School Mental Health

, Volume 11, Issue 4, pp 707–718 | Cite as

Associations Between Depression Literacy and Help-Seeking Behavior for Mental Health Services Among High School Students

  • Cixin WangEmail author
  • Kristine M. Cramer
  • Hsiu-Lan Cheng
  • Kieu Anh Do
Original Paper


Despite the growth in school-based mental health services (SBMHS), rates of mental health help-seeking among adolescents remain low, especially for ethnic minority youth. This study examined factors associated with adolescents’ help-seeking of mental health services among a sample of 369 racially diverse high school students (age M = 15.5 years, SD = 0.72, 81.3% were ethnic minorities). We examined the relationships among mental health literacy for depression, knowledge barriers related to services and providers, perceived stigmatization by others, emotional/behavioral difficulties, and actual help-seeking behavior. Logistic regression results showed that adolescents with higher mental health literacy for depression and more emotional/behavioral difficulties are more likely to report seeking help in general and from providers outside of school specifically, but not for services inside of school alone. Asian-American students were less likely to seek help than Caucasian peers. It is important to promote mental health literacy to encourage help-seeking among high school students.


Help-seeking behavior Mental health literacy Stigma Emotional and behavioral difficulties 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Altweck, L., Marshall, T. C., Ferenczi, N., & Lefringhausen, K. (2015). Mental health literacy: A cross-cultural approach to knowledge and beliefs about depression, schizophrenia and generalized anxiety disorder. Frontiers in Psychology, 6, 1272. Scholar
  2. Amaral, G., Geierstanger, S., Soleimanpour, S., & Brindis, C. (2011). Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers. Journal of School Health,81(3), 138–145. Scholar
  3. Anyon, Y., Ling Ong, S., & Whitaker, K. (2014). School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors, and service use. Asian American Journal of Psychology,5(2), 134–144. Scholar
  4. Atkins, M. C., Hoagwood, K. E., Kutash, K., & Seidman, E. (2010). Toward the integrations of education and mental health in schools. Administration and Policy in Mental Health and Mental Health Services Research,37, 40–47. Scholar
  5. Australian Mental Health and Classification Network. (2005). Strength and Difficulties Questionnaire training manual. Retrieved December 24, 2018 from
  6. Barlis, J. (2018). Mental health literacy, stigma, and attitudes toward help-seeking at school for Asian- and Latino-American adolescents. Master thesis. University of Maryland, College Park.Google Scholar
  7. Bathje, G. J., & Pryor, J. B. (2011). The relationships of public and self-stigma to seeking mental health services. Journal of Mental Health Counseling,33, 161–176.CrossRefGoogle Scholar
  8. Becker, K. D., Buckingham, S. L., & Brandt, N. E. (2015). Engaging youth and families in school mental health services. Child and Adolescent Psychiatric Clinics of North America,24(2), 385–398.CrossRefGoogle Scholar
  9. Bowers, H., Manion, I., Papadopoulos, D., & Gauvreau, E. (2013). Stigma in school-based mental health: Perceptions of young people and service providers. Child and Adolescent Mental Health,18, 165–170.CrossRefGoogle Scholar
  10. Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural andcontextual influences in mental health help seeking: a focus on ethnicminority youth. Journal of Consulting and Clinical Psychology, 70, 44–45. Scholar
  11. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved December 24, 2018 from
  12. Chandra, A., & Minkovitz, C. S. (2006). Stigma starts early: Gender differences in teen willingness to use mental health services. Journal of Adolescent Health,38, 754.e1–754.e8.CrossRefGoogle Scholar
  13. Cheng, H., Wang, C., McDermott, R., Kriedel, M., & Rislin, J. (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling and Development. Scholar
  14. Coles, M. E., Ravid, A., Gibb, B., George-Denn, D., Bronstein, L. R., & McLeod, S. (2016). Adolescent mental health literacy: Young people’s knowledge of depression and social anxiety disorder. Journal of Adolescent Health,58, 57–62.CrossRefGoogle Scholar
  15. Collier, A. F., Munger, M., & Moua, Y. K. (2012). Hmong mental health needs assessment: a community-based partnership in a small mid-western community. American Journal of Community Psychology, 49, 73–86.CrossRefGoogle Scholar
  16. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science,15, 37–70. Scholar
  17. Corrigan, P. W., & Kosyluk, K. A. (2014). Mental illness stigma: Types, constructs, and vehicles for change. In P. W. Corrigan (Ed.), The stigma of disease and disability: Understanding causes and overcoming injustices (pp. 35–56). Washington, DC: American Psychological Association. Scholar
  18. Costello, E. J., Copeland, W., & Angold, A. (2011). Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? Journal of Child Psychology and Psychiatry,52(10), 1015–1025. Scholar
  19. Gagnon, M. M., Gelinas, B. L., & Friesen, L. N. (2017). Mental health literacy in emerging adults in a university setting: Distinctions between symptom awareness and appraisal. Journal of Adolescent Research, 32, 642–664. CrossRefGoogle Scholar
  20. Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing,26, 979–999. Scholar
  21. Georgakakou-Koutsonikou, N., & Williams, J. M. (2017). Children and young people’s conceptualizations of depression: A systematic review and narrative meta-synthesis. Child: Care. Health & Development,43, 161–181. Scholar
  22. Goodman, R., Meltzer, H., & Bailey, V. (1998). The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child and Adolescent Psychiatry,7, 125–130.CrossRefGoogle Scholar
  23. Goodman, R., & Scott, S. (1999). Comparing the strengths and difficulties questionnaire and the child behavior checklist: Is small beautiful? Journal of Abnormal Child Psychology,27, 17–24.CrossRefGoogle Scholar
  24. Gudino, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by type? Journal of Emotional and Behavioral Disorders,17(1), 3–16. Scholar
  25. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry,10(113), 1–9. Scholar
  26. Guo, S., Kataoka, S. H., Bear, L., & Lau, A. S. (2014). Differences in school-based referrals for mental health care: Understanding racial/ethnic disparities between Asian American and Latino youth. School Mental Health,6, 27–39. Scholar
  27. Hart, S. R., Kastelic, E. A., Wilcox, H. C., Heley, K. M., Ruble, A. E., & Swartz, K. L. (2014). Achieving depression literacy: The Adolescent Depression Knowledge Questionnaire (ADKQ). School Mental Health,6, 213–223. Scholar
  28. Hart, L. M., Mason, R. J., Kelly, C. M., Cvetkovski, S., & Jorm, A. F. (2016). ‘Teen Mental Health First Aid’: A description of the program and an initial evaluation. International Journal of Mental Health Systems,10(3), 1–18. Scholar
  29. Hawes, D. J., & Dadds, M. R. (2004). Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Australian and New Zealand Journal of Psychiatry,38(8), 644–651.CrossRefGoogle Scholar
  30. Hess, R., Pearrow, M., Hazel, C., Sander, J., & Wille, A. (2017). Enhancing the behavioral and mental health services within school-based contexts. Journal of Applied School Psychology,33(3), 214–232.CrossRefGoogle Scholar
  31. Jorm, A., Korten, A., Jacomb, P., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia,166(4), 182–186.CrossRefGoogle Scholar
  32. Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. The American Journal of Psychiatry,159, 1548–1555. Scholar
  33. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 593–602. Scholar
  34. Kim, J. E., Saw, A., & Zane, N. (2015). The influence of psychological symptoms on mental health literacy of college students. American Journal of Orthopsychiatry,85, 620–630. Scholar
  35. Komiya, N., Good, G. E., & Sherrod, N. B. (2000). Emotional openness as a predictor of college students’ attitudes toward seeking psychological help. Journal of Counseling Psychology,47, 138–143.CrossRefGoogle Scholar
  36. Kutcher, S., Wei, Y., & Coniglio, C. (2016). Mental health literacy: Past, present, and future. The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie,61(3), 154–158. Scholar
  37. Kutcher, S., Wei, Y., & Morgan, C. (2015). Successful application of a Canadian mental health curriculum resource by usual classroom teachers in significantly and sustainably improving student mental health literacy. The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie,60(12), 580–586. Scholar
  38. Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian American. Mental Health Services Research,3(4), 201–214.CrossRefGoogle Scholar
  39. Lindsey, M. A., & Marcell, A. V. (2012). “We’re going through a lot of struggles that people don’t even know about”: The need to understand African American males’ help-seeking for mental health on multiple levels. American Journal of Men’s Health,6(5), 354–364.CrossRefGoogle Scholar
  40. Lyon, A. R., Ludwig, K. A., Stoep, A. V., Gudmundsen, G., & McCauley, E. (2013). Patterns and predictors of mental healthcare utilization in schools and other service sectors among adolescents at risk for depression. School Mental Health,5, 155–165. Scholar
  41. Mariu, K. R., Merry, S. N., Robinson, E. M., & Watson, P. D. (2011). Seeking professional help for mental health problems among New Zealand secondary school students. Clinical Child Psychology & Psychiatry,17, 284–297. Scholar
  42. Mendoza, H., Masuda, A., & Swartout, K. M. (2015). Mental health stigma and self-concealment as predictors of help-seeking attitudes among Latina/o college students in the United States. International Journal for The Advancement of Counselling,37(3), 207–222. Scholar
  43. Milin, R., Kutcher, S., Lewis, S. P., Walker, S., Wei, Y., Ferrill, N., et al. (2016). Impact of a mental health curriculum on knowledge and stigma among high school students: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry,55, 383–391. Scholar
  44. Miller, L., Musci, R., D’Agati, D., et al. (2018). Teacher mental health literacy is associated with student literacy in the Adolescent Depression Awareness Program. School Mental Health. Scholar
  45. Na, S., Ryder, A. G., & Kirmayer, L. G. (2016). Toward a culturally responsive model of mental health literacy: Facilitating Help-Seeking Among East Asian Immigrant to North America. American Journal of Community Psychology,58(1–2), 211–225. Scholar
  46. Nagai, S. (2015). Predictors of help-seeking behavior: Distinction between help-seeking intentions and help-seeking behavior. Japanese Psychological Research,57, 312–322. Scholar
  47. Olsson, D., & Kennedy, M. (2010). Mental health literacy among young people in a small US town: Recognition of disorders and hypothetical helping responses. Early Intervention in Psychiatry,4, 291–298. Scholar
  48. Richter, J., Sagatun, Å., Heyerdahl, S., Oppedal, B., & Røysamb, E. (2011). The strengths and difficulties questionnaire (SDQ)—Self Report. An analysis of its structure in a multiethnic urban adolescent sample. Journal of Child Psychology and Psychiatry,52(9), 1002–1011.CrossRefGoogle Scholar
  49. Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help seeking for mental health problems. AeJAMH (Australian e-Journal for the Advancement of Mental Health). Scholar
  50. Rickwood, D. J., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2007). When and how do young people seek professional help for mental health problems? The Medical Journal of Australia,187, S35–S39.CrossRefGoogle Scholar
  51. Sheffield, J. K., Fiorenza, E., & Sofronoff, K. (2004). Adolescents’ willingness to seeking psychological help: Promoting and preventing factors. Journal of Youth and Adolescence,33, 495–507. Scholar
  52. Sue, D. W. (1994). Asian-American mental health and help-seeking behavior: Comment on Solberg et al., (1994), Tata and Leong (1994), and Lin (1994). Journal of Counseling Psychology,41, 292–295.CrossRefGoogle Scholar
  53. Swartz, K. L., Kastelic, E. A., Hess, S. G., Cox, T. S., Gonzales, L. C., Mink, S. P., et al. (2010). The effectiveness of a school-based adolescent depression education program. Health Education & Behavior,37, 11–22. Scholar
  54. Vanderbleek, L. M. (2004). Engaging families in school-based mental health treatment. Journal of Mental Health Counseling,26(3), 211–224.CrossRefGoogle Scholar
  55. Vogel, D. L., Bitman, R. L., Hammer, J. H., & Wade, N. G. (2013). Is stigma internalized? The longitudinal impact of public stigma on self-stigma. Journal of Counseling Psychology,60, 311–316. Scholar
  56. Vogel, D. L., Wade, N. G., & Ascheman, P. L. (2009). Measuring perceptions of stigmatization by others for seeking psychological help: Reliability and validity of a new stigma scale with college students. Journal of Counseling Psychology,56, 301–308. Scholar
  57. Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology,53, 325–337. Scholar
  58. Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology,54, 40–50.CrossRefGoogle Scholar
  59. Wang, C., Do, K. A., Frese, K., & Zheng, L. (2018). Asian immigrant parents’ perception of barriers preventing adolescents from seeking school-based mental health services. School Mental Health. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Counseling, Higher Education, and Special Education, 3234 Benjamin BuildingUniversity of MarylandCollege ParkUSA
  2. 2.Graduate School of EducationUniversity of California, RiversideRiversideUSA
  3. 3.Department of Counseling Psychology, School of EducationUniversity of San FranciscoSan FranciscoUSA
  4. 4.Department of Human Ecology, 2103 Richard A. Henson CenterUniversity of Maryland Eastern ShorePrincess AnneUSA

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