Improving help-seeking in adolescence: the importance of mental health stigma and mental health literacy.

青春期是心理健康问题发展的特别脆弱时期，大约一半的心理健康问题出现在14岁之前（Kessler等人，2005年）。尽管青少年心理健康是公共卫生的优先事项，但年轻人明显缺乏寻求帮助的意愿。大约三分之二的青少年尽管表现出心理健康问题的临床症状，却无法获得正式支持（Merikangas等人，2011年）。这种缺乏寻求帮助的一种解释是耻辱，这一直被认为是青少年寻求帮助的最重要障碍之一（Gulliver et al., 2010）。鉴于耻辱与缺乏寻求帮助之间的密切联系，减少年轻人的心理健康耻辱已被确定为研究和政策制定的优先领域（世卫组织，2013年）。不寻求帮助的青少年出现心理健康问题恶化的可能性是其他人的7倍（Neufeld et al., 2017）。因此，显然有必要改善寻求帮助的情况，要做到这一点，我们需要更好地了解耻辱对青少年寻求帮助行为的影响。我的博士研究结果表明，在12-17岁的青少年中，来自朋友和父母的耻辱感与寻求帮助的减少有关。因此，考虑是否可以同时向父母和青少年提供信息，以减少父母的耻辱感，可能是有益的。此外，研究结果表明，同伴主导的倡议可能有助于减少来自朋友的耻辱感。然而，在制定反污名策略时，青少年的观点往往被忽视，从而降低了其有效性（Gronholm等人，2018）。采用合作生产方法（即青年和研究人员分享研究权力和责任）将使青年能够为影响其生活的决定作出贡献并形成这些决定。在奖学金期间，将与合作学校的年轻人并通过与See Me（苏格兰国家反耻辱计划）的联系采用合作制作方法。这将以我博士的统计结果为基础，使年轻人能够考虑关键的研究结果，并确定潜在的家庭和基于同龄人的反耻辱策略。通过共同努力，年轻人将能够根据他们认为博士学位产生的关键信息，以及向年轻人和其他关键利益相关者传播的最佳方法，帮助塑造研究成果。我将以年轻人焦点小组的形式进行额外的定性研究，以扩展我的博士学位。我计划与农村地区的学校合作，在那里，耻辱被认为是寻求帮助的更大障碍。这将进一步加强我们对耻辱对农村年轻人寻求帮助行为的影响的理解，将他们自己的观点纳入研究过程，以告知和加强我们对影响他们生活的问题的理解。研究问题包括：生活在农村地区的年轻人在多大程度上认为心理健康问题的耻辱是他们社区的一个重大问题？污名化是否会影响农村青少年的求助意向？-农村地区的青少年认为自己是成功求助的促进者？调查结果将用于通知我未来的研究，并告知与合作伙伴组织（如See Me）的年轻人一起工作。研究结果将通过突出青少年对耻辱的声音和经历，以及根据青少年自己确定的耻辱负面后果的解决方案，为知识做出重要贡献。改善年轻人的心理健康以及农村的心理健康是苏格兰政府2017-2027年心理健康战略的关键部分，因此该研究将对政策制定产生重要影响。

Adolescence is a particularly vulnerable period for the development of mental health problems, with around half of all mental health problems emerging before the age of 14 (Kessler et al., 2005). Despite adolescent mental health being a public health priority there is a notable lack of help-seeking among young people. Around two thirds of adolescents do not access formal support despite showing clinical symptoms of a mental health problem (Merikangas et al., 2011). One explanation for this lack of help-seeking is stigma which is consistently noted as one of the most significant barriers to help-seeking among adolescents (Gulliver et al., 2010). Given the strong link between stigma and a lack of help-seeking, the reduction of mental health stigma among young people has been identified as a priority area for research and policy development (WHO, 2013). Adolescents who do not seek help are seven times more likely to see a worsening of mental health problems (Neufeld et al., 2017). There is therefore a clear need to improve help-seeking, and to do so, we need to better understand the impacts of stigma on adolescents' help-seeking behaviour. Results from my PhD research suggest that perceived stigma from friends and parents is associated with decreased help-seeking among adolescents aged 12-17. Therefore, it may be beneficial to consider whether information can be provided to both parents and adolescents together, to reduce perceived stigma from parents. Additionally, findings suggest that peer-led initiatives may be helpful in reducing perceived stigma from friends. However, adolescents' views have often been overlooked in the development of anti-stigma strategies, thus reducing their effectiveness (Gronholm et al., 2018). Adopting a co-production approach (i.e. where young people and researchers share power and responsibility for research) would enable young people to contribute to and shape the decisions that affect their lives. During the fellowship, a co-production approach will be adopted with young people in partner schools and via links with See Me (Scotland's national anti-stigma programme). This will build on statistical findings of my PhD by enabling young people to consider the key research findings and identify potential family and peer-based anti-stigma strategies. By working together, young people will be enabled to help shape research output based on what they believe are the key messages resulting from the PhD, and what the best methods of disseminating to young people and other key stakeholders would be.I will expand on my PhD with additional qualitative research in the form of focus groups with young people. I plan to work with schools in the rural areas, where stigma is known to be a greater barrier to help-seeking. This would further enhance our understanding of the impact of stigma on rural young people's help-seeking behaviour by bringing their own perspectives into the research process to inform and enhance our understanding of issues as they affect their lives. Research questions include:-To what extent do young people living in rural areas perceive stigma towards mental health problems to be a significant issue within their communities?-Does stigma impact on help-seeking intentions of adolescents living in rural communities?-What do adolescent in rural areas perceive as being facilitators of successful help-seeking?Findings will be used to inform my future research, and to inform work with young people in partner organisations such as See Me. Findings will make important contributions to knowledge by highlighting adolescent voices and experiences of stigma, as well as signposting solutions to stigma's negative consequences, as identified by adolescents themselves. Improving young people's mental health, as well as rural mental health, is a key part of the Scottish Government's Mental Health Strategy, 2017-2027, therefore the research will have important implications for policy development.