Helpful coping strategies and help-seeking behaviors for mental health problems: a vignette study in young people and professionals

Abstract

Background

Understanding young people’s and professionals’ attitudes towards ways to deal with mental health problems is important to overcome barriers to care. We investigated the short- and long-term perceived helpfulness of a list of coping strategies and help-seeking behaviors in a vignette study. Differences between stakeholder groups were also assessed.

Methods

Belgian youth (N = 919), aged 16–24 years, and professionals (N = 569) in youth work, social welfare services, and mental health services took part in the study. Young people were either recruited from a random community sample (N = 5000), a school/university setting or via social media. For professionals convenience sampling was used (mailing list, informing relevant services in the sector). Each participant read one out of six vignettes describing a young person with mental health complaints and the help that young person had received. Descriptive statistics were used to assess consensus about perceived helpfulness. Expectations of the impact of mental health interventions were also assessed. Regression analyses were performed to examine differences between stakeholder groups.

Results

Young people showed positive attitudes towards the helpfulness of professional resources. For the short term, they slightly preferred some personal coping strategies and informal sources of help over professional resources. Performing a hobby and talking to a confidant were found the most helpful coping strategy and help-seeking behavior, respectively, by young people both for the short and the long term. Professionals’ views were mostly consistent with those of young people. Nevertheless, and somewhat counterintuitive, young people had more positive expectations of the impact of professional help than professionals themselves.

Conclusions

Whilst informal strategies still play an important role when dealing with mental health complaints, young people showed generally favorable attitudes towards helpfulness and particularly the impact of professional resources. The list of helpful personal coping strategies identified in this study may provide a focus for implementation in first-line care and for future empirical studies. We highlight the need for educating young people about where to find professional help, and what treatment involves to set realistic expectations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-026-07891-8.

Background

Young adulthood is a particularly vulnerable period for mental health problems, with epidemiological studies showing the median age of first onset of common mental disorders being 19–20 years [1]. This heavily contrasts with the fact that young people have worse access to mental health services than other age groups [2]. Visits to the emergency department for psychiatric purposes are rising among youth in the US, underscoring the mismatch between needs and access to the appropriate services [3].

This mismatch may be partly explained by the multiple barriers young people face upon engaging with services [4, 5]. Psychological barriers include a preference for self-reliance, i.e., the belief that one can handle the problem on one’s own, and fear of stigma [4, 6]. In addition, young people may hold negative attitudes and feelings towards healthcare providers and mental health treatment including the idea that treatment won’t help, feeling uncomfortable to share sensitive information with a stranger, and being afraid not to be taken seriously [4, 7]. Consistent with these attitudes, a previous study by Jorm and Wright [8] in Australia found that young people agreed about the likely helpfulness of general practitioners (GPs), counsellors, phone counselling, family, friends, physical activity, and support groups. Cognitive behavior therapy, however, was not believed to be particularly helpful by young people in the general population. By contrast, dealing with the problem alone, receiving psychotropic medication and being admitted to a psychiatric ward were perceived as potentially harmful. In summary, young people tend to demonstrate stronger initial help-seeking intentions towards trusted and familiar sources, such as family and friends, before engaging with formal mental health services [9].

These findings contrast, however, with attitudes reported among professionals in previous Australian research, where professionals were inclined to endorse informal strategies, such as social support, less strongly, while showing greater endorsement of formal mental health interventions, such as antidepressants and cognitive behavioral therapy [10, 11].

Since the study of Jorm and Wright [8], there have been new developments that merit consideration. The internet and social media have become an important source of information on mental health [12]. In comparison with older adults, young people are more likely to rely on commercial search engines and user-generated content for information than mental health websites or professional online resources. Mainly social motivations (e.g. a desire to connect) seem to drive young people to share their difficulties on social media [13]. Mental health professionals can now become influencers on platforms such as TikTok, although only a limited number of them have verified status, raising questions about credibility [14].

Another development in the field that is gaining traction worldwide are integrated youth services where multiple health and social needs can be met from a single platform of care [2]. The global spread started with the Australian headspace initiative, which entails easy-access, youth-friendly, integrated primary care services for youth between the ages of 12 and 25 years [15]. Apart from aiming at intervention in the early stages of distress, youth participation and co-design is a crucial feature of this service model [16]. Thus, the emergence of broad-spectrum youth mental health approaches in many countries since the beginning of the century makes it plausible that young people’s attitudes towards the helpfulness of interventions have changed.

Therefore, the first aim of our study was to reinvestigate which coping strategies (i.e., personal behavioral approaches to deal with distress) and help-seeking behaviors (i.e., acts of help-seeking from external resources) young people consider helpful for dealing with mental health problems. In contrast to the previous study by Jorm and Wright [8], we made a distinction between short-term (over a period of hours and days) and long-term (over a period of weeks and months) helpfulness, given that some strategies or behaviors might provide immediate relief without leading to lasting positive changes, and vice versa. Second, we compared the user perspective with professionals’ views to bring to light any potential differences. Finally, we investigated young people’s and professionals’ expectations regarding the impact of specific mental health interventions.

Methods

Youth sample

Young people (16–24 years) from a random community sample (N = 5000) that was drawn by Statbel, the Belgian statistical office, were invited to participate in the study by mail. A QR code in the study information leaflet led to the online questionnaire. Due to a low response rate (about 10%), additional recruitment strategies were put in place. First, three Flemish secondary schools and the Student Health Centre of KU Leuven university passed on the study information to their pupils/students. Second, a social media campaign was initiated on Facebook and Instagram by WAT WAT, a Flemish online platform that provides information to young people on various themes (e.g. mental health, sexuality). Only young people older than 18 years could participate following the link in the advertisement because it was not possible to seek consent from a parent/guardian in this way.

Professional sample

The University Psychiatric Center KU Leuven sent an email with an invitation to mental health professionals subscribed to their mailing list. In addition, the research team informed youth organizations, student services, social welfare services, and the coordinators of the mental health care networks in Flanders about the study. Professionals working with young people between the ages of 16 and 24 were allowed to participate. Professionals could access the questionnaire via a weblink.

Questionnaire

The main part of the questionnaire constituted of a vignette: a brief, written description of a young person with mental health problems, followed by a series of questions. Vignettes were constructed, approximating real-world situations, to be able to predict participants’ attitudes, intentions and behavior [17]. In our study there were six vignettes, each made up of two parts. In the first part, the young person in the vignette was presented with a (fictitious) name, age, family and living situation, and a description of the mental health complaints was provided including the impact on daily life functioning. In the second part, the participants could read how the young person came into contact with professional help and what kind of help the young person had received. See Additional file 1 for the study vignettes. Every participant was assigned one vignette to read, either by choosing a random number between 1 and 6 (allocation system used in social media campaign for young people and questionnaire for professionals) or by inserting the number they had received in the study information leaflet (allocation system used for young people in the random sample or in the school-based/university setting), leading to the corresponding vignette. These two allocation systems were used as it was not technically possible to include a random number generator in the online questionnaire.

After being presented the first part of the vignette, participants could rate the perceived severity of the mental health complaints and their concern for the young person in the vignette on a scale from 1 to 5 (1: “not at all severe/concerned”; 5: “very severe/concerned”). Next, participants were asked to share their beliefs about the helpfulness of 32 coping strategies and help-seeking behaviors, in the short (hours to days) and in the long term (weeks to months), for the person presented in the vignette. Response options for this part of the questionnaire were “not at all”, “not really”, “slightly”, “clearly”, “very” helpful. We did not include a neutral position to ensure that the scale functioned as ordinal rather than nominal. Participants could also indicate a “don’t know” option. Afterwards, participants were shown the second part of the vignette. Participants were asked to rate the impact of treatment, i.e., how they thought the person in the vignette would have been doing with and without the professional help mentioned in the vignette, on a scale from 1 to 5 (1: “very bad”; 5: “very good”). Questions about socio-demographic characteristics and experience with mental health care were also presented, specific to the stakeholder group. To assess their current mental health status, young people participants to complete the CORE-10 [18, 19]. A pilot (22 young people, 13 psychiatric trainees) allowed to test the vignettes and questionnaire for comprehensibility and feasibility. Participants were specifically asked whether they considered the vignette to be realistic, i.e. a good example of a young person with emerging mental health problems.

REDCap (Research Electronic Data Capture), a secure web-based software platform designed to support data capture for research studies, was used to develop and administer the online questionnaire [20, 21]. The questionnaire language was Dutch.

Statistical analysis

The helpfulness scores for the different vignettes were pooled per stakeholder group (see Additional File 2 for comparability checks). Consensus about the helpfulness of the coping strategy/help-seeking behavior was considered to have been reached when at least 70% of young people gave a “helpful” (= 1) rating (i.e., “slightly”, “clearly” and “very” were scored 1), which is a commonly used cut-off in consensus studies [22]. In the case of consensus, binary logistic regressions were carried out to examine differences in helpfulness ratings according to stakeholder group (with young people as the reference category). We chose the binary approach due to empty cells in some response categories.

All analyses were co-varied for the possible confounding effects of perceived severity of the mental health problems and concern for the person in the vignette. Only differences significant at the P ≤ 0.01 level were considered relevant, given the large number of comparisons examined. Furthermore, for each respondent a new continuous variable was created subtracting the score relating to how the person would have been doing without help from the score corresponding to how they thought the person was doing with the help mentioned in the vignette, which represented the perceived effectiveness/impact of the intervention. Finally, to investigate the relationship between perceived severity of the complaints, and concern for the person in the vignette on the one hand, and expectations of the impact of treatment on the other hand, a linear regression analysis was carried out based on young people’s responses. We used the same approach to examine the impact of previous experience with mental health care (“yes” = 1, “no” = 0) and satisfaction with that care (5-point Likert scale with “very dissatisfied” = 1 and “very satisfied” = 5) in young people.

All analyses were performed using JMP^® Pro 16 (SAS Institute Inc., Cary, NC, 1989–2023).

Patient and public involvement

The list of coping strategies and help-seeking behaviors was based on previous research [10], but adapted and supplemented following a focus group discussion with 11 young people with lived experience. Furthermore, four young people with lived experience were involved in the creation of the vignettes. These young people shared their personal stories, relaying to EW the mental health problems they had faced and how they had navigated informal and professional help during an interview. The participants were familiarized with the vignette format with the goal of co-writing the vignette by the end of the interview (see Additional file 3). Two psychiatrists (GE and MV), working in youth mental health care, also supplied two additional vignettes. These vignettes served as an example in the questionnaire of a young person experiencing mental health problems that impacted their daily functioning, and who had to navigate the mental health care system for help. Whether the young person had a formal diagnosis (based on a specific set of criteria) was considered inconsequential by the research team as even subthreshold manifestations of psychopathology can cause significant impairment [23].

Ethics

We obtained ethical approval for the study from the medical ethics committee of the University Hospitals Leuven – UZ Leuven, Belgium (s64072). Minors (young people < 18 years old) gave electronic personal assent in addition to written parental consent. Consent forms for parents were included with the study information leaflet, as was a pre-stamped envelope to send them back. For each record in REDCap that concerned a minor, the research team checked for written parental consent. When absent, the record was deleted permanently from the server. From young people over 18 years old, electronic informed consent was obtained.

Results

Respondent characteristics

About three out of four participating young people were female (see Table 1). The mean age of young people was 19.5 years (SD = 2.4), with a minimum of 16 years and a maximum of 24 years. On a scale from 1 to 5 (1 = “bad”, 5 = “excellent”), young people rated their mental health as being worse (median = 2.0, SE = 0.03) than their physical health (median = 3.0, SE = 0.03). 69% of the participating young people reported psychological distress to some extent. Vignette 1 was completed by 120 young people, vignette 2 by 139, vignette 3 by 188, vignette 4 by 182, vignette 5 by 158, and vignette 6 by 132.

Table 1.

Respondent characteristics

Characteristic		N (%)
Young people (N = 919)
Gender
	Male	224 (24%)
	Female	670 (73%)
	Other	25 (3%)
Birthplace
	Belgium	882 (96%)
	Other	37 (4%)
Living situation
	Living with one or both parents	784 (85%)
	Living alone	31 (3%)
	Living with friends or partner	85 (9%)
	Other	19 (2%)
Education
	Secondary education	331 (36%)
	Higher education	413 (45%)
	Other	38 (4%)
Employment
	Yes	373 (41%)
Psychological distress (CORE-101)
	Non-clinical range	248 (27%)
	Mild psychological distress	171 (19%)
	Moderate psychological distress	197 (21%)
	Moderate-to-severe psychological distress	155 (17%)
	Severe psychological distress	109 (12%)
Sought professional help for psychological distress
	Yes	448 (49%)
Professionals (N = 569)
Gender
	Male	122 (21%)
	Female	447 (79%)
Professional background
	Psychologist or therapist	165 (29%)
	Mental health worker or nurse	172 (30%)
	Social worker	94 (17%)
	Psychiatrist	37 (7%)
	Other	101 (18%)
Main activity
	Mental health services	288 (51%)
	Social welfare services	91 (16%)
	Primary care services	76 (13%)
	Youth work	37 (7%)
	Other	77 (14%)
Average number of contact hours with young people (age 16–24 years) per week
	0 to 10 h	320 (56%)
	10 to 20 h	145 (25%)
	20 h or more	104 (18%)

¹Barkham M, Bewick B, Mullin T, Gilbody S, Connell J, Cahill J, Mellor-Clark J, Richards D, Unsworth G, Evans C. The CORE-10: A short measure of psychological distress for routine use in the psychological therapies. Couns. Psychother. Res. 2013;13(1):3–13

The majority of the participating professionals was female. Their mean age was 38.2 years (SD = 10.8), with a minimum of 22 years and a maximum of 71 years. The sample was diverse in terms of professional background. Vignette 1 was completed by 37 professionals, vignette 2 by 91, vignette 3 by 125, vignette 4 by 125, vignette 5 by 96, and vignette 6 by 95.

Helpfulness of coping strategies

Table 2 shows the percentage of young people selecting each response option regarding the short- and long-term helpfulness of the coping strategies listed. For professionals, the percentage who considered the coping strategy “helpful” is displayed (see Additional file 4 for frequencies per response category for professionals). The results of the binary logistic regressions are also presented in terms of odds ratios and p-values.

Table 2.

Helpfulness ratings of coping strategies (frequencies in percent) per stakeholder group, with odds ratios and 95% confidence intervals for the comparison between young people and professionals

	Short/long	Young people							Professionals	OR [95% CI]
		Don’t know	Not at all	Not really	Slightly	Clearly	Very	‘Helpful’	‘Helpful’
Performing a hobby	Short	2	0	5	40	40	13	93	88	0.5 *** [0.4; 0.8]
	Long	2	1	7	33	40	18	91	96	2.6*** [1.6; 4.3]
Hugging an animal/a pet	Short	3	1	3	34	40	18	92	92	1.0 [0.6; 1.5]
	Long	4	11	23	32	20	10	62	76	-
Going into nature	Short	2	3	6	45	33	11	89	94	1.7** [1.2; 2.6]
	Long	3	7	15	37	28	11	76	92	3.5*** [2.5; 5.0]
Being creative e.g. writing, making a moodboard	Short	6	3	8	46	31	6	83	90	1.9*** [1.3; 2.6]
	Long	7	4	17	39	26	8	73	89	3.5*** [2.6; 4.8]
Listening to uplifting music	Short	1	5	12	53	22	7	82	70	0.5*** [0.4; 0.6]
	Long	2	46	32	14	4	2	20	31	-
Exercising	Short	3	5	11	35	32	13	80	86	1.1 [0.9; 1.6]
	Long	3	8	12	27	34	16	77	91	2.8*** [2.0; 3.9]
Meditation, mindfulness or relaxation	Short	3	4	12	52	22	6	80	85	1.4 [1.0; 1.8]
	Long	5	4	12	37	31	11	79	95	5.0*** [3.3; 7.4]
Resting or taking a nap	Short	2	7	13	40	28	10	78	79	1.1 [0.9; 1.5]
	Long	3	26	33	25	10	3	38	52	-
Taking psychotropic medication (e.g. antidepressants, sleeping pills)	Short	8	7	14	31	30	11	72	77	1.4** [1.1; 1.9]
	Long	8	17	23	27	18	6	51	61	-

Note: Only coping strategies for which consensus on helpfulness was reached among young people are displayed. **: P ≤ 0.01, ***: P ≤ 0.001 (only differences with P ≤ 0.01 for stakeholder effect were considered relevant). Abbreviations: OR = odds ratio. CI = confidence interval

At least 70% of young people considered performing a hobby, going into nature, being creative, exercising and meditation, mindfulness or relaxation to be helpful coping strategies in both the short and the long term. Hugging an animal or pet, listening to uplifting music, resting or taking a nap, and taking psychotropic medication were considered helpful in the short term, but not in the long term.

Young people considered listening to uplifting music and performing a hobby more helpful in the short term than professionals. In contrast, professionals considered taking psychotropic medication more helpful than young people did in the short term. Going into nature and being creative were deemed more helpful by professionals in both the short and the long term. Professionals also considered exercising, performing a hobby, and meditation, mindfulness or relaxation more helpful in the long term than young people did.

Consensus on the helpfulness of the coping strategies binge-watching, taking natural remedies, eating comfort food, gaming, praying or being spiritual, smoking marihuana, consuming alcohol, self-harming, and smoking cigarettes was not reached among young people, for either the short or the long term. See Additional file 5.

Helpfulness of help-seeking behaviors

Table 3 corresponds to Table 2 in presenting the helpfulness of the listed help-seeking behaviors.

Table 3.

Helpfulness ratings of help-seeking behaviors (frequencies in percent) per stakeholder group, with odds ratios and 95% confidence intervals for the comparison between young people and professionals

	Short/long	Young people							Professionals	OR [95% CI]
		Don’t know	Not at all	Not really	Slightly	Clearly	Very	‘Helpful’	‘Helpful’
Talking to a confidant	Short	1	1	4	27	41	27	95	99	3.8*** [1.9; 7.6]
	Long	1	0	2	13	44	39	96	98	2.6 [1.1; 5.8]
Calling or meeting a friend	Short	0	1	6	33	42	18	93	94	1.2 [0.8; 1.8]
	Long	1	4	14	36	34	11	81	89	1.8*** [1.3; 2.5]
Seeing a psychologist	Short	2	2	8	33	32	24	89	95	2.3*** [1.5; 3.5]
	Long	2	1	1	10	37	50	97	99	2.9** [1.3; 6.6]
Seeing a psychiatrist	Short	4	3	6	35	32	20	87	92	1.7** [1.2; 2.5]
	Long	5	2	2	12	41	38	91	94	1.8** [1.1; 2.7]
Contacting a helpline	Short	5	3	6	37	37	13	87	98	10.8*** [5.5; 21.0]
	Long	6	3	10	30	35	15	80	90	2.2*** [1.6; 3.1]
Consulting a youth service	Short	11	2	5	31	35	16	82	97	8.0*** [4.7; 13.7]
	Long	11	2	2	17	40	28	85	98	11.6*** [6.0; 22.6]
Looking for experiences of other young people with psychological difficulties	Short	4	6	10	53	24	5	82	76	0.8 [0.6; 1.0]
	Long	5	8	17	41	22	7	70	65	0.9 [0.7; 1.1]
Consulting a general practitioner	Short	4	5	15	37	26	12	75	91	3.9*** [2.7; 5.5]
	Long	5	5	12	27	33	19	79	91	3.1*** [2.2; 4.3]
Admission to a psychiatric hospital	Short	12	5	15	30	26	13	69	74	-
	Long	12	5	9	20	35	20	75	66	0.7 [0.6; 0.9]
Reading a self-help book	Short	7	9	21	43	16	4	63	62	-
	Long	7	8	13	37	26	10	73	78	1.4** [1.1; 1.9]

Note: Only coping strategies for which consensus on helpfulness was reached among young people are displayed. **: P ≤ 0.01, ***: P ≤ 0.001 (only differences with P ≤ 0.01 for stakeholder effect were considered relevant). Abbreviations: OR = odds ratio. CI = confidence interval

Young people found informal sources (i.e., talking to a confidant, calling or meeting a friend) most helpful in the short term. For the long term, calling or meeting a friend dropped slightly in the ranking, below several professional resources. Seeing a psychologist, seeing a psychiatrist, contacting a helpline, consulting a youth service, looking for experiences of other young people with psychological difficulties, and consulting a GP were all considered helpful in both the short and the long term. Admission to a psychiatric hospital and reading a self-help book were only considered helpful in the long term.

Seeing a psychologist, seeing a psychiatrist, contacting a helpline, consulting a youth service, and consulting a GP were deemed more helpful by professionals in both the short and the long term. Professionals also considered calling or meeting a friend and reading a self-help book more helpful in the long term than young people did.

Consensus was not reached looking up information about mental health on the internet, searching for posts on social media about psychological difficulties, calling the emergency number, and going to emergency services; these behaviors were not deemed helpful in either the short or the long term. See Additional file 5.

Expectations of impact of treatment

Table 4 shows the mean and standard deviation of the continuous variable relating to the expectations of impact of the professional help mentioned in the vignettes, displayed per vignette and stakeholder group.

Table 4.

Mean and standard deviation of the continuous variable relating to the expectations of impact of the professional help mentioned in the vignettes, per vignette and stakeholder group

	Young people	Professionals
Vignette 1 Background: Sam, 18-year-old girl with depressive symptoms (feeling unhappy, having no hope for the future, sleeping problems, lack of energy and appetite, concentration problems, social isolation) and conflict at home (parent with alcohol problems). Sam chats with a helpline and receives a list of professional resources in the neighborhood.	1.6 (SD = 0.9)	1.1 (SD = 0.9)
Vignette 2 Background: Bo, 23-year-old girl with eating problems (over-dieting, unhappy about appearance, over-exercising, feeling tired and cold, fainting). Bo goes to a dietician and is then referred to a multidisciplinary team that has specific expertise with eating disorders.	2.2 (SD = 1.0)	1.9 (SD = 0.7)
Vignette 3 Background: Tim, 17-year-old boy with behavioral problems (aggression, anger directed towards himself and others, feelings of shame, loneliness) and relational trauma (neglect from a parent). Tim goes to a youth service and can have up to 10 therapeutic sessions.	1.87 (SD = 0.8)	1.5 (SD = 0.7)
Vignette 4 Background: Alex, 22-year-old girl with emotion regulation problems (sudden mood swings, low self-esteem and emotional expression, self-harming, suicidal thoughts) and relational trauma (no contact with one parent). Alex goes to the general practitioner who gets help for the young person from a crisis outreach team.	2.0 (SD = 0.9)	1.5 (SD = 0.8)
Vignette 5 Background: Noah, 20-year-old boy with autism spectrum disorder and depressive symptoms (feeling unhappy, irritability, loss of interest, social isolation, lack of day structure, running away). Noah is admitted to a residential inpatient treatment center for young adults.	1.9 (SD = 0.9)	1.4 (SD = 0.8)
Vignette 6 Background: Joachim, 19-year-old boy with substance issues and psychotic symptoms (paranoia, bizarre thoughts, incoherent speech, anxiety, suicide attempt), who is living in poverty. Joachim goes to the emergency services and is admitted to a short-stay, hospital-based mental health crisis unit.	2.0 (SD = 1.0)	1.6 (SD = 0.7)

Note: For each respondent a new continuous variable was created subtracting the score relating to how the person would have been doing without help (on a scale from 1 to 5, 1: “very bad” and 5: “very good”) from the score corresponding to how they thought the person was doing with the help mentioned in the vignette (on a scale from 1 to 5, 1: “very bad” and 5: “very good”)

A linear regression model (R² = 0.04) considering young people’s responses showed a significant positive association between perceived severity (b = 0.2, p = 0.0004)/concern for the person (b = 0.2, p = 0.0018) and the expectations of the impact of treatment. Experience with mental health care did not significantly influence these expectations (general experience: R²= 0.05, b = -0.03, p = 0.4567; first-line outpatient care: R²= 0.05, b = -0.07, p = 0.0579; second-line outpatient care: R²= 0.05, b = -0.01, p = 0.0544). However, among young people who had received care, those who reported higher satisfaction with their treatment held more positive expectations about the impact of treatment in the vignettes (R²= 0.05, b = 0.11, p = 0.0082).

When comparing both groups (R² = 0.10), professionals had lower expectations of the impact of suggested treatment options than young people (b = -0.15, p < 0.0001).

Discussion

This study used vignette methodology to investigate young people’s attitudes towards the short- and long-term helpfulness of coping strategies and informal and formal sources of help for dealing with mental health complaints. We found generally very positive attitudes towards the helpfulness of professional resources in young people, both in the short and the long term. In comparison to young people, professionals generally considered professional resources to be more helpful than young people, although the differences were relatively small in terms of frequencies. Nevertheless, young people had more positive expectations of the result of professional help.

Our study showed that more informal ways of dealing with mental health complaints, including strategies that involve important others and adopting a healthy lifestyle, still gain substantial traction. Previous studies have indeed found that young people clearly prefer to deal with mental health problems themselves first, and if help is needed rather seek informal and self-help resources than help from professional resources [4, 9, 24]. Targeting lifestyle factors (e.g. physical activity, smoking, sleep) have also been part of prevention strategies [25]. What our study adds, is the distinction between short- and long-term helpfulness. For the short term, informal help-seeking behaviors (e.g. talking to a confidant, calling or meeting a friend) were considered more helpful than professional resources (e.g. talking to a psychologist, talking to a psychiatrist). Nevertheless, also for the short term, young people found taking psychotropic medication helpful, which contrasts with previous findings [10]. In terms of long-term helpfulness, professional resources were considered more helpful than some informal sources by young people. There was agreement, for instance, among young people that seeing a psychiatrist and psychiatric admission are helpful, which does not confirm the presumption that young people feel that psychiatry is for “crazy” people [5]. Strategies pertaining to a healthy lifestyle (e.g. exercising, meditation), on the other hand, were deemed both helpful in the short and the long term, although professionals were more convinced of their long-term helpfulness. However, whilst lifestyle interventions might be beneficial for purposes of maintaining mental wellness by improving resilience and building social safety nets [26], the evidence-base for their usefulness in mental health treatment is still limited [25, 27]. Further research, by means of randomized controlled trials, is necessary to assess effectivity of these interventions whilst also uncovering the underlying mechanisms that explain their effects [25]. Furthermore, interventions that constitute acceptable and effective care should also be considered helpful by the target population and the clinicians that deliver them. The identified helpful personal coping strategies in this study can provide focus for future empirical studies.

The positive attitudes towards helpfulness of professional resources might be explained by the fact that participants could share a more nuanced view, being able to rate both short- and long-term helpfulness, where professional help is regarded more suitable for making sustainable change. Another possible explanation is that mental health literacy has improved among youth in recent years. Worldwide there have been many examples of youth focused awareness campaigns that target mental health promotion and educate on the warning signs of emerging mental health disorders [2]. Furthermore, with increasing levels of psychological distress due to the COVID-19 pandemic the mental health of young people has been high on the agenda [28].

Given that young people consider existing professional resources to be very helpful, it is crucial that they are aware of where to find them, which is not always the case at present [5]. Addressing this issue, professionals and policy makers should realize that they likely overestimate the impact of web-based platforms since looking up information on the internet was not considered helpful by young people in our study. In a study from Ireland, it has been shown that almost all young people engage in some form of online help-seeking [29].

However, a systematic review showed that online platforms providing youth with basic mental health information did not increase the likelihood of formal help-seeking behavior [30]. These platforms do play a role in improving young people’s awareness and understanding of mental health issues [31] but a sustained effort to diversify guidance to help-seeking to meet the different needs of youth is still adamant [32].

Looking for experiences of other young people with psychological difficulties was found helpful by young people in our vignette study. Without training and adequate supervision however, peers often feel and are inadequately prepared to help, particularly in a mental health crisis [33]. A co-facilitation model, allowing contributions from peer workers and clinicians, might increase the impact of interventions in young people [34]. Further research in this area is needed, focusing on the values underpinning youth peer support and exploration of how peer support workers can bring their unique set of experiential expertise to different practices [35]. Surprisingly, looking for peer experiences was deemed more helpful by young people in the short term than consulting a GP. Policy makers often consider GPs as important gatekeepers that act as a first point of contact, who can then refer to more specialized care options. A referral letter from a GP is sometimes necessary to receive reimbursement [36]. However, they should keep in mind that this might not apply to young people.

Finally, young people in our study had higher positive expectations of the impact of specific mental health interventions compared with professionals. On the one hand, this might reflect confidence that treatment works. Particularly in young people, the association between patients’ early treatment outcome expectations and their posttreatment outcomes appears stronger [37]. More positive outcome expectations are associated with a greater likelihood of engaging in a collaborative working relationship with the therapist, thereby increasing the chances of clinical improvement. On the other hand, young people might hold unrealistic expectations. Young people are largely unsure of what to expect when seeking professional help [38]. Prior to treatment, young people tend to hold the belief that treatment will be brief and follow a concrete, linear course, looking for a “quick fix” [39]. However, recovery from mental illness is a non-linear, ongoing process towards stability and not “a return to normal” [40], as is described by young people with lived experience. It is about learning to be independent whilst also getting the necessary support, experiencing symptom reduction whilst also learning to “cope with”, and becoming the “best version of themselves” whilst leaving room for identity exploration and discovery of their purpose in life. Professionals feel like having to wave the “magic wand” to make things better, representing an overestimation of their impact on outcomes which might negatively impact other options, such as informal support and self-management [41]. Treatment failure can then occur in two cases according to a hypothesis of De Soet and colleagues [42]: (1) when treatment does not meet young people’s expectations and (2) when they lose hope after failing to experience improvement despite prolonged treatment. Therefore, clinical workers should perform a balancing act: conveying optimism that treatment can work, without promising an unrealistic degree of speed or change [37]. Nevertheless, in young people, the association between treatment beliefs on the one hand and treatment attendance and outcomes on the other hand, remains largely underexplored and insufficiently understood [42].

Based on our results, we come to the following recommendations as part of a youth mental health approach:

1. Since coping strategies such as engaging in hobbies, spending time in nature, being creative, exercising, and practicing meditation, mindfulness or relaxation were deemed helpful for dealing with mental complaints in both the short and the long term, schools and early intervention services should explore how they can offer these activities themselves or collaborate with leisure organizations to provide them.

2. As we observed positive attitudes towards professional resources, especially for the long term, young people should be informed about how to access these services. Multiple avenues should be considered for information provision, as the impact of online tools might be overrated, and not all young people are likely to consult their GP. Young people with lived experience could play an important role, since seeking out the experiences of peers with psychological difficulties was considered helpful in the short term. These young people could act as ambassadors for early intervention services, for instance by speaking about their own care pathways [43].

3. Our findings highlight the need to educate young people about what treatment involves and how it can improve their situation. Professionals should make this an important talking point during the initial treatment phase.

The findings have a number of limitations that must be acknowledged. The study included a non-random sample of youth and professionals. There was an overrepresentation of females in both populations. For the professional group this is in line with the reality in clinical practice, however. About 70% of young people reported psychological distress to some degree and about half had previous contact with professional help. We did not investigate how attitudes towards the helpfulness of interventions related to specific mental health difficulties, although differences were found in previous studies [8, 10]. However, we did not find an association between experience with care and expectations of the impact of treatment in young people. To be able to investigate how the nature of a problem, severity, psychosocial context, etc. influences the perceived helpfulness of specific interventions, a factorial survey experiment might be more suitable. Also, the number of respondents per vignette was unequal, certainly in the professional group, because respondents showed a preference for the middle numbers. Furthermore, we did not include contact with family in our list of help-seeking behaviors, which is a limitation, as families have been shown to play an important part in young people’s help-seeking journeys [9]. Additionally, our study did not explore the interplay between different coping strategies and help-seeking behaviors, which may be an interesting focus to better approximate real-life scenarios. Finally, young people and professionals were asked to consider the helpfulness of the coping strategies/help-seeking behaviors for the young person described in the vignette. Whilst this might have helped young people to distance themselves from their own personal experience, it might have added more depth to have an idea about the helpfulness of the coping strategies/help-seeking behaviors from a first-person perspective.

Conclusion

This study identified multiple coping strategies and help-seeking behaviors that were considered helpful for dealing with mental health complaints according to young people and professionals. Whilst informal strategies still play an important role when dealing with mental health complaints, young people showed generally favorable attitudes towards helpfulness and particularly the impact of professional resources. Professionals’ views were mostly consistent with those of young people. The list of helpful personal coping strategies identified in this study may provide a focus for implementation in first-line care and for future empirical studies. We highlight the need for educating youth about where to find professional help, and what treatment involves.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

GP

General practitioner

REDCap

Research Electronic Data Capture

Author contributions

Eline Wittevrongel, Marina Danckaerts and Ruud van Winkel developed the concept for the study and designed the study; Geert Everaert and May Vrijens were involved in the writing process of the vignettes; Eline Wittevrongel and Ruud van Winkel coordinated the study; Eline Wittevrongel collected the data; Eline Wittevrongel performed the analyses and interpreted the data. Eline Wittevrongel and Maarten Jackers drafted the manuscript; Geert Everaert, May Vrijens, Marina Danckaerts and Ruud van Winkel provided critical revisions of the manuscript. All authors read and approved the final manuscript.

Funding

EW is supported by the Funds Julie Renson, Queen Fabiola and King Baudouin Foundation (Chair for Transition Psychiatry). RVW is supported by a Research Foundation Flanders Senior Clinical Fellowship (FWO 1803616 N) and by the Funds Julie Renson, Queen Fabiola and King Baudouin Foundation (Chair for Transition Psychiatry). The funders had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

Data availability

Eline Wittevrongel confirms that she had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The data used in this study are not publicly available due to privacy and ethical restrictions but can be obtained from the corresponding author on reasonable request.

Declarations

Ethical approval and consent to participate

We obtained ethical approval for the study from the medical ethics committee of the University Hospitals Leuven – UZ Leuven, Belgium (s64072). Minors (young people < 18 years old) gave electronic personal assent in addition to written parental consent. From young people over 18 years old, electronic informed consent was obtained.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.