Youth Mental Health Help-Seeking Information Needs and Experiences: A Thematic Analysis of Reddit Posts

Helping others

This subtheme refers to youths’ experiences of managing the mental health issues of others and youth seeking advice on how to help others with specific mental health issues. These moments generally occurred between individuals with a significant relationship (e.g., youth and partner, youth and friend). One individual explained their long-term challenge trying to manage their girlfriend’s struggle with self-harm:

My girlfriend . . . she is struggling with self-harm, I must stop her, and I’ve been trying my best for last 3 months. I need advice. . . . [P]

Another individual expressed concerns about a friend’s dietary habits and lifestyle changes and asked how to help the friend:

. . .I’m 17 and my female friend of the same age told me she pukes to keep low calories. . . . [she] is more and more shifting to a body obsessive lifestyle, weighing calories, working out a lot, etc. How do I help her? [P]

Managing difficult emotions and symptoms

Youth reflected upon their struggles managing various emotions and symptoms of their own mental health issues. Some youth expressed uncertainty with how to manage specific symptoms and feelings. For example, one individual wrote:

My depression is causing me physical pain. . . It’s getting worse every day and I don’t know how to stop it or if I even want to. [P]

One topic that appeared in several posts was the use of medications to manage symptoms of mental illness. In these posts, youth expressed concerns about the side effects of medications, primarily referencing the experiences of others.

I’m 18 years old, struggled with my mental health most of my life. . . I think I should get on antidepressants and stop smoking. But everything I’ve looked up . . . says they make you numb and can do more bad then good. . .Are antidepressants really that bad? [P]

Understanding signs and symptoms

Many youths sought knowledge on what encompasses certain mental illnesses. This included understanding how to recognize a given mental illness and how to discern whether help is needed. For example, the following post was about what qualifies as having a specific mental illness:

. . . I would be nonstop yawning and couldn’t breathe . . . [The school therapist] said that I could have been having an anxiety attack especially since I was so stressed and stuff at the time. How can I tell if I’m having a panic attack or anxiety attack? [P]

Other individuals were interested in understanding signs and symptoms of mental illnesses and discerning whether they required professional help:

. . .I kind of lose control of all filters and all that comes out of my mouth is just venom when I am arguing or just pissed off in general. . .Should I look into being diagnosed [with PTSD]? [P]

Lastly, some youth wanted to know if their signs and symptoms were “normal” or if there was something “wrong” with them. An individual wrote:

Is it normal having a consistent amount of panic attacks? . . . So, would any of you have any idea of what to do? Because I definitely don’t. [P]

Self-disclosure experiences

First, the sentiments and experiences surrounding disclosing personal mental health information varied on Reddit. While some individuals found self-disclosure to be helpful, others reported an inability or unwillingness to disclose their issues. One individual describes their experience self-disclosing to a friend:

. . .Finally, just now, I told my best friends everything, from the suicidal thoughts I had in 5th grade, to the current state of my mental health. All the weight lifted off my shoulders ngl [not gonna lie]. [P]

In contrast, many others wanted to hide their illness and were against sharing their mental health issues:

I also want to talk to someone, a professional but I don’t want to be looked as depressed or insane, which I am depressed, but I don’t want them to realize it. [P]

Of note, several youths expressed an unwillingness or inability to disclose their mental health struggles with their parents.

My possible neurodivergence has been very disrupting for me. . .I really want professional advice on this, though I’m pretty sure that my parents will refuse to take me to the psychiatrist for diagnosis. I can’t even talk to them about my problems. . . [P]

Social barriers

Social barriers are derived from societal constructs stemming from social norms, perceptions, and values. Many youths reported social barriers that prevented or deterred them from disclosing their mental health status, including the perceived expectations, perceptions, and reactions of others. For example, many youths wrote about their struggle to self-disclose to parents due to anxiety surrounding reactions and perceptions:

. . . I don’t really know how she [parent] feels about therapy (I don’t know if she [parent] considers it shameful/embarrassing/only for really crazy people.) [P]

Other youth expressed concerns about the way they would appear to others if they openly shared their mental health struggles. For example, one youth wrote:

I don’t want to seem dramatic for attention, and I’m afraid if I ask for help irl [in real life] I’ll get called dramatic. I’m just tired of everything. I don’t know what to do. [P]

Another individual commented on how gender roles and the fear of appearing weak affects their decisions:

I want to reach out for help, but at the same time I’m fucking terrified of being weak and admitting I feel bad. I’m a girl, but I kind of feel that “never open up, be a human rock” pressure that a lot of men say they experience. [P]

Psychological barriers

Psychological barriers to disclosing to others refers to internal thoughts, feelings or beliefs that prevent or deter individuals from revealing their mental health issues. Some youth commented on feeling embarrassed:

When I was a younger teen, I cried a lot when I didn’t totally get my depression and my sister and mom would sort of laugh it off and I felt really embarrassed. . . [P]

Another individual mentioned feeling ashamed and scared:

I know that I can’t do this [struggle with mental health issues] by myself anymore, but I just feel so scared and ashamed to have this conversation with my parents. [P]

Knowledge

Multiple individuals expressed some knowledge gaps with respect to seeking mental health care. Without the information necessary to facilitate help-seeking, youth may be at a disadvantage when trying to access mental health services. Youth posed questions such as who qualifies for therapy, how to find a program or therapist, and how therapy works. For example:

The thought of asking for therapy also scares me as I’m not sure if it costs money and have no clue how it works. Just the shear thought of opening up to a complete stranger scares me. [P]

Others were unsure of how to start receiving care in the first place:

I want to see an expert who can provide answers, but I don’t know where to start. Also, please let me know if you have suggestions for types of programs or therapies I can look for. [P]

Access

Individuals wrote about barriers to accessing mental health services. Some wrote about tangible barriers (long waitlists, cost of services, language barriers, etc.); for example:

I keep seeing this and that about sites like BetterHelp, but I’m really worried that places like those require a lot of money. [P]

Others spoke about emotional challenges when attempting to secure mental health care. For example, one individual wrote about the courage needed to make an appointment:

. . . I tried to make an appointment to get tested for ADHD, but I scheduled the wrong thing and couldn’t work up the courage to make a new appointment . . . [P]

Perceptions

Many youths wrote about the varying perceptions they had regarding different mental health services, some of which may serve as barriers to accessing care. If an individual has a negative perception of the service (e.g., does not work, cannot be trusted, side effects), they may be less likely to seek out services whether that individual has any previous experience with mental health services. Most posts regarding perceptions of mental health services were specific to medicine and healthcare professionals (doctors, therapists, etc.). For example:

And my mom says I need medicine, but I don’t want to turn into a fat, slow, idiot again. I would legitimately rather die than take meds and ruin my future, GPA, and social life. [P]

Another wrote about their feelings toward doctors:

Talking to a doctor always just makes things worse. I’m just stuck feeling like this. [P]

Unhelpful and challenging experiences

Several youths commented on unhelpful or challenging experiences when receiving care (therapy, doctors, medications, etc.). Some youth felt dismissed or ignored while utilizing mental health services:

I slipped into extreme episodes of what I just know was depression. . . I tried to explain this to my counselor, but she dismissed it as down to my anxiety. I told her that I have episodes of feeling completely empty, and she told me it’s just due to stress. [P]

Another individual commented on the prolonged wait time for mental health services:

I’ve waited 3 horrible months for a psychiatrist appointment to get tested for ADHD and now it seems like I’m just gonna leave with more questions than answers. . . [P]

This individual also expressed dissatisfaction with the service they received as well as their unwillingness to seek further care due to their negative experience. This was not unique to a single individual as other youth also expressed the same hesitancy:

I’m so scared of going back to therapy because I feel so embarrassed, that I’m making it all up in my head or that I’m being over dramatic. . .I’m so scared to seek therapy again in case I get told it’s just anxiety again. I just feel like there is something much more going on. [P]

Helpful experiences

There were some helpful experiences described by youth, mostly on topics of therapy and medications. Some youth simply stated that therapy was helpful and recommended therapy to others:

I’d heavily recommend seeing a therapist. I had really bad depression and seeing a good therapist has helped me so much. [R]

Others commented on their helpful experience with medication:

In my personal experience [medicine prescribed for mental health issues] can help you. Of course, would you first have to find the right one for you and they will not erase the problem. Mine are helping me to feel a little bit more stable, the bad day are still bad, but it doesn’t get me as near as before. [R]

Suggestions

A few youths mentioned specific preferences related to mental health services. One individual expressed a desire to have anonymous therapy to avoid detection from others:

. . .I want to try to find some kind of anonymous therapy so I can try to get some help without him [parent] knowing. . . [P]

Others were hesitant about making an appointment for mental health care. One individual inquired about email booking for appointments:

I think I might contact my GP, but I’m a little on the shy side. Do you know if it’s possible to book an appointment with a GP via email? [R]

Future directions

Given the barriers to help-seeking revealed through this study, future research should explore potential solutions to overcoming these barriers and further investigate the preferences of youth concerning mental health services and resources. Some youth expressed specific preferences surrounding mental health services, for example, desire to remain anonymous and to avoid direct person-to-person contact. However, preferences expressed by youth on Reddit were limited in their description and warrant further investigation.

Another priority for future research is mental health literacy. For example, strategies are needed to improve youth’s ability to understand and navigate their own and other’s mental health issues and available mental health services and resources. Additionally, informing youth about how they can receive help (particularly anonymous help) can aid in facilitating the help-seeking process. This could also reduce concerns regarding social stigma and psychological barriers. Furthermore, researchers should continue to use Reddit as a source of information for qualitative studies given the level of anonymity it gives to its users and the rich, disinhibited narratives that it provides.

Lastly, future research is needed to understand differences in mental health needs and experiences across gender identities and developmental stages, as differences have been previously documented related to help seeking behaviors (Patalay & Fitzsimons, 2018; Rosenfield & Mouzon, 2013). For example, Schnyder et al. (2020) reported that for younger children and youth (4–12 years old), “self-reliance,” “unsure if help needed,” and “the problem will get better by itself” were the top three parent-reported barriers to their children seeking mental health care. Whereas for older youth (13–17 years old), the top three barriers reported by parents were “self-reliance,” “child refused,” and “unsure where to get help.” Analysis of differences by gender and developmental stage may provide insights into how mental health care can be improved for specific subgroups within the larger child and adolescent population.

Strengths and limitations

While mental health needs and experiences have been previously studied, this study analyses unrestricted, informal narratives of youth revealing themes that may not be apparent when using traditional modes of data collection. Data extracted from platforms such as Reddit allow users to maintain anonymity which may lead users to be more candid and willing to share their experiences (De Choudhury & De, 2014). This improves the accuracy and representativeness of the narratives used in the study. A study strength was verification by multiple researchers throughout each step including preparation, data collection, analysis, and document writing. Lastly, to the best of our knowledge, this is the first study to manually extract and utilize data from Reddit to investigate the mental health experiences and information needs of youth.

Although nearly 3,000 Reddit posts were collected for this study, our findings cannot be generalized to all youth struggling with mental health issues given that each youth experience is unique to the individual posting. Furthermore, there is no publicly available real-time demographic information on Reddit users, so we are not able to describe our sample or comment on applicability. Additionally, though it has been documented that mental health and help seeking behaviors differ between age groups and genders (Farrer et al., 2008; Rosenfield & Mouzon, 2013), the anonymous nature of many of the posts we collected limited the comparisons that could be made between subgroups of users including age groups and genders. While Reddit use has been reported to be different across genders (e.g., males accessing Reddit more often than females) (Pew Research Center, 2019), recent reports have suggested females are more active on “personal” subreddits and more likely to discuss the need for social supports (Thelwall & Stuart, 2019). The inability to capture data on gender, unless disclosed in a post, limits our understanding of gender differences related to the mental health experiences and information needs we collected. Despite the inability to include demographic data, the results of this study can provide valuable insight into the general mental health experiences and information needs of youth and may help to inform future studies investigating subgroups within the youth population.

Another limitation to using Reddit as a data source is the functionality of the platform itself. While Reddit serves as a rich information source, the limited filtering options make it difficult to manually extract data for narrower sets of inclusion criteria (e.g., filtering for specific days). This limitation may be partially overcome by using automated systems for data extraction such as a Python wrapper PRAW (De Choudhury & De, 2014). Although extracting data from Reddit poses limitations (e.g., assumptions about the relative accuracy of the posts given restricted platform user data), a large sum of posts from a known time frame were still able to be extracted from relevant subcommunities and used to draw general conclusions.