Four Pillars of Help-Seeking Attitudes: Emotional,Societal,Cognitive,and Relational Insights From New Zealand Youth

Help-Seeking & Youth Mental Health

Addressing youth mental health goes beyond merely identifying a problem and then obtaining the necessary support: it requires an appreciation of help-seeking behaviors (Rickwood, 2022). Help-seeking is an active, problem-focused coping strategy that involves the pursuit of support from an accessible network for a situation or condition (Cornally & McCarthy, 2011; Rickwood, 2022). Although support can be viewed in multiple ways, it has previously been categorized into four main types (see Barker, 2007): (a) instrumental support (direct assistance such as financial aid, skills training, or health services); (b) informational support (providing essential advice, information, or referrals for assistance); (c) affiliative support (companionship with others who share mutual interests); and (d) emotional support (addressing emotional needs). For young people, this network includes self-help efforts (e.g., searching for information and resources online), informal support from family and friends, semi-professional assistance from teachers, mentors, and coaches, and formal assistance from health care professionals (Mazzer & Rickwood, 2013; Rickwood et al., 2005, 2007). Each of these sources has the potential to provide not only immediate assistance but also increase an individual’s willingness to seek help in the future (Barker, 2007). Indeed, the advantages of help-seeking are profound: early and proactive engagement in mental health support can prevent long-term adversities and reduce the severity and persistence of mental health issues (Rickwood et al., 2005; Vogel et al., 2007). Such proactive measures can enhance resilience and improve coping strategies, equipping individuals to better manage future challenges (Masten, 2001). Conversely, delays or aversions to seeking help can exacerbate mental health problems, leading to chronic issues that severely impact daily functioning and overall well-being (Mojtabai et al., 2002).

The help-seeking process is complex and iterative. It involves the awareness and recognition of a problem, appraisal of need, decisions on possible actions, intentions and approaches, engagement with help sources, and ultimately, achieving desired outcomes (Rickwood, 2022; see also Barker, 2007). ² Previous literature has examined the underlying reasons to seek help, the methods employed, and the types of support accessible in specific environments (e.g., Aguirre Velasco et al., 2020; Barker, 2007; Gulliver et al., 2010; Heerde & Hemphill, 2018; Radez et al., 2021; Rickwood, 1995; Rickwood et al., 2007). One particular emphasis is on young people’s attitudes toward help-seeking, including the sources of these attitudes and how they encourage (or discourage) an individual’s willingness to seek and accept support (Hammer et al., 2018; Rickwood, 2022).

Common Barriers to Seeking Help

Help-seeking is further nuanced by the significant barriers young people encounter. In a World Health Organization (WHO) report on adolescent help-seeking behaviors and social support, Barker (2007) explains that the help-seeking process is driven by personal and exogenous factors. Personal factors comprise a range of motivations, the perception of need, agency, internalized norms, and attitudes toward help and social support. In a systematic review by Gulliver et al. (2010), key personal barriers included difficulty with recognizing mental health symptoms, a preference for self-reliance, and perceived stigma. In a more recent systematic review, Aguirre Velasco et al. (2020) report that over half of the studies identified stigma toward mental health (including self-stigma) as the primary personal barrier, with other significant factors including family beliefs toward mental health services, poor mental health literacy, and a desire for autonomy and confidentiality among young people. Similar to global trends, many young New Zealanders encounter personal barriers when coping with mental health difficulties. These barriers can include fears of stigmatization, breaches of confidentiality, and being labeled as seeking attention (Rowe et al., 2014). Extant literature further substantiates that New Zealand youth and their peers in the broader Pacific region tend to exhibit a strong preference for independently resolving their problems, show a notable reluctance to seek assistance from authority figures and formal support sources, and have internalized self-stigma, viewing help-seeking as an indicator of personal “weakness” (Barker, 2007; Curtis, 2010). These findings indicate that key personal factors that influence adolescent help-seeking include one’s views on mental health, their attitudes toward help (and its potential social repercussions), and the logistics of accessing quality support. There is also a feedback loop wherein past personal experiences—and emotional responses to these experiences—shape future decisions regarding help-seeking.

According to Barker (2007), exogenous factors include family, community-level, and wider sociocultural influences, such as societal norms around seeking help, the availability and cost of services, and the characteristics of help sources. Importantly, exogenous factors interact with personal ones, thereby emphasizing the complex nature of adolescent help-seeking behavior. For instance, societal and cultural contexts play a crucial role in shaping individual development (Erikson, 1968), and these environments significantly impact how young people navigate issues such as help-seeking and associated stigma (Barker, 2007). Specifically, the self-stigma that seeking help is a “weakness” is a powerful attitude that has roots in societal, cultural, and gender-specific norms which emphasize virtues of self-reliance, stoicism, and resilience (Addis & Mahalik, 2003). For many young people, admitting to needing assistance can be perceived as a failure to meet these standards of independence and strength (Addis & Mahalik, 2003; Rickwood et al., 2007). In some parts of the world, social support is actively encouraged, while in others, personal challenges might be preferred to be kept private (Cauce et al., 2002). In New Zealand, cultural and societal norms accentuate the beliefs regarding seeking assistance. Here, the deeply entrenched values of stoicism and self-reliance (which were brought to the forefront by European settler colonists in the mid-1800s) highlight the significance of self-sufficiency needed for survival in a geographically-isolated island nation in the Pacific. Although bolstering resilience, these values may inadvertently deter young individuals from seeking help amidst acute mental health crises (Walmsley, 2021). Meanwhile, the New Zealand ethos also includes principles of communal interdependence and strong collaboration (Durie, 1994, 2001), largely influenced by indigenous communities and migrants from Asia. As such, these diverse cultural influences demonstrate that the reluctance to seek help is not uniformly experienced among all New Zealanders. These values and societal norms add layers of complexity to public attitudes and the societal imperative associated with help-seeking behaviors (Deane et al., 1999). Within this sociocultural landscape, gender dynamics play a discernible role (Butler, 2023; Xiao et al., 2022); young men, for instance, encounter stigmas that often dissuade them from pursuing help for mental health concerns, mirroring larger societal paradigms that equate masculinity with stoic self-dependence.

Another important exogenous help-seeking factor relates to the availability of support for young people. There are significant global disparities in the availability of adolescent mental health services by country and region (Barker, 2007), and unfortunately young people often lack knowledge of the available resources (MacDonald et al., 2018). In New Zealand, the Government’s 2018 Inquiry into Mental Health and Addiction identified several barriers hindering young people’s access to mental health services, including privacy concerns, lack of awareness about where to seek help, and worries about healthcare professionals’ attitudes. Cost and location also pose significant challenges. Vulnerable groups such as Māori, Pacific, Rainbow, and disabled youth are less likely to seek help compared to their peers (NZ Government Inquiry into Mental Health & Addiction, 2018). Further, individuals aged 16 or older can consent to healthcare (like adults do), while those under 16 may require parental approval unless deemed “mature” enough by healthcare providers (KidsHealth, 2021).

Although New Zealand offers diverse mental health services for youth, many individuals face barriers to accessing quality care (Kercher et al., 2024; Sheppard et al., 2018). It is especially evident within the New Zealand secondary education system. Mental health care services in schools are designed to be culturally-sensitive and holistic, although in practice it can be quite fragmented. Licensed “school psychologists” (the term used in North America) are not common. Instead, a confusing array of coordinators and professionals exists (for a comprehensive review, see Ministry of Education, 2017), and many individuals within this system have limited formal training in mental health, often holding only basic postgraduate qualifications in education rather than in health or psychology. Certain professionals—such as school guidance counselors—are not always required to register with professional bodies such as the New Zealand Association of Counselors (NZAC), and even trained, licensed educational psychologists face serious resource constraints, limiting their availability to students.

Theoretical Framework

The Current Study

Amidst rising global mental health challenges (Carvajal-Velez et al., 2023; Vigo et al., 2016), the experiences of young people offer crucial insight into individual attitudes toward help (Clement et al., 2015; P. Corrigan, 2004; Rickwood et al., 2007). While extensive research has documented adolescent help-seeking attitudes, there is a limited understanding of the origins of self-stigma within these attitudes. Addressing this gap is significant, as understanding these origins informs us about the complex interplay between development and environment, both of which shape the help-seeking process among young people. Moreover, there is a scarcity of large-scale qualitative studies in this area. This gap is notable, as such studies can provide in-depth insight into the nuanced ways in which individuals perceive and navigate help-seeking. This type of research can reveal how the self-stigma about seeking help is formed and the potential avenues through which this stigma can be changed.

The purpose of the current study is to understand the discourse of a large sample of young people around help-seeking attitudes in New Zealand. Specifically, this research investigates the pervasive self-stigma associated with seeking help, often perceived as a sign of “weakness”—a sentiment deeply rooted in New Zealand’s societal norms (e.g., Barker, 2007; Curtis, 2010; Vogel et al., 2007). Using a rigorous qualitative approach, the study examines these attitudes and their formation through various influences, including cultural, social, and individual developmental factors. By gaining a more comprehensive understanding of this phenomenon, the study is intended to shed light on the complexities of seeking help among young people in New Zealand and contribute to the improvement of youth-centric policies and interventions that are tailored to their specific needs, experiences, and circumstances.

Sample & Procedures

The sample comprises a large group of young people (n = 668) between the ages of 16 to 21 years living in New Zealand. Self-identified gender is 66.2% female, 24.9% male, 6.7% non-binary/third gender, and 2.2% prefer not to say. The mean participant age is 17.05 years (SD = 1.92). Participants were able to report their ethnicity by selecting more than one category, and therefore, the sum of percentages listed does not equal 100%: 76.2% New Zealand European, 16.0% Asian, 11.1% New Zealand Māori, 5.5% another ethnicity, 4.6% Pacific, and 1.2% prefer not to say. All geographic regions in New Zealand are represented.

Participants were recruited for this study via social media (Instagram), utilizing paid advertisements targeted specifically at users who were located in New Zealand and aged between 16 and 21 years old. Given Instagram’s higher female user base, a recruitment ratio of two males for every female was established to balance the participant demographics. ³ Recruitment materials noted that participants could enter a random draw to win one of 10 gift cards. The study was fully anonymous, and the project had received ethical approval from the University of Canterbury Human Ethics Committee. The online questionnaire used a mixed but quantitative-dominated design. The items ranged from young people’s experiences with stress, how they attempted to cope with stress, and their experiences around seeking help as a means of coping. ⁴ The question that generated the data for this study included the following open-ended prompt: “‘Asking for help is a sign of weakness.’ Do you agree or disagree with this statement? Why?”

The decision to focus on a single open-ended prompt in this study was strategic, and aimed at exploring attitudes toward help-seeking and self-stigma without overcomplicating the research focus or diluting its central aim. The dataset yielded a diverse array of help-seeking attitudes and justifications for these attitudes, aligning with the broad objective of the study. All quotes presented in the study are precisely as they were written by the participants, including slang, misspellings, and grammatical errors.

Methodology

This study is firmly rooted in a critical realist ontology (Terry et al., 2017). Critical realism is a philosophical approach that posits a reality independent of human thoughts and beliefs but acknowledges that our understanding of this reality (as researchers) is always mediated by social, cultural, and linguistic factors (Archer et al., 1998; Sayer, 2000). Specifically, critical realism is useful in studying help-seeking attitudes and behaviors because it enables researchers to explore not just the observable behaviors (e.g., whether or not young people seek help) but also the underlying mechanisms (e.g., developmental factors, societal norms, and cultural beliefs) and individual interpretations that influence these behaviors. By distinguishing between the real (underlying mechanisms), the actual (events that occur), and the empirical (observed experiences), critical realism enables researchers to explore the relationships between social structures and individual actions.

This study adopted Interpretative Phenomenological Analysis (IPA) as its qualitative research methodology (Eatough & Smith, 2017; Smith, 2011; Smith et al., 2009). IPA considers how individuals make sense of their personal and social worlds, particularly through the lens of their lived experiences. This methodology is relevant to the current research on help-seeking attitudes, as it allows for an examination of the subjective experiences and the meanings individuals ascribe to these experiences. IPA focuses on the interpretative efforts of the researcher to understand participants’ perspectives, which aligns with a critical realist ontology, offering a complementary view of how individuals perceive (and are influenced by) the social structures around them.

Data Analysis Approach & Process

This study utilizes a “Big Q” approach to the qualitative data analysis (Braun & Clarke, 2013, 2022; Terry et al., 2017). A Big Q approach highlights the significance of context, meaning, and the subjective reality of participants. This considers the data analysis as a creative process—rather than a technical one—in relation to researcher engagement with the dataset and their positionality. This approach is germane for investigating the complex nature of help-seeking attitudes and self-stigma, as a Big Q approach facilitates an in-depth exploration of these phenomena (Braun & Clarke, 2013; Terry et al., 2017). Importantly, a Big Q approach complements the ontology and methodology by focusing on the depth and context of subjective experiences (IPA), aligning with an emphasis on social structures (critical realism). These allow the research topic to be examined through reflexivity, contextual sensitivity, and prioritizing participant voice, ensuring that the research captures nuanced individual realities and situates them within broader contexts, enhancing interpretation and authenticity.

In this study, reflexive thematic analysis (RTA) was used to guide the data analysis process (Braun & Clarke, 2013, 2022). RTA involves the identification, analysis, and interpretation of patterns of meaning (“themes”) within a qualitative dataset. The analyses performed were inductive, signifying that the themes identified are strongly linked to the data themselves, rather than being imposed by pre-existing theoretical interests. The focus on semantic (i.e., closer to participants’ language) and latent (i.e., informed by underlying concepts) features of the dataset has allowed the researcher to inspect the diverse ideas, assumptions, and conceptualizations that are informing the content of the dataset (Terry et al., 2017).

Seven-Step Data Analysis Process

By combining human judgment with advanced AI software, I created an expanded version of the multi-phase Reflexive Thematic Analysis (RTA) method (Braun & Clarke, 2013, 2022; Terry et al., 2017) to gain a comprehensive understanding of the complexities of help-seeking attitudes among young people. I present a flowchart summarizing this process in Figure 1.

OPEN IN VIEWER

Figure 1.

Flowchart summarizing the data analysis process and relevant activities performed in the current study.

First, I began the analysis process by reading and re-reading the dataset to become immersed in and familiar with its depth and breadth. I made initial notes that could form the basis for codes and used a reflexive journal to capture my initial (and evolving) understanding of the dataset. I noted any biases that might have emerged and reflected on these comments throughout the process to consider how my personal experiences might influence my analysis. By maintaining this reflexive practice, I aimed to enhance the rigor, transparency, and integrity of the research, further integrating these insights into the final stage of the analysis process.

Second, I produced succinct labels (codes) that identify features of the dataset relevant to the research objective. To manage the large sample efficiently, I divided the analysis into manageable segments, each comprising text from fifty participants at a time. This segmentation allowed for a detailed and focused examination of the data, facilitating an efficient, effective, and comprehensive coding process. Utilizing ChatGPT-4, I developed an open coding process for each segment, with the following prompt:

You are a researcher. Your task is to conduct qualitative coding, specifically initial or open coding, on a transcript that I will provide. I expect the codes to be detailed, with clear and precise names. Each code must come with a detailed description. You’ll need to apply these codes to sentences or parts of sentences in the transcript. As you compile a list of codes, you should be able to identify all the sentences or parts of sentences to which these codes were applied. In other words, each code should accompany real example quotes (from the transcript) that have been assigned to that code. I expect you to provide these codes, descriptions, and example quotes accurately.

ChatGPT-4 effectively managed the analysis of text segments from fifty participants at a time, with each submission ranging from a single sentence to a short paragraph, facilitating manageable processing without the complexity of longer, more intricate texts. This reduces the likelihood of “hallucinations” (Lakshmanan, 2022), where the system produces nonsensical responses when it is overwhelmed with information and attempts to predict likely responses (Morgan, 2023). For each segment of fifty participants, I engaged ChatGPT-4 in an iterative coding process, continually asking it to identify additional codes by prompting: “Please give me more codes.” This procedure was repeated until the system could not identify any new codes, ensuring a thorough exploration of the data.

During this process, I closely examined the codes provided by ChatGPT-4 against the original text. Whenever I identified potential gaps in the coding—codes I believed were present but not identified by ChatGPT-4—I specifically requested the system to search for these missing elements. For instance, I might ask, “In the quotes you’ve inspected, do you see anything that relates to [gender norms]?” This method established a collaborative approach where my manual review of the text and ChatGPT-4′s automated analysis complemented each other, achieving a balance of human insight and algorithmic precision. By the end of this process, I had systematically dissected and coded the dataset, ensuring a comprehensive and nuanced analysis that reflected the varied experiences and perspectives within the participant responses. A total of 493 initial codes were identified.

Using the following prompt, these 493 initial codes were further inspected to identify and remove duplicate codes (or items that appeared similar):

I will now paste a list of “codes” (analytic units used in thematic analysis). I would like you to create a new list. I would like you to remove any codes that appear duplicates or are extremely similar. For example, if multiple codes include “Sign of Strength” please only retain one of those codes. For example, if one code is “Strength in Vulnerability” and another is “Vulnerability as Strength,” please only retain one of those codes and use a similar name.

Once condensed and checked manually 300 codes were available. At this point, multiple iterations based on my judgment took place in which I identified and integrated logical commonalities amongst the codes. For instance, participant comments in which seeking help was described as a willingness for self-improvement (“. . . asking for help shows you are willing to improve”) and seeking help creates the conditions for self-improvement (“. . . asking for help is how we learn and grow”) were integrated into a code named “Opportunities for Personal Improvement” as a logical commonality. Both statements underscore the notion that asking for help is a proactive step toward personal growth and development, thus establishing a logical connection between the two comments. At the end of the coding process, 184 unique codes were identified.

Third, codes were clustered together into candidate themes. Based on my thorough familiarity with the dataset, I anticipated four themes relevant to the identified codes, each reflecting core principles of human experience: cognitive, emotional, behavioral/relational, and sociocultural. To systematically process the vast number of unique codes, I utilized ChatGPT-4 for an initial sorting task. Here, I listed the codes and added their descriptions into the system, asking it to suggest potential themes:

I will now paste “codes” (analytic units used for thematic analysis). Please complete an inductive thematic analysis of the codes according to Braun and Clarke (2013). Make sure that each theme has a detailed description, and includes all of the codes that are assigned to that theme.

ChatGPT-4 processed the request and suggested four candidate themes based on the relationships and patterns it identified among the codes and their descriptions. These closely aligned with the initial themes I had anticipated.

Fourth, themes were refined by manually reviewing each candidate theme at the level of the coded data extracts and considering the validity of individual themes in relation to codes and example quotes in the dataset. The process was a recursive one, moving back and forth as needed. This integration involved constant juxtaposition of the data against the emerging framework to ensure coherence. I continually refined the identified codes and checked their suitability for placement in the candidate themes, ensuring they accurately represented the dataset in a coherent and logical manner.

I proactively identified and incorporated negative cases—instances that contradict or challenge the candidate themes—to ensure the robustness and depth of my thematic development. In the appropriate analytic context (see Mahoney & Goertz, 2004), inspecting negative cases can enhance rigor, credibility, and trustworthiness by ensuring that thematic analysis is comprehensive and nuanced, accurately reflecting the dataset’s complexity and challenging the researcher’s assumptions. Noteworthy negative cases are presented in the Results section.

Overall, this step represents a dynamic engagement with participant commentary. I was able to develop more refined themes based on my understanding of the dataset, moving from descriptive coding to conceptual thinking, and each finalized theme cohered around a central organizing concept (Terry et al., 2017).

Fifth, I defined and named the themes. ChatGPT-4 drafted comprehensive definitions of each theme:

I will now paste “themes” (analytic units used for thematic analysis), “codes” (analytic units used for thematic analysis), code descriptions, and example quotes. Please carefully read the text I will provide you and, based only on this text, draft a name and comprehensive description for each theme based on this information.

This provided me with details on each theme and helped in drafting a narrative that ties the codes to the theme, ensuring the integration of relevant example quotes. This process then required manual inspection and careful oversight to ensure that these names and definitions were suitable. This step involved identifying the essence of each theme in relation to the dataset and determining what aspects of the dataset each theme represents.

Beyond the standard RTA process, I conducted sub-analyses of the dataset based on participant demographics to gain a broad view of the clear trends and patterns among specific cohorts. I focused on three demographic characteristics: (a) gender (male, female, and gender diverse/third gender), (b) age (grouped as minors [16–17 years] and young adults [18–21 years]), and (c) ethnicity (NZ European, Asian, and NZ Māori, which represent the three largest ethnic cohorts in the sample). I employed ChatGPT-4 to analyze the dataset based on participant demographic characteristics (e.g., gender) and then performed a comparative analysis across cohorts (e.g., male, female, and gender diverse/third gender) to identify clear commonalities and divergences.

I will share a collection of quotes highlighting individuals’ attitudes toward seeking help, specifically from participants who identify as [a particular demographic cohort; e.g., males]. Your task is to thoroughly review these quotes and identify trends or patterns that are unique to this [demographic characteristic; e.g., gender]. Additionally, provide a list of example quotes that support your findings to illustrate the identified trends. Respond in a clear and structured manner to ensure readability.

I now want you to perform a comparative analysis of the summaries you have just generated in this chat for the different cohorts (e.g., male, female, and gender-diverse participants). To perform a comparative analysis of the summaries generated for different sub-samples (e.g., male, female, and gender-diverse participants), follow these steps: First, review the summaries carefully for each demographic cohort, noting the main trends, patterns, and narratives identified in each summary. Next, identify commonalities by highlighting any recurring themes or attitudes consistent across all demographic cohorts. Note any shared barriers or facilitators to seeking help mentioned by participants. Then, identify divergences by pointing out any unique trends, patterns, or narratives specific to each demographic cohort. Highlight differences in attitudes, behaviours, or perceptions related to seeking help among the different groups. Finally, create a comprehensive summary by detailing and organising the commonalities and divergences. Provide specific examples or quotes to support your analysis. Ensure the summary is clear and comprehensive, capturing the essence of the comparative analysis.

ChatGPT-4 was less successful in comprehensively achieving this task; as such, I manually inspected and reflected upon the original quotes, codes, and themes to ensure accuracy and rigor.

My seventh and final step involved the re-evaluation of my reflexive journal comments and the integration of reflexive commentary. As I reviewed the codes and themes, I critically examined my own roles, biases, and influences based on the observations I had made throughout the research process. This ensured that the interpretation of the dataset and the themes were not only informed by the dataset but also by an awareness of my subjective perspective. By revisiting my reflexive journal, I was able to contextualize the thematic analysis within my own experiences and preconceptions, which is crucial for the rigor, credibility, and trustworthiness when navigating the complexities of help-seeking within the specific context of New Zealand youth.

Theme 1: Vulnerability and Emotional Hurdles When Considering Help

This theme describes the emotional intricacies that underscore the process of seeking help, particularly highlighting the potent negative emotions that influence young people’s attitudes and subsequent actions or inactions. Central to this is the pervasive belief that seeking assistance equates to admitting weakness. Within the dataset, emotions—especially fear and vulnerability—are significant factors that determine whether a young person will seek assistance or choose to remain silent (see Figure 2).

OPEN IN VIEWER

Figure 2.

Theme 1: Vulnerability and emotional hurdles when considering help.

Fear stands out as the most pronounced emotion in the dataset. Most of the fears discussed relate to help-seeking and the potential negative judgments from peers and social alienation. These include being pitied, ridiculed, rejected, ostracized, and looked down on by others. Such fears are ultimately rooted in individuals’ need for social belonging and the concerns that arise from potential exclusion. In particular, participants fear being perceived as attention-seekers, especially when expressing distress or seeking help. They also describe a widespread fear of personal inadequacy, referring to self-perception and the concern of being seen as useless or inadequate. For instance, one respondent explains, “I avoid asking for help because it makes me feel stupid; I want to appear as having the answers and wisdom for everything - and asking for help is a direct sign that I don’t” (female, 17 years).

Participants refer to a fear of dependency repercussions, namely their concerns about imposing on others or not receiving the necessary support. A strong narrative revolves around the fear of burdening others—that bringing one’s problems to others would bother, annoy or inconvenience others. This was exemplified by a participant who states “I love my friends, but I don’t want to burden them. They shouldn’t be responsible for my mental health when they themselves don’t fully know how to deal with their own” (female, 18 years).

Participants voice a fear of emotional disregard, referring to concern about one’s feelings being dismissed or exploited. It underscores the need for emotional validation and the distress of not being understood or taken seriously. One participant (female, 17 years) explains, “People [are] scared that their feelings aren’t valid or they have no reason to be feeling that way.” Fifth, there is a profound narrative in the dataset referring to a fear of personal vulnerability and emotional expression. In particular, individuals express discomfort with being emotionally open, fearing potential rejection. One participant (male, 16 years) adds, “I do struggle to ask since I feel uncomfortable doing so not being a fault of others but instead myself.”

In my experience working with young people and considering the comments in this dataset, it is evident that emotions and how individuals choose to communicate these feelings to others are paramount when thinking about help and seeking assistance. While fear is a powerful emotion, it is also clear in the dataset that the willingness to be emotionally vulnerable plays a significant role in shaping young people’s help-seeking attitudes. Vulnerability is a complex emotion, with some participants in this study viewing it as a sign of weakness, while others see it as a strength. It became evident upon reflection that while fear is powerful on its own, a young person’s willingness to be emotionally vulnerable has a considerable—if not greater—impression on their help-seeking attitudes and behaviors.

In this dataset, vulnerability is a pivotal factor influencing one’s attitudes toward seeking help. A small majority of the participants described vulnerability as a pathway to personal growth, embracing it as a sign of strength and a crucial step toward seeking assistance. This viewpoint is encapsulated by one participant’s reflection: “It takes strength and courage to admit you need help. Vulnerability is scary but it comes with great rewards” (nonbinary/third gender, 19 years), highlighting the perception of vulnerability as an opportunity for self-improvement and growth. Meanwhile, there were notable exceptions that highlight the complexity of this topic. These negative cases (where vulnerability was perceived strictly as a sign of weakness) offer a contrasting view. For instance, some adolescents expressed reluctance to seek help due to a fear of appearing vulnerable, viewing it as an admission of defeat rather than an opportunity for growth. Echoing the sentiments of numerous participants, one individual succinctly captures a common perspective: “. . .feeling vulnerable and letting people know how I’m feeling has never and will never be ideal” (female, 17 years), highlighting a reluctance to share their feelings and vulnerabilities.

The evolution of attitudes toward vulnerability is also evident, as experiences and time influence perceptions. As another participant shared, “The most help I have gotten for my mental health struggles was by asking for help. It is often hard and I really struggled against it for a long time. But asking for help was the best thing I’ve ever done, now I’m getting proper treatment for my mental health, and can ask others for help more often” (female, 16 years), reflecting a journey from reluctance to recognition of the benefits of seeking help.

Whereas nearly all participants were willing to acknowledge their emotions around help, a few individuals dismissed their feelings as inconsequential, potentially implying a devaluation of emotional distress. For example, one participant (unreported gender, 16 years) explained, “I agree with this because it’s just feelings so it doesn’t matter.”

Beyond fear and vulnerability, other emotions are apparent in the dataset. This includes guilt, embarrassment, disappointment, shame, anxiety, and overcoming pride. These collectively signal the range of emotions that are involved in young people’s attitudes toward seeking help. For example, one participant explains, “It takes a lot of strength already push your pride away to accept that you do need aid from others” (female, 17 years).

Theme 2: Societal Narratives and Internalized Barriers When Considering Help

Theme 2 focuses on the interplay between societal norms, cultural beliefs, and individual attitudes toward seeking help. Based on participant dialog, this theme highlights how societal narratives, gender stereotypes, and generational misunderstandings shape (and often hinder) the process of seeking help. The theme is interwoven with emotions (Theme 1), which are not solely personal experiences but are also shaped by societal norms, cultural messages, and interactions. The dominant narrative within this theme is the pervasive societal stigma associated with seeking help, which often manifests as internalized beliefs and barriers (see Figure 3).

OPEN IN VIEWER

Figure 3.

Theme 2: Societal narratives and internalized barriers when considering help.

A large majority of participant comments revolves around internalized beliefs, societal expectations, and stereotypes in relation to help-seeking. Participant dialog reflects an awareness amongst young people that self-stigma (i.e., viewing help as a weakness) is powerful and can act as a significant barrier that makes individuals reluctant to reach out. For example, one participant comments, “i disagree with the statement in theory but i also know that i have internalized it and it is part of why i dont ask for help” (male, 21 years).

A few participants make explicit stigma-related references to Aotearoa New Zealand, acknowledging the presence of societal stigma in the national community. There is also resistance against this kind of mindset; for example, “. . . if people would stop thinking like this New Zealand’s Suicide Rate would be lower as people would feel more comfortable about asking for that help and not feeling like they are weak for seeking that help” (female, 16 years). The dataset includes a notable group of comments specific to the stigma that exists within an individualistic culture. For example, one participant explains, “It’s a brave statement in such an individualistic society to recognize that you need extra support. Mental health is often stigmatized” (female, 19 years).

Although it is not widely mentioned in the dataset, a few participants acknowledge that the portrayal of mental health and mental health services in literature, media, and marketing can either encourage or deter individuals from seeking help. For example, one individual explains, “Although it is constantly encouraged, the reinforcement of asking for help and promoting help services publicly actually strengthens this statement further as people feel self conscious if others see them visibly asking for help” (female, 18 years).

Gender norms and expectations are part of the dialog around help-seeking attitudes and behaviors. The term “toxic masculinity” is used explicitly by a small group of participants. Further, the dataset includes commentary that stigma around masculinity might deter men from seeking help due to a societal belief that it is a sign of weakness:

“I think for men at least there is often a particular double edged sword emotional framework we live by. Asking for help is extremely difficult for us because it is opening up and trying to rely on others. So much so that we often can’t open up unless the truth is slightly muddled by a veil of indifference. On the other end of the sword we have a much better capacity to hold and deal with our issues by ignoring them. But when that fails. . .. . .” (male, 21 years)

This particular text comprises valuable insight into the double standard for men, acknowledging that there are two conflicting sides to the emotional framework that some men operate within. On the one hand, there is difficulty in asking for help; on the other hand, there is the ability (and perceived need) to suppress or ignore issues. The text highlights that, for some men, asking for help is not just about seeking assistance—it is about vulnerability (“opening up”). This can be challenging for multiple reasons, including societal norms that often equate masculinity with strength, independence, and stoicism. The mention of the “veil of indifference” suggests that even when some men do open up, they might downplay their feelings or present their issues with a sense of detachment. This could be a protective coping mechanism to avoid appearing too vulnerable. From a reflexive stance, it is clear that this narrative aligns closely with the “Kiwi bloke” stereotype (Keppel, 2012), often characterized by ruggedness, practicality, and certain laconic humor that exists within New Zealand.

The dataset includes an attitude that generational differences exist in relation to societal stigma and cultural beliefs. This includes a particular sentiment that older generations might have different views on help-seeking compared to younger generations. One participant explains, “I disagree but i think its very hard asking for help and the way that lots of adults dont understand what teenagers are going through” (female, 16 years). Despite the apparent generational gap, however, a few participants recognize a societal shift in attitudes toward help-seeking. This acknowledges the existence of outdated stigmatizing views while recognizing the progressive change toward more accepting attitudes around help: “The mentality that it is a sign of weakness has regressed in the last decade but is still a common trope in the mentalities of our age” (male, 20 years).

Theme 3: Wisdom, Maturity, and Thought When Considering Help

This theme focuses on the cognitive and social cognitive processes that underpin help-seeking attitudes. This underscores the importance of logical reasoning, self-regulation, and decision-making in the face of negative emotions and vulnerability (Theme 1) and societal norms and stigma (Theme 2). Theme 3 also highlights the developmental journey of young people, emphasizing their desire to be perceived as mature and independent. This aspiration, coupled with their evolving cognitive and social cognitive processes, seems to influence their attitudes and actions toward seeking help (Figure 4).

OPEN IN VIEWER

Figure 4.

Theme 3: Wisdom, maturity, and thought when considering help.

Multiple comments revolve around logic and rationality; that is, a reasoned approach young people take when deciding to seek assistance. For some, acknowledging that a problem exists is an important first step: “You are making the first step to solving whatever problem you have. . .” (nonbinary/third gender, 17 years). Participants discuss the decision-making steps involved in seeking and receiving help, such as weighing pros and cons and considering potential outcomes; for example, “Not asking can get you caught up in your issues and possibly make it worse” (female, 19 years).

The dataset includes extensive commentary around the specific conditions in which seeking help is deserved, justified, and appropriate. Some participants feel as though young people need to be able to appraise when a situation warrants help. If this is not done, then seeking help can be viewed as shifting responsibility onto others. Within the evaluative process of deciding whether or not help is needed, it became clear that a critical assessment of the individual (e.g., disposition, needs, and motives) and a cognitive appraisal of the context (e.g., the severity of the situation) take place (R. S. Lazarus & Folkman, 1984). For example, one participant explains, “. . . if you’re asking for help for something that you should be doing then it is laziness and a bit of weakness if it is something that should require help then it is not” (male, 19 years). These kinds of sentiments suggest a complex view of help-seeking behavior. From this stance, asking for assistance is not universally applauded but rather is conditional on the situation and the individual’s perceived responsibility within that situation. This may suggest that one’s belief that seeking help is not necessarily needed—but requested nevertheless—may be an act of unnecessary reliance on others. Further, this implies that the perceived predictability of advice can discourage help-seeking behavior or be seen as attention-seeking. In the dataset, there is concern over the potential misuse or overuse of mental health conditions as excuses for certain behaviors. This, potentially, trivializes the experiences of those genuinely dealing with mental health issues. While it is not a commonly expressed sentiment, one individual explains, “I think that the excuse of mental health has become over used by people who do not actually experience struggles” (female, 16 years).

The dataset highlights the importance for young people to manage their emotions when faced with a problem, pertaining to research on adolescent self-regulation (P. J. Lazarus & Costa, 2020; Skinner & Zimmer-Gembeck, 2016; Thompson, 1991). Building on the extant literature, the current study acknowledges that individuals need to reassess their initial emotional reactions about seeking help when they feel calmer. For example, one participant explains, “Talking to others about your problems is an impulse for me and I prefer to not act on impulse and embarrass myself” (female, 17 years). There is also consideration of overthinking and excessive rumination, acknowledging the harmful effects of dwelling on problems for extended periods without seeking help.

One participant offers a detailed experience of the help-seeking process and exemplifies many of the codes identified in Theme 3:

“I spent months in a toxic, unhealthy situation where I really needed help but was convinced I could do it by myself and didn’t need help. I think it was one of the strongest things I’ve ever done, even though at the time it felt like the most betraying, defeated time of my life. And it will always be hard to 1. Recognise that you’ve lost control 2. leave that uncomfortable comfortable situation 3. Convince your mind It’s okay to ask for help 4. Find someone that you can trust to not leave you and understand 5. Decide how, when, where, why you’ll tell them 6. Tell them and answer their questions 7. Deal with letting go. And the restrictions they’ll put in place.” (female, 16 years)

This individual acknowledges having spent “months in a toxic, unhealthy situation,” signaling that they were aware of the detrimental environment (acknowledging the problem). However, the belief that they could handle it on their own might have been a rationalization to avoid confronting the issue or seeking external help. The steps described also suggest a logical progression of thoughts and actions that one might undertake when handling a challenging situation (logic and rationality). Second, the participant’s reflection on the need for help highlights the decision-making process. Steps like “Decide how, when, where, why you’ll tell them,” and “Tell them and answer their questions” are explicit indicators of the decision-making process. These steps imply evaluating various options (weighing the pros and cons) and choosing the best course of action based on the individual’s circumstances and anticipated outcomes (considering potential outcomes). Third, features of emotional self-regulation are present. The statement “I think it was one of the strongest things I’ve ever done” reflects the individual’s ability to regulate their emotions and persevere, even when faced with internal conflict and external challenges. The process of convincing oneself that “It’s okay to ask for help” is a form of emotional self-regulation, where the individual has to manage their fears, pride, or shame to reach out for assistance. “Deal with letting go. And the restrictions they’ll put in place” suggests the individual’s awareness of the need to manage their reactions and emotions in response to the potential consequences of seeking help.

Extensive comments in the dataset present a nuanced understanding of help-seeking attitudes juxtaposed against young people’s perceptions of maturity and independence. This tension— situated within their developmental journey from childhood to adulthood—reveals a balance between the desire to be seen as mature and the inherent need for support (Eckert, 1994). While many young people strive to signal their readiness for adult responsibilities (Tilton-Weaver et al., 2001), this ambition can influence their approach to seeking help. A prevailing narrative within this dataset illustrates an internal conflict: the dichotomy between relying on others for assistance and the pursuit of autonomy. Help-seeking is perceived by many participants as an act of maturity, demonstrating self-awareness and the wisdom to acknowledge when support is necessary. However, this same narrative hints at an underlying concern that seeking help could compromise their self-reliance, suggesting a tension between the aspiration for independence and the practical recognition of one’s limits. Upon considering negative cases, it was clear that an alternative viewpoint frames help-seeking as a sign of immaturity. For some, dependency on others is seen as a form of “surrender,” “cheating,” or a betrayal of self-reliance. These contrasting views give rise to a deeper conversation about independence: though many participants express a staunch belief in self-sufficiency, there is also an acknowledgment across the dataset of the unrealistic nature of this ideal. This recognition of the impossibility of handling everything alone creates a space for internal conflict, where the desire for independence coexists with an understanding of the necessity for interdependence. It is important to acknowledge that societal norms and cultural values amplify the emphasis on independence. Communities that put a premium on self-sufficiency may consider help as a sign of personal deficit or even as “cheating” one’s way through challenges. Indeed, this could be a tendency to deceive oneself into believing that they do not need help, viewing this self-reliance as a sign of strength (even when the opposite might be true!).

Theme 4: Humanity, Relationships, and Comparisons in Considering Help

This theme emphasizes the relational and social dimensions of seeking help. It highlights the impact of interpersonal bonding, shared struggles, social connections, and community strength in the process of seeking help. The theme has obvious linkages to the aforementioned themes. Several concepts in the dataset highlight the shared experiences in the process of seeking (and offering) help (Figure 5).

OPEN IN VIEWER

Figure 5.

Theme 4: Humanity, relationships, and comparisons in considering help.

At a broad level, participants discuss help and humanity. A set of pithy comments describe the mutual reliance between individuals, emphasizing that no one exists in isolation and that people all rely on others in various capacities throughout their lives (e.g., “No man is an island” and “It takes a village”). This underscores the belief that seeking help is an essential aspect of human existence. My interpretation here is that young people may express staunch values of self-reliance and independence as influenced by cultural norms, their developmental stage, and personal characteristics; yet, these beliefs can also paradoxically live alongside a universal recognition of human interdependence. Further, seeking help is discussed as having the potential to lead to deeper interpersonal connections with others. In the dataset, the knowledge that others have faced similar challenges can also be comforting; for example, “Knowing other people might be struggling too makes you feel better about your situation” (female, 16 years). Across the dataset, it is evident that a supportive community can make the process of seeking help more accessible and less daunting. In particular, family members and close friends serve as an important point of contact for young people. There are also comments highlighting the importance of formal (professional) help as well as the interaction between informal and formal sources of help. One participant explains, “. . . everyone needs to ask for help at times and get real proper help not just venting to your friends because that also harms them, you need to ask someone that knows what they’re talking about for help as soon as you feel hate toward yourself” (female, 16 years). Within the dataset, young people also express frustrations about the limited access to high-quality mental health support in Aotearoa New Zealand. One participant states “. . . the NZ mental health systems are SHIT they don’t do anything, it would be a waste of time trying to find an actual good therapist/councilor” (female, 16 years). Collectively, this indicates that young people understand the significance of reaching out for professional assistance when necessary; however, challenges in accessing high-quality mental health services within the national healthcare framework may present substantial obstacles to seeking help. This is a systemic problem that has been recently reported in New Zealand (e.g., Kercher et al., 2024).

Building on previous themes, there can be downsides when the helper focuses too much on their own experiences and adds a relative (and potentially comparative) stance. Relational and social interactions might include delegitimising the validity of the helpee’s problem or need for mental health support; for example, one participant explains, “Asking for help from people in my family makes me feel like I am weak as usually they invalidate and compare what I’m going through to how they had to deal with ‘so much worse’” (nonbinary/third gender, 18 years). Several participants discuss shutting people out as a deterrence from reaching out and building connections with others, underscoring the implications of this isolation on their mental health.

Extensive dialog within the dataset highlights a tendency among individuals to compare their problems or struggles with those of others. Within relational and social contexts, this “comparative suffering” leads young people to downplay or dismiss their own struggles, particularly if they perceive others in their community as facing more serious challenges. One individual articulates this sentiment, stating, “. . . for me I know that others have it worse than me and I am complaining about my own problems” (male, 18 years). Another explains, “I love my friends, but I don’t want to burden them. It’s as simple as that, really. I don’t like to ‘rank’ or compare the amount of anxiety we all have, but I feel I sit lower on that scale. They’re all so talented and successful yet so anxious and have so many things on their plate” (female, 18 years). In my experience working with young people in New Zealand as an academic and researcher in schools, the phenomenon of comparative suffering has been notably prominent. It particularly stood out to me as it was evident across a broad spectrum of participant comments in this dataset. The narrative signals a potential for comparative suffering to influence young people’s attitudes toward seeking help. Specifically, the belief that their issues are not “serious enough” compared to others may deter them from reaching out for the support they need, driven by a range of fears. This mindset appears further complicated by developmental considerations, as adolescence and young adulthood are periods marked by intense self-awareness and a heightened sensitivity to social judgments (Erikson, 1968). As individuals explore their identity within the sociocultural context and perspectives on maturity, the pressure to appear self-reliant may intensify feelings of isolation during personal struggles. Consequently, the act of comparing struggles may not only diminish one’s own experiences but also constructs psychological barriers to seeking help, reinforcing stigma around mental health and vulnerability during a critical stage of development.

Based on participant commentary, young people sometimes experience a feeling of hypocrisy in the context of help-seeking. Specifically, they express a sense of inconsistency between their beliefs or attitudes about seeking help and their actual behaviors. This can manifest as someone who outwardly promotes the importance of seeking help but internally struggles to do so. It is possible that societal norms and cultural values exacerbate feelings of hypocrisy. For instance, if there is an expectation to appear mature, individuals might promote these values outwardly while internally struggling with their own feelings and vulnerabilities.

Meanwhile, a self-other discrepancy is apparent, highlighting the difference in how a person views their own help-seeking behaviors compared to that of others. This is different from (although it can be related to) my interpretation of comparative suffering, where a person is making a relative judgment about the legitimacy of their problems. Specifically, a self-other discrepancy is a judgment in which an individual believes that other people should be able to seek and receive help, but this is not a standard held for oneself. For example, one participant explains, “For myself I agree with this statement but for other people i don’t. I think other people deserve help and getting it makes them strong because it is frowned upon in society, however for myself I feel as though I should be able to solve all my problems myself” (female, 16 years). This discrepancy can include internal conflict, guilt, or cognitive dissonance. This may deter individuals from seeking help even if they outwardly advocate for it. For example, one participant comments, “I believe that asking for help is good but I struggle to apply it to myself because then I feel people look at me like I’m weak” (female, 18 years).

Summary of Group Differences in Narratives Based on Participant Demographics

Study Limitations & Future Research

It is important to recognize limitations that deserve attention in future research to refine and expand upon the findings presented. First, the study’s reliance on Instagram for participant recruitment might not fully capture the diverse experiences of young people in New Zealand due to the platform’s specific user demographics. Although efforts were made to balance gender representation and avoid sampling exclusively through schools and universities, this method introduces inherent biases. Future research should consider utilizing a multi-platform approach for recruitment, including both online and offline methods, to ensure a more culturally representative sample of the youth population. Second, the recruitment approach did not verify participants’ identities beyond self-report, which poses challenges to the reliability of demographic characteristics. This limitation was mitigated to some extent by using IP addresses to confirm geographical locations, but future studies could improve reliability by incorporating additional verification steps, such as using platforms that offer more robust authentication methods. Third, as mentioned previously, the use of artificial intelligence (AI) through a Large Language Model (LLM) in the data analysis raises concerns about the potential oversimplification of complex human experiences. The study attempts to balance the efficiency of AI with human judgment; however, future research should continue to explore the optimal integration of AI tools in qualitative research, ensuring the preservation of data richness and context. Addressing ethical considerations related to data privacy and algorithmic bias will also be crucial in the future use of AI in research.

The current research signals a broad spectrum for further investigation, particularly regarding how the cascading effects of stigma influence help-seeking attitudes and the manner in which support is accessed and utilized by young people. Generally, addressing stigma around mental health challenges is an essential step forward (Sharpe et al., 2022). Exploring the dynamics of how these attitudes vary across different cultural backgrounds (both within New Zealand and elsewhere in the world) can shed light on more effective, culturally-sensitive approaches to encouraging help-seeking behaviors. Such research could also enhance interventions by addressing the complex interplay between individual autonomy and communal support, aiming to reduce stigma. By examining these aspects, we can gain deeper insights into the barriers and facilitators of help-seeking, ultimately contributing to a more supportive environment for all individuals—especially young people—in their times of need.