Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12—17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.
Achenbach, T.M. (1991a). Manual for the Child Behavior Checklist/4—18 and 1991 Profiles. Burlington, VT: University of Vermont Department of Psychiatry.
2.
Achenbach, T.M. (1991b). Manual for the Teacher's Report Form and 1991 Profiles. Burlington, VT: University of Vermont Department of Psychiatry.
3.
Achenbach, T.M. (1991c). Manual for the Youth Self-report and 1991 Profiles . Burlington, VT: University of Vermont Department of Psychiatry.
4.
American Psychiatric Association. (APA). ( 1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.
5.
Andersen, R.M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36, 1—10.
6.
Arbuckle, J.L., & Wothke, W. (1999). Amos 4.0 user's guide. Chicago : SmallWaters.
7.
Bentler, P.M., & Bonett, D.G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin,88, 588—606.
8.
Brewin, C., Wing, J., Mangen, S., Brugha, T., & MacCarthy, B. (1987). Principles and practice of measuring needs in the long-term mentally ill: The MRC Needs for Care Assessment. Psychological Medicine, 17, 971—981.
9.
Browne, M.W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K.A. Bollen & J.S. Long (Eds.), Testing structural equation models (pp. 136—162). Newbury Park, CA: SAGE Publications.
10.
Costello, E.J., Angold, A., & Keeler, G.P. (1999). Adolescent outcomes of childhood disorders: The consequences of severity and impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 121—128.
11.
Costello, E.J., Pescosolido, B.A., Angold, A., & Burns, B.J. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health , 9, 165—190.
12.
Farmer, E.M.Z., Burns, B.J., Phillips, S.D., Angold, A., & Costello, E.J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54, 60—66.
13.
Feehan, M., McGee, R., & Stanton, W. (1993). Helping agency contact for emotional problems in childhood and early adolescence and the risk of later disorder. Australian and New Zealand Journal of Psychiatry, 27, 270—274.
14.
Ford, T., Hamilton, H., Goodman, R., & Meltzer, H. (2005). Service contacts among the children participating in the British Child and Adolescent Mental Health Surveys. Child and Adolescent Mental Health, 10, 2—9.
15.
Garralda, M.E. (2004). The interface between physical and mental health problems and medical help seeking in children and adolescents: A research perspective. Child and Adolescent Mental Health, 9, 146—155.
16.
Goldberg, D., & Huxley, P. (1992). Common mental disorders: A bio-social model. London: Routledge.
17.
Gledhill, J., Kramer, T., Iliffe, S., & Garralda, M.E. (2003). Training general practitioners in the identification and management of adolescent depression within the consultation: A feasibility study. Journal of Adolescence, 26, 245—250.
18.
Harrington, R., Rutter, M., & Fombonne, E. (1996). Developmental pathways in depression: Multiple meanings, antecedents, and endpoints. Developmental Psychopathology , 8, 601—616.
19.
Horwitz, S.M., Leaf, P.J., Leventhal, J.M., Forsyth, B., & Speechley, K.N. (1992). Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics, 89, 480—485.
20.
Kramer, T., & Garralda, M.E. (1998). Psychiatric disorders in adolescents in primary care. British Journal of Psychiatry , 173, 508—513.
21.
Logan, D.E., & King, C.A. (2001). Parental facilitation of adolescent mental health service utilisation: A conceptual and empirical review. Clinical Psychology: Science and Practice, 8, 319—333.
22.
Luk, E.S.L., Brann, P., Sutherland, S., Mildred, H., & Birleson, P. (2002). Training general practitioners in the assessment of childhood mental health problems. Clinical Child Psychology and Psychiatry, 7, 571—579.
23.
Maughan, B., Iervolino, A.C., & Collishaw, S. (2005). Time trends in child and adolescent mental disorders. Current Opinion in Psychiatry, 18, 381—385.
24.
Offer, D., & Schonert-Reichl, K.A. (1992). Debunking the myths of adolescence: Findings from recent research. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1003—1014.
25.
Pavuluri, M.N., Luk, S., & McGee, R. (1996). Help-seeking for behavior problems by parents of preschool children: A community study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 215—222.
26.
Rickwood, D.J., & Braithwaite, V.A. (1994). Social-psychological factors affecting help-seeking for emotional problems. Social Science and Medicine, 39, 563—572.
27.
Saunders, S.M., Resnick, M.D., Hoberman, H.M., & Blum, R.W. (1994). Formal help-seeking behavior of adolescents identifying themselves as having mental health problems. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 718—728.
28.
Sawyer, M.G., Arney, F.M., Baghurst, P.A., et al. (2000). The mental health of young people in Australia: Child and adolescent component of the national survey of mental health and well-being. Canberra: Commonwealth Department of Health and Aged Care.
29.
Sawyer, M.G., Arney, F.M., Baghurst, P.A., et al. (2001). The mental health of young people in Australia: Key findings from the child and adolescent component of the national survey of mental health and well-being. Australian and New Zealand Journal of Psychiatry, 35, 806—814.
30.
Sayal, K., & Taylor, E. (2004). Detection of child mental health disorders by general practitioners. British Journal of General Practice , 54, 348—352.
31.
Shaffer, D., Fisher, P., Christopher, P.L., Dulcan, M.K., & Schwab-Stone, M.E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28—38.
32.
Sourander, A., Helstelä, L., Ristkari, T., Ikäheimo, K., Helenius, H., & Piha, J. (2001). Child and adolescent mental health service use in Finland. Social Psychiatry and Psychiatric Epidemiology , 36, 294—298.
33.
Stanger, C., & Lewis, M. (1993). Agreement among parents, teachers, and children on internalising and externalising behavior problems. Journal of Clinical Child Psychology, 22, 107—115.
34.
Tucker, L.R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1—10
35.
Verhulst, F.C., & Koot, J.M. (1992). Child psychiatric epidemiology: Concepts, methods and findings. Beverly Hills, CA: SAGE Publications.
36.
Verhulst, F.C., Van der Ende, J., Ferdinand, R.F., & Kasius, M.C. (1997). The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents. Archives of General Psychiatry,54, 329—336.
37.
Walker, Z., & Townsend, J. (1998). Promoting adolescent mental health in primary care: A review of the literature. Journal of Adolescence, 21, 621—634.
38.
Westert, G.P., Schellevis, F.G., De Bakker, D.H., Groenewegen, P.P., Bensing, J.M., & Van der Zee, J. (2005). Monitoring health inequalities through general practice: The second Dutch National Survey of General Practice . European Journal of Public Health, 15, 59—65.
39.
Wissow, L.S., Roter, D.L., & Wilson, M.E. (1994). Pediatrician interview style and mothers' disclosure of psychosocial issues. Pediatrics, 93, 289—295.
40.
Zwaanswijk, M., Van der Ende, J., Verhaak, P.F.M., Bensing, J.M., & Verhulst, F.C. (2003). Factors associated with adolescent mental health service need and utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 692—700.
41.
Zwaanswijk, M., Van der Ende, J., Verhaak, P.F.M., Bensing, J.M., & Verhulst, F.C. (2005). Help-seeking for child psychopathology: Pathways to informal and professional services in The Netherlands . Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1292—1300.
