What Teens Want: Barriers to Seeking Care for Depression

  • Jennifer P. WisdomEmail author
  • Gregory N. Clarke
  • Carla A. Green


This study examined the experiences of teenagers seeking and receiving care for depression from primary care providers. We investigated teens’ perceived barriers in obtaining care to determine how primary care can effectively address depressed teens’ stated needs. In-depth individual (n = 15) and focus group (n = 7) interviews with adolescents were conducted and analyzed using grounded theory and prominent themes were identified. Teenagers reported faring best when providers actively considered and reflected upon the teenagers’ developmentally appropriate desires to be normal, to feel connected, and to be autous. These goals are achieved by providers establishing rapport, exchanging information about depression etiology and treatment, and helping teens make decisions about their treatment. To the extent that providers improve efforts to help teens feel normal, autonomous, and connected, the teens report they are more likely to accept treatment for depression and report success in treatment.


depression adolescents identity primary care patient–provider communication 



This research was supported by a National Research Service Award from the Agency for Health Care Policy and Research and a Greenlick Grant from the Department of Public Health and Preventive Medicine at the Oregon Health & Science University, both to the first author. This work was completed during the first author’s appointment at the Center for Health Research, Kaiser Permanente Northwest. The authors would like to thank the teenagers who participated in the study and Chrystal Agnor, Christopher Kelleher, and Cheryl Ritenbaugh for their invaluable assistance.


  1. Ackard D. M., Newmark-Sztainer D. (2001). Health care information sources for adolescents: Age and gender differences on use, concerns, and needs. Journal of Adolescent Health 29: 170–176PubMedCrossRefGoogle Scholar
  2. Angermeyer M. C., Matschinger H., Riedel-Heller S. G. (1999). Whom to ask for help in case of a mental disorder? Social Psychiatry and Psychiatric Epidemiology 34(4): 202–210PubMedCrossRefGoogle Scholar
  3. Asarnow J. R., Jaycox L. H., Anderson M. (2002). Depression among youth in primary care models for delivering mental health services. Child and Adolescent Psychiatric Clinics of North America 11(3): 477–497PubMedCrossRefGoogle Scholar
  4. Aseltine R. H., Gore S., Colten M. E. (1994). Depression and the social developmental context of adolescence. Journal of Personality and Social Psychology 67: 252–263PubMedCrossRefGoogle Scholar
  5. Azjen I. (1996).The directive influence of attitudes on behavior. In: Gollwitzer P. M., Bargh J. A. (eds) The Psychology of action: Linking cognition and motivation to behavior. New York NY, The Guilford PressGoogle Scholar
  6. Birmaher B., Ryan N. D., Williamson D. E., Brent D. A., Kaufman J., Dahl R. E., Perel J., Nelson B. (1996). Childhood and adolescent depression: A review of the past 10 years, Part 1. Journal of the American Academy of Child and Adolescent Psychiatry 35: 1427–1439PubMedCrossRefGoogle Scholar
  7. Blankertz L. (1998). The value and practicality of deliberate sampling for heterogeneity: A critical multiplist perspective. American Journal of Evaluation 19: 307–324Google Scholar
  8. Brown C., Dunbar-Jacob J., Palenchar D. R., Kelleher K. J. Bruehlman R. D., Sereika S., Thase M. E. (2001). Primary care patients’ personal illness models for depression: a preliminary investigation. Family Practice 18(3): 314–320PubMedCrossRefGoogle Scholar
  9. Burack J. H., Irby D. M., Carline J. D., Root R. K., Larson E. (1999). Teaching compassion and respect: Attending physicians’ responses to problematic behaviors. Journal of General Internal Medicine 14: 49–55PubMedCrossRefGoogle Scholar
  10. Centers for Disease Control (2002). Suicide in the United States. [On-line]. Available:
  11. Charmaz K. (1997). Good days, bad days: The self in chronic illness and time. New Brunswick, NJ, Rutgers University PressGoogle Scholar
  12. Clarke G., Debar L., Lynch F., Powell J., Gale J., O'Connor E., Ludman E., Bush T., Lin E.H., Von Korff M., Hertert S. (2005). A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication. Journal of the American Academy of Child and Adolescent Psychiatry, 44 (9): 888-898PubMedGoogle Scholar
  13. Connolly J., Geller S., Marton P., Kutcher S. (1992). Peer responses to social interaction with depressed adolescents. Journal of Clinical Child Psychology 21(5): 365–370Google Scholar
  14. Culp A. M., Clyman M. M., Culp R. E. (1995). Adolescent depressed mood, reports of suicide attempts, and asking for help. Adolescence 30(120): 827–837PubMedGoogle Scholar
  15. DeBar L.L., Clarke G.N., O’Connor E., Nichols G.A. (2001). Treated prevalence, incidence, and pharmacotherapy of child and adolescent mood disorders in an HMO. Mental Health Services Research 3(2): 73–89PubMedCrossRefGoogle Scholar
  16. Dew M. A., Dunn L. O., Bromet E. J., Schulberg H. C. (1988). Factors affecting help- seeking during depression in a community sample. Journal of Affective Disorders 14(3): 223–234PubMedCrossRefGoogle Scholar
  17. Esters I. G., Cooker P. G., Ittenbach R. F. (1998). Effects of a unit of instruction in mental health on rural adolescents’ conceptions of mental illness and attitudes about seeking help. Adolescence 33: 469–476PubMedGoogle Scholar
  18. Estroff S. (1989). Self, identity, and subjective experiences of schizophrenia: In search of the subject. Schizophrenia Bulletin 15(2): 189–196PubMedGoogle Scholar
  19. Estroff S. E., Lachicotte W. S., Illingsworth L. C., Johnston A. (1991). Everybody’s got a little mental illness: Accounts of illness and self among people with severe, persistent mental illness. Medical Anthropology Quarterly 5(4): 331–369CrossRefGoogle Scholar
  20. Flament M. F., Cohen D., Choquet M., Jeammet P., Ledoux S. (2001). Phenomenology, psychosocial correlates, and treatment seeking in major depression and dysthymia of adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 40: 1070–1078PubMedCrossRefGoogle Scholar
  21. Freeborn D. K., Pope C.R. (1994). Promise and performance in managed care: The prepaid group practice model. Baltimore, MD, The Johns Hopkins University PressGoogle Scholar
  22. Gammell D. J., Stoppard J. M. (1999). Women’s experiences of treatment of depression: Medicalization or empowerment? Canadian Psychology 40: 112–128CrossRefGoogle Scholar
  23. Gjerde P. F. (1995). Alternative pathways to chronic depressive symptoms in young adults: Gender differences in developmental trajectories. Child Development 66: 1277–1300PubMedCrossRefGoogle Scholar
  24. Heisler M., Bouknight R. R., Hayward R. A., Smith D. M., Kerr E. A. (2002). The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. Journal of General Internal Medicine 17(4): 243–252PubMedCrossRefGoogle Scholar
  25. Hirschfeld R. M. A., Keller M. B., Panico S., Arons B. S., Barlow D., Davidoff F., Endicott J., Froom J., Goldstein M., Gorman J. M., Marek R. G., Maurer T. A., Meyer R., Phillips K., Ross J., Schwenk T. L., Sharfstein S. S., Thase M.E., Wyatt R.J. (1997). The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of the American Medical Association 277: 333–340PubMedCrossRefGoogle Scholar
  26. Jorm A. F., Christensen H., Medway J., Korten A. E., Jacomb P. A., Rodgers B. (2000). Public belief systems about the helpfulness of interventions for depression: associations with history of depression and professional health-seeking. Social Psychiatry and Psychiatric Epidemiology 35(5): 211–219PubMedCrossRefGoogle Scholar
  27. Lauber C., Nordt C., Falcato L., Rossler W. (2003). Do people recognize mental illness? Factors influencing mental health literacy. European Archives of Psychiatric Clinical Neuroscience 253: 248–251CrossRefGoogle Scholar
  28. Lewinsohn P., Clarke G. N., Seeley J. R., Rohde P. (1994). Major depression in community adolescents: Age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry 33: 809–818PubMedCrossRefGoogle Scholar
  29. Link B. G., Phelan J. C. (2001). Conceptualizing stigma. Annual Review of Sociology 27: 363–385CrossRefGoogle Scholar
  30. Link B. G., Phelan J. C., Bresnahan M., Stueve A., Pescosolido B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health 89(9): 1328–1333PubMedGoogle Scholar
  31. Logan D. E., King C. A. (2001). Parental facilitation of adolescent mental health service utilization: A conceptual and empirical review. Clinical Psychology 8(3): 319–333Google Scholar
  32. Logan D. E., King C. A. (2002). Parental identification of depression and mental health service among depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 41(3): 296–304PubMedCrossRefGoogle Scholar
  33. Luber M. P., Hollenberg J. P., Williams-Russo P., DiDomenico T. N., Meyers B. S., Alexopoulos G. S., Charlson M. E. (2000). Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice. International Journal of Psychiatry in Medicine 30: 1–13PubMedCrossRefGoogle Scholar
  34. Markowitz F. E. (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior 39: 335–347PubMedCrossRefGoogle Scholar
  35. Offer D., Howard K. I., Schonert K. A., Ostrov E. (1991). To whom do adolescents turn for help? Differences between disturbed and nondisturbed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 30(4): 623–630PubMedCrossRefGoogle Scholar
  36. Park R. J., Goodyer I. M. (2000). Clinical guidelines for depressive disorders in childhood and adolescence. European Child and Adolescent Psychiatry 9: 147–161PubMedCrossRefGoogle Scholar
  37. Pincus H. A., Pettit A. R. (2001). The societal costs of chronic major depression. Journal of Clinical Psychiatry 62: 5–9PubMedGoogle Scholar
  38. Pommier J., Mouchtouris A., Billot L., Romero M. I., Zubarew T., Deschamps J. (2001). Self-reported determinants of health service use by French adolescents. International Journal of Adolescent Medicine and Health 13(2): 115–129Google Scholar
  39. Regier D. A., Narrow W. E., Rae D. S., Manderscheid R. W., Locke B. Z., Goodwin F. K. (1993). The de facto US mental and addictive disorders service system: Epidemiological catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50: 85–94PubMedGoogle Scholar
  40. Rogers A., May C., Oliver D. (2001). Experiencing depression, experiencing the depressed: The separate worlds of patients and doctors. Journal of Mental Health 10(3): 317–333CrossRefGoogle Scholar
  41. Seaberg D. C., Godwin S. A., Perry S. J. (2000). Teaching patient empathy: The ED visit program. Academic Emergency Medicine 7(12): 1433–1436PubMedCrossRefGoogle Scholar
  42. Shye D., Freeborn D. K., Mullooly J. P. (2000). Understanding depression care in the HMO outpatient setting: What predicts key events on the pathway to care? Research in Community and Mental Health 11: 29–63CrossRefGoogle Scholar
  43. Strauss A., Corbin J. (1998). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA, Sage PublicationsGoogle Scholar
  44. Ustun T. B. (2000). Cross-national epidemiology of depression and gender. Journal of Gender Specific Medicine 3: 54–58PubMedGoogle Scholar
  45. Venarde D. F. (1999). Medication and meaning: Psychotherapy patients’ subjective experiences of taking selective seratonin reuptake inhibitors (SSRIs). Doctoral Dissertation. State University of New Jersey, PiscatawayGoogle Scholar
  46. Whittington C. J., Kendall T., Fonagy P., Cottrell D., Cotgrove A., Boddington E. (2004). Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363: 1341–1345PubMedCrossRefGoogle Scholar
  47. Wisdom J. P., Green C. A., (2004). ‘Being in a Funk’: Teens’ efforts to understand their depressive experiences Qualitative Health Research 14(9): 1227–1238PubMedCrossRefGoogle Scholar
  48. Wu P., Hoven C. W., Bird H. R., Moore R. E., Cohen P., Alegria M., Dulcan M. K., Goodman S. H., Horwitz S. M., Lichtman J. H., Narrow W. E., Rae D. S., Regier D. A., Roper M. T. (1999). Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 38(9): 1081–1090PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Jennifer P. Wisdom
    • 1
    • 3
    Email author
  • Gregory N. Clarke
    • 2
  • Carla A. Green
    • 1
    • 2
  1. 1.Departments of Public Health and Preventive Medicine and PsychiatryOregon Health & Science UniversityPortlandUSA
  2. 2.Center for Health ResearchKaiser Permanente NorthwestPortlandUSA
  3. 3.Department of Public Health and Preventive MedicineOregon Health & Science UniversityPortlandUSA

Personalised recommendations