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Revista chilena de pediatría

versión impresa ISSN 0370-4106

Rev. chil. pediatr. vol.88 no.3 Santiago jun. 2017

http://dx.doi.org/10.4067/S0370-41062017000300003 

Original article

 

Validation of the general help-seeking questionnaire for mental health problems in adolescents

Validación del cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes

 

Cecilia Olivaria, Mónica Guzmán-Gonzálezb

aDepartament of Psychology. Universidad Católica del Maule, Talca, Chile
bSchool of Psychology. Universidad Católica del Norte , Antofagasta,Chile

Correspondencia a:


Help-seeking behavior is a protective factor in young people, essential for their mental health, wellbeing and development. However, some adolescents do not seek professional help when they need to. In this context, it is relevant to study the help-seeking behavior for mental health problems in adolescent population. Objective: To adapt and validate the general help-seeking questionnaire for mental health problems in Chilean adolescents. Subjects and Method: Cross-sectional and correlational study of a non-random sample of 793 adolescent students, between 14 and 19 years old, from the city of Talca (Chile). The general help-seeking questionnaire, vignette version, (GHSQ-V) was administered after a transcultural adaptation and criterion validation. Descriptive statistics, exploratory factor analysis and non-parametric Mann-Whitney U test were used for analysis. Results: An exploratory analysis identified two factors regarding available sources of help: 1) informal sources;
2) formal sources. Reliability was calculated separately for each of the health problems, resulting alpha values ranging from 0.87 to 0.75. In addition, the scale showed significant association with the variables self-efficacy and depression in the hypothesized directions. Finally, significant differences were identified in the willingness to seek help by adolescent’s level of mental health literacy, for all mental health issues presented, except suicide. Conclusion: The adaptation of the GHSQ-V for Chilean adolescent and youth population is a valid and reliable instrument to measure willingness to seek help for mental health problems in our socio-cultural environment.

Keywords: Help-Seeking Behavior, Mental Health, Adolescents.


 

Introduction

The help-seeking behavior is a fundamental behavior in young people for their mental health and well-being and is considered a protective factor in the health and development of adolescents1. A timely search and care for mental health problems may decrease harmful consequences to them1-3. However, a large number of adolescents and young people do not seek professional help, even though they have the need to receive it4,5. In this context, it is very important to study the behavior of seeking help for mental health problems in the teenager population.

To seek for help could be defined as the behavior of actively seeking help from other people. It is about communicating with others to get help in response to a problem or stressful experience5. It is a way of coping, based on social relationships and interpersonal skills6. It is a learned skill, which is adaptive and is related to psychological well-being7. The help can be obtained from a variety of sources by varying the level of formality, from informal sources (e.g. friends and family) to formal sources (e.g. health professional).

In a recent review8, it was found that one of the most commonly used measures for the study of seek for help question is ‘The General help-seeking questionnaire’9. This instrument, besides evaluating the intention to seek help from professionals, allows assessing the intention to seek help from informal sources. This is relevant, since informal sources would be preferred by adolescents when faced with a mental health problem9-12, so it is of interest to have a measure that includes both types of sources of help. The GHSQ6,9 is an instrument used to identify the support figures favored by the participants, and their intention to seek help.

There are different versions of this questionnaire. The original version evaluates the intent to seek help for suicidal problems, and for general emotional problems. The study of the psychometric properties of this questionnaire has shown that the measure of intention to seek help is related to the search for current help measured during the last month and predicts the future intention of seeking help. Adequate levels of reliability9. This questionnaire is one of the most used internationally for research in the topic of seeking help11,13,14.

In the present study, considering that one of the dimensions of the seek for help is the type of problem that the young one presents8, the last version of this questionnaire will be adapted, called ‘Vignette’ version (GHSQ-V, 15), which presents six specific mental health problems and one of physical health, in order to evaluate the seek for help. One of the advantages of this instrument is that it uses a matrix format, which allows modifying the sources of aid and the types of problem, according to the requirements of the studied population9.

Based on the above, the objective of the present study was to transculturally adapt the English version of the GHSQ-V and to study its psychometric properties, in order to have a valid and reliable spanish instrument in our environment, which allows us to continue advancing in the study of the behavior of seeking help for mental health issues in adolescents and youths.

Material and Methods

Non-experimental, transversal and correlational research.

Participants

The study was performed with a non-probabilistic sample. Participants were 793 young people between 14 and 19 years old; mean: 17.03 years (SD = 1.72). The sample consisted of 499 females (63.2%) and 291 males (36.8%). There were 3 participants who omitted the information. Of the total number of participants, 417 (52.6%) corresponded to students of secondary education and 376 (47.4%) to first-year university students in the region of Talca.

Procedure

In a first stage the cross-cultural adaptation of the questionnaire was carried out, following the recommendations proposed by Hambleton, Merenda and Spielberger, (16) for which the following steps were followed: 1) Obtaining authorization from the original author to carry out the adaptation And validation of the questionnaire; 2) Translation of the original text (from English into Spanish) by 2 bilingual persons from the area of ​​psychology and mental health, who worked independently; 3) Retro translation; 4) Submission to expert judges, to evaluate level of understanding of items and writing of these. After obtaining this revised version by expert judges, a sample of 20 adolescents, both secondary and university students, was applied through cognitive interviews and then applied in a group way to a pilot sample of 60 high school students, In order to detect possible problems of understanding the items and the relevance of the sources of aid. From this piloting, and considering the recommendations of the author of the questionnaire, to verify the cultural relevance of the sources of help, 2 items that did not fit the socio-cultural reality of adolescents were eliminated. Therefore, the questionnaire adapted here does not include the items of “telephone help” or “religious” as a source of help. These items had been reported in other studies, as being excluded by the youngsters11.

Instead, the source of “counselor or teacher of my educational establishment” is incorporated. In a second stage, participants were enrolled in secondary schools and different careers of a university in the region of Talca. Consent and assent were requested. The questionnaires were applied collectively in the classroom. This study was approved by the ethics committee of Universidad Católica del Maule.

Instruments

In addition to a socio-demographic questionnaire, which included age, gender, level of education, educational establishment, and the general questionnaire to find help to adapt, the questionnaires of general self-efficacy and depressive symptomatology were applied. These last two were included in order to be able to evaluate the validity of the criterion of the instrument to be validated. Thus, self-efficacy would be expected to be directly related to the willingness to seek help, and depressive symptomatology is inversely related to willingness to seek help.

1) General Help-Seeking Questionnaire, ‘Vignette’ version (GHSQ-V15)

It asks participants to assess the likelihood that they would seek help from different specific sources of help proposed (partners, friends, parents, other family members and mental health professionals). This is applied for seven different types of health problems (Stress, Anxiety, Depression, Suicidal Ideation, Substance Abuse, Psychosis, and Physical Illness). Each question is presented with an example, or vignette, describing a teenager who has one of the health problems listed. An example of a vignette would be:

“In the last two weeks, Juan has found it difficult to relax. He has also been feeling rather overwhelmed, “nervous” and intolerant. He has tended to overreact to things that happen”.

Following each vignette, participants evaluate their intention to seek help for each source of aid on a 7-point Likert scale, ranging from 1 = extremely probable to 7 = extremely unlikely. Then, with each Likert scale completed, 2 questions are indicated: The first (item K), measures mental health literacy issues (MHL). The second question, (item L), measures the need for perceived help. Therefore, each question in the questionnaire consists of 10 items (item a, item j), which measure the intention to seek help, and the additional items described.

2) General Self-Efficacy Scale 17

Has 10 items, in 4-point Likert format. The answers range from ‘Incorrect’ (1 point) to ‘Correct’ (4 points). The minimum score is 10 points, and the maximum is 40 points.

3) Center for Epidemiological Studies Depression Questionnaire (CES-D) adapted in Chile18

This instrument measures the frequency of depressive symptoms and depressive mood during the last 2 weeks. It is a 20-item scale with 4 response alternatives in Likert format.

Results

Prior to conducting the main analyzes, a preliminary examination of the data was performed. Of an initial total of 810 participants, 4 were excluded because they had a high number of missing data (> 10%) and 13 because they were identified as atypical multivariate outliers. For this analysis, the Mahalanobis statistic was taken, excluding those that exceeded the critical value (p < 0.001).

Statistical descriptions

Table 1 shows the descriptive statistics of the variables evaluated, where it is observed that the intention to seek help is greater for informal sources than for formal sources, in all problem areas.

Table 1. Means and standard deviations (SD) of help seeking intentions for different problems and from different help sources

In addition, we evaluated whether there were differences in the intention to seek help in the different problem areas, and in the levels of depression and self-efficacy (variables included to assess the validity of criteria) according to gender. As the variables are not normally distributed, a non-parametric test was initially performed to evaluate differences (Mann-Whitney test). However, the results obtained do not differ from those obtained with a parametric test. Considering this precedent, and also that a large sample was evaluated, we chose to report the results of the t test. In this regard, Table 2 shows that there are differences in the intention to seek help in the areas of stress and anxiety, but not in other problematic areas. Specifically, women indicate a greater intention to seek help while facing stress and anxiety than men.

Differences were also detected in the levels of depression and self-efficacy, with a higher depressive symptomatology in women and higher levels of self-efficacy in men.

Reliability

The reliability coefficients were calculated separately for each problem, as suggested by Wilson et al.9.

The alpha values obtained were 0.75, 0.74, 0.82, 0.87, 0.79, 0.83 and 0.74 for the problems of stress, anxiety, depression, suicide, substance abuse, Psychosis and chronic disease, respectively.

Validity

In order to examine the factor structure of the GHSQ, an exploratory factor analysis (EFA) was performed with the principal axis extraction and oblique rotation method. This technique was chosen, instead of the confirmatory factor analysis, because the evaluation of the factorial structure of the instrument has been a little explored in previous studies, except for some exceptions (e.g. Tuliao & Velásquez, 2014).

Thus, according to Wilson et al.9,15 each problem area can be considered rather a separate scale, EFA were run for each topic.

The results of the Bartlett’s tests of sphericity (p < 0.001) and the KMO index = 0.77, 0.72, 0.82, 0.85, 0.79 and 0.74, respectively.

The initial EFA, with a freely estimated solution, which considered as eigenvalues greater than 1 and the Scree test, allowed to identify three factors in the case of stress, anxiety and chronic disease, which explain 69%, 45%, 67%, 22% and 69.73% of the variance, respectively. A two-factor solution was then tested for these areas, accounting for 56.47%, 53.62% and 55.87% of the variance for stress, anxiety and chronic disease. In the case of stress and anxiety, the results obtained identify the first factor that groups informal sources of help (partner, friend, parent and other relatives) and a second factor that groups formal sources (psychologist, physician, psychiatrist , Advisor). In the case of heart disease, the same pattern of results is observed, except that the source represented by the medical professional has no significant load on any factor.

In the other problem areas: depression, suicide, substance abuse and psychosis, the freely estimated solution converged into two factors, accounting for 60.29%, 68.21%, 58.90% and 64.14% % of the variance respectively. In all cases and as shown in Table 3, the same pattern of results is identified, with a first factor that groups the four informal sources theoretically proposed and a second grouping the formal ones.

On the other hand, criterion validity was examined by associating the GSHQ with the variables depression and self-efficacy. As shown in Table 2, scores for all problem areas were inversely associated with depression levels (p < 0.01) and directly with self-efficacy (p < 0.01). That is, to a greater intention of seeking help in the face of stress, anxiety, depression, suicide, substance abuse, psychosis and chronic illness, less presence of depressive symptomatology, as predicted.

Table 2. Correlation matrix between variables of interest and the mean difference between males and females

Table 3. Principal Axis Exploratory Factor Analysis of the GHSQ

In addition, and in a manner consistent with the hypothesized, the greater intention of seeking help for problems of stress, anxiety, depression, suicide, substance abuse, psychosis and chronic illness was associated with higher levels of self-efficacy.

On the other hand, it was examined whether there was an association between the intention to seek aid and the MHL. To this end, a series of t-tests were carried out in order to assess differences in the intention to seek help based on whether or not the young person recognized the mental health problem. As shown in Table 4, statistically significant differences in all problem areas are identified, except for suicide. Specifically, those who recognize the mental health problem are more likely to seek help than those who do not, in the area of stress, anxiety, depression, substance abuse, psychosis and chronic illness.

Table 4. Differences in help seeking intentions for mental health problems according to literacy level

Discussion

The present study had the purpose of reporting the process of adaptation and validation, in Chilean adolescents, of the GHSQ-V. Coinciding with previous studies, adolescents tended to seek help from informal sources than from formal sources11,19. An exploratory factor analysis was carried out, which showed two dimensions regarding the sources of help for mental health problems and for physical illness: the formal sources of help and the informal sources of help, which is consistent with the dimensions identified in the study by Tuliao and Velasquéz20.

Regarding criterion validity, the scores obtained from the GHSQ-V questionnaire were expected to be related both to the self-efficacy questionnaire scores and to the depressive symptomatology questionnaire scores. Thus, self-efficacy was directly related to the willingness to seek help, which is consistent with the theoretical construct, since people with higher self-efficacy have more favorable attitudes towards seeking help and to seek help in an optimal manner21. On the other hand, those who scored higher in depressive symptomatology were less willing to seek help, which has already been documented in studies with adolescents22,23.

Young people with a higher score in MHL are more willing to seek help compared to young people with low scores in this variable, which is consistent with previous studies, which show that a higher level of MHL favors a positive attitude towards these issues, and a greater willingness to seek timely help13,24. However, it is noteworthy that this was achieved for all mental health issues studied, except in the case of suicide. That is, adolescents who recognized suicide presented higher MHL in this subject, but were not more willing to seek help for this issue as expected, compared to those adolescents who did not recognize this issue. This may be linked to what has been described as the process of denial of aid, which implies that when the identified health problem is more serious, the adolescent tends to avoid help or to get away from it25.

Finally, possible gender differences in the variables studied were identified, and adolescents were more willing to seek help for stress and anxiety compared to men. This could be explained by the tendency of female adolescents to experience more emotional discomfort than male adolescents, associated with greater vulnerability to the stressors of this stage of life26. Also, gender differences were observed in the variables of self-efficacy and Depressive symptomatology. Self-efficacy was significantly higher in males, which has been reported in previous studies in adolescent population27,28. Likewise, the fact that depressive symptomatology is significantly higher in female adolescent, it is also a finding that has been extensively documented in some researches with similar samples29,30.

One of the limitations of this study is that the sample of adolescents was an unrepresentative sample, but was intended by age range, from 14 to 19 years old and belonging to the region of Talca. It will be of interest to perform other psychometric studies broadening the range of the sample and in specific populations of adolescents, such as mental health services consultants for teenagers. Despite this, it is concluded that the adapted GHSQ-V in Chilean adolescent and youth population is a valid and reliable instrument to measure willingness to seek help for mental health issues in our socio-cultural environment.

To have this questionnaire will help further research studies in the field of, for example, the barriers to seeking help, which may be of interest for researchers and for health professionals alike, who, by identifying which willingness barriers to seek help from adolescents are facing, may develop strategies to reduce them and favor a positive attitude towards seeking help from a mental health professional. Promoting a timely seek for help in adolescents may contribute to a reduction in the development of mental health problems, in which, for example, it has been determined that encouraging young people to seek help when they feel depressed is an important strategy for reducing Suicide risk31.

 

References

1. Barker G, Olukoya A, Aggleton P. Young people, social support and help-seeking. Int J Adolesc Med Health. 2005;17(4): 315-35.

2. Del Mauro JM, Jackson Williams D. Children and Adolescents’ Attitudes Toward Seeking Help From Professional Mental Health Providers. Int J Adv Counselling. 2012;35(2):120-38.

3. Hunt J, Eisenberg D. Mental health problems and help-seeking behavior among college students. J Adolesc Health. 2010;46(1):3-10.

4. Gulliver A, Griffiths KM, Christensen H.
Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry. 2010;10(1):113.

5. Carlisle J, Shickle D, Cork M,
McDonagh A. Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration. J Med Ethics. 2006;32(3):133-7.

6. Rickwood D, Deane FP, Wilson CJ, Ciarrochi J. Young people’s help-seeking for mental health problems. Australian e-journal for the Advancement of Mental health. 2005;4(3):218-51.

7. Unrau YA, Grinnell RM. Exploring out-of-home placement as a moderator of help-seeking behavior among adolescents who are high risk. Res Soc Work Pract. 2005;15(6):516-30.

8. Rickwood D, Thomas K, Bradford S. Help-seeking measures in mental health: a rapid review. https://www.saxinstitute.org.au/wp-content/uploads/02_Help-seeking- measures-in-mental-health.pdf.

9. Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: Properties of the general help seeking questionnaire. Canadian Journal of Counselling and Psychotherapy/Revue canadienne de counseling et de psychothérapie. 2007;39(1).

10. Rughani J, Deane FP, Wilson CJ. Rural adolescents’ help-seeking intentions for emotional problems: The influence of perceived benefits and stoicism. Aust J Rural Health. 2011;19(2):64-9.

11. D’Avanzo B, Barbato A, Erzegovesi S, Lampertico L, Rapisarda F, Valsecchi L. Formal and informal help-seeking for mental health problems. A survey of preferences of italian students. Clin Pract Epidemiol Ment Health. 2012;8:47-51.

12. Leavey G, Rothi D, Paul R. Trust, autonomy and relationships: the help-seeking preferences of young people in secondary level schools in London (UK).
J Adolesc. 2011;34(4):685-93.

13. Wilson CJ, Deane FP, Marshall KL, Dalley A. Reducing adolescents’ perceived barriers to treatment and increasing help-seeking intentions: effects of classroom presentations by general practitioners.
J Youth Adolescence. 2008;37(10):
1257-69.

14. Moran P. Attachment style, ethnicity
and help-seeking attitudes among adolescent pupils. Br J Guid Counc. 2007;35(2):205-18.

15. Wilson CJ, Rickwood DJ, Bushnell JA, Caputi P, Thomas SJ. The effects of need for autonomy and preference for seeking help from informal sources on emerging adults’ intentions to access mental health services for common mental disorders and suicidal thoughts. Advances in Mental Health. 2011;10(1):29-38.

16. Hambleton RK, Merenda PF, Spielberger CD. Adapting educational and psychological tests for cross-cultural assessment. Psychology Press; 2004.

17. Cid HP, Orellana YA, Barriga O. Validación de la escala de autoeficacia general en Chile. Rev Med Chile 2010;138:551-7.

18. Fuentealba RG, Bravo CA, Urrutia CM. Normas y punto de corte para la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D) en población juvenil chilena. Terapia Psicológica. 2004;22(2):145-56.

19. Sheffield JK, Fiorenza E, Sofronoff K. Adolescents’ willingness to seek psychological help: Promoting and preventing factors. J Youth Adolescence. 2004;33(6):495-507.

20. Tuliao AP, Velásquez PA. Revisiting the General Help Seeking Questionnaire: Adaptation, exploratory factor analysis, and further validation in a Filipino college student sample. Philippine Journal of Psychology. 2014;47(1):1-17.

21. Olivari Medina C, Urra Medina E. Autoeficacia y conductas de salud. Ciencia y Enfermería. 2007;13:9-15.

22. Wilson CJ, Rickwood D, Deane FP. Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist. 2007;11(3):98-107.

23. Wilson CJ, Deane FP. Help-negation and suicidal ideation: the role of depression, anxiety and hopelessness. J Youth Adolescence. 2010;39(3):291-305.

24. Ranahan P. Mental health literacy: A conceptual framework for future inquiry into child and youth care professionals’ practice with suicidal adolescents. Child Youth Care Forum 2010;39:11-25.

25. Wilson CJ, Bushnell JA, Caputi P. Early access and help seeking: practice implications and new initiatives. Early Intervention in Psychiatry. 2011;5:34-39.

26. Cova F, Maganto C, Melipillán R. Género, Adversidad Familiar y Síntomas Emocionales en Preadolescentes. Psykhe (Santiago). 2005;14:227-32.

27. Olivari C, Almagiá E. Influencia de la autoeficacia y la autoestima en la conducta de fumar en adolescentes. Terapia psicológica. 2005;23(2):5-11.

28. del Carmen Reina M, Oliva A, Parra Á. Percepciones de autoevaluación: Autoestima, autoeficacia y satisfacción vital en la adolescencia. 2010.

29. Cova SF, Melipillán R, Valdivia M,
Bravo L, Valenzuela B. Sintomatología depresiva y ansiosa en estudiantes de enseñanza media. Rev Chil Pediatr. 2007;78:151-9.

30. Veytia López M, González Arratia López Fuentes NI, Andrade Palos P, Oudhof H. Depresión en adolescentes: El papel de los sucesos vitales estresantes. Salud mental. 2012;35(1):37-43.

31. Joyce A, Pauli-Myler T, Zazryn T, Batras D, Mayers K. Promoting Help-Seeking among Adolescents and Young Adults through Consideration of the Adaptive Functions of Low Mood: A pilot study. Int J Ment Health Promot. 2011;13(4):30-5.

___________________

Received: 18-3-2016; Accepted: 22-8-2016

Ethical Responsibilities

Human Beings and animals protection: Disclosure the authors state that the procedures were followed according to the Declaration of Helsinki and the World Medical Association regarding human experimentation developed for the medical community.

Data confidentiality: The authors state that they have followed the protocols of their Center and Local regulations on the publication of patient data.

Rights to privacy and informed consent: The authors have obtained the informed consent of the patients and/or subjects referred to in the article. This document is in the possession of the correspondence author.

Financial Disclosure

This investigation has been financed by the National Commission for Scientific and Technological Research (CONICYT), through the National Fund of Scientific and Technological Development, Fondecyt Project N° 11130473 and the Fund of research VRIP by Universidad Católica del Maule (Project N°434154), awarded to the primary autor.

Conflicts of Interest

Authors state that any conflict of interest exists regards the present study.

Correspondencia a:

Cecilia Olivari

colivari@ucm.cl

1. Barker G, Olukoya A, Aggleton P. Young people, social support and help-seeking. Int J Adolesc Med Health. 2005;17(4): 315-35.         [ Links ]

2. Del Mauro JM, Jackson Williams D. Children and Adolescents’ Attitudes Toward Seeking Help From Professional Mental Health Providers. Int J Adv Counselling. 2012;35(2):120-38.         [ Links ]

3. Hunt J, Eisenberg D. Mental health problems and help-seeking behavior among college students. J Adolesc Health. 2010;46(1):3-10.         [ Links ]

4. Gulliver A, Griffiths KM, Christensen H.
Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry. 2010;10(1):113.         [ Links ]

5. Carlisle J, Shickle D, Cork M,
McDonagh A. Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration. J Med Ethics. 2006;32(3):133-7.         [ Links ]

6. Rickwood D, Deane FP, Wilson CJ, Ciarrochi J. Young people’s help-seeking for mental health problems. Australian e-journal for the Advancement of Mental health. 2005;4(3):218-51.         [ Links ]

7. Unrau YA, Grinnell RM. Exploring out-of-home placement as a moderator of help-seeking behavior among adolescents who are high risk. Res Soc Work Pract. 2005;15(6):516-30.         [ Links ]

8. Rickwood D, Thomas K, Bradford S. Help-seeking measures in mental health: a rapid review. https://www.saxinstitute.org.au/wp-content/uploads/02_Help-seeking- measures-in-mental-health.pdf.         [ Links ]

9. Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: Properties of the general help seeking questionnaire. Canadian Journal of Counselling and Psychotherapy/Revue canadienne de counseling et de psychothérapie. 2007;39(1).         [ Links ]

10. Rughani J, Deane FP, Wilson CJ. Rural adolescents’ help-seeking intentions for emotional problems: The influence of perceived benefits and stoicism. Aust J Rural Health. 2011;19(2):64-9.         [ Links ]

11. D’Avanzo B, Barbato A, Erzegovesi S, Lampertico L, Rapisarda F, Valsecchi L. Formal and informal help-seeking for mental health problems. A survey of preferences of italian students. Clin Pract Epidemiol Ment Health. 2012;8:47-51.         [ Links ]

12. Leavey G, Rothi D, Paul R. Trust, autonomy and relationships: the help-seeking preferences of young people in secondary level schools in London (UK). J Adolesc. 2011;34(4):685-93.         [ Links ]

13. Wilson CJ, Deane FP, Marshall KL, Dalley A. Reducing adolescents’ perceived barriers to treatment and increasing help-seeking intentions: effects of classroom presentations by general practitioners. J Youth Adolescence. 2008;37(10):1257-69.         [ Links ]

14. Moran P. Attachment style, ethnicity
and help-seeking attitudes among adolescent pupils. Br J Guid Counc. 2007;35(2):205-18.         [ Links ]

15. Wilson CJ, Rickwood DJ, Bushnell JA, Caputi P, Thomas SJ. The effects of need for autonomy and preference for seeking help from informal sources on emerging adults’ intentions to access mental health services for common mental disorders and suicidal thoughts. Advances in Mental Health. 2011;10(1):29-38.         [ Links ]

16. Hambleton RK, Merenda PF, Spielberger CD. Adapting educational and psychological tests for cross-cultural assessment. Psychology Press; 2004.         [ Links ]

17. Cid HP, Orellana YA, Barriga O. Validación de la escala de autoeficacia general en Chile. Rev Med Chile 2010;138:551-7.         [ Links ]

18. Fuentealba RG, Bravo CA, Urrutia CM. Normas y punto de corte para la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D) en población juvenil chilena. Terapia Psicológica. 2004;22(2):145-56.         [ Links ]

19. Sheffield JK, Fiorenza E, Sofronoff K. Adolescents’ willingness to seek psychological help: Promoting and preventing factors. J Youth Adolescence. 2004;33(6):495-507.         [ Links ]

20. Tuliao AP, Velásquez PA. Revisiting the General Help Seeking Questionnaire: Adaptation, exploratory factor analysis, and further validation in a Filipino college student sample. Philippine Journal of Psychology. 2014;47(1):1-17.         [ Links ]

21. Olivari Medina C, Urra Medina E. Autoeficacia y conductas de salud. Ciencia y Enfermería. 2007;13:9-15.         [ Links ]

22. Wilson CJ, Rickwood D, Deane FP. Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist. 2007;11(3):98-107.         [ Links ]

23. Wilson CJ, Deane FP. Help-negation and suicidal ideation: the role of depression, anxiety and hopelessness. J Youth Adolescence. 2010;39(3):291-305.         [ Links ]

24. Ranahan P. Mental health literacy: A conceptual framework for future inquiry into child and youth care professionals’ practice with suicidal adolescents. Child Youth Care Forum 2010;39:11-25.         [ Links ]

25. Wilson CJ, Bushnell JA, Caputi P. Early access and help seeking: practice implications and new initiatives. Early Intervention in Psychiatry. 2011;5:34-39.         [ Links ]

26. Cova F, Maganto C, Melipillán R. Género, Adversidad Familiar y Síntomas Emocionales en Preadolescentes. Psykhe (Santiago). 2005;14:227-32.         [ Links ]

27. Olivari C, Almagiá E. Influencia de la autoeficacia y la autoestima en la conducta de fumar en adolescentes. Terapia psicológica. 2005;23(2):5-11.         [ Links ]

28. del Carmen Reina M, Oliva A, Parra Á. Percepciones de autoevaluación: Autoestima, autoeficacia y satisfacción vital en la adolescencia. 2010.         [ Links ]

29. Cova SF, Melipillán R, Valdivia M,
Bravo L, Valenzuela B. Sintomatología depresiva y ansiosa en estudiantes de enseñanza media. Rev Chil Pediatr. 2007;78:151-9.         [ Links ]

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