community organizations	411	29	113	37	>120	75	30	ns	59	24	ns	51	25	ns
Posts on social media	358	25	103	34	>120	68	27	ns	51	20	ns	57	28	ns
Someone you follow on social media	342	24	101	33	>120	61	24	ns	46	18	<80	56	28	ns
School security guard	262	18	76	25	>120	53	21	ns	29	12	<80	44	22	ns

^a Percent who definitely or probably would seek out support/information (from the following sources) if they were struggling with feelings of sadness and depression. ns, not significant.

We conducted subgroup analyses (Table 1) using indexing for subgroups in comparison with the full sample. Indexing was chosen over Z tests for group comparisons, as the groups were not mutually exclusive, a prerequisite for Z tests. Scores higher than 120 were considered overindexed, and scores lower than 80 were underindexed. Compared with the full sample, Hispanic participants overindexed on seeking support from online sources (online resources: 57% vs. 44%; online friends: 55% vs. 42%; and online community: 39% vs. 31%) and social media (posts on their social media: 34% vs. 25%; someone they follow on social media: 33% vs. 24%). Black/African American participants overindexed on considering support from school psychologists (62% vs. 51%) and teachers (52% vs. 43%). Asian participants underindexed on several items, including considering support from a dating partner (39% vs. 55%), their religious group (28% vs. 37%), and coaches (29% vs. 36%). LGBTQ+ participants overindexed on considering support from out-of-school mental health professionals (68% vs. 53%) and online sources (online resources: 53% vs. 44%; online friends: 54% vs. 42%; and online community: 38% vs. 30%).

Barriers to Teen Help Seeking

Participants reported their top reasons for avoiding talking about uncomfortable or difficult emotions with adults; possible responses were strongly agree, agree, disagree, and strongly disagree (Table 2). The barriers most highly endorsed by participants were all classified as nonstigma barriers. Top reasons included lack of understanding (51% agreed or strongly agreed), discomfort (51%), avoidance of discomfort (48%), focus on problem solving rather than listening (49%), inability to relate (47%), and perceived burden (47%). Stigma-adjacent barriers, including not wanting others to know they are struggling (43%), not wanting to be seen as weak (42%), and disclosure with others (37%), were ranked eighth, ninth, and 21st, respectively, among all barriers to help seeking. Stigma barriers—feeling shame, embarrassment, or guilt (42%) and not being seen as normal (32%)—were ranked 13th and 30th, respectively, among the full list of barriers.

TABLE 2.

Categorized barriers to help seeking with adults: comparison with total sample by sample groups^a

Barrier and reported reason for not seeking help	Total		Hispanic			Black/African American			Asian			LGBTQ+
	N	%	N	%	Index level	N	%	Index level	N	%	Index level	N	%	Index level
Nonstigma barriers	​	​	​	​	​	​	​	​	​	​	​	​	​	​
They might not understand me/what I am feeling.	724	51	155	51	ns	141	56	ns	134	54	ns	116	57	ns
I would be very uncomfortable talking about it.	722	51	160	52	ns	123	49	ns	117	47	ns	102	50	ns
They would try to solve it rather than just listening to me.	704	49	149	49	ns	132	53	ns	131	52	ns	108	53	ns
I would rather avoid any discomfort when it comes to my emotions/feelings.	683	48	143	47	ns	131	52	ns	122	49	ns	106	52	ns
They can’t relate to my situation.	678	47	141	46	ns	132	53	ns	120	48	ns	99	49	ns
I don’t want to be a burden to them.	669	47	158	52	ns	131	52	ns	124	50	ns	115	57	>120
I should be able to handle my emotions and cope on my own.	643	45	143	47	ns	124	50	ns	123	49	ns	106	52	ns
The thought of reaching out for help is too overwhelming.	602	42	150	49	ns	107	43	ns	103	41	ns	95	47	ns
They would escalate the situation in ways I’m not comfortable with.	602	42	134	44	ns	126	50	ns	114	46	ns	92	46	ns
I don’t need to—I can handle things on my own.	600	42	126	41	ns	100	40	ns	105	42	ns	83	41	ns
I worry it will backfire and make the situation worse.	594	42	135	44	ns	107	43	ns	93	37	ns	99	49	ns
I don’t know the words or language to use to express my feelings.	593	42	142	46	ns	105	42	ns	103	41	ns	91	45	ns
They would listen to me but not know how to help me solve my problems.	591	41	137	45	ns	108	43	ns	102	41	ns	98	49	ns
My problems are not serious enough to talk to others about them.	567	40	120	39	ns	97	39	ns	114	46	ns	88	44	ns
I would be seen as dramatic.	562	39	129	42	ns	91	36	ns	110	44	ns	106	52	>120
They would give generic/canned advice that isn’t right for me personally.	548	38	131	43	ns	101	40	ns	93	37	ns	87	43	ns
They would bring it up in the future, and I won’t want to be reminded of it.	542	38	130	42	ns	111	44	ns	93	37	ns	90	45	ns
I don’t know how to ask for help.	518	36	124	41	ns	99	40	ns	97	39	ns	84	42	ns
I am not interested in talking with others.	504	35	125	41	ns	88	35	ns	84	34	ns	73	36	ns
I don’t think reaching out to anyone would be helpful.	482	34	105	34	ns	91	36	ns	92	37	ns	79	39	ns
It’s hard to find moments when it’s safe to do so.	475	33	120	39	ns	92	37	ns	81	32	ns	81	40	>120
I can’t afford to talk to a professional.	472	33	110	36	ns	103	41	>120	87	35	ns	68	34	ns
They haven’t earned my trust enough.	460	32	114	37	ns	101	40	>120	91	36	ns	74	37	ns
They would bring it up in the future as ammunition in an argument.	459	32	119	39	>120	91	36	ns	72	29	ns	64	32	ns
That’s not how I’ve seen my role models cope.	437	31	112	37	ns	95	38	>120	73	29	ns	67	33	ns
They would belittle my struggles or minimize my feelings.	430	30	104	34	ns	95	38	>120	70	28	ns	75	37	>120
They would just brush it off.	427	30	99	32	ns	88	35	ns	76	30	ns	68	34	ns
They would bring it up in the future to make me feel like I owe them.	419	29	113	37	>120	82	33	ns	66	26	ns	64	32	ns
It would reflect badly on my family.	408	29	106	35	>120	83	33	ns	73	29	ns	58	29	ns
They would not want to help me or hear about my struggles.	383	27	96	31	ns	86	34	>120	70	28	ns	63	31	ns
They would give bad advice that leads me down the wrong path.	381	27	90	29	ns	82	33	>120	73	29	ns	58	29	ns
I don’t have anyone to talk to.	338	24	89	29	>120	67	27	ns	52	21	ns	57	28	ns
Stigma-adjacent barriers	​	​	​	​	​	​	​	​	​	​	​	​	​	​
I don’t want anyone to find out that I’m struggling.	621	43	145	47	ns	106	42	ns	114	46	ns	96	48	ns
I don’t want to be seen as “weak” or “not mentally strong.”	599	42	145	47	ns	122	49	ns	101	40	ns	99	49	ns
They would share what we discuss with others.	530	37	116	38	ns	125	50	>120	86	34	ns	80	40	ns
They would judge me unfairly or look down on me.	473	33	119	39	ns	94	38	ns	81	32	ns	73	36	ns
It would damage my reputation.	400	28	107	35	>120	77	31	ns	65	26	ns	49	24	ns
Stigma barriers	​	​	​	​	​	​	​	​	​	​	​	​	​	​
I would feel shame, embarrassment, and/or guilt in talking about it.	596	42	142	46	ns	105	42	ns	115	46	ns	103	51	>120
I wouldn’t be seen as “normal” anymore.	452	32	119	39	>120	78	31	ns	83	33	ns	79	39	>120

^a Data represent the number and percent of respondents who strongly agreed or agreed with the statement “I avoid talking about uncomfortable/difficult emotions with adults because . . . .” LGBTQ+, lesbian, gay, bisexual, transgender, queer or questioning, plus others; ns, not significant.

Subgroup analyses (Table 2) using indexing for group differences revealed significant barriers for Hispanic, Black/African American, and LGBTQ+ participants. Hispanic participants, as compared with the full sample, overindexed on nonstigma barriers, including being reminded about the problem in the future (39% vs. 32%), poor reflection on their family if they were to reach out (35% vs. 29%), and not having anyone to talk to (29% vs. 24%). Hispanic participants also overindexed on stigma-adjacent barriers (damaging their reputation; 35% vs. 28%) and stigma barriers (not being seen as normal; 39% vs. 32%). Black/African American participants overindexed on nonstigma barriers, including not being able to afford professional help (41% vs. 33%), distrust (40% vs. 32%), and their struggles being minimized (38% vs. 30%). Black/African American participants also overindexed on stigma-adjacent barriers (disclosure with others; 50% vs. 37%). LGBTQ+ participants overindexed on nonstigma barriers, including perceived burden (57% vs. 47%), being seen as dramatic (52% vs. 39%), not finding safe moments to talk (40% vs. 33%), and their struggles being minimized (37% vs. 30%). Stigma barriers were significantly higher among LGBTQ+ participants, specifically feeling shame, embarrassment, or guilt (51% vs. 42%) and not being seen as normal (39% vs. 32%). Barriers to help seeking were not significantly different among Asian participants compared with the full sample.

Categorized Barriers to Teen Help Seeking: Adult Support Versus Friend Support

Participants reported their top reasons for avoiding talking about uncomfortable or difficult emotions with friends, in addition to adults. To evaluate the differences in barriers to help seeking when considering reaching out to adults versus friends, we conducted Z tests for group differences (Table 3). Significant differences were found among adults versus friends across all categories. Nonstigma barriers included solving rather than listening (49% for adults vs. 42% for friends; p<0.001), not knowing how to help (50% for friends vs. 41% for adults; p<0.001), distrust (37% for friends vs. 32% for adults; p=0.01), minimizing the issue (34% for friends vs. 30% for adults; p=0.01), weaponizing the information (35% for friends vs. 29% for adults; p<0.001), not wanting to help (34% for friends vs. 27% for adults; p<0.001), and giving bad advice (33% for friends vs. 27% for adults; p<0.001). Stigma-adjacent barriers included not wanting anyone to know they are struggling (49% for friends vs. 43% for adults; p=0.03), not wanting to be seen as weak (47% for friends vs. 42% for adults; p=0.01), disclosure with others (47% for friends vs. 37% for adults; p<0.001), feeling unfairly judged (37% for friends vs. 33% for adults; p=0.04), and damaging their reputation (35% for friends vs. 28% for adults; p<0.001). Stigma barriers included feeling shame, embarrassment, or guilt (46% for friends vs. 42% for adults; p=0.03) and not being seen as normal (37% for friends vs. 32% for adults; p<0.001).

TABLE 3.

Categorized barriers to help seeking: reaching out to adults versus friends^a

Barrier and reported reason for not seeking help	Reaching out to adults		Reaching out to friends		Significance in group difference
	N	%	N	%
Nonstigma barriers	​	​	​	​	​
They might not understand me/what I am feeling.	724	51	724	51	ns
I would be very uncomfortable talking about it.	722	51	727	51	ns
They would try to solve it rather than just listening to me.	704	49	598	42	p<.001
I would rather avoid any discomfort when it comes to my emotions/feelings.	683	48	701	49	ns
They can’t relate to my situation.	678	47	630	44	ns
I don’t want to be a burden to them.	669	47	697	49	ns
I should be able to handle my emotions and cope on my own.	643	45	664	46	ns
The thought of reaching out for help is too overwhelming.	602	42	601	32	ns
They would escalate the situation in ways I’m not comfortable with.	602	42	568	40	ns
I don’t need to—I can handle things on my own.	600	42	641	45	ns
I worry it will backfire and make the situation worse.	594	42	614	43	ns
I don’t know the words or language to use to express my feelings.	593	42	552	39	ns
They would listen to me but do not know how to help me solve my problems.	591	41	711	50	p<.001
My problems are not serious enough to talk to others about them.	567	40	600	42	ns
I would be seen as dramatic.	562	39	598	42	ns
They would give generic/canned advice that isn’t right for me personally.	548	38	569	40	ns
They would bring it up in the future, and I won’t want to be reminded of it.	542	38	579	41	ns
I don’t know how to ask for help.	518	36	515	36	ns
I am not interested in talking with others.	504	35	513	36	ns
I don’t think reaching out to anyone would be helpful.	482	34	484	34	ns
It’s hard to find moments when it’s safe to do so.	475	33	500	35	ns
I can’t afford to talk to a professional.	472	33	N/A	N/A	ns
They haven’t earned my trust enough.	460	32	523	37	p=.01
They would bring it up in the future as ammunition in an argument.	459	32	503	35	ns
That’s not how I’ve seen my role models cope.	437	31	439	31	ns
They would belittle my struggles or minimize my feelings.	430	30	440	31	ns
They would just brush it off.	427	30	488	34	p=.01
They would bring it up in the future to make me feel like I owe them.	419	29	501	35	p<.001
It would reflect badly on my family.	408	29	408	29	ns
They would not want to help me or hear about my struggles.	383	27	480	34	p<.001
They would give bad advice that leads me down the wrong path.	381	27	475	33	p<.001
I don’t have anyone to talk to.	338	24	351	25	ns
Stigma-adjacent barriers	​	​	​	​	​
I don’t want anyone to find out that I’m struggling.	621	43	679	39	p=.03
I don’t want to be seen as “weak” or “not mentally strong.”	599	42	678	47	p=.01
They would share what we discuss with others.	530	37	673	47	p<.001
They would judge me unfairly or look down on me.	473	33	525	37	p=.04
It would damage my reputation.	400	28	497	35	p<.001
Stigma barriers	​	​	​	​	​
I would feel shame, embarrassment, and/or guilt in talking about it.	596	42	651	46	p=.03
I wouldn’t be seen as “normal” anymore.	452	32	529	37	p<.001

^a Data represent the number and percent of respondents who strongly agreed or agreed with the statement “I avoid talking about uncomfortable/difficult emotions with adults/friends because . . . .” ns, not significant; N/A, not applicable.

Discussion

Stigma related to mental health challenges has been a top focus in its relationship to help seeking among adults for decades, but as teens and young adults change, the need to evaluate these constructs to younger generations is necessary. It is becoming clearer that barriers to help seeking for teens are changing. Many young people report that traditional stigma plays less of a role in their discussions about mental health. Teens have notably different perceptions of mental health conditions and do not seem to espouse the same fear and shame-based perceptions as adults.

It is important to consider the unique experiences that are shaping teens’ lives, such as the rise of social media and the effects of COVID-19 on mental health. Both have likely helped to bring the challenges of mental health conditions and the importance of caring for one’s mental health to the forefront, likely reducing stigma-related concerns for young people. There has also been a rise in the number of stigma reduction campaigns implemented in schools and communities (23), which may play a role in mental health awareness. The need to further understand stigma and other barriers to help seeking among teens is essential to develop new and/or modify existing interventions to improve help seeking for this group.

Research discussed in this article with teens nationwide shows that stigma as a barrier to help seeking was less of a concern than other top barriers, including difficulty in communicating mental health and emotional needs and uncertainty of whom to trust and when to share this information. It is clear from the results that teens would benefit from opportunities to develop language around their experiences, particularly difficult emotions, determining who in their lives they could and should talk to about these experiences, and practice asking for help. Additionally, because avoidance of discomfort was identified as a top barrier to sharing, increasing teens’ tolerance of being uncomfortable in honest, help-seeking conversations may be beneficial. Because professional support for mental health conditions was considered less frequently than adult and friend support, there is a clear opportunity for clinicians to assist teens in developing language about how to talk about difficult emotions, how to identify trusted adults and supports in teens’ lives, and how to give constructive feedback when seeking support from others in the instance when the “help” provided was not helpful.

It is important to focus on the role that identity and race-ethnicity play when it comes to help seeking. Certain groups—especially Hispanic, Black/African American, and LGBTQ+ teens—indicate that their support systems may be insufficient in providing the comfort and safety that they need to fully communicate their mental health needs, thereby creating more barriers to help seeking, including some that are on the stigma spectrum. It is critical that any source of teen support—whether it be parents, mental health professionals, or teachers—are prepared to meet teens with their unique and individualized needs, providing a safe space that is free of judgment or prejudice. It is also important to understand and address the needs of Asian teens, who were less likely to consider support from various sources than their peers and may be experiencing cultural barriers associated with help-seeking behaviors (such as a culture of silence) (24).

Teens reported stronger stigma-related barriers when it came to reaching out to friends compared with adults. This finding may come as a surprise, as it is often assumed that peers are well suited to support teens with personal struggles because of their shared experiences and commonalities. It suggests additional considerations for peer support interventions and clear roles for peers so that they do not carry the burden to support other teens in their struggles with mental health conditions.

Moreover, the results suggest that additional attention is needed to enable the conditions for help seeking, specifically assisting adults in creating environments in which teens feel understood and heard. Adults who were more likely to try to fix a problem without listening were a barrier to help seeking; therefore, developing tools and supports to enhance adults’ skills to actively listen, respond empathically, and ask permission (in non–life-threatening situations) to offer solutions may enhance help seeking among teens.

There were both strengths and limitations to this study. Strengths include asking young people directly about their experiences and the factors that affect their likelihood of asking for help from various people in their lives. Significant efforts were taken to ensure representation among racial and ethnic groups as well as sexual identity and sexual orientation groups to understand nuances among attitudes and behaviors related to help seeking and stigma. However, it is recognized that there was significant diversity within racial, ethnic, and sexual identity groups, and sampling was not sufficient to ensure representativeness within each group. Additional limitations included reliance on samples of families and teens that opt in to online research panels. Although it was a nationally representative sample, a portion of people who do not have access to reliable technology or who do not participate in online research may not have been included in this study.

Overall, this study provides a critical lens for understanding the barriers to help seeking and the experience of stigma among teens by focusing on their perspectives to understand how best to support them through difficult emotional experiences. The changing landscape of stigma as found in this study removes age-old scripts but uncovers new and additional barriers as well as opportunities for support for this nation’s teens.