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. Author manuscript; available in PMC: 2018 Feb 28.
Published in final edited form as: Violence Against Women. 2016 Aug 30;23(12):1442–1461. doi: 10.1177/1077801216662342

Professional Help-Seeking for Adolescent Dating Violence in the Rural South: The Role of Social Support and Informal Help-Seeking

Jasmine M Hedge 1, Natallia Sianko 1, James R McDonell 1
PMCID: PMC5332345  NIHMSID: NIHMS834021  PMID: 27580981

Abstract

Structural equation modeling with three waves of data was used to assess a mediation model investigating the relationship between perceived social support, informal help-seeking intentions, and professional help-seeking intentions in the context of adolescent dating violence. The sample included 589 adolescents from a rural, southern county who participated in a longitudinal study of teen dating violence victimization and perpetration. Results suggest that informal help-seeking intentions are an important link between perceived social support and professional help-seeking intentions. Findings highlight the importance of informal help-seeking and informal help-giving in fostering professional help-seeking for adolescent victims and perpetrators of dating violence.

Keywords: help-seeking, adolescent dating violence, mediation, structural equation modeling, social support

Introduction

Adolescent dating violence is a pressing and complex social problem with serious physical and psychological consequences for those involved. Victims and perpetrators often need emotional, information, and instrumental support to distance themselves from further violence, and to improve their mental health and well-being. Professional help may be the most efficacious source of support as it is known to provide protection against a variety of mental health risks (Baskin et al., 2010; G. Martin, 2002). However, studies have shown that adolescent victims and perpetrators of dating violence rarely seek help (Ashley & Foshee, 2005; Wilson, Deane, Ciarrochi, & Rickwood, 2005) and those who do seek help generally turn to friends and family rather than formal or professional sources.

A number of studies have investigated adolescents’ unwillingness to seek professional help for dating violence and other mental health–related problems, but few studies have explored pathways that foster willingness to seek professional help. In addition, few studies have explored adolescents’ willingness to seek professional help within the rural south. The purpose of this study is to explore help-seeking intentions of rural southern adolescents, and to investigate one possible pathway to professional help-seeking through social support and informal help-seeking. Evidence suggests that perceptions of social support predict informal help-seeking behaviors among adolescents (Sheffield, Fiorenza, & Sofronoff, 2004), and informal help-seeking behaviors often lead to professional help-seeking (Postmus, Severson, Berry, & Yoo, 2009). Therefore, this study specifically tests the mediating role of informal help-seeking intentions in the relation between perceived social support and professional help-seeking intentions for adolescent dating violence among rural, southern adolescents.

Adolescent Dating Violence Prevalence and Impact

As many as one third of adolescents have experienced physical or sexual dating violence (Cyr, McDuff, & Wright, 2006; Foshee et al., 1996; Haynie et al., 2013). Prevalence rates have varied from study to study due to differences in the types of violence asked about on surveys, age ranges of participants, and survey administration (Ocampo, Shelley, & Jaycox, 2007). For instance, a Harvard School of Public Health study found that 20% of female students in Grades 9–12 reported being physically or sexually hurt by a dating partner in their lifetime (Silverman, Raj, Mucci, & Hathaway, 2001), whereas the California Department of Alcohol and Drugs Programs found 8.2% of male and female 11th graders had been victims of physical dating violence in the past 12 months (WestEd, 2004).

Adolescent dating violence has been understudied in rural, southern areas, but a few studies provide support for high prevalence rates among this population. Spencer and Bryant (2000) found rates of dating violence among rural adolescents nearly twice that of suburban or urban teens. In addition, McDonell, Ott, and Mitchell (2010) reported that the odds of dating violence victimization among southern adolescents were 1.3 times those of adolescents living outside of the South.

Poor outcomes associated with adolescent dating violence include a wide variety of health, mental health, and behavioral problems. In addition to the risks of physical injury, dating violence has been linked to eating disorders, suicidal thoughts, depression (Ackard, Eisenberg, & Neumark-Sztainer, 2007; Banyard & Cross, 2008; Kaura & Lohman, 2007), substance use (Exner-Cortens, Eckenrode, & Rothman, 2013; Foshee, Reyes, Gottfredson, Chang, & Ennett, 2013), lower academic achievement (Chiodo et al., 2011), risky sexual behavior (Bonomi, Anderson, Nemeth, Rivara, & Buettner, 2013), and adverse health outcomes (Haynie et al., 2013), among others. Clearly, adolescent dating violence is a serious public health concern with significant implications for adolescent well-being.

Help-Seeking Definitions and Importance

Help-seeking refers to the behavior of actively obtaining advice, information, treatment, and general support in response to a problem or distressing experience (Rickwood, Deane, Wilson, & Ciarrochi, 2005). It is a form of coping that often relies on social relationships and interpersonal skills. More specifically, informal help-seeking is the behavior of obtaining support from friends and family, whereas professional help-seeking is the behavior of obtaining support from those who have appropriate training in providing services, such as teachers, counselors, law enforcement officers, or clergy.

Help-seeking is considered an effective coping strategy throughout a wide variety of disciplines (Ansara & Hindin, 2010; Garcia, 2010). In the context of dating violence, help-seeking is instrumental in reducing mental health risks like depression and anxiety (Carlson, McNutt, Choi, & Rose, 2002), improving conflict negotiation and management skills, and ensuring self-protection from further violence (Ashley & Foshee, 2005).

Although informal help-seeking is often beneficial, informal help-givers may not be prepared to provide adequate support for complex problems like dating violence (Black, Tolman, Callahan, Saunders, & Weisz, 2008; Ocampo et al., 2007). Ocampo et al. (2007) stated that peers are likely to provide emotional support, a sympathetic ear, and advice to leave a violent relationship, but peers are not likely to provide the kind of practical help that would enable the victim to actually leave the abuser. Therefore, professionals must be relied on to provide appropriate information, skills, and services related to ending violence and addressing mental health concerns.

Adolescent Help-Seeking Behaviors

Adolescents rarely seek any help for their problems, and are exceptionally unlikely to seek professional help (Elias-Lambert, Black, & Chigbu, 2014; Fröjd, Marttunen, Pelkonen, von der Pahlen, & Kaltiala-Heino, 2007; C. E. Martin, Houston, Mmari, & Decker, 2012). Slight variations in likelihood exist for some groups of adolescents. Generally, females and older adolescents are more likely to seek help than male and younger adolescents. The role of culture in adolescent help-seeking is unclear, as several studies have found few or no ethnic differences (Eliot, Cornell, Gregory, & Fan, 2010; Garland et al., 2005), whereas other studies have found important differences in help-seeking behaviors by race and ethnicity. For example, in a study of women who had experienced violence at the hands of an intimate partner, Flicker et al. (2011) found that White women were more willing to seek help from friends than were Latina women, whereas African American and Latina women were more likely to seek help from the police than were White women. There were no racial or ethnic differences in willingness to seek help from family members.

Help-seeking behaviors for dating violence victimization and perpetration have been consistent with general findings on adolescent help-seeking. Ashley and Foshee (2005) found that 60% of adolescent victims and 79% of adolescent perpetrators did not seek help. The majority of adolescents who sought help chose friends and family members rather than professionals. Similarly, Fry et al. (2013) reported adolescent victims who sought informal help initially disclosed only to friends in three out of four cases. Watson, Cascardi, Avery-Leaf, and O’Leary (2001) found that females were more likely than males to seek help for dating violence, but Ashley and Foshee found conflicting evidence in that male perpetrators were more likely to seek help than female perpetrators. In terms of professional help-seeking, only 8% of high school students who faced dating violence chose to disclose to formal sources of support (Watson et al., 2001). Interestingly, male victims and perpetrators were more likely to seek professional help than female victims and perpetrators (Ashley & Foshee, 2005).

A number of studies have explored factors related to the evident unwillingness to seek help for dating violence and other mental health–related problems. One such study by Ocampo et al. (2007) found that fewer than half of participants thought a minister, priest, doctor, or school nurse would be quite a bit or extremely helpful. Focus group participants reported they generally did not trust and did not feel close to adults in professional roles. Students were especially concerned with confidentiality when disclosing to professionals, as well as to peers and family members. In addition, researchers have reported that adolescents fear they will be blamed for the abuse (Foshee et al., 1996). Worries about stigma (Clement et al., 2015), poor attitudes toward the value of professional help (Rickwood et al., 2005), and the belief that one should manage his or her own problems (Sawyer et al., 2000) have also been noted as factors related to unwillingness to seek help for mental health–related concerns.

Perceived Social Support and Help-Seeking

Perceived social support connotes the belief that help is available from social network members (Gottlieb & Bergen, 2010). Measures of perceived social support assess whether there are friends and family members available to offer support when needed. By comparison, measures of informal help-seeking assess whether a person will ask or has asked friends and family members for support with a specific need or problem.

It is logical that those with higher perceptions of available support from friends and family members would be more likely to ask friends and family members for help when a need arises than would those with lower perceptions of social support. Findings of Sheffield et al. (2004) support this relationship. They found that adolescents with greater levels of perceived social support were more likely than those with lower levels to seek informal help for a mental illness.

Other studies have focused on the relationship between social support and professional help-seeking with conflicting results. Sherbourne (1988) indicated adolescents with more close friends were less likely to seek professional help, whereas Rickwood and Braithwaite (1994) indicated no differences in professional help-seeking by levels of social support. In a study of adolescent self-harm, Wu, Steward, Huang, Prince, and Liu (2011) found that medical contact was associated with higher levels of negative social support and fewer social network members outside of the home, suggesting that positive social support leads to lower rates of professional help. However, Chang, Chen, and Alegría (2014) found no statistically significant effects of social support on lifetime formal service use.

The Link From Informal to Formal Help-Seeking

Evidence suggests that informal help-seeking may be instrumental in seeking professional help. Most women who seek professional services do so after seeking help from family and friends (Postmus et al., 2009). One study found that victims of sexual assault with higher levels of informal help were more likely to use mental health services than victims with lower levels of informal help (Norris, Kaniasty, & Scheer, 1990). Vera et al. (1998) confirmed that discussing emotional problems with family and friends was strongly associated with the use of mental health services. In a comprehensive review of the literature on preventing suicide risk, Whitlock, Wyman, and Moore (2014) found that strong connections with adults in important social settings, such as schools, increase the likelihood that adolescents will seek formal mental health services and, thus, reduce their overall risk of suicide.

Various arguments have been used to explain the relationship between formal and informal help-seeking. Friends and family encourage help-seekers to pursue instrumental support from professionals (Rose, Campbell, & Kub, 2000; Villatoro, Morales, & Mays, 2014), provide important links to social service agencies and other types of care (Pickard & Ingersoll, 2015; Taylor, Neighbors, & Broman, 1989), and provide tangible supports like child care and transportation that free up time and resources to seek professional help (Goodman, Bennet, & Dutton, 1999; Sime & Fox, 2014).

The current body of literature on adolescent dating violence and help-seeking has not focused on a link between informal and formal help-seeking, other than to gauge the extent to which adolescent help-givers encourage, or intend to encourage, other adolescents to seek professional services. These findings are mixed. Ocampo et al. (2007) stated that none of the participants reported they would encourage their friends to talk to an adult such as a parent, teacher, school administrator, or the police. Fry et al. (2013) found only 19% of adolescent help-givers recommended victims reach out to professional help through a hotline. In contrast, the authors also indicated that 50% of help-givers suggested their friend talk to an adult, and 47% of help-givers talked to an adult on behalf of their friend.

Altogether, there is a lack of research on factors related to adolescents’ willingness to seek help, on the relationship between social support and help-seeking, and on the link between informal and professional help-seeking. Given the need for studies that explore pathways to professional help-seeking in the context of adolescent dating violence, and the need to further explore the relationships between perceived social support, informal help-seeking, and professional help-seeking, the following research questions were proposed:

  • Research Question 1: To what extent do rural, southern adolescents intend to seek informal and professional help if they experience dating violence? How does help-seeking differ by gender, ethnicity, and age?

  • Research Question 2: To what extent do informal help-seeking intentions mediate the relationship between perceived social support and professional help-seeking intentions, within the context of adolescent dating violence?

Method

Procedure

This study is part of an ongoing, 4-year research initiative that examines the developmental trajectory of dating violence victimization and perpetration among adolescents in the rural south. All sixth- through ninth-grade students from 10 schools in a rural South Carolina school district were invited to participate in the study. Information letters and invitations were sent to 3,256 eligible students in four grade cohorts. An a priori power analysis was conducted for the parent study resulting in a sample size estimate of 420 adolescents. A total of 589 adolescents agreed to participate. Data were collected in four waves across 4 years using student and caregiver surveys. The first three waves of data were used for this study.

Participants

At baseline, participants ranged from 10–18 years old. Approximately 39% were 10–12 years old, 58% were 13–15 years old, and 3% were 16–18 years old. The ethnic distribution of student participants was 45.6% African American, 38.6% White, and 13.7% Hispanic or Other minorities. The proportion of African American students exceeded that of Whites in the study despite the fact that the White population of the county was nearly twice that of the African American population. Female students represented 52.5% of the sample whereas male students represented 47.5% of the sample. Of note, more than half of the sample (58.1%) had a family income below the county’s median income of US$32,979. The prevalence of dating violence victimization and perpetration was very high in this sample, supporting the need for exploring pathways to professional help-seeking. The percentages of adolescents who reported experiences with dating violence at Time 3 are displayed in Table 1.

Table 1.

Prevalence of Adolescent Dating Violence Perpetration and Victimization.

Type of involvement in dating violence Total sample
(%)		 Females
(%)		 Males
(%)
Victim of psychological/emotional 30.9 34.2 27.2
Victim of physical 18.0 19.0 16.7
Victim of sexual touching 14.7 19.0 10.2
Victim of forced sex 12.2 16.0 7.7
Perpetrator of psychological/emotional 19.9 20.4 19.1
Perpetrator of physical 11.0 13.4 7.7
Perpetrator of sexual touching 7.7 9.3 5.7
Perpetrator of forced sex 5.4 7.1 3.7
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Approach to Analysis

Descriptive statistics were used to explore the extent to which rural, southern adolescents intended to seek informal and professional help for dating violence. One-way ANOVAs were used to test differences in informal and professional help-seeking by gender, ethnicity, and age. Familywise alpha levels were adjusted for t tests and ANOVAs using the Bonferroni procedure. Results were interpreted accordingly. In addition, adolescent responses about informal and professional help-seeking intentions were grouped into four categories in an effort to better understand the distribution of help-seeking intentions among participants in the study. Correlation analyses were then used to explore the relationships among variables in the study. Finally, structural equation modeling (SEM) was used with longitudinal data to test the mediating effect of informal help-seeking intentions on the relation between perceived social support and professional help-seeking intentions.

Predictor Measure

The Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988) was used to assess perceived social support from friends, family, and significant others at Time 1. The measure consisted of 11 items and three subscales. Response options ranged from very strongly disagree to very strongly agree on a 7-point Likert-type scale. Higher scores represented higher perceptions of availability of social support from friends, family, or significant others. Internal consistency reliabilities for the friends, family, and significant other subscales were .92, .91, and .92, respectively.

Mediator Measure

Informal help-seeking intentions were measured at Time 2 by assessing how likely students would be to seek help for psychological and emotional dating violence, physical dating violence, or sexual dating violence from a parent, friend, or another adult. For instance, a set of questions on the student survey measured informal help-seeking for psychological and emotional dating violence using the following stem: “If someone you were dating threatened or humiliated you, called you names, or tried to control you, how likely would you be to tell … ” Participants were then asked to rate the likelihood of telling each informal source. Response options ranged from not at all likely to very likely on a 4-point Likert-type scale. Higher scores on a subscale represented a better likelihood of informal help-seeking for that type of dating violence. Internal consistency reliabilities were .66 for the psychological and emotional dating violence subscale, .69 for the physical dating violence subscale, and .73 for the sexual dating violence subscale.

Outcome Measure

Professional help-seeking intentions were measured similarly to informal help-seeking intentions. Adolescents were asked at Time 3 to rate how likely they would be to seek help for psychological and emotional dating violence, physical dating violence, or sexual dating violence from a doctor, teacher, minister, or counselor. Participants rated how likely they would be to tell each formal source about each type of dating violence. This resulted in three subscales of professional help-seeking intentions. Response options ranged from not at all likely to very likely on a 4-point Likert-type scale. Higher scores on a subscale represented a better likelihood of professional help-seeking for that category of dating violence. Internal consistency reliabilities were excellent for this sample at .91 for the psychological and emotional subscale, .91 for the physical subscale, and .93 for the sexual subscale.

Results

Help-Seeking Intentions

Overall, students reported they would be somewhat likely to seek informal and professional help if they experienced dating violence. Mean scores of professional help-seeking (M = 2.24, SD = 0.98) were slightly lower than mean scores of informal help-seeking (M = 2.82, SD = 0.85). This was a statistically significant difference, t(513) = 12.17, p = .000, indicating that adolescents were more willing to seek informal help than professional help. Students also reported stronger intentions to seek help from informal sources for physical dating violence than for psychological dating violence, t(532) = −2.45, p = .015. Students were more willing to seek professional help for physical dating violence, t(512) = −4.61, p = .000, and sexual dating violence, t(512) = −4.52, p = .000, than for psychological dating violence. See Table 2 for mean scores by type of dating violence.

Table 2.

Mean Scores of Informal and Professional Help-Seeking Intentions by Type of DV.

M SD
Informal help-seeking intentions for psychological DV 2.80 0.86
Informal help-seeking intentions for physical DV 2.86 0.91
Informal help-seeking intentions for sexual DV 2.80 0.85
Professional help-seeking for psychological DV 2.14 1.00
Professional help-seeking for physical DV 2.27 1.12
Professional help-seeking for sexual DV 2.24 0.98
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Note. DV = dating violence.

In terms of sources of help-seeking, adolescents were more willing to talk to a parent than a friend regarding sexual dating violence, t(527) = 2.97, p = .003. There were no significant differences by sources of informal help-seeking for psychological or physical dating violence (see Table 3 for mean scores). Adolescents reported slightly higher preferences for talking to a counselor than a doctor, t(509) = 3.52, p = .000, or minister, t(510) = 4.59, p = .000, about psychological dating violence. They also reported slightly higher preferences for talking to a teacher than a doctor, t(511) = 2.32, p = .021, or minister, t(511) = 3.42, p = .001, about psychological dating violence. Adolescents were more willing to talk to a doctor about sexual dating violence than a teacher, t(512) = 4.39, p = .000, a minister t(513) = 6.47, p = .000, or a counselor, t(513) = 2.23, p = .021. Mean scores were very similar for talking to a doctor, teacher, or counselor (Table 4) concerning physical dating violence, but adolescents were significantly less likely to be willing to seek help from a minister for physical violence than from a doctor, t(508) = −3.44, p = .001; teacher, t(510) = −3.01, p = .003; or counselor, t(510) = −4.23, p = .000.

Table 3.

Mean Scores and Standard Deviations of Informal Help-Seeking Intentions by Source.

Psychological DV Physical DV Sexual DV
Help-seeking from friend 3.05 (1.03) 3.02 (1.12) 2.88 (1.29)
Help-seeking from adult 2.39 (1.17) 2.45 (1.21) 2.47 (1.15)
Help-seeking from parent 2.94 (1.15) 3.09 (1.14) 3.05 (1.20)
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Note. DV = dating violence.

Table 4.

Mean Scores and Standard Deviations of Professional Help-Seeking Intentions by Source.

Psychological DV Physical DV Sexual DV
Help-seeking from doctor 2.10 (1.09) 2.30 (1.21) 2.44 (1.23)
Help-seeking from minister 2.06 (1.13) 2.16 (1.20) 2.15 (1.24)
Help-seeking from teacher 2.18 (1.13) 2.29 (1.18) 2.27 (1.24)
Help-seeking from counselor 2.24 (1.16) 2.33 (1.21) 2.35 (1.25)
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Note. DV = dating violence.

One-way ANOVAs showed some differences between groups on informal and professional help-seeking intentions. Females had significantly higher intentions than males to seek informal help, F(1, 522) = 49.87, p = .00, and professional help, F(1, 504) = 5.25, p = .02. There were no statistically significant differences for informal or professional help-seeking intentions by ethnicity. A grade-level variable was used as a proxy for age to test group differences for informal and professional help-seeking intentions. No differences existed for informal help-seeking intentions, but there was a statistically significant difference by grade for professional help-seeking, F(3, 511) = 4.33, p = .01. A Tukey post hoc test revealed that ninth graders were more likely than 11th graders to say they would seek professional help for dating violence. There were no statistically significant differences between other grade levels.

In an effort to better understand the distribution of help-seeking intentions among participants in the study, responses were categorized into four groups: high intentions of both informal and professional help-seeking, high intentions of informal help-seeking and low intentions of professional help-seeking, low intentions of informal help-seeking and high intentions of professional help-seeking, and low intentions on both informal and professional help-seeking. Nearly half of the sample (49.5%) reported high intentions of both informal and professional help-seeking for dating violence. However, 18.6% of the sample reported low informal and low professional help-seeking intentions. Nearly a third of participants (30.9%) reported high intentions of informal help-seeking coupled with low intentions of professional help-seeking, whereas only 1% of participants reported high intentions of professional help-seeking coupled with low intentions of informal help-seeking.

Mediating Role of Informal Help-Seeking Intentions

Pearson’s correlations among the study variables are presented in Table 5. All the study variables were significantly related to one another at the p < .01 level. Correlations were strongest between measures assessing the same latent construct. The measures of informal help-seeking intentions, professional help-seeking intentions, and perceived social support were all positively related to one another suggesting that higher levels of one construct are associated with higher levels of the other constructs.

Table 5.

Pearson’s Correlations Among Observed Variables.

1 2 3 4 5 6 7 8 9
1. Family social support —
2. Significant other social support .74* —
3. Friend social support .60* .66* —
4. Informal help-seeking for
psychological DV		 .25* .23* .25* —
5. Informal help-seeking for
physical DV		 .22* .20* .22* .80* —
6. Informal help-seeking for sexual
DV		 .21* .20* .24* .71* .80* —
7. Professional help-seeking for
psychological DV		 .18* .15* .13* .23* .22* .19* —
8. Professional help-seeking for
physical DV		 .21* .18* .12* .27* .28* .25* .81* —
9. Professional help-seeking for
sexual DV		 .18* .17* .14* .27* .26* .30* .71* .80* —
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Note. DV = dating violence.

*

p < .01.

SEM was used to test the mediating effect of informal help-seeking intentions on the relationship between perceived social support and professional help-seeking intentions. Three waves of data were used to model for time-lapse between the latent constructs. The measurement model specified the relationship of observed variables with these latent constructs. Family social support, significant other social support, and friend social support were indicators of the latent variable of perceived social support at Time 1. Intentions of informal help-seeking for psychological, physical, and sexual dating violence were indicators of informal help-seeking intentions for dating violence at Time 2. Last, intentions of professional help-seeking for psychological, physical, and sexual dating violence were the observed indicators of the latent outcome variable of professional help-seeking intentions at Time 3. One indicator per construct served as the reference variable.

The Analysis of Moment Structures (AMOS) version 22 (Arbuckle, 2006) software for SPSS was used to model a direct effect from perceived social support at Time 1 to informal help-seeking intentions at Time 2, and a direct effect from informal help-seeking intentions at Time 2 to professional help-seeking intentions at Time 3 (see Figure 1). The overall model fit was assessed using three criteria: the chi-square to degrees of freedom ratio, with ratios of less than 3 indicative of a good fit (Carmines & McIver, 1981); the comparative fit index (CFI), with values close to 1 indicative of a very good fit (McDonald & Ho, 2002); and the root mean square error of approximation (RMSEA), with values of .05 or lower indicating a close fit to the data (Browne & Cudeck, 1993).

Figure 1.

Figure 1

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Structural equation model showing relationships among social support at Time 1, informal help-seeking intentions at Time 2, and professional help-seeking intentions at Time 3. Note. Values are standardized coefficients. DV = dating violence.

Results demonstrated that the model was a good fit for the data. The chi-square to degrees of freedom ratio, CFI, and RMSEA were 56/25, .99, and .05, respectively. Unstandardized estimates, standard errors, and standardized estimates are presented in Table 6. Regression weights for the observed variables and their latent constructs were all statistically significant at p < .001.

Table 6.

Parameter Estimates for Model in Figure 1.

Parameter Unstandardized
estimates (SE)		 Standardized
estimates
Measurement model
  Perceived Social Support (T1) → Family Social
    Support (T1)		 1.00a .83
  Perceived Social Support (T1) → Significant Other
    Social Support (T1)		 1.11 (.05) .90
  Perceived Social Support (T1) → Friend Social
    Support (T1)		 0.89 (.05) .74
  Informal Help-Seeking Intentions (T2) → Informal
    Help-Seeking Intentions for Psychological Dating
    Violence (T2)		 1.00a .85
  Informal Help-Seeking Intentions (T2) → Informal
    Help-Seeking Intentions for Physical Dating
    Violence (T2)		 1.18 (.04) .95
  Informal Help-Seeking Intentions (T2) → Informal
    Help-Seeking Intentions for Sexual Dating
    Violence (T2)		 1.14 (.05) .85
  Professional Help-Seeking Intentions (T3)
    → Professional Help-Seeking Intentions for
    Psychological Dating Violence (T3)		 1.00a .85
  Professional Help-Seeking Intentions (T3) →
    Professional Help-Seeking Intentions for Sexual
    Dating Violence (T3)		 1.11 (.05) .84
  Professional Help-Seeking Intentions (T3) →
    Professional Help-Seeking Intentions for Physical
    Dating Violence (T3)		 1.21 (.04) .96
Structural model
  Perceived Social Support (T1) → Informal
    Help-Seeking Intentions (T2)		 0.20 (.03) .29
  Informal Help-Seeking Intentions (T2) →
    Professional Help-Seeking Intentions (T3)		 0.37 (.05) .32
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Note. All estimates were significant at p < .001.

a

Served as the reference variable.

The mediating role of informal help-seeking intentions was confirmed. Both of the tested direct effects were significant at p < .001. The standardized direct effects of perceived social support on informal help-seeking intentions (βs = .29) and informal help-seeking intentions on professional help-seeking intentions (βs = .32) supported the hypothesis that perceived social support leads to increased informal help-seeking intentions, which, in turn, boosts professional help-seeking intentions. The standardized indirect effect of perceived social support on professional help-seeking was .092, p = .012. Due to well-researched differences in help-seeking intentions by gender, the model was also tested separately for males and females. The model remained a good fit for the data in both instances.

Discussion

Findings from this study indicate that rural, southern adolescents were only somewhat willing to seek informal and professional help for dating violence. Consistent with the literature, adolescents intended to seek informal help more often than professional help. This is a concerning reality with high prevalence rates of dating violence in the sample, and a need for supports to aid in escaping violence and safeguarding mental health.

Findings also revealed that adolescents are more willing to seek informal and professional help for physical and sexual dating violence than for emotional/psychological dating violence. This may indicate that adolescents are less concerned with emotional/psychological dating violence than other forms. Unfortunately, studies show that psychological violence is predictive of anxiety, depression, low self-esteem, and illegal drug use (Baldry, 2003; Straight, Harper, & Arias, 2003). In addition, evidence suggests that psychological violence often leads to physical violence (Henning & Klesges, 2003), and psychological violence may have a greater impact on mental health than other forms of violence (Exner-Cortens et al., 2013; Rizzo, Esposito-Smythers, Spirto, & Thompson, 2010).

Help-seeking intentions by gender, race, and age are widely discussed in the help-seeking literature. Findings from this study confirmed that female adolescents have higher help-seeking intentions than males. In addition, ethnicity played no role in adolescents’ willingness to seek help. Results related to age were more complex. Informal help-seeking intentions did not vary by grade level, a proxy for age, but professional help-seeking intentions were different for 9th and 11th graders. Past studies have shown that younger adolescents are less likely to seek help than older adolescents, but current findings revealed that younger adolescents were more willing to seek professional services than older adolescents. It is not clear why this difference exists in the sample, but it may reflect a need for further exploration on age and professional help-seeking intentions.

Interestingly, adolescents in this study reported that they would be pretty likely to talk to a parent about all types of dating violence, and would even prefer to talk to a parent over a friend for sexual violence. Most studies have reported that adolescents were more willing to seek help from peers than any other source (Black et al., 2008; Ocampo et al., 2007; Watson et al., 2001); however, Black and Weisz (2003) found African American youth were more willing to seek help from adult family members than from friends. The large proportion of African American youth in this sample and the culture of the rural south may account for the findings of adolescents’ willingness to seek help from a parent.

Although results showed adolescents were somewhat unlikely to seek professional help for dating violence, some preferences were revealed regarding sources of professional help-seeking. Adolescents were more willing to seek help from teachers and counselors than ministers and doctors for emotional/psychological dating violence, but were more willing to seek help from a doctor than other sources for sexual dating violence. However, adolescents were equally as willing to seek help from a teacher, counselor, or doctor for physical dating violence. These preferences may reflect attitudinal differences about the severity of different types of dating violence, or about the role of various service providers. More research is needed to better understand the factors underlying these preferences.

A closer look at the distribution of help-seeking intentions among participants in the study revealed that the majority of adolescents who would be willing to seek professional help would also be willing to seek informal help. Remarkably, only 1% of adolescents willing to seek professional help were unwilling to seek informal help. This finding suggests that informal help-seeking intentions share an important relationship with professional help-seeking intentions. Perhaps informal help-seeking intentions and behaviors encourage professional help-seeking.

Findings from the tested mediation model in this study indicate that informal help-seeking intentions mediate the relationship between perceived social support and professional help-seeking intentions. In other words, informal help-seeking intentions are a critical component in the relationship between perceived social support and professional help-seeking intentions. Adolescents with higher levels of perceived social support were more willing to seek informal help for dating violence than those with lower levels of perceived social support, and in turn, were more willing to seek professional help.

It is important to consider explanations of this relationship to contemplate how this knowledge might be applied to the problem of dating violence and adolescents’ unwillingness to seek help in violent dating relationships. For example, adolescents without systems of support may feel like they have no one to talk with, or may not feel their social relationships are intimate enough for personal information to be divulged. In contrast, it is likely that adolescents with networks of support know to whom they can turn when confronted with dating violence. Supportive relationships will have been established already and seeking specific help will be less difficult. These adolescents will know who is available to support them and, therefore, will be more capable of seeking informal help if the need arises.

Adolescents who seek informal help may be encouraged to seek professional help from their friends and family, may choose to look for other sources of help to complement informal help, or may receive instrumental assistance, such as transportation, allowing them to seek professional services. Receiving informal help may also change adolescents’ attitudes about help-seeking or about the seriousness of dating violence.

With these explanations in mind, several suggestions for prevention and intervention efforts are apparent. First, approaches which enhance social support and which compel adolescents to think critically about their social networks must be encouraged. For example, community-building endeavors with goals of improving family functioning and strengthening community-wide social networks are essential. Adolescents need to know family and friends are available to lend support in times of need. Schools and community centers may engage adolescents in conversations about which people within their social networks would be approachable and helpful in troubling situations, effectively creating opportunities for adolescents to make informal help-seeking plans before violent situations occur.

Second, potential help-givers need preparation for providing effective help to victims and perpetrators of dating violence. Adolescents, parents, and other community members need information about the seriousness of dating violence and its effects on young people. Education regarding recognizing violent dating situations, effectively supporting a victim or perpetrator, safely intervening on behalf of a victim, actively encouraging a victim or perpetrator to seek professional help, and appropriately assessing when to seek professional help for a victim or perpetrator should prepare informal help-givers to provide constructive and valuable support.

Finally, professional helpers need to inform the community at large about their role in caring for adolescents. It is essential for communities to know what kinds of options are available for adolescents when help is needed. Adolescents ought to know how to seek out professional help, how professional help might assist them, and what kinds of confidentiality agreements exist between professionals and clients. Also, professional helpers such as teachers, counselors, ministers, doctors, police officers, and social workers must build relationships with adolescents in a manner that leads them to view professionals as friendly, approachable, and trustworthy.

A clear limitation of this study concerns the measurement of help-seeking intentions rather than help-seeking behaviors. Help-seeking intentions are not perfect predictors of help-seeking behaviors, but evidence suggests a number of positive and significant associations between help-seeking intentions and prospective help-seeking behavior for personal and emotional problems (Wilson et al., 2005). Another major limitation is a lack of consideration of other factors related to informal and professional help-seeking intentions, such as attitudes about dating violence, previous exposure to violence, experience with informal or professional help-seeking in the past, and availability of professional services. Also, the current study did not specifically test the role of social support in preventing adolescent dating violence, but instead reasoned that social support may be critical in preventing adolescent dating violence given its relationship with help-seeking. Other limitations include a recruitment method that resulted in a sample that was not necessarily representative of the county as a whole, and an inability to generalize findings to adolescents outside of the rural south. Future research should address these issues.

Nevertheless, this study confirms the importance of exploring pathways to professional help-seeking for dating violence, and indicates that social support, informal help-seeking, and informal help-giving may be essential focus points for intervention and prevention efforts related to dating violence victimization and perpetration. It also provides an important assessment of dating violence and help-seeking intentions in the rural south, a population which is significantly understudied. All in all, adolescents and their families need education about the deleterious effects of dating violence, appropriate strategies for providing help, and options for professional services.

Acknowledgments

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by grant 1R01HD067505 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Biographies

Jasmine M. Hedge is a research associate at Clemson University and the project director of a longitudinal study of adolescent dating violence in rural South Carolina. She has particular interest in protecting children’s rights and in strengthening families and communities by engaging children and youth in research and action. Currently, she is conducting research on children’s perspectives of contact and visitation with an incarcerated parent as part of her doctoral work in International Family and Community Studies at Clemson University.

Natallia Sianko is a social scientist interested in understanding how contextual, family, and individual factors interact to maximize positive outcomes for children and youth. She has particular interest in creating and improving measures of child and family well-being in complex contexts. Currently, she is a consultant on a multi-year, multi-site project on dating violence among adolescents in rural communities. In this role, she is working on several publications to advance understanding of youth involvement in violent relationships, including an article that uses a person-oriented analytic approach to model risky and beneficial outcomes among youth with a history of family violence.

James R. McDonell is leading a program of research to understand the typical experiences of families living in the rural Southeast, to understand the opportunities and challenges of communities across the Southeast to support families, and to extend knowledge, policies, and practices to strengthen community support for young people and their families. He is currently conducting research to better understand the factors that influence the growth trajectory of violence in adolescent dating relationships and to test the efficacy of school-wide interventions to reduce bullying and improve behavior among elementary and middle school students.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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