Problem recognition in youth mental health help-seeking: A Walker and Avant concept analysis
Abstract
Background & Aim: Help-seeking is central to youth mental health research and nursing practice, yet existing models and instruments often assume that youth recognize distress as a problem requiring support. This concept analysis aimed to clarify youth mental health help-seeking, focusing on problem recognition as an early and rarely assessed component.
Methods & Materials: Walker and Avant's eight-step method was used. Searches of PubMed, EBSCO, and Google Scholar focused on literature published during 2011-2026, with earlier seminal works retained. Thirty-two core sources were analyzed to examine conceptual uses, defining attributes, cases, antecedents, consequences, and empirical referents.
Results: Help-seeking was conceptualized as a progressive process involving three defining attributes: recognition of a problem, intentional decision-making, and engagement with appropriate support sources. Antecedents included psychological distress or functional difficulty, mental health literacy, beliefs and stigma, trusted relationships, service accessibility, and support pathways. Consequences included improved mental health, enhanced coping, increased self-efficacy, normalization of help-seeking, and strengthened social connection. Empirical referents were identified for each attribute, although existing measures commonly assess attitudes, intentions, or behaviors and rarely assess problem recognition directly.
Conclusion: Clarifying problem recognition as a defining attribute strengthens the conceptual foundation of youth mental health help-seeking and informs nurses' early assessment, therapeutic communication, mental health education, and timely referral across school, university, community, and clinical settings.
1. World Health Organization. Mental health of adolescents [Internet]. Geneva: World Health Organization; [cited 2026 May 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
2. Ministry of Health of the Republic of Indonesia. Indonesia Health Survey (SKI) 2023 [Internet]. Jakarta: Health Policy Development Agency; 2023 [cited 2026 May 25]. Available from: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/
3. United Nations Department of Economic and Social Affairs. Definition of youth [Internet]. New York: United Nations; [cited 2026 Aug 1]. Available from: https://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf
4. Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry. 2021;30(2):183-211. doi:10.1007/s00787-019-01469-4
5. Asiedua E, Maya E, Ganle JK, Eliason S, Ansah-Ofei AM, Senkyire EK, et al. Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana. BMJ Open. 2023;13(8):e064830. doi:10.1136/bmjopen-2022-064830
6. Giordano V, Mercuri C, Simeone S, Rea T, Virgolesi M, Nocerino R, et al. Behavioral delays in seeking care among post-acute myocardial infarction women: a qualitative study following percutaneous coronary intervention. Front Glob Womens Health. 2025;6:1501237. doi:10.3389/fgwh.2025.1501237
7. Gregg JE, Simpson J, Nilforooshan R, Perez-Algorta G. What is the relationship between people with dementia and their caregiver's illness perceptions post-diagnosis and the impact on help-seeking behaviour? A systematic review. Dementia. 2021;20(7):2597-617. doi:10.1177/1471301221997291
8. Guney E, Aydemir AF, Iyit N, Alkan O. Gender differences in psychological help-seeking attitudes: a case in Turkiye. Front Psychol. 2024;15:1289435. doi:10.3389/fpsyg.2024.1289435
9. Ng CWQ, Lim JNW, Liu J, Hartman M. Presentation of breast cancer, help-seeking behaviour and experience of patients in their cancer journey in Singapore: a qualitative study. BMC Cancer. 2020;20(1):1080. doi:10.1186/s12885-020-07585-8
10. Kim PY, Yon KJ. Stigma, loss of face, and help-seeking attitudes among South Korean college students. Couns Psychol. 2019;47(3):331-57. doi:10.1177/0011000019872790
11. Pan Q, Hao Z. Chinese college students' help-seeking behavior: an application of the modified theory of planned behavior. PsyCh J. 2023;12(1):119-27. doi:10.1002/pchj.605
12. Shi W, Hall BJ. Help-seeking intention among Chinese college students exposed to a natural disaster: an application of an extended theory of planned behavior (E-TPB). Soc Psychiatry Psychiatr Epidemiol. 2021;56:1273-82. doi:10.1007/s00127-020-01993-8
13. Han KS, Shin J, Shin HJ, Lee SY, Song M, Lee N. Rodgers' evolutionary concept analysis: mental health help-seeking for adolescents. J Korean Acad Psychiatr Ment Health Nurs. 2025;34(2):220-32. doi:10.12934/jkpmhn.2025.34.2.220
14. Chakawa A, Shapiro SK. The association between problem recognition, race/ethnicity, and professional help-seeking intentions across psychological disorders. Emerg Adulthood. 2022;10(4):891-909. doi:10.1177/21676968211000491
15. Schomerus G, Stolzenburg S, Freitag S, Speerforck S, Janowitz D, Evans-Lacko S, et al. Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. Eur Arch Psychiatry Clin Neurosci. 2019;269(4):469-79. doi:10.1007/s00406-018-0896-0
16. Wright A, Jorm AF, Harris MG, McGorry PD. What's in a name? Is accurate recognition and labelling of mental disorders by young people associated with better help-seeking and treatment preferences? Soc Psychiatry Psychiatr Epidemiol. 2007;42:244-50. doi:10.1007/s00127-006-0156-x
17. O'Neill A, Humphrey N, Stapley E. A systematic review of qualitative research focusing on emotional distress among adolescents: Perceived cause and help-seeking. Adolescent Res Rev. 2023;8:387-402. doi:10.1007/s40894-022-00203-7
18. Saunders S, Bowersox N. The process of seeking treatment for mental health problems. Ment Health Learn Disabil Res Pract. 2007;4(2):99-123. doi:10.5920/mhldrp.2007.4299
19. Rickwood D, Deane F, Wilson C, Ciarrochi J. Young people's help-seeking for mental health problems. Aust J Adv Ment Health. 2005;4(3):1-34. doi:10.5172/jamh.4.3.218
20. Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173-83. doi:10.2147/PRBM.S38707
21. McPhail L, Thornicroft G, Gronholm PC. Help-seeking processes related to targeted school-based mental health services: systematic review. BMC Public Health. 2024;24:1217. doi:10.1186/s12889-024-18714-4
22. World Health Organization, UNICEF. Guidance to improve access to mental health care for children and young people [Internet]. Geneva: World Health Organization; 2024 [cited 2026 May 25]. Available from: https://www.who.int/news/item/09-10-2024-who-and-unicef-launch-guidance-to-improve-access-to-mental-health-care-for-children-and-young-people
23. van den Toren SJ, van Grieken A, Lugtenberg M, Boelens M, Raat H. Adolescents' views on seeking help for emotional and behavioral problems: A focus group study. Int J Environ Res Public Health. 2020;17(1):191. doi:10.3390/ijerph17010191
24. Walker LO, Avant KC. Strategies for theory construction in nursing. 6th ed. Boston: Pearson; 2019.
25. Bamine V, Tanaka K. Help-seeking in nursing and medical students: a concept analysis. J Res Nurs. 2025;30(2):125-38. doi:10.1177/17449871241268451
26. Jackson SA. Help-seeking behavior. Salem Press Encyclopedia of Health [Internet]. 2024 [cited 2026 May 25]. Available from: https://research.ebsco.com/c/3q5j6g/viewer/html/idcscikucn
27. Merriam-Webster Online Dictionary. Help [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/dictionary/help
28. Merriam-Webster Thesaurus. Help [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/thesaurus/help
29. Oxford English Dictionary. Seek [Internet]. Oxford: Oxford University Press; [cited 2026 May 25]. Available from: https://www.oed.com/search/dictionary/?scope=Entries&q=seek
30. Merriam-Webster Thesaurus. Seek [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/thesaurus/seek
31. Cornally N, McCarthy G. Help-seeking behaviour: A concept analysis. Int J Nurs Pract. 2011;17(3):280-8. doi:10.1111/j.1440-172X.2011.01936.x
32. Hammer JH, Parent MC, Spiker DA. Mental Help Seeking Attitudes Scale (MHSAS): development, reliability, validity, and comparison with the ATSPPH-SF and IASMHS-PO. J Couns Psychol. 2018;65(1):74-85. doi:10.1037/cou0000248
33. Yee T, Ryan K. Examining international students' help-seeking intentions utilizing the theory of planned behavior. Int J Adv Couns. 2023;45:370-84. doi:10.1007/s10447-022-09491-z
34. Yang X, Hu J, Zhang B, Ding H, Hu D, Li H. The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: mediating roles of perceived social support and psychological help-seeking stigma. Front Psychol. 2024;15:1356435. doi:10.3389/fpsyg.2024.1356435
35. Amarasuriya SD, Jorm AF, Reavley NJ. Predicting intentions to seek help for depression among undergraduates in Sri Lanka. BMC Psychiatry. 2018;18:122. doi:10.1186/s12888-018-1700-4
36. Astipa GV, Widyorini E, Wijaya DA, Utami MSS, Medaringo AGE. The association between mental health literacy and help-seeking intention to mental well-being among secondary school students in Semarang, Indonesia. Int J Health Lit Sci. 2025;3(1):22-32. doi:10.60074/ihelis.v3i1.66
37. Goh PK, Chung S, Jhawar N, Wong AWWA, Mellor GS, Banerjee M, et al. ADHD knowledge as a barrier to problem recognition in Asian American and Native Hawaiian/Pacific Islander versus White college students. J Atten Disord. 2026;30(2):234-48. doi:10.1177/10870547251389337
38. Setia Lesmana MH, Chung MH. Mediating roles of perceived stigma and mental health literacy in the relationship between school climate and help-seeking behavior in Indonesian adolescents. PLoS One. 2024;19(5):e0298017. doi:10.1371/journal.pone.0298017
39. Wang W, Gao S, Chen Q, Ma S. The influence of explainable artificial intelligence and mental health literacy on professional psychological help-seeking behavior: the mediating role of psychological problem cognition. Behav Sci (Basel). 2025;15(12):1646. doi:10.3390/bs15121646
40. Oexle N, Ribeiro W, Fisher HL, Gronholm PC, Laurens KR, Pan P, et al. Childhood bullying victimization, self-labelling, and help-seeking for mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2020;55:81-8. doi:10.1007/s00127-019-01743-5
41. Lian Z, Wallace BC, Fullilove RE. Mental health help-seeking intentions among Chinese international students in the U.S. higher education system: The role of coping self-efficacy, social support, and stigma for seeking psychological help. Asian Am J Psychol. 2020;11(3):147-57. doi:10.1037/aap0000183
42. Evans-Lacko S, Stolzenburg S, Gronholm PC, Ribeiro W, York-Smith M, Schomerus G. Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people. Soc Psychiatry Psychiatr Epidemiol. 2019;54:59-67. doi:10.1007/s00127-018-1602-2
43. Doan N, Patte KA, Ferro MA, Leatherdale ST. Reluctance towards help-seeking for mental health concerns at secondary school among students in the COMPASS study. Int J Environ Res Public Health. 2020;17(19):7128. doi:10.3390/ijerph17197128
44. Robles CC, Bronstein J. Easing the path for improving help-seeking behaviour in youth. EClinicalMedicine. 2020;18:100256. doi:10.1016/j.eclinm.2019.100256
45. Yosep I, Iskandar S, Mardhiyah A, Ramdhani MR, Hikmat R. The effect of the nurse-led ROOTS program and soft skills training on emotional regulation to prevent bullying in high school students in Bandung city. Nurs Pract Today. 2026;13(2):187-97. doi:10.18502/npt.v13i2.21468
2. Ministry of Health of the Republic of Indonesia. Indonesia Health Survey (SKI) 2023 [Internet]. Jakarta: Health Policy Development Agency; 2023 [cited 2026 May 25]. Available from: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/
3. United Nations Department of Economic and Social Affairs. Definition of youth [Internet]. New York: United Nations; [cited 2026 Aug 1]. Available from: https://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf
4. Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry. 2021;30(2):183-211. doi:10.1007/s00787-019-01469-4
5. Asiedua E, Maya E, Ganle JK, Eliason S, Ansah-Ofei AM, Senkyire EK, et al. Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana. BMJ Open. 2023;13(8):e064830. doi:10.1136/bmjopen-2022-064830
6. Giordano V, Mercuri C, Simeone S, Rea T, Virgolesi M, Nocerino R, et al. Behavioral delays in seeking care among post-acute myocardial infarction women: a qualitative study following percutaneous coronary intervention. Front Glob Womens Health. 2025;6:1501237. doi:10.3389/fgwh.2025.1501237
7. Gregg JE, Simpson J, Nilforooshan R, Perez-Algorta G. What is the relationship between people with dementia and their caregiver's illness perceptions post-diagnosis and the impact on help-seeking behaviour? A systematic review. Dementia. 2021;20(7):2597-617. doi:10.1177/1471301221997291
8. Guney E, Aydemir AF, Iyit N, Alkan O. Gender differences in psychological help-seeking attitudes: a case in Turkiye. Front Psychol. 2024;15:1289435. doi:10.3389/fpsyg.2024.1289435
9. Ng CWQ, Lim JNW, Liu J, Hartman M. Presentation of breast cancer, help-seeking behaviour and experience of patients in their cancer journey in Singapore: a qualitative study. BMC Cancer. 2020;20(1):1080. doi:10.1186/s12885-020-07585-8
10. Kim PY, Yon KJ. Stigma, loss of face, and help-seeking attitudes among South Korean college students. Couns Psychol. 2019;47(3):331-57. doi:10.1177/0011000019872790
11. Pan Q, Hao Z. Chinese college students' help-seeking behavior: an application of the modified theory of planned behavior. PsyCh J. 2023;12(1):119-27. doi:10.1002/pchj.605
12. Shi W, Hall BJ. Help-seeking intention among Chinese college students exposed to a natural disaster: an application of an extended theory of planned behavior (E-TPB). Soc Psychiatry Psychiatr Epidemiol. 2021;56:1273-82. doi:10.1007/s00127-020-01993-8
13. Han KS, Shin J, Shin HJ, Lee SY, Song M, Lee N. Rodgers' evolutionary concept analysis: mental health help-seeking for adolescents. J Korean Acad Psychiatr Ment Health Nurs. 2025;34(2):220-32. doi:10.12934/jkpmhn.2025.34.2.220
14. Chakawa A, Shapiro SK. The association between problem recognition, race/ethnicity, and professional help-seeking intentions across psychological disorders. Emerg Adulthood. 2022;10(4):891-909. doi:10.1177/21676968211000491
15. Schomerus G, Stolzenburg S, Freitag S, Speerforck S, Janowitz D, Evans-Lacko S, et al. Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. Eur Arch Psychiatry Clin Neurosci. 2019;269(4):469-79. doi:10.1007/s00406-018-0896-0
16. Wright A, Jorm AF, Harris MG, McGorry PD. What's in a name? Is accurate recognition and labelling of mental disorders by young people associated with better help-seeking and treatment preferences? Soc Psychiatry Psychiatr Epidemiol. 2007;42:244-50. doi:10.1007/s00127-006-0156-x
17. O'Neill A, Humphrey N, Stapley E. A systematic review of qualitative research focusing on emotional distress among adolescents: Perceived cause and help-seeking. Adolescent Res Rev. 2023;8:387-402. doi:10.1007/s40894-022-00203-7
18. Saunders S, Bowersox N. The process of seeking treatment for mental health problems. Ment Health Learn Disabil Res Pract. 2007;4(2):99-123. doi:10.5920/mhldrp.2007.4299
19. Rickwood D, Deane F, Wilson C, Ciarrochi J. Young people's help-seeking for mental health problems. Aust J Adv Ment Health. 2005;4(3):1-34. doi:10.5172/jamh.4.3.218
20. Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173-83. doi:10.2147/PRBM.S38707
21. McPhail L, Thornicroft G, Gronholm PC. Help-seeking processes related to targeted school-based mental health services: systematic review. BMC Public Health. 2024;24:1217. doi:10.1186/s12889-024-18714-4
22. World Health Organization, UNICEF. Guidance to improve access to mental health care for children and young people [Internet]. Geneva: World Health Organization; 2024 [cited 2026 May 25]. Available from: https://www.who.int/news/item/09-10-2024-who-and-unicef-launch-guidance-to-improve-access-to-mental-health-care-for-children-and-young-people
23. van den Toren SJ, van Grieken A, Lugtenberg M, Boelens M, Raat H. Adolescents' views on seeking help for emotional and behavioral problems: A focus group study. Int J Environ Res Public Health. 2020;17(1):191. doi:10.3390/ijerph17010191
24. Walker LO, Avant KC. Strategies for theory construction in nursing. 6th ed. Boston: Pearson; 2019.
25. Bamine V, Tanaka K. Help-seeking in nursing and medical students: a concept analysis. J Res Nurs. 2025;30(2):125-38. doi:10.1177/17449871241268451
26. Jackson SA. Help-seeking behavior. Salem Press Encyclopedia of Health [Internet]. 2024 [cited 2026 May 25]. Available from: https://research.ebsco.com/c/3q5j6g/viewer/html/idcscikucn
27. Merriam-Webster Online Dictionary. Help [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/dictionary/help
28. Merriam-Webster Thesaurus. Help [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/thesaurus/help
29. Oxford English Dictionary. Seek [Internet]. Oxford: Oxford University Press; [cited 2026 May 25]. Available from: https://www.oed.com/search/dictionary/?scope=Entries&q=seek
30. Merriam-Webster Thesaurus. Seek [Internet]. Springfield (MA): Merriam-Webster; [cited 2026 May 25]. Available from: https://www.merriam-webster.com/thesaurus/seek
31. Cornally N, McCarthy G. Help-seeking behaviour: A concept analysis. Int J Nurs Pract. 2011;17(3):280-8. doi:10.1111/j.1440-172X.2011.01936.x
32. Hammer JH, Parent MC, Spiker DA. Mental Help Seeking Attitudes Scale (MHSAS): development, reliability, validity, and comparison with the ATSPPH-SF and IASMHS-PO. J Couns Psychol. 2018;65(1):74-85. doi:10.1037/cou0000248
33. Yee T, Ryan K. Examining international students' help-seeking intentions utilizing the theory of planned behavior. Int J Adv Couns. 2023;45:370-84. doi:10.1007/s10447-022-09491-z
34. Yang X, Hu J, Zhang B, Ding H, Hu D, Li H. The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: mediating roles of perceived social support and psychological help-seeking stigma. Front Psychol. 2024;15:1356435. doi:10.3389/fpsyg.2024.1356435
35. Amarasuriya SD, Jorm AF, Reavley NJ. Predicting intentions to seek help for depression among undergraduates in Sri Lanka. BMC Psychiatry. 2018;18:122. doi:10.1186/s12888-018-1700-4
36. Astipa GV, Widyorini E, Wijaya DA, Utami MSS, Medaringo AGE. The association between mental health literacy and help-seeking intention to mental well-being among secondary school students in Semarang, Indonesia. Int J Health Lit Sci. 2025;3(1):22-32. doi:10.60074/ihelis.v3i1.66
37. Goh PK, Chung S, Jhawar N, Wong AWWA, Mellor GS, Banerjee M, et al. ADHD knowledge as a barrier to problem recognition in Asian American and Native Hawaiian/Pacific Islander versus White college students. J Atten Disord. 2026;30(2):234-48. doi:10.1177/10870547251389337
38. Setia Lesmana MH, Chung MH. Mediating roles of perceived stigma and mental health literacy in the relationship between school climate and help-seeking behavior in Indonesian adolescents. PLoS One. 2024;19(5):e0298017. doi:10.1371/journal.pone.0298017
39. Wang W, Gao S, Chen Q, Ma S. The influence of explainable artificial intelligence and mental health literacy on professional psychological help-seeking behavior: the mediating role of psychological problem cognition. Behav Sci (Basel). 2025;15(12):1646. doi:10.3390/bs15121646
40. Oexle N, Ribeiro W, Fisher HL, Gronholm PC, Laurens KR, Pan P, et al. Childhood bullying victimization, self-labelling, and help-seeking for mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2020;55:81-8. doi:10.1007/s00127-019-01743-5
41. Lian Z, Wallace BC, Fullilove RE. Mental health help-seeking intentions among Chinese international students in the U.S. higher education system: The role of coping self-efficacy, social support, and stigma for seeking psychological help. Asian Am J Psychol. 2020;11(3):147-57. doi:10.1037/aap0000183
42. Evans-Lacko S, Stolzenburg S, Gronholm PC, Ribeiro W, York-Smith M, Schomerus G. Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people. Soc Psychiatry Psychiatr Epidemiol. 2019;54:59-67. doi:10.1007/s00127-018-1602-2
43. Doan N, Patte KA, Ferro MA, Leatherdale ST. Reluctance towards help-seeking for mental health concerns at secondary school among students in the COMPASS study. Int J Environ Res Public Health. 2020;17(19):7128. doi:10.3390/ijerph17197128
44. Robles CC, Bronstein J. Easing the path for improving help-seeking behaviour in youth. EClinicalMedicine. 2020;18:100256. doi:10.1016/j.eclinm.2019.100256
45. Yosep I, Iskandar S, Mardhiyah A, Ramdhani MR, Hikmat R. The effect of the nurse-led ROOTS program and soft skills training on emotional regulation to prevent bullying in high school students in Bandung city. Nurs Pract Today. 2026;13(2):187-97. doi:10.18502/npt.v13i2.21468
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| help-seeking behavior; mental health; adolescent; young adult; nursing; problem recognition; concept analysis | ||
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How to Cite
1.
Annisa F, Uthis P. Problem recognition in youth mental health help-seeking: A Walker and Avant concept analysis. Nurs. pract. today. 2026;:X-X.
