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EMPIRICAL RESEARCH
Adolescents’ Suicidal Thinking and Reluctanceto Consult General Medical Practitioners
Coralie J. Wilson Æ Frank P. Deane ÆKellie L. Marshall Æ Andrew Dalley
Received: 28 April 2009 / Accepted: 1 July 2009 / Published online: 15 July 2009
� Springer Science+Business Media, LLC 2009
Abstract Appropriate help-seeking is widely recognized
as a protective factor, and vital for early treatment and
prevention of mental health problems during adolescence.
General medical practitioners (GPs), that is, family doctors,
provide a vital role in the identification of adolescents with
mental health problems and the provision of treatment as
well as access to other specialists in mental health care
services. The current study examined the association
between suicidal ideation and intentions to seek help from
a GP for suicidal thoughts, emotional problems and phys-
ical health problems, using a sample of 590 Australian high
school students that was 56.7% female and aged 13–18
years (M = 15.56 years, SD = .66 years). Higher levels of
suicidal ideation and general psychological distress were
related to lower intentions to seek help from a GP for
suicidal and physical problems. The results suggest that
even at subclinical levels, increases in suicidal ideation or
psychological distress may lead to help avoidance. School
personnel and other gatekeepers need to be aware of this
trend in order to be more assertive in encouraging and
supporting appropriate help-seeking for mental health
problems. School health promotion programs should con-
sider including information to explicitly address the help-
negation process.
Keywords Suicidal ideation � Psychological distress �Help-seeking � Primary health care � Barriers
Introduction
Mental illness and substance use disorders are highly pre-
valent among adolescents. If left untreated, they can cause
distress and disability that last for decades (McGorry et al.
2007). Worldwide, up to 20% of children and adolescents
experience a disabling mental illness (Belfer 2008), with
approximately 50% of all adult mental health disorders
starting by age 14, and three quarters starting before age 24
(Belfer 2008; Kessler et al. 2005). Within Australia, the
statistics are higher with approximately one in four young
people aged 13–24 years experiencing a mental health
problem (Sawyer et al. 2000). These are mostly anxiety
disorders (15.4%), followed by substance use disorders
(12.7%) and affective disorders (6.3%) (Australian Bureau
of Statistics 2008). Internationally, suicide is the third
leading cause of death in the 15–24 year age group and
remains the focus of worldwide concern (Belfer 2008). In
2005, approximately 10% of deaths amongst American
15–24 year olds were by suicide. Between 2004 and 2006,
C. J. Wilson � F. P. Deane
Illawarra Institute for Mental Health, Wollongong,
NSW, Australia
F. P. Deane
e-mail: Frank_Deane@uow.edu.au
C. J. Wilson (&)
Graduate School of Medicine, University of Wollongong,
Building 28, Wollongong, NSW 2522, Australia
e-mail: Coralie_Wilson@uow.edu.au; cwilson@uow.edu.au
F. P. Deane
School of Psychology, University of Wollongong, Wollongong,
NSW, Australia
K. L. Marshall � A. Dalley
Illawarra Division of General Practice, Wollongong,
NSW, Australia
K. L. Marshall
e-mail: kmarshall@idgp.org.au
A. Dalley
e-mail: adalley@idgp.org.au
123
J Youth Adolescence (2010) 39:343–356
DOI 10.1007/s10964-009-9436-6
suicide accounted for 20% of all Australian deaths in the
16–24 age group (ABS 2008), and has resulted in a ‘‘state
of emergency’’ being declared in Australia’s youth mental
health (News Release, October 2008). Together, these
statistics underscore the need for mental health research to
focus on factors involved in protecting against the dis-
ability of mental illness, and specifically, against the
development of acute suicidality.
Help-Negation for Suicidal Thoughts
Appropriate help-seeking can successfully reduce the long-
term impact of many mental health problems and is partic-
ularly important when adolescents are suicidal and need
accurate advice (Rickwood et al. 2007). However, epide-
miological studies indicate that only about a quarter of young
people with a mental health problem seek professional care
(Sawyer et al. 2000), and many prefer no help for depressive
and suicidal symptoms (e.g., Gould et al. 2004; Sen 2004).
Thus, despite the benefits of seeking and receiving profes-
sional psychological help, these studies suggest that up to
75% of young people with a mental health problem do not
seek appropriate mental health care for their problem. These
epidemiological studies also raise the possibility that, in this
population group, a trend towards help avoidance occurs in
response to symptoms of psychological distress.
Help-negation is defined as ‘‘the refusal to accept or
access available helping resources’’ (Rudd et al. 1995,
p. 499). It has been found in acutely suicidal inpatient
samples (Rudd et al. 1995) and non-clinical (i.e., non-
acutely suicidal) adolescent and university student samples
(Carlton and Deane 2000; Deane et al. 2001; Gould et al.
2004; Saunders et al. 1994; Wilson et al. 2005a). While
help-negation in acutely suicidal samples is not too sur-
prising in that those who are acutely suicidal are known to
feel pessimistic and think that nothing can help (Belfer
2008; Rudd et al. 1995), reasons for why the help-negation
process occurs in non-clinical samples are unclear.
Two Australian studies, one with first-year university
students (Deane et al. 2001) and one with high school
students (Wilson et al. 2005a), found an inverse relation-
ship between suicidal ideation and help-seeking intentions.
Suicidal ideation refers to people’s thoughts and ideas
about death, suicide, and serious self-injurious behaviors
(Reynolds 1988). It is both a proxy measure for suicide
(Martin 2002) and an independent estimate of risk for
suicide completion (Brown et al. 2000). Intentions were
measured because they proximate behavior (Webb and
Sheeran 2006). In both samples as levels of suicidal idea-
tion increased intentions to seek help from a range of
informal and formal help-sources decreased. Conversely,
as levels of ideation increased, intentions to seek help from
no-one increased simultaneously. Both studies also tested
whether hopelessness would explain the help-negation
process, but neither study found support for this hypothesis.
These findings raise both concern and opportunity. The
concern is that the help-negation process might prevent
young people from seeking help when it is needed. It is
generally agreed that suicidal behaviors have develop-
mental pathways. It is also agreed that these pathways
typically begin with emotional and/or psychological dis-
tress that develops into ideation, continues to attempt, and
ends with suicide completion (e.g., Cole et al. 1992; Felner
et al. 1992; Pfeffer et al. 1993; Schweitzer et al. 1995;
Yung and McGorry 1996). Despite methodological issues
and evidence suggesting that reported rates of ideation may
underestimate actual rates by as much as two-thirds
(Beautrais 1998; Madge and Harvey 1999; Wagner 1997),
suicidal ideation appears relatively common in young
people. Australian and non-Australian studies converge to
suggest that up to 62.6% of young people report suicidal
ideation at some point in their lifetime (e.g., Martin et al.
1997; Meehan et al. 1992; Smith and Crawford 1986), up
to 43% of young people report suicidal ideation within the
previous year (e.g., Centers for Disease Control and Pre-
vention 1991; Rudd 1989; Schweitzer et al. 1995), and up
to 23.4% of young people report current and/or recurrent
suicidal ideation (e.g., Goldney et al. 1989; Reinherz et al.
1995; Swanson et al. 1992). This suggests that, at any point
in time, up to 23.4% of young people worldwide are
potentially at risk to act on their suicidal thoughts. Findings
of help-negation suggest that compared to those without
ideation, these high-risk young people are those who are
most likely to avoid seeking help for their potentially lethal
thoughts. The opportunity is for suicide prevention
research to identify factors that can explain and potentially
reverse adolescents’ help-negation for suicidal thinking.
General Medical Practitioners’ (GPs) Role
in Adolescent Suicide Prevention
GPs provide primary health care that is both clearly rec-
ognized by the general public and generally accessible for
adolescents in need of care (Veit et al. 1996). Interna-
tionally, GPs are known as family doctors or family phy-
sicians because they provide broad-based health care for
adults and children in a family. In Australia, GPs provide
comprehensive and coordinated medical care that is not
focused on a particular illness or treatment type. They are
often the first point of contact for young people seeking
health care and thus, can provide a vital role in the iden-
tification of adolescents with mental health problems. They
can also provide treatment and access to other specialist
mental health care services (Stanistreet et al. 2004).
However, the extent to which GPs have the capacity
to contribute to young peoples’ mental health care,
344 J Youth Adolescence (2010) 39:343–356
123
particularly suicide prevention, is impeded by the natural
underrepresentation of young people among GP attenders.
Young people, as a population group, do not have the same
need to consult a GP as often as other population groups
(e.g., older age groups with chronic diseases, such as car-
diovascular disease, that need regular monitoring). Even
though young Australians make up about 13% of the
population (ABS 2006), less than 1 in 10 of all consulta-
tions are made by those aged 15–24 and they mainly attend
for coughs and colds. Only 1 in 12 specifically request help
for psychological problems (Britt et al. 2008). This means
that young people do not provide the same natural oppor-
tunity for GPs to identify and treat their mental health
needs as other groups. Unless a young person specifically
seeks a GP’s help for a mental health problem, the GP’s
capacity to provide mental health care is limited largely by
circumstance.
These statistics reinforce the need for prevention strat-
egies to consider more effective ways to encourage young
people to consult GPs, particularly when they are experi-
encing suicidal ideation and other indications of psycho-
logical distress (Stanistreet et al. 2004). It is noteworthy
that in both studies that have examined the help-negation
effect for formal and informal help sources (Deane et al.
2001; Wilson et al. 2005a), the young people in both
samples were least reluctant to seek help from a GP
compared to other formal sources such as counselors and
psychologists, and to informal sources such as friends and
family. This suggests that the help-negation process might
interfere less with help-seeking from a GP than other
sources. If so, it also suggests that strategies to specifically
target variables involved in the help-negation process for
GPs might promote higher rates of proactive consultation
for mental health problems, which may subsequently result
in lower rates of acute lifelong mental health problems and
suicide completion.
There are several factors that may have a role in the
help-negation process for a GP. Firstly, it is possible that
the help-negating effect of suicidal ideation can be
explained by co-occurring psychological distress symp-
toms. Since suicidal ideation without other psychological
disturbance is rare in adolescents (Belfer 2008; Marttunen
et al. 1991), even when levels of suicidal ideation are not
acute, an adolescent might experience increased levels of
general psychological distress that subsequently reduce
their intentions to seek help for suicidal thoughts.
Secondly, it is possible that perceived barriers to health
care seeking will explain aspects of the help-negation
process for GPs. Variables that inhibit the utilization and
success of health care are commonly described as ‘‘barri-
ers’’. These are broadly categorized as ‘‘person-related’’
(perceived or belief-related) and ‘‘treatment-related’’ (e.g.,
service imposed cost) (Saunders et al. 2006). The
predominance of perceived barriers over treatment-related
barriers is highlighted in both quantitative and qualitative
research (e.g., Sawyer et al. 2000; Wilson and Deane
2001). Several categories of perceived barriers relate spe-
cifically to seeking help from a GP. These include: limited
knowledge about the types of help GPs provide; perceived
difficulties in the doctor-patient relationship; fears about
both the process and content of a GP consultation; and
developmental processes such as individuation (see Wilson
et al. 2008, for a review). In adolescents, perceived barriers
to seeking professional psychological help have explained
the help-negating effect of suicidal ideation on help-seek-
ing intentions for a mental health professional (Wilson
et al. 2005a). A similar pattern of results might also be
found for seeking help from a GP.
Thirdly, according to the belief-desire-intention (BDI)
model of practical reasoning (Bratman 1987), an individ-
ual’s beliefs represent their knowledge and way of repre-
senting the world. Beliefs lead to desires (goals), which
subsequently predict intentions to perform a behavior or
activity. Put another way, based on an individual’s beliefs,
their desires motivate their prospective behavioral inten-
tions. Conversely, having no desire to perform an activity
reduces behavioral intentions (Elliot 1999). This suggests
that adolescents with no current or existing desire to con-
sult a GP for a mental or physical health problem will
report lower intentions to consult a GP than those whose
current desire is high. It also suggests that desire will have
a role in explaining the help-negation effect for a GP for
different types of health problems.
Study Aims
The first aim of the current study was to examine the
help-negation effect on three types of problems that a GP
might help an adolescent manage: thoughts about suicide,
an emotional problem, and a physical health concern.
Consistent with earlier studies, the help-negation effect
in this study is represented by an inverse relationship
between suicidal ideation and help-seeking intentions. We
hypothesized that an inverse relationship would be found
between adolescents’ levels of suicidal ideation and their
intentions to seek help from a GP for all three problem-
types.
The second study aim was to identify and examine the
role of potentially modifiable variables on the help-nega-
tion process for a GP. We hypothesized that higher levels
of general symptoms of psychological distress, perceived
barriers to engaging in treatment with a GP, and current
desire would explain the help-negating effect of suicidal
ideation for suicidal thoughts, emotional problems and
physical health concerns.
J Youth Adolescence (2010) 39:343–356 345
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Method
Participants
Five hundred and ninety participants (approximately 70%
of the available participant pool) were recruited from Years
10 and 11 in three unstreamed public high schools in the
Illawarra region of New South Wales (NSW), Australia.
The schools served students coming from a range of
socioeconomic backgrounds with the majority coming
from what would be characterized as ‘‘middle class’’ and
‘‘blue-collar’’ families. (Additional information on the
family structure or parent employment status of students
attending each school was not available.) Eighty-five per-
cent (n = 501) of the sample described their cultural
affiliation as Australian and 1% as Indigenous (n = 3).
Additional sample characteristics are reported in Table 1.
Results focusing on different measures and hypotheses
from a subset of the current sample have been reported
elsewhere (Wilson et al. 2008).
Procedure
Study approvals were provided by the University of Wol-
longong Human Ethics Committee and the NSW Depart-
ment of Education and Training Strategic Research
Directorate. The current cross-sectional study comprised
two parts. The first part comprised an anonymous survey
that included the eight critical items of the Suicidal Idea-
tion Questionnaire (SIQ; Reynolds 1988). The second part
comprised a non-anonymous survey that involved students
rating the eight critical items for a second time as a suicide
screen. Both parts of the study were described in an
information sheet that was posted to parents. Students were
provided with written and verbal information regarding the
study during school classes. Parental and student consent
was required for both parts of the survey prior to partici-
pation. Participants completed the research survey indi-
vidually under the supervision of the first author. Twelve
students scored higher than four on three of the eight items
and received additional assessment using individual inter-
views with a school counselor or registered psychologist.
All 12 students had been previously identified by school
welfare staff as having mental health needs.
Measures
Intentions
Intentions to seek future help from a GP were measured by
items adapted from the General Help-Seeking Question-
naire (GHSQ; Wilson et al. 2005b). The items have been
used in other studies with adolescents (Deane et al. 2007;
Wilson et al. 2003). There were three items with the same
general structure ‘‘If you have [problem-type], how likely
are you to talk to a GP about it?’’ The three problem-types
were ‘‘a physical health concern’’, ‘‘an emotional problem,
like being depressed or stressed out’’, and ‘‘thoughts about
suicide’’. (In Australia, national television and radio
advertisements define what is meant by ‘‘GP’’ and explain
the types of help a GP can provide.) Each item is rated on a
scale from 1 = ‘‘Extremely unlikely’’ to 7 = ‘‘Extremely
Table 1 Sample characteristics
a 89.3% (n = 528) of the total
sample was aged 15–16 years
Sample characteristics Total sample Level of suicidal ideation
Minimal Moderate Critical
ntotal (% total sample) 590 (100%) 529 (89.7%) 49 (8.3%) 12 (2.0%)
nfemale (% total sample) 335 (56.7%) 292 (49.4%) 35 (5.9%) 8 (1.3%)
nmale (% total sample) 251 (43.3%) 233 (39.5%) 14 (2.4%) 4 (1.0%)
M(SD)age in years 15.56 (.66) 15.59 (.66) 15.27 (.73) 15.55 (.73)
Rangeage in years 13–18a 13–17 14–18 15–16
M(SD)SIQ-CI 3.38 (7.38) 1.34 (2.06) 16.14 (6.60) 41.33 (5.14)
RangeSIQ-CI scores 0–48 0–8 9–32 34–48
Level of general psychological distress
Minimal Moderate Severe
ntotal (% total sample) – 455 (77.1%) 125 (21.2%) 10 (1.7%)
nfemale (% total sample) – 239 (40.5%) 91 (15.4%) 4 (1.0%)
nmale (% total sample) – 213 (36.1%) 34 (5.8%) 5 (1.0%)
M(SD)age in years – 15.59 (.66) 15.45 (.67) 15.78 (.67)
Rangeage in years – 14–18 13–17 15–17
M(SD)HSCL-21 35.39 (10.11) 31.06 (5.41) 48.22 (5.84) 71.60 (7.06)
RangeHSCL-21 scores 21–84 21–40 40–63 64–84
346 J Youth Adolescence (2010) 39:343–356
123
likely’’, with 4 = ‘‘Not sure’’. These items have demon-
strated acceptable reliability and validity in research with
adolescents and university students (e.g., Deane et al. 2001;
Wilson et al. 2005a, b). They have also been related to
prospective consultations with a GP (Wilson et al. 2008),
suicidal ideation, depression, and hopelessness (Wilson
et al. 2005b, 2007), and perceived barriers to help-seeking
mental health care and engaging in treatment with a GP
(e.g., Deane et al. 2007; Wilson et al. 2005a).
Desire
Current desire to receive help from a GP was measured by
three items that were developed for the current study and
that ask participants ‘‘Would you like to receive help from
a doctor for…’’ (a) ‘‘a physical problem’’, (b) ‘‘an emo-
tional problem’’, and (c) ‘‘suicidal thoughts’’. Participants
replied to each of the items selecting from 1 = ‘‘No’’,
0 = ‘‘Yes’’. Wording for the stem question is consistent
with recommendations made elsewhere for conceptualizing
and measuring the desire construct (Grantham and Gordon
1986; Tinsley 1992; Tinsley and Westcott 1990).
Perceived Barriers
Perceived barriers to engaging in treatment with a GP were
measured by the 11 items comprising the Barriers to
Engagement in Treatment Screen (BETS; Wilson et al.
2008). All items assess adolescents’ perceived knowledge-
and belief-based barriers to consulting a GP. Example
items include: ‘‘I know what to expect when I go to see a
GP’’, ‘‘I feel comfortable talking to a GP who I don’t
know’’, ‘‘I believe a GP can understand my thoughts and
feelings’’, and ‘‘I’m not embarrassed to talk about my
problems’’ (see Wilson et al. 2008, for a full list of items).
Each item is rated on a 4-point scale from 0 = ‘‘Agree’’ to
3 = ‘‘Disagree’’. The average of all 11 items was used to
obtain a total barrier score. Higher scores represent higher
perceived barriers to engaging in treatment. The BETS has
satisfactory reliability and validity in adolescent samples.
In adolescent samples it has been negatively correlated
with intentions to consult a GP for psychological and
physical problems, as well as subsequent self-reports of
consultations with a GP (Deane et al. 2007; Wilson et al.
2008). In the current study, a Cronbach alpha coefficient
of .81 was obtained and indicates acceptable internal
consistency.
Suicidal Ideation
Suicidal ideation was measured by the 8 critical items of
the Suicidal Ideation Questionnaire (SIQ; Reynolds 1988):
(1) ‘‘I thought about killing myself’’; (2) ‘‘I thought about
how I would kill myself’’; (3) ‘‘I thought about when I
would kill myself’’; (4) ‘‘I thought about what to write in a
suicide note’’; (5) ‘‘I thought about writing a will’’; (6) ‘‘I
thought about telling people I plan to kill myself’’; (7) ‘‘I
thought about how easy it would be to end it all’’; (8)
‘‘I thought if I had the chance I would kill myself’’. These
items examine the intensity and lethality of current suicidal
thoughts (e.g., ‘‘I thought about killing myself’’ and ‘‘I
thought if I had a chance I would kill myself’’), together
with the specificity and availability of a suicide plan (e.g.,
‘‘I thought about how I would kill myself’’ and ‘‘I thought
about when I would kill myself’’), in the last month. The
eight items were selected due to their ability to discrimi-
nate between suicidal and non-suicidal psychiatric adoles-
cents (Pinto et al. 1997). A Cronbach alpha coefficient of
.98 was obtained for the eight items in the current sample
showing good internal consistency. The eight items are
rated on a 7-point scale (0–6). In the current study, scores
of 0 (‘‘I never had this thought before’’) or 1 (‘‘I had this
thought before but not in the last month’’) indicated a
minimal level of current suicidal ideation, scores of 2
(‘‘About once a month’’) to 4 (‘‘About once a week’’)
indicated a moderate level of suicidal ideation, and scores
of 5 (‘‘A couple of times a week’’) or 6 (‘‘Almost every
day’’) indicated thoughts at a critical level of frequency
that should be investigated (Reynolds 1988).
Psychological Distress
Symptoms of general psychological distress were measured
by the 21-item Hopkins Symptom Check-List (HSCL-21;
Green et al. 1988). The measure has satisfactory concurrent
and construct validity in clinical and non-clinical samples
(Deane et al. 1992). It has been related to prior help-seeking
experience, gender, treatment fearfulness, and higher levels
of suicidal ideation in non-patient adolescents (Carlton and
Deane 2000), and higher levels of depression and anxiety
in non-patient university students (Harari et al. 2005).
A Cronbach alpha coefficient of .92 was obtained for the
current sample. The 21 items examine the degree to which
general psychological symptoms (e.g., self-blame, feeling
blue), performance distress (e.g., difficulty speaking,
remembering things), and somatzsation (e.g., back pain, hot/
cold spells) have affected individuals in ‘‘the past 7 days,
including today’’. The items are self-rated on a 4-point scale
(1–4) that can be summed to obtain a psychological distress
score ranging from 21 to 84 where higher scores indicate
greater degrees of psychological distress. In the current
study, scores of 1 (‘‘Not at all’’) were nominated as indi-
cating a minimal level of psychological distress, scores of 2
(‘‘A little’’) and 3 (‘‘Quite a bit’’) as indicating a moderate
level, and scores of 4 (‘‘Extremely’’) as indicating a severe
level of current psychological distress.
J Youth Adolescence (2010) 39:343–356 347
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Results
Preliminary Analyses
Prior to analysis, the raw data were examined through
SPSS programs for the extent to which they met the
assumptions of the analyses conducted. For intentions to
seek help for a physical problem, 100 students (16.9% of
the sample) reported that they were unlikely to seek help
with a score of 1, 2 or 3; whereas, 425 students (71.9% of
the sample) reported they were likely with scores of 5, 6 or
7 (M = 4.99, SD = 1.57). For an emotional problem, 357
students (60.5% of the sample) were unlikely to seek help
and 124 (21.0% of the sample) were likely (M = 3.09,
SD = 1.65). For suicidal thinking, 326 students (55.3% of
the sample) were unlikely to seek help; whereas, 140 stu-
dents (23.7% of the sample) were likely (M = 3.21,
SD = 1.97). As shown by the frequencies reported in
Table 1, SIQ and HSCL-21 scores indicated that these
variables were also skewed in that most cases had low
levels of suicidal ideation (M = 3.38, SD = 7.38) and
psychological distress (M = 35.39, SD = 10.11). Conse-
quently, before use as continuous variables, loglinear
transformation was applied to all GHSQ, SIQ and HSCL-
21 scores to correct for skew. For ease of expression, Log
GHSQ, Log SIQ, and Log HSCL-21 are referred to as
intentions, suicidal ideation and psychological distress
when described in the results.
Being younger was related weakly but significantly to
both higher levels of suicidal ideation (r = -.10; p = .015)
and general psychological distress (r = -.09; p = .025).
Being female was also related weakly but significantly to
higher levels of suicidal ideation (r = -.14; p = .001) and
psychological distress (r = -.16; p = .000), higher per-
ceived barriers to consulting a GP (r = -.14; p = .001), and
higher help-seeking intentions to consult a GP for physical
problems (r = -.08; p = .041). Being male was related
weakly but significantly to higher intentions to consult a GP
for suicidal thoughts (r = .11; p = .009). To guard against
the possibility of age and sex effects, both variables were
controlled in the following analyses.
Help-Negation from a GP for Suicidal, Emotional
and Physical Problems
To examine differences between groups with different
levels of clinically relevant suicidal ideation and psycho-
logical distress, a series of one-way analyses of variance of
the help-seeking intention measures (dependent variables)
was conducted. Due to the very small sample sizes in the
critical suicidal ideation and severe psychological distress
groups (Table 1), these groups were combined with the
moderate groups for each distress-type before conducting
the analyses of variance. Table 2 provides mean intention
ratings by problem-type for the new suicidal ideation and
psychological distress groups in the study (moderate-criti-
cal for suicidal ideation, moderate-severe for psychological
distress). Significant differences were found between
groups with varying levels of suicidal ideation and psy-
chological distress for intentions to seek help for suicidal
thoughts and physical problems. Help-seeking intentions
for suicidal thinking were significantly lower for those with
moderate-critical levels of suicidal ideation compared to
those with minimal scores. For those experiencing mod-
erate-severe levels of psychological distress, help-seeking
intentions for suicidal thoughts and physical problems were
also significantly lower than for those experiencing mini-
mal levels (Table 2).
The trends and levels of significance found in the
analyses of variance were confirmed by the correlations
between the continuous suicidal ideation and help-seeking
intentions scores, as well as between the psychological
distress and intentions scores (see Table 3). With trans-
formations applied, the negative associations between
intentions to seek help for an emotional problem and both
suicidal ideation and psychological distress became sig-
nificant (non-parametric correlations conducted with raw
data prior to transformation had magnitudes and levels of
significance that were consistent with each association
reported in Table 3). As predicted, for all problem-types,
there were small to moderate but negative and significant
correlations between levels of suicidal ideation and inten-
tions, and between levels of psychological distress and
Table 2 Mean intentions to seek help from a GP by problem-type
and current level of suicidal ideation or psychological distress
Problem-type Suicidal ideation
Minimal Moderate-critical Fa pa
M SE M SE
Suicidal thoughts 3.31 .09 2.26 .25 15.53 .000
Emotional 3.09 .07 2.72 .22 2.59 .108
Physical 5.09 .07 4.24 .20 16.15 .000
Psychological distress
Minimal Moderate-severe M SE
M SE
Suicidal thoughts 3.37 .09 2.55 .18 16.53 .000
Emotional 3.10 .08 2.86 .15 1.97 .161
Physical 5.10 .07 4.59 .14 10.27 .001
a Means differ according to level of suicidal ideation or psycholog-
ical distress in the same row at the listed F and p values with gender
and age controlled for. Note. Intentions were rated on a 7-point scale
(1 = ‘‘Extremely unlikely’’, 4 = ‘‘Unsure’’, 7 = ‘‘Extremely likely’’)
and higher scores indicate higher help-seeking intentions
348 J Youth Adolescence (2010) 39:343–356
123
intentions. There were also moderate positive and signifi-
cant correlations between barriers to engaging in treatment
and suicidal ideation, psychological distress, and no current
desire to receive help from a GP. Significant positive
correlations were found between no desire for help and
levels of both suicidal ideation and psychological distress.
For each type of problem, there were moderate negative
correlations between barriers and intentions. A consistent
finding was the significant negative and moderate correla-
tions between no desire for help and intentions to seek
future help from a GP for suicidal, emotional and physical
problems.
We explored the possibility that adolescents contem-
plating suicide might avoid future help from a GP as a
function of psychological distress, no desire to receive
help, or because they perceive barriers to consulting a GP.
Three regression analyses were run, one for seeking help
from a GP for each problem-type: suicidal thoughts,
emotional problems, and physical problems. For each
regression model, suicidal ideation and psychological dis-
tress were entered in Step 1, desire for help in Step 2, and
barriers to engaging in treatment in Step 3. The results of
the regression analyses are presented in Table 4. To control
for Type 1 error, p was set to .01.
When predicting help-seeking intentions for suicidal
thoughts, both suicidal ideation and psychological distress
were unique predictors in Step 1. Entering desire in Step 2
and barriers to treatment in Step 3 failed to eliminate the
significant relationship between suicidal ideation and
intentions found in Step 1. However, desire together with
barriers increased the variance explained in intentions at
Step 3 from approximately 9–27% (Step 3: F(6,561) = 35.52,
p = .000, Adj, R2 = .27). For help-seeking intentions for
emotional problems, at Step 1 there were no significant
predictors. However, entering desire for help at Step 2 and
barriers at Step 3 increased the variance explained for help-
seeking intentions for emotional problems from approxi-
mately 2–18% (Step 3: F(6,564) = 21.55, p = .000, Adj,
R2 = .18). For intentions to seek help for physical prob-
lems, at Step 1, the only unique predictor was suicidal
ideation, and entering desire then barriers into the model at
Steps 2 and 3 could not eliminate the significant relationship
between suicidal ideation and intentions found at Step 1. As
for the other models, barriers together with desire for help
increased the variance explained in intentions at Step 3 from
approximately 6–16% (Step 3: F(6,563) = 18.47, p = .000,
Adj, R2 = .16).
The regression analyses were repeated to examine the
possibility that adolescents with high levels of psycholog-
ical distress might negate future help from a GP because
they have no desire for help, because they perceive barriers
to consulting a GP, or because they are experiencing sui-
cidal ideation. Psychological distress and desire for help
were entered in Step 1, barriers to engagement in treatment
in Step 2, and suicidal ideation in Step 3 (see Table 5).
When predicting help-seeking intentions for suicidal
thoughts, psychological distress and no desire for help were
both unique predictors at Step 1. Entering barriers to the
model at Step 2 resulted in the relationship between psy-
chological distress and intentions for suicidal thinking
becoming non-significant, indicating that barriers explained
the help-negating effect of psychological distress symp-
toms, in regards to suicidal problems. Entering suicidal
ideation at Step 3 improved the variance explained in the
model by about 1% but the significance of relationships in
Step 2 was not altered (Step 3: F(6,561) = 35.52, p = .000,
Adj, R2 = .27). For help-seeking intentions for emotional
problems, desire for help was the only predictor at Step 1
and suggests that not having a desire for the help of a GP
explains the help-negating effect of psychological distress
Table 3 Intercorrelations between measures
Measure 2 3 4 5 6 7 8 9
1 Suicidal ideation (SIQ-CI) .51*** .34*** -.20*** -.12** -.29*** .02 .07 .13**
2 General distress (HSCL-21) .39*** -.17*** -.09* -.24*** .08 .02 .14***
3 Barriers (BETS) -.29*** -.35*** -.45*** .12** .19*** .26***
Intentions (GHSQ)
4 Physical problem .37*** .28*** -.22*** -.10* -.17***
5 Emotional problem .62*** -.09* -.28*** -.29***
6 Suicidal thinking -.02 -.25*** -.33***
No desire for help
7 Physical problem .33*** .41***
8 Emotional problem .65***
9 Suicidal thinking
n = 590. SIQ-CI, Suicidal Ideation Questionnaire-Critical Items; HSCL-21, Hopkins Symptom Checklist-21 item version; GHSQ, General Help-
Seeking Questionnaire; BETS, Barriers to Engaging in Treatment
*** p \ .001; ** p \ .01; * p \ .05
J Youth Adolescence (2010) 39:343–356 349
123
Ta
ble
4H
iera
rch
ical
reg
ress
ion
sw
ith
suic
idal
idea
tio
n,
gen
eral
psy
cho
log
ical
dis
tres
s,n
od
esir
efo
rh
elp
and
per
ceiv
edb
arri
ers
toh
elp
pre
dic
tin
gin
ten
tio
ns
tose
ekh
elp
fro
ma
gen
eral
med
ical
pra
ctit
ion
erfo
rsu
icid
al(s
ui)
,em
oti
on
al(e
mo
)an
dp
hy
sica
l(p
hy
s)p
rob
lem
s
Inte
nti
on
s-su
iIn
ten
tio
ns-
emo
Inte
nti
on
s-p
hy
s
BS
Eb
Ad
jR
2B
SE
bA
dj
R2
BS
Eb
Ad
jR
2
Ste
p1
.09
*.0
2*
.06
*
Su
icid
alid
eati
on
-.3
8*
**
.08
-.2
1-
.18
.08
-.1
2-
.21
**
*.0
6-
.18
Gen
eral
dis
tres
s-
.31
**
.13
-.1
2-
.01
.11
-.0
4-
.17
.08
-.1
0
Ste
p2
.18
*.1
0*
.11
*
Su
icid
alid
eati
on
-.3
4*
**
.08
-.1
9-
.14
.07
-.0
9-
.21
**
*.0
6-
.18
Gen
eral
dis
tres
s-
.23
.12
-.0
9-
.10
.11
-.0
5-
.16
.08
-.0
9
No
des
ire
for
hel
p-
.49
**
*.0
6-
.30
-.4
1*
**
.06
-.2
9-
.26
**
*.0
4-
.23
Ste
p3
.27
*.1
8*
.16
*
Su
icid
alid
eati
on
-.2
5*
**
.08
-.1
4-
.07
.07
-.0
5-
.16
**
.05
-.1
4
Gen
eral
dis
tres
s.0
2.1
2.0
1.1
1.1
1.0
5-
.03
.08
-.0
2
No
des
ire
for
hel
p-
.38
**
*.0
6-
.23
-.3
3*
**
.06
-.2
3-
.18
**
*.0
4-
.20
Bar
rier
sto
hel
p-
.43
**
*.0
5-
.34
-.3
5*
**
.05
-.3
2-
.20
**
*.0
4-
.24
**
*p\
.00
1;
**
p\
.01
;*
p(F
Change)\
.00
1
Ta
ble
5H
iera
rch
ical
reg
ress
ion
sw
ith
gen
eral
psy
cho
log
ical
dis
tres
s,n
od
esir
efo
rh
elp
,p
erce
ived
bar
rier
sto
seek
ing
hel
p,
and
suic
idal
idea
tio
np
red
icti
ng
inte
nti
on
sto
seek
hel
pfr
om
a
gen
eral
med
ical
pra
ctit
ion
erfo
rsu
icid
al(s
ui)
,em
oti
on
al(e
mo
)an
dp
hy
sica
l(p
hy
s)p
rob
lem
s
Inte
nti
on
s-su
iIn
ten
tio
ns-
emo
Inte
nti
on
s-p
hy
s
BS
Eb
Ad
jR
2B
SE
bA
dj
R2
BS
Eb
Ad
jR
2
Ste
p1
.15
*.1
0*
.06
*
Gen
eral
dis
tres
s-
.49
**
*.1
0-
.19
-.1
3.0
9-
.06
-.2
9*
**
.07
-.1
7
No
des
ire
for
hel
p-
.50
**
.06
-.3
1-
.06
**
*.0
6-
.30
-.1
6*
**
.04
-.1
5
Ste
p2
.26
*.1
8*
.12
*
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dis
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s-
.15
.10
-.0
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.13
.10
.06
-.1
3.0
8-
.07
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des
ire
for
hel
p-
.38
**
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**
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.04
-.1
0
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rier
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p-
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**
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-.3
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.22
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*.0
4-
.27
Ste
p3
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Gen
eral
dis
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1
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des
ire
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**
*.0
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.23
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3-
.10
.04
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0
Bar
rier
sto
hel
p-
.43
**
*.0
5-
.34
-.3
4*
**
.05
-.3
2-
.21
**
*.0
4-
.25
Su
icid
alid
eati
on
-.2
5*
**
.08
-.1
4-
.08
.07
-.0
5-
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**
.06
-.1
3
**
*p\
.00
1;
**
p\
.01
;*
p(F
Change)\
.01
350 J Youth Adolescence (2010) 39:343–356
123
symptoms for emotional problems. Entering perceived
barriers at Step 2 increased the variance explained by
approximately 8%. Entering suicidal ideation at Step 3
failed to significantly increase the variance explained in the
model and made no difference to the significance of the
other relationships in the model (Step 3: F(6,562) = 21.27,
p = .000, Adj, R2 = .18). Finally, when predicting inten-
tions to seek help for physical problems, at Step 1, psy-
chological distress and no current desire for help were both
unique predictors. However, Step 3 suggests that barriers to
engaging in treatment make a significant contribution to
seeking help from a GP. Entering barriers into the model
resulted in non-significant relationships between psycho-
logical distress and intentions and between no desire and
intentions, increasing the variance explained by approxi-
mately 6%. Entering suicidal ideation at Step 3 increased
the variance explained in intentions by approximately 1%,
but again, the significance of relationships in Step 2
remained the same in Step 3 (Step 3: F(6,563) = 14.61,
p = .000, Adj, R2 = .13).
As a precaution, all analyses were again repeated with
the order of entry for desire for help and barriers reversed
for each model to examine whether this made any differ-
ence to the analyses. In the first set of regressions
(Table 4), with barriers entered in Step 2 and desire for
help in Step 3, for each problem-type no current desire to
receive help from a GP still contributed significant variance
over and above barriers when predicting intentions (Desire:
p = .000 in Step 3 for suicidal and emotional problems,
and p = .002 in Step 3 for physical problems). In the
second set of regressions (Table 5), this pattern was repe-
ated for barriers entered in Step 1 and desire in Step 2
(Desire: p = .000 in Step 2 for suicidal and emotional
problems and p = .017 in Step 2 for physical problems).
For both sets of regressions, the significant inverse asso-
ciations between suicidal ideation and intentions and
between psychological distress and intentions remained
unchanged.
Finally, we conducted the same analyses as above but
with the high scorers in the top 2% (n = 12) (equivalent to
a suicidal attempter, Reynolds 1987) extracted from the
sample. With the reduced sample, the analyses replicated
the results described above, and suggest that consistent
with Deane et al. (2001) and Wilson et al. (2005a), the
current results apply to adolescents at both acute and sub-
clinical levels of suicidal ideation.
Discussion
The current study found that, as levels of suicidal ideation
and psychological distress increase, adolescents’ intentions
to seek help from a GP for suicidal and physical problems
decrease. These results were confirmed by differences
between groups (based on levels of suicidal ideation and
psychological distress) and in correlational analyses.
Adolescents who reported moderate-critical levels of sui-
cidal ideation or moderate-severe levels of psychological
distress also reported help-seeking intentions that were at
the unlikely end of the response spectrum for suicidal
thoughts and emotional problems and intentions that were
unsure for physical problems (Table 2). Similarly, higher
levels of both suicidal ideation and psychological distress
were associated significantly with greater numbers of
adolescents reporting they had no desire to receive help
from a GP for any of the three problem-types (Table 3),
and higher levels of suicidal ideation and psychological
distress together predicting lower intentions for suicidal
and physical problems (Tables 4, 5).
The current study has confirmed the help-negating effect
of suicidal ideation and extended the effect to the symptoms
of general psychological distress. In so doing, it replicates a
trend found in earlier studies of 269 high school students
(mean age = 15.86 years) (Wilson et al. 2005a) and 302
first year university students (mean age = 20.58 years)
(Deane et al. 2001). In the earlier studies, bivariate corre-
lations between suicidal ideation (measured by the full
version of the SIQ) and help-seeking intentions for a GP
were r = -.23 for personal-emotional problems (Wilson
et al. 2005a), and r = -.15 (Wilson et al. 2005a) and r =
-.13 (Deane et al. 2001) for suicidal thoughts. In the cur-
rent study (mean age = 15.56), the correlations were r =
-.12 for emotional problems and r = -.29 for suicidal
thoughts. Thus, the results converge to suggest that adoles-
cents and young adults with the highest, and most likely
clinically relevant, levels of suicidal ideation and psycholog-
ical distress are least likely to intend to seek help from a GP.
The help-negating effect of suicidal ideation and general
psychological distress suggests that there may be common
processes occurring that lead young people to reject help.
Referred to as ‘‘automatic processing’’, adolescents’ first
response to a problem is to do what they have done in the
past and often what is easiest (Black and Frauenknecht
1990). This suggests that since most adolescents have not
consulted a GP for mental health problems in the past, it is
unlikely they would automatically consider consulting a
GP for mental health problems in the future. However,
since most adolescents have previously received help from
a GP for physical health problems, automatic processing
does not explain why suicidal or psychologically distressed
adolescents would be reluctant to seek help from a GP for
physical problems.
The constricted cognitive-affective state associated pri-
marily with suicidal ideation, but also other forms of
psychological distress (e.g., depressive symptoms), may
play a role. Applying new problem solution strategies
J Youth Adolescence (2010) 39:343–356 351
123
requires both the ability to recognize that automatic strat-
egies are not sufficient to solve the problem and the ability
to consider a broader range of problem solutions than have
been used in the past. Cognitive constriction might inter-
fere with these abilities. General problem identification is
defined as the adolescent’s primary means of recognizing
that a problem exists and usually includes attitudinal,
affective, behavioral and/or physiological cues (Fra-
uenknecht and Black 2003). While it might seem reason-
able to expect that higher levels of suicidal ideation and
other forms of psychological distress would assist adoles-
cents to recognize their distress symptoms and need for
help, the current results do not support this hypothesis.
Either high distress does not increase problem identifica-
tion or there may be other processes that interfere with
help-seeking intentions. Cognitive constriction might lead
to normal problem cues becoming distorted or overlooked.
Similarly, when the help of a GP is not an automatic prob-
lem solution, cognitive constriction might interfere with
the adolescent’s capacity to consider a GP’s help for
managing mental and physical health problems. It is pos-
sible that help-negation is a function of distressed adoles-
cents’ difficulty recognizing and responding to problem
cues, or their difficulty recognizing that consulting a GP
provides a new and valuable solution option. Further
research needs to examine each of these possibilities, as
these factors may be useful in interventions to inhibit the
help-negation process and facilitate more effective health
care seeking from primary health care clinicians.
Based on previous findings (e.g., Marttunen et al. 1991;
Wilson et al. 2005a), we investigated whether general
psychological distress, current desire for help from a GP
and perceived barriers to engaging in treatment with a GP
might contribute to the help-negating effect of suicidal
ideation (Table 4). The results suggest that none of these
variables had a role in decreasing help-seeking intentions
for suicidal thoughts and physical problems over and above
suicidal ideation itself. Although psychological distress
was also inversely related to help-seeking intentions, when
psychological distress was controlled it could not fully
account for the help-negation effect for suicidal thoughts or
physical problems. Neither could a lack of current desire
for help or perceived barriers to consulting a GP. These
results provide further evidence that suicidal ideation itself
acts as a substantial barrier to help-seeking for suicidal and
physical problems (Deane et al. 2001; Saunders et al.
1994).
In contrast, for emotional problems such as ‘‘feeling
depressed or stressed out’’, the help-negating effect of
suicidal ideation was explained by symptoms of general
psychological distress. This suggests that when adolescents
identify their problem as ‘‘emotional’’, general psycho-
logical distress symptoms may have a greater role in
explaining their reluctance to seek help from a GP than
when they identify their problem as ‘‘suicidal’’ or ‘‘physi-
cal’’. It is possible that it is the type of problem that an
adolescent identifies as theirs, and perhaps the meaning
they associate with their problem-type, that promotes their
help-seeking reluctance. Stigma associated with different
types of mental health problems has been widely associated
with professional psychological help-seeking as a barrier to
health service use (e.g., Barney et al. 2006; Samargia et al.
2006; Vogel et al. 2007a). The extent to which stigma has a
role in explaining the help-negation effect for GPs, for at
least some types of mental and physical health problems, is
unknown and requires further research.
Other variables that are worthy of investigation include
those linked to troubled or challenging family and peer
contexts, which are also linked to helplessness in
achievement situations and psychological distress in young
people (Haddad 2000; Ryan et al. 2000). For example,
healthy achievement motivation and independent help-
seeking are promoted through positive and supportive
interactions within the family (e.g., Hokoda and Fincham
1995), whereas troubled or unsupportive family relation-
ships can inhibit the development of autonomy and might
promote help-seeking avoidance through processes of
learned helplessness (Haddad 2000). Variables associated
specifically with the primary health care setting are also
important to consider. Many studies report that GPs under-
diagnose and under-treat psychological disorders in
patients (MaGPIe Research Group 2006). Emerging evi-
dence also suggests that while GPs’ identification of
symptoms of psychological distress may not be inade-
quate, at least some capable GPs choose not to diagnose
and treat mental ill-health (MaGPIe Research Group
2004); this can be because of time and other resource
constraints experienced in primary care (Kang et al. 2003;
Launer 2004; Vandana and Ambelas 2004). More research
is needed on this issue. Similarly, research is also needed
to examine the impact of failed past attempts to access
treatment from health care professionals and the role of
learned helplessness on the help-negation relationship. In
the meantime, help-seeking promotion programs should
include strategies to improve GPs’ capacity to work
effectively with young people and reduce stigma associ-
ated with mental health problems (Wilson et al. 2005b;
Rickwood et al. 2006).
We assessed whether a desire to seek help from a GP
would contribute to the help-negation effect. Adding desire
to consult a GP significantly improved the variance
explained in intentions to seek help for suicidal thoughts,
emotional problems and physical problems over and above
the contribution of suicidal ideation and general psycho-
logical distress (Table 4). Consistent with the BDI model
of practical reasoning (Bratman 1987), this result supports
352 J Youth Adolescence (2010) 39:343–356
123
the hypothesis that having adolescents focus on their desire
to consult a GP is a change agent that contributes to their
prospective help-seeking intentions. Future research is
needed to clarify the relationship between beliefs, desire
and help-seeking intentions in relation to suicidal ideation
and general psychological distress.
Finally, we examined whether perceived barriers to
engaging in treatment and desire to receive help from a GP
would together explain the negative relationship between
psychological distress symptoms and help-seeking inten-
tions for emotional problems. The results suggest that
having no desire for help independently predicts lower
intentions to seek help for emotional problems, and
explains the help-negating effect of psychological distress
symptoms for emotional problems. In comparison, per-
ceived barriers independently explained the help-negating
effect of distress symptoms for physical problems, whereas
the effect for suicidal problems was explained by no desire
in conjunction with perceived barriers (Table 5). The
results suggest that while suicidal ideation independently
acts as a help-seeking barrier for suicidal and physical
health problems, perceived barriers together with desire
have a strong combined influence on adolescents’ reluc-
tance to consult a GP for suicidal problems. The results
also suggest that perceived barriers have a strong inde-
pendent influence on adolescents’ reluctance to consult a
GP for physical problems. Barrier items included beliefs
that talking to an unfamiliar GP would be uncomfortable, a
GP would not understand adolescent’ thoughts and feel-
ings, and talking to a GP would be embarrassing. Future
research needs to identify variables that influence specific
beliefs adolescents have about seeking help from a GP for
different problem-types, as well as the specific role these
beliefs have in the help-negation process for different
health care practitioners.
As an adjunct to the main results, the current study
revealed that, in this Australian high school sample, 10.3%
of the students who took part reported that they were
experiencing moderate to critical levels of suicidal ideation
and almost 23% of the sample reported that they were
experiencing moderate to severe symptoms of psycholog-
ical distress. The presence of these vulnerable adolescents
highlights the need for school personnel to be sensitive to
the signs of young people who are struggling. In schools, it
is important that all personnel are aware that, statistically, 1
in 10 of the students they interact with could be experi-
encing moderate-critical levels of suicidal ideation and
approximately 1 in 5 of their students might be experi-
encing moderate-severe levels of psychological distress.
Teachers and other school personnel need ongoing pro-
fessional development in symptom recognition, referral
and strategies for supporting distressed students in the
educational environment.
Finally, with implications for policy and directions in
prevention and early intervention, it is notable that most of
the acutely distressed adolescents in the current study were
aged 15–17 years. Within Australia, the legal age for
obtaining a Medicare Card that is independent of parents is
15 years. However, cost may still be a barrier to adoles-
cents consulting a GP because few have their own Medi-
care card and many believe that they cannot access a GP
without payment or without their parents finding out
(Chown et al. 2008). This means that, although capacity for
self-referral develops over adolescence alongside inde-
pendence from parents and the need for autonomy (Vogel
et al. 2007b; Wilson and Deane 2001), at least some ado-
lescents who are most in need of professional health care
might be additionally hindered from consulting a GP
because of perceived financial dependence on their parents.
Again, further research is needed on this issue. In the
meantime, the current results highlight the need for the
Government to revisit the legal age for obtaining a Medi-
care card or to consider an alternative method of financial
support that is independent of parents, with the aim of
facilitating greater access for younger adolescents to pri-
mary health care.
Limitations
There are several limitations to the current study that
should be noted. Firstly, given that we used a convenience
sample that was drawn from three high schools in the same
geographical area, the extent to which these results gen-
eralize to samples from rural or remote locations or to
adolescents who are not at school is unknown. Secondly, in
our sample, students with minimal levels of suicidal idea-
tion and other psychological distress symptoms were over-
represented because this was a non-clinical sample. Thus,
the results may not generalize to groups of young people
with moderate-critical/-severe symptom levels who are
identified in other ways (e.g., at risk groups such as
unemployed young people or youth who drop out of high
school). Further research is needed to replicate the results
of the current study in larger samples of moderately to
critically/severely psychologically distressed adolescents.
Recruiting larger representative samples might be achieved
by using a combination of cross-sectional and targeted
sampling. Thirdly, the results were based solely on self-
report measures and biases in reporting may be present
(e.g., minimizing problems and levels of suicidal ideation;
Madge and Harvey 1999). Further research might include
more in-depth suicide screening and measurement of lon-
gitudinal help-seeking behavior. Finally, intentions were
measured by single items for each problem-type. To
improve reliability, future research might include multiple
items for each problem-type.
J Youth Adolescence (2010) 39:343–356 353
123
Conclusions
The current study found that help-negation occurs for sub-
clinical levels of suicidal ideation and general psycholog-
ical distress in adolescents. Higher levels of both suicidal
ideation and general psychological distress were associated
significantly with lower intentions to seek help from a GP
for suicidal and physical problems. Findings of help-
negation in sub-clinical samples suggest that young people
who are most in need of receiving help early are also those
who are most likely to avoid seeking help. The opportunity
remains for suicide prevention research to identify factors
that can explain and potentially reverse adolescents’ help-
negation for suicidal thinking for all help sources. In the
meantime, school personnel and other gatekeepers need to
be aware of the help-negation trend in order to be more
assertive in encouraging and supporting appropriate help-
seeking for mental health problems. School health pro-
motion programs should consider including information to
explicitly address the help-negation process.
Acknowledgments The authors wish to thank the following people
for their contribution to project coordination and data collection.
From the Illawarra Division of General Practice: Beth Bignell and
Janette Ellis. From the New South Wales Department of Education
and Training: Helen Clancy, Dianne Young, Kathy Russell, Fiona
Kyle, and Greg Hand together with the School Counsellors and
welfare staff who provided follow-up student support. From the
University of Wollongong: the intern clinical psychologists and
clinical supervisors who also provided follow-up student support. Our
thanks also go to Professor John Bushnell who reviewed an earlier
draft of this manuscript, and the Australian Commonwealth Depart-
ment of Health and Ageing and University of Wollongong who
provided infrastructure funding for this research.
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Author Biographies
Coralie J. Wilson is a Behavioral Health Scientist and Academic
Leader for the Professional and Personal Development Curriculum
Theme and Behavioral Health Science Curriculum in the Graduate
School of Medicine at the University of Wollongong. She received
her PhD in clinical psychology research from the University of
Wollongong and has major research interests in help-seeking and
psychological medicine.
Frank P. Deane is a Clinical Psychologist, Professor of Psychology
and Director of the Illawarra Institute for Mental Health at the Uni-
versity of Wollongong. He received his PhD from Massey University
and has major research interests in the areas of mental health and drug
and alcohol service use, medication alliance, the use of homework in
clinical practice and help-seeking.
Kellie L. Marshall is a Clinical Psychologist and Deputy CEO of the
Illawarra Division of General Practice. She received her DPsyc in
Clinical Psychology from the University of Wollongong and has
research interests in mental health care in general practice.
Andrew Dalley is a General Practitioner and CEO of the Illawarra
Division of General Practice. He received his DPH from the Uni-
versity of Wollongong and has research interests in service delivery in
general practice.
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