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Studies have documented the high need and demand for mental health services for adolescents with substance use problems during the pandemic. The circumstances identified in the literature point to various internal and external adolescent risk factors at multiple levels (i.e., individual, relationship, community, societal) that converge to impact adolescents’ perceptions of mental health and their help-seeking behaviors. However, little is known about how these risk factors are associated with high school adolescents’ uptake of telemental heathcare (TMHC) during the COVID-19 pandemic. Further research is warranted to examine individual (e.g., depression and suicidality), family (e.g., child physical and psychological maltreatment), school (e.g., feeling connected to others), and community (e.g., virtual access to resources and connectedness) factors that might influence adolescents to seek help—particularly those who perceive that they are susceptible to substance use and mental health issues. Utilizing the ecological systems theory and the Health Belief Model, we hypothesized that adolescents are more likely to seek and experience TMHC if they perceive that they are susceptible to mental health problems or substance misuse. This study examined (a) whether adolescents’ ecological risk factors (depression, suicide attempts, parental emotional abuse, parental physical abuse, low virtual connectedness, and not feeling close to people at school) and substance use during the COVID-19 pandemic would drive adolescents to use TMHC services and (b) whether these associations would be moderated by gender.
Methods
Data were drawn from the Adolescent Behaviors and Experiences Survey collected by the U.S. Centers for Disease Control and Prevention from January to June 2021. A hierarchical multiple logistic regression analysis was conducted using a national sample of 1,460 students in Grades 9–12 in the United States who reported having used more alcohol and/or drugs during the pandemic than before it started.
Results
The results showed that only 15.3% of students sought TMHC (84.7% did not). Among them, 13.4% were males and 16.9% were females. Students reporting increased substance use during the pandemic were more likely to use TMHC if they experienced more severe mental health problems (e.g., suicide attempts [OR=1.96, p<.001]) compared with other ecological factors, such as issues with their family, school, or community. An analysis of the moderating effect showed a significant result (OR=.74, 95, p<.05): the closer male students felt to people at school, the more likely they were to seek TMHC, whereas the closer female students felt to people at school, the less likely they were to seek TMHC.
Implications/Conclusions
The findings highlighted that feeling close to people at school is an important aspect of understanding the help-seeking behavior of female and male adolescent substance users. More strategies to increase the utilization of mental healthcare must be considered for adolescents. Moreover, due to differences between male and female adolescents in help-seeking behaviors, it is important to consider differentiated treatment strategies and screening tools.