A Systematic Review of Qualitative Research Focusing on Emotional Distress Among Adolescents: Perceived Cause and Help-Seeking

Abstract

Causal attributions and help-seeking is not well explored among adolescents, despite evidence of perceived causes for difficulties influencing how adults engage with treatment and seek help. This study reviewed extant literature to understand what adolescents at increased risk of developing mental health difficulties and those with clinically significant symptoms perceive to be the cause of emotional distress; to determine the extent to which perceived cause influences help-seeking; and to identify potential differences/commonalities between these groups. A systematic review and qualitative thematic synthesis were conducted. 3,691 articles were identified, 18 were eligible to be included and were synthesized using thematic synthesis. Six main themes related to perceived cause are reported. Three of those themes were shared between the clinical and at-risk groups: (1) challenging social factors and perceived difference, (2) problematic family dynamics, and (3) cause is complex and multifaceted. Three themes were not: (4) unfairness and perceived lack of agency and (5) concern for self and others, were exclusive to the at-risk group, and (6) coping with a mental health difficulty was exclusive to the clinical group. Four main themes related to causal attributions and help-seeking were found, including: (1) cause and implications for self-preservation; (2) the degree of personal and wider knowledge and understanding of cause; (3) perceived extent of control in managing cause; and (4) cause having potential to affect others. The findings of this review demonstrate that perceived cause for emotional distress plays a role in help-seeking among adolescent groups and highlights likely differences in how adolescents at-risk of mental health difficulties and those with clinically significant symptoms attribute cause for their difficulties and subsequently seek help. This has important implications for how to support young people experiencing or at risk of mental health difficulties and presents a strong case for pursuing more research in this area.

Adolescent help-seeking: an exploration of associations with perceived cause of emotional distress

“…In exploring further the role of perceived cause for emotional distress in relation to help-seeking among adolescents, this work broadly supports our earlier systematic review of the literature ( 63 ) where four themes related to causal attribution and help seeking were identified, including: (1) cause and implications for self-preservation; (2) the degree of personal and wider knowledge and understanding of cause; (3) perceived extent of control in managing cause; and (4) cause having potential to affect others. However, findings from O'Neill et al ( 63 ) were drawn from literature that did not explicitly focus on causal attributions for emotional distress and subsequent approach to help-seeking. To narrow this gap, the present study offered this explicit focus by drawing comparisons with our companion study ( 5 ).…”

“…There may also be a desire not to burden others with their difficulties ( 71 ). In our systematic literature review ( 63 ), we too found that the degree to which the perceived cause had implications for self-preservation or impacting others influenced help-seeking, although cause having the potential to impact others was only found as a theme for the at-risk group in our review and not the clinical group ( 63 ). The present study empirically demonstrates this association once again within an at-risk group.…”

“…This association indicates an external locus of control, the degree to which one believes circumstances and outcomes are caused by internal or external factors, in relation to both cause and help-seeking. Indeed, perceived extent of control in managing cause was also found as a theme that related to causal perceptions in O'Neill et al ( 63 ). It is, therefore, likely that locus of control impacts causal attributions which may in turn impact their approach to help-seeking.…”

“…What is clear is that ideal-type 3: “motivated and solution focused” demonstrates how adolescents can be active agents in their own recovery and management if appropriately supported to do so. Shared decision making has been promoted across health-care settings ( 62 ), it is less well explored in school settings with adolescents considered to be at-risk of mental health difficulties ( 63 ). Indeed, it is argued that there is often a deficit focus in relation to adolescence, rather than an acknowledgment of their skills and the enormous potential of this developmental period ( 64 ).…”

The Power Threat Meaning Framework: a qualitative study of depression in adolescents and young adults

“…The DSM-5 is based on symptom criteria that largely discounts etiology and the subjective understanding of why one is depressed, which likely contributes to its low diagnostic validity for depressive disorders in this age-group ( 14 – 17 ). A shared understanding of the causes and contributing factors is essential for therapeutic alliance, and subjective causal beliefs seem to influence help-seeking ( 18 ). An integrated individual understanding also affects compliance with treatment and ability to handle symptoms ( 19 ).…”