Help Seeking Behaviors of Youth with Suicidal Ideation: Who Perceives Need for Care and Seeks Actual Service?

BACKGROUND AND PURPOSE: Suicide prevention approaches often rely on identifying at-risk individuals and connecting them with mental health services. However, it is an ongoing challenge in suicide prevention to connect individuals who are at higher risk for suicide attempts with appropriate mental health care services. For example, only about 29% of individuals with suicidal ideation either sought or initiated mental health service (Hom, Stanley, & Joiner, 2015). Andersen’s Behavioral Model proposes that predisposing factors (e.g., age, gender), enabling factors (e.g., income, health insurance), and need factors (e.g., perceived and evaluated needs) are associated with one’s decision to use services. The Three-stage Model (Cauce et al., 2002) suggests that help-seeking is a process that moves from recognizing needs to actually seeking treatment. This study aimed to examine which factors of Andersen’s Model can explain behaviors of individuals with suicidal ideation in different stages of help-seeking: perceived needs for mental service and actual use of services.

METHODS: Participants with suicidal ideation (N=191) were drawn from a non-probability sample of undergraduate college students (N=799). Past-year service utilization, past-year need for mental health treatment (as perceived by themselves and by friends or family), and demographic and clinical constructs identified based on Andersen’s Behavioral Model of Health Service Use were assessed. A multiple logistic regression analysis was used to identify independent correlates of (1) mental health service utilization, and multiple regression analyses examined (2) self-perceived need for mental health services, and (3) other-perceived need for mental health services.

RESULTS: Within the sample with suicidal ideation, 10.5% reported suicide attempt history. Only 39.5% used mental health services over the past year. Results showed that being encouraged to seek help by others was a strong and uniquely significant correlate of actual mental health service utilization (OR = 2.99, p < 0.001). Further, friends or family were significantly more likely to encourage them to seek help when respondents had more intense suicidal ideation (β = 0.285, p < 0.01) and suicide attempt history (β = 0.199, p < 0.05). Depression severity, female gender, and White race were associated with increased self-perceived need for mental health services, but self-perceived need for mental health service was not independently associated with actual service utilization.

CONCLUSIONS AND IMPLICATIONS: Interestingly, perceived need for help by individuals with suicidal ideation themselves did not lead them to actually seek help. Instead, perceived need by others was the sole significant correlate of service utilization. For individuals with suicidal ideation, the ambiguity in determining need for help may transform into certainty when someone tells them they are in need. It is an important target for public health interventions aimed at facilitating pathways into mental health treatment for college students, and potentially other young adults. Educating people to recognize signs of suicide and to encourage peers and family members to use proper mental health services may increase utilization of mental health services among individuals at risk for suicide.