Table 1.
Literature summary
| STUDY | LOCATION | LEVEL OF EVIDENCE | N | FINDINGS |
|---|---|---|---|---|
| Booth et al,1 2004 | Australia | II: Qualitative study; purposive sampling (by sex, age, SES, and rural or urban location) | 810 | Three identified barriers to help-seeking: concerns about confidentiality, knowledge of services and discomfort with disclosing health concerns, and accessibility and characteristics of services |
| Rickwood et al,2 2007 | Australia | II: Narrative review | 48 papers | For mental health problems, engaging in appropriate help is protective; school counselors, GPs, and youth workers are gatekeepers to mental health services for youth; nontraditional access points (eg, Internet) are increasingly useful to engage youth |
| Tylee et al,3 2007 | UK, Switzerland | I: Systematic review | 90 studies | Assess effects of different service models of health care provision for youth in primary care or community health settings; research provides clear guidance on barriers for young people accessing primary care; evidence has not been translated into comprehensive design of youth-friendly services |
| Klein et al,4 1998 | US | II: Telephone survey | 259, aged 14–19 y | Assess adolescents’ use and knowledge of health services, perceived access, and barriers to access; adolescents identified physicians, health centres, and hospital clinics as available services; many did not know where to go for mental health services or reproductive health needs |
| James,5 2007 | Australia | III: Program review | 4 | Youth experiences of mental illness and treatment needs are different from those of adults; young people are in the best position to judge what is youth-friendly; barriers to accessing mental health services included concerns about confidentiality, lack of experience with the system, no GP, inadequate understanding of mental health issues |
| Santor et al,6 2007 | Canada | II: Non-randomized controlled trial | 1124 grade 7, 8, and 9 students | Improving pathways to care depends on providing opportunities to seek help and actively promoting their use; benefits of a school-based intervention greatest among students with specific needs, such as high levels of distress |
| Hobcraft and Baker,7 2006 | Canada, Ghana | III: Interviews | 2 | Financial, logistical, and emotional challenges to accessing services; role of health care policy and resource allocation in protecting the rights of youth |
| Rosenfeld et al,8 1996 | US | II: 4 focus groups | 20, aged 13–21 y | Pilot survey; urban adolescents wanted dignified, respectful treatment and to be listened to and taken seriously by primary care providers |
| Oberg et al,9 2002 | US | III: Narrative review | 112 studies | Access to care is a socio-organizational complex of health care delivery and multiple covariable parameters; integrated community health care delivery models require collaboration among health care and other professionals |
| Brindis et al,10 2002 | US | III: Review | NA | Access to preventive health services through annual visits to physicians increases adolescents’ knowledge and skills and improves their opportunities to assume responsibility for their own health and well-being |
| CIHI,11 2005 | Canada | I: Literature review | 133 studies | Youth with more assets report better health and higher self-worth and are less likely to engage in potentially harmful practices (eg, substance misuse) |
| Zachrisson et al,12 2006 | Norway | I: Population-based cross-sectional health survey | 11 154, aged 15–16 y | Help-seeking passes through several “filters,” each excluding some help-seekers; a minority of adolescents with mental health problems seek help; help-seeking in those with the highest symptom load is low; half the help-seekers achieved contact with GPs; few reached other services |
| Biddle et al,13 2004 | UK | I: Cross-sectional survey | 3004, aged 16–24 y | Strongest predictors of help-seeking are case severity and previous help-seeking; boys are less likely to seek help or confide than girls are |
| Black et al,14 2008 | US | II: Convenience sample survey | 57 | Adolescents who experienced dating violence most often sought help from peers; when violence occurred in isolation, survivors were more likely to receive no support from others; male and female help-seeking differed |
| Kari et al,15 1997 | UK | II: Survey | 347, aged 12–18 y | Barriers to adolescents accessing primary care included stigma, service organization, and lack of knowledge |
| Deane et al,16 2007 | Australia | I: Control group survey | 506 high school students | Low rates of help-seeking and poor access to health care for adolescents are particular problems in rural locations; intervention resulted in increases in intention to seek professional health care; despite increases, intentions remained relatively low |
| Chandra and Minkovitz,17 2007 | US | II: Purposive sample | 57 grade 8 students | Five themes about mental health stigma: personal experience, personal knowledge, family conversations, peer conversations, and perceived social consequences of seeking help |
| Kang et al, 200518 and 200619 | Australia | II: Systematic analysis of multiple service models | 77 papers | Seven principles of better practice robust across all services and sectors: access facilitation, evidence-based practice, youth participation, collaboration, professional development, sustainability, and evaluation |
| Edwards et al,20 2007 | US | II: Review of legislation and literature | NA | Building on assets ameliorates problematic behaviour and develops resiliency; school-based services have a vital role in implementing the Positive Youth Development model |
| Browne et al,21 2004 | Canada, South Africa | I: Literature review RCTs or quasi-experimental comparison group studies with qualitative studies added | 23 reviews | Programs designed to develop protective factors through increased skill or competence are more effective than those aimed at reducing negative behaviour; effective services address individual needs and address the whole child, including clustered emotional behaviour problems; recommend collaborative service delivery with an intersectoral governance structure |
| Anderson-Butcher and Fink,22 2005 | US | II: Purposive sample; survey and regression analysis | 149 youth program participants | Informal relationships and social norms developed in youth programs make a difference in the lives of youth |
| Butler Walker et al,23 2008 | Canada | III: Report on a planning process involving health resource workers | NA | Establishes frameworks for addressing community health issues from a community perspective; identifies key individuals and agencies, background information, goals, objective, strategies, activities, and indicators for each community health issue addressed |
| Bruce et al,24 2003 | Canada | II: Youth-designed survey, focus groups, program evaluation, and documents | 152, aged 15–24 y | Three themes in the transition to adulthood: belonging and connectedness vs independence; value and need the support of adults,; and meaningful involvement with families, schools, and communities are significant builders of assets, skills, and resilience |
CIHI—Canadian Institute for Health Information, NA—not applicable, RCT—randomized controlled trial, SES—socioeconomic status.