To enhance help-seeking for internalizingproblems in adolescents from ethnic minorities, it is important to explore their help-seekingbehaviour for these problems. As proposed by Cauce et al. (Cauce et al., 2002) help-seekingbehaviour should be considered a protracted process which begins with the time when a problems is first noticed. A focus on the process of help-seeking rather than help-getting will more fully account for the influence of culture and context (Cauce et al., 2002). To date, a few studies have investigated the mental health help-seeking pathway of adolescents from different ethnic backgrounds (Molock et al., 2007, Lee et al., 2009) however; none of these studies have focused specifically on perceptions of adolescent girls regarding their help-seekingbehaviour for internalizingproblems. Since adolescent females from ethnic minorities are considered a high risk group with regard to internalizingproblems (Stevens et al., 2005, van Oort et al., 2006, McLaughlin et al., 2007) it is of interest to focus on the help-seekingbehaviour of this specific group.
Evidence suggests that poor ‘mental health literacy’ (MHL), the latter defined as ‘knowledge and beliefs about mental health disorders which aid their recognition, management and prevention’ , may be a major fac- tor in the low uptake of mental health care among indi- viduals with mental health problems . Findings from recent studies suggest that this includes Iraqi and Afghan refugees being resettled in Australia [22–24]. One aspect of the MHL in refugee samples that appears worthy of further investigation is the ability of these individuals to recognise the signs of a trauma-related problem in them- selves. Previous research in community based samples of individuals with symptoms of other mental health prob- lems, such as eating disorders, suggest that self-recogni- tion of mental health problems is poor and that this is a factor in help-seeking behavior, including the low uptake of mental health care [25–28]. To our knowledge, how- ever, self-recognition of PTSD symptomatology, and the potential association of this with help-seeking behavior, has not yet been examined in resettled refugee popula- tions. Findings in this regard may have implications for mental health promotion and/or early intervention pro- grams, for example, the need to target poor MHL among individuals at high risk of or with early signs of PTSD.
Corrigan (2004) distinguishes between the two separate types of stigma; public stigma and self-stigma. The first, public stigma, is the perception held by others that an individual is socially unacceptable (Vogel, Wade& Hackler, 2007). It refers to the negative stereotypes and prejudice held by a collective of people or society. Public stigma affects an individual’s helpseekingbehaviour as they wish to avoid being labelled ‘mentally ill’ (Corrigan, 2004). Hence, in an effort to evade the loss of opportunity that comes with stigmatising labels, individuals refrain from going to clinics or interacting with mental health providers with whom the prejudice is associated (Corrigan, 2004). The latter, self-stigma, occurs when an individual identifies themselves with the stigmatised group and applies corresponding stereotypes and prejudices to the self (Eisenberg et al., 2009). For example, those who strongly endorse mental health stigma may believe that seeking services from a psychological professional is a sign of being unpredictable or permanently damaged (Thompson, Bazile& Akbar, 2004). According to Corrigan (2004), self-stigma may hinder an individual’s helpseekingbehaviour if the use of services means acknowledging their own mental health problems and if the individual’s negative attitudes about people with mental health problems would harm their own self-esteem.
Concordant with previous Dutch studies among UMs, mental health problems were frequently reported by the UMs. 3 22 These problems were spontaneously reported throughout the interviews without explicitly being asked about, and that counted for their own as well as those of other undocumented relatives. The majority of the respondents were under the impression that their mental health problems and those of their peers were directly related to their status as UM. This is a ﬁ nding that has not emerged so clearly in earlier research and indicates that UMs regard their mental health problems as ‘ a normal response to an abnormal situation. ’ Knowledge about the effects of the lack of status on the different areas of life seems to be essential for health- care providers helping UMs with mental health pro- blems. This knowledge might help the GP to ﬁ nd the underlying reasons for their mental health problems and might prevent unnecessarily ‘ medicalising ’ and ‘ pathologising ’ of UMs psychological responses to their dif ﬁ cult life circumstances.
mental illness in general differ between Asian and western cultures [18,19]. The study reported here demonstrates that the IDLS does detect clear differences between medi- cal students in second and fourth year courses, and between non-medical students from ethnic Chinese back- grounds and other undergraduates residing in Australia. These differences are obvious across all the key areas (depression within the context of major general health problems and major mental health problems, common psychological symptoms of depression, attitudes to the use of evidence-based treatments, patterns of health care utilisation and expectations of discrimination).
for their developmental age. This also applied to the way the child’s gender was thought to influence their behaviour; for two of the parents of boys for example, their concerns were minimised because of the dominant narrative that ‘boys will be boys’ and are allowed to be active and energetic. The ideas that these sleep patterns were ‘normal’ seemed to be reassuring for parents, as it indicated that their children were behaving in a customary manner and so removed any need to seek help. It may have been useful to them because it meant they did not need to expose themselves to potential scrutiny and judgment about being a ‘bad’ parent (Peckover, 2002). Furthermore, it is understandable that parents would want to view their child as ‘normal’ because of the connotations of being described as ‘abnormal’ and consequential experiences of ‘othering’; ‘othering’ in this context refers to how difference (disabilities and sleep problems) can be pathologised, resulting in stereotyping of individuals, discrimination and social distancing (Jenson, 2011). The parents in this study may have been attuned to this because the reality that their child has a disability may already have
Goldberg and Huxley (1992) proposed a model which describes a series of filters at each stage up the pathway to more specialised help for mental health problems, so that only a small minority will be seen by mental health professionals. The first filter incorporates ‘illness behaviour" (Mechanic, 1968), where a person adopts a ‘sick role’ in order to receive ‘provisional validation" that they have a problem from someone close to them; a family member or friend. During this initial help-seeking encounter, some sort of meaning is co-constructed and advice maybe given or a course of action decided upon. Goldberg and Huxley (1992) suggest that cultural influences have a decisive effect in this process. Studies have found that many people who perceive their mental health problems as being spiritual or religious in origin will tend to seek out religious/spiritual support prior to and often in place of seekinghelp from NHS mental health services (Narrow, Reiger & Rae, 1993; Cole, Leavey & King, 1995). Many people find that their problems can be dealt with and contained by this process and do not progress past this filter. A person will pass through the second filter when their helper is unable or unwilling to detect the problem. Goldberg and Huxley (1992) explain that the inability or unwillingness on the part of the helper to acknowledge psychological distress is a major reason why many people go on to seek help from other sources.
Among a population of community-based adults with chronic hip and knee pain, the majority had not sought help from their GPs over the last 12 months. The strongest determinants of seekinghelp from GPs or allied health professionals for this pain were reduced mobility, living in urban areas, pain severity and obesity. The presence of co-morbidities, anxiety/depression and socio-demo- graphic characteristics were of much less importance. A further important finding was that only a minority of the group reported pain that was confined to the hips or the knees, the majority having pain at both joint sites. In addi- tion the data suggest that people seek help from alterna- tive practitioners for quite different reasons, with pain severity, anxiety and mobility problems showing negative associations. The demographic data also indicate that this subgroup differs from the other help-seeking groups (see Additional file 1: Table including baseline descriptives). Those respondents who reported difficulty walking were more likely to consult their GP, allied health care profes- Percentage of people with hip and/or knee pain who have
Spiritual helpseeking in resolving health problems takes diverse forms and varying intensity in different societies. In this context, spiritual helpseeking is an illness behavior or activity carried out by an individual with infertility who perceives herself as needing informal, personal and spiritual assistance with the purpose of getting pregnant. Many Africans practiced Western and traditional African religions concurrently and often utilised the services of both (Nigosian, 1994). In many African cultures, it is common practice to resort to diviners/healers (Adejumo, Faluyi & Adejuwon, 2013), Christian or Islamic practices in resolving spiritual and health challenges. In South Africa, a healer or Sanusi can be both a diviner and herbalist, just as a prophet or „lebone‟ is believed to possess the Holy Spirit and is able to foretell the future and advice on how to avert an undesirable event (Nigosian, 1994; Mokgobi, 2015). To Moslems in Nigeria, alfas are trusted to connect the Moslem faithful to Allah for spiritual assistance. Some couples, who believed that their infertility was due to witchcraft, curse or any cause other than physical are those who seek spiritual help (Okonofua, 1996) from spiritual churches and prayer camps. In Nigeria, herbalists prescribe certain ritual or actions, such as women bathing at night at road intersections, or making sacrifices to evil spirits that may be responsible for their infertility (Okonofua, 1996). The Holy Qur‟an (Surah 42: 49-50) teaches that infertility is ordained by Allah and could happen to any couple. However, a basic Islamic principle permits persons facing hardship to use all „lawful‟ means to solve their problem, while at the same time preserving their trust in God that He will help them achieve their goal (Fadel, 2002). This probably explains Dhar, Chaturvediand Nandan (2013) explains that spiritual well-being is considered is the missing link in the dimension of health. There are inconclusive evidences in the literature on helpseeking behavior and role of psychological factors. Mojtabai, Olfson and Mechanic (2002) in a study among patients with emotional disorders including anxiety found that the nature and severity of disease appeared to predict help-seeking from mental health professionals.
Daskalakis 1997). These findings would suggest that parents of a child with higher levels of aggressive behavior (i.e. increased symptom severity) and higher levels of impairment (e.g. expelled from daycare or has injured another child at pre-school), would be more likely to recognize the child’s behavior as problematic and seek help for the child’s aggression. Research on problem type suggests that parents of children with externalizing problems and symptoms of hyperactivity are more likely to seek and use help than parents of children with internalizingproblems, such as depression and anxiety (Brown et al. 2007; Chavira et al. 2004; Pavuluri et al. 1996; Wu et al. 1999). This may be due in part to perceived parental burden (i.e. family challenges perceived as being caused or exacerbated by their child’s mental health problems, such as expenses and strains on family relationships) being lower for anxiety and depressive disorders than for other disorders, such as attention deficit hyperactivity disorder and conduct disorder (Angold et al. 1998). Disruptive and aggressive behaviors tend to be more obvious to others, such as parents and teachers, as they can create a public disruption, whereas an anxious or depressed child can more easily go unnoticed by others. Possibly due to the more public nature of externalizing problems, these types of behaviors can have more severe consequences, such as getting expelled from childcare, or preventing parents from completing necessary tasks (e.g. grocery shopping).
The medical student participants were the only students in the present study to raise competitiveness in their education environment and potential public stigma if they sought help as sources of stress. Competitiveness between medical students is high (Chew-Graham et al., 2003) and we have previously found that it impacts their attendance at workshops designed to provide them with anxiety coping skills (Dennis, Warren, Neville, Laidlaw, & Ozakinci, 2012). Stigma relating to admitting to mental health or wellbeing problems has been reported before amongst medical students in the UK (Chew-Graham et al., 2003) and USA (Givens & Tjia, 2002; Grant, Rix, Mattick, Jones, & Winter, 2013; Roberts et al., 2001) and the current study supports this work. This stigma can be linked to competitiveness as medical students report admitting to mental wellbeing difficulties may lead to them being viewed as ‘weak’ by others (Dennis et al., 2012; Givens & Tjia, 2002; Grant et al., 2013).
It is generally accepted that mental illness refers to changes in ones thoughts, emotions and behaviours, which cause distress and/or prevent a person from living a meaningful and fulfilling life (Mental Health Foundation, 2016). However, there has been much debate over the years around what is mental illness. For a long time the disease-model of mental illness has dominated and definitions have focused on diagnosis using such manuals as the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its 5 th edition (American Psychiatric Association, 2013) and the International Statistical Classification of Diseases and Related Health Problems (ICD), in its 10 th edition (World Health Organization, 1992). In more recent years, there has been a growing shift in which these definitions are being challenged by dimensional approaches with the individual being placed at the centre of understanding mental health difficulties (Manderscheid at al., 2010; Kinderman, 2014; Van Os et al., 1999). Despite these important developments in our
screening questionnaire, but on self-reported mental health problems and unemployment. Eighty per cent of the respondents were German citizens. Thus, it was not possible to examine differences in help- seekingbehaviour between ethnic groups. Despite these limitations, our findings offer implications for future research and for interventions for improving help-seeking among unemployed persons with mental health problems. Awareness and attitudes of health care professionals concerning mental health issues should be improved, beginning with students of medi- cine and psychology. Training for employment agency staff on mental health problems and services would be helpful, for example, in terms of supported em- ployment. This approach includes employment activ- ities based on individual preferences and needs, integration of employment services into mental health services and personalised benefits planning . Due to the fact that the concept of supported employment is not routinely implemented in the German health care system or the German Federal Employment Agency, policy changes and funding are needed to ad- dress this limitation. Since migration plays a major role in Europe, future studies should include more ethnically diverse samples to examine different coping styles and help-seeking needs in the case of mental health problems and unemployment.
This study of helpseekingbehaviour by Norwegian pris- oners indicated a prevalence rate of health service use at about 66% of the prison population. Sleep problems were highly associated with use of prison health services. Higher age and drug use when not imprisoned also pro- moted helpseeking. The type of imprisonment influ- enced health service use: those in preventive detention or on remand had less contact with health care profes- sionals than those serving sentences. There was a ten- dency for higher levels of prison health care staffing and closed prisons to be associated with increased contact. When only mental and physical health problems were taken into account, there was a tendency towards increased helpseekingbehaviour. In the adjusted model, however, the influence of mental health and physical disorders was clearly attenuated, which may indicate that the prisoners with mental and physical health pro- blems did not seek professional help unless they had a co-occurring problem - for instance, sleep difficulties or drug use. This assumption is supported by the clear associations between mental and physical problems and sleep problems.
It was also noted that helpseeking is influenced by the severity of the disorder. Most participants reported that it’s rare for patients to seek help at the health facilities, until they feel the condition is severe. Conditions char- acterized by frequent relapses were deemed severe and therefore require quick attention whereas seemingly less severe ones were often overlooked. Both caregivers and patients wait until the condition is severe enough, when behavior is deemed out of proportion or when it is fre- quent. This is somehow related to the perception most people have about mental illness. Unusual behavior is mostly attributed to supernatural spirits. The person is being possessed by spirits. In this case it is hoped to last for a brief period. If the behavior persist or the condi- tion worsens then the explanatory model changes. Testimonies from beneficiaries
Several researchers have shown that adolescents’ decisions to forgo professional health help can result from beliefs that treatment will be unhelpful or that people who seek help are weak (e.g., Corrigan, 2004; Curtis, 2010; Komiti, Judd, & Jackson, 2006). This is illustrated by Yap et al. (2011), who examined the help young people (12-25 years old) provided to persons thought to be developing a mental health problem or in a mental health crisis. Participants in the study participated in telephone surveys in which they were randomly read one of four vignettes involving depression, depression with alcohol misuse, social phobia, and psychosis. The gender and age of the character in the vignette was chosen to correspond with the gender and age of the participant; for instance, participants ages 12 to 17 were read versions of vignettes portraying a person aged 15 years and in secondary school. The results suggest that young people’s decision to offer assistance and recommend professional helpseeking was influenced by the disorder described in the vignette; so that, social phobia was associated with higher scores on ‘weak not sick’ stigmatizing attitudes, reflecting the perception that people with social phobia did not require help because they were ‘weak’ or could control their behaviour, as opposed to being mentally ill. Overall, the findings demonstrate that young people’s ability to appreciate the severity of mental health problems and respond in a supportive manner are not optimal. In particular, young people’s ability to recognize the need for professional help was hindered when they perceived the person with the mental health condition to be ‘weak.’
To the public and many professionals, ‘EDs’ are primarily associated with girls and young women. Owing to a powerful assumption that ‘EDs’ are a women’s condition, ‘EDs’ in men have been overlooked, understudied, and under- reported (Greenberg & Schoen, 2008). The silence around ‘EDs’ in men is reflected in a dearth of literature on prevalence, aetiology, treatment and outcome. Furthermore, a review into ‘ED’ provision for men in the United Kingdom (UK) (Copperman, 2000) documented that symptoms indicative of eating problems in men are often unrecognised in a clinical setting. In fact, the biggest roadblock to diagnosing ‘AN’ in males may be that clinicians consider males to be immune to the problem: ‘The diagnosis of males with ‘EDs’ is usually a straightforward process, but first you have to think of it as a possibility’ (Andersen, 1990, p. 133). Even when men do receive a diagnosis, there are concerns that appropriate care is still not initiated (Morgan, 2010).
A further trigger to action was awareness of public health cam- paigns for cancer. In 2012, national media campaigns to highlight key symptoms of lung and colorectal cancer were launched by the UK Department of Health. Some patients reported knowledge of these campaigns and mentioned that this had affected their deci- sion making, or at least triggered the thought of cancer ( Table 1 , quote 30). In one instance, knowledge of the bowel cancer campaign prompted a patient to push the GP to take their symptoms more seriously ( Table 1 , quote 31). However, the campaigns did not con- sistently encourage help-seeking; in some instances, patients differ- entiated their symptoms from those described in the media ( Table 1 , quote 32).
Regarding inter-rater agreement, the children’s self- report of depressive symptoms, and not symptoms of anxiety, was associated with teacher-rated internalizing symptoms. This finding indicates that the teachers de- tect children with depressive symptoms more easily than those with anxiety symptoms. Depressed children can be perceived as less joyful, with diminished interest in activ- ities, reduced motivation or energy and commitment to school work, tiredness, restlessness and irritable mood. The teacher might more easily observe these factors as such symptoms become more starkly contrasted with ex- pected child behavior. On the other hand, it might be more difficult for teachers to differentiate between a pathological fear and a more natural fear of stressful school situations. Another possibility is that since these children seem to struggle academically, teachers can more easily identify them. When teachers try to support children who are struggling academically, they may find that some of these children have depressive symptoms. However, children with anxious symptoms who never- theless do relatively well at school are not easily detected in the same way by their teacher. Caution should be exercised when teachers are used as informants to refer children to indicated interventions for anxiety.
34 Teachers, fellow students from other universities, supervisors or partners could be asked to search and access a certain article. ‘Whenever I really want a paper and cannot access or find it at the databases I have access to, I use the databases my girlfriend has access to. She is studying on the University of Utrecht, which has more/other databases.’ This citation shows the most common use of networking: partners who had access to other databases where asked to search for an article, and in some cases login codes where exchanged. However, teachers and supervisors were named as possible sources to overcome an access problem, but the participants never contacted them for this situation. This will be further discussed in the next chapter. 4.3.8 Successfully accessing , access problems  and unsolved access problems  Table 4 shows the results of observations. The 11 participants tried to access a total of 140 articles in the one hour of their observation with an average of 12.7 per participants. In total, 65 access problems  were encountered, with an average of 5.8 per participant, and was not able to solve 33 of these 65 encountered access problems , an average of 3 per participant. In summary this means that the participants were able to directly access 53.6 percent on average , but encountered access problems  with 46.3 of all scientific literature. Indirectly, 76.4 was eventually accessed  with extra effort of the participants and 23.6 percent of all articles was inaccessible  in the observations. These results show the direct impact of access problems in the information seeking process and can be addressed as large as almost one out of each two articles represented an access problem.