Barriers to mental health services among at-risk and symptomatic adolescents in the community

Child Adolesc Psychiatry Ment Health. 2025 Nov 5;19(1):121. doi: 10.1186/s13034-025-00978-2.

ABSTRACT

BACKGROUND: Adolescence is a sensitive period of social, biological, and cognitive development. Prolonged suffering from psychiatric symptoms during this important phase of development has well-established social, health, and occupational costs in adulthood. The purpose of this study was to identify the barriers to engaging in mental health treatment among symptomatic, community-dwelling adolescents.

METHODS: In a cross-sectional study, barriers to mental health service use and psychiatric symptoms, including depressive symptoms, anxiety symptoms, and sleep disturbance, were self-reported by 277 adolescents (age 15.14 ± 2.21 years; 52% female; 93.5% Hispanic or Latino).

RESULTS: Clinically elevated psychiatric symptoms were common in this sample; 26% self-reported clinically significant depressive symptoms, 41% self-reported clinically significant anxiety symptoms, and 46% self-reported clinically significant sleep disturbance. Having clinically elevated symptoms of anxiety was associated with more barriers overall, p < 0.001. Having more exposure to early life adversity (ELA), being in high school or college relative to middle school, and having clinically elevated symptoms of anxiety were each independently associated with more cost concerns, ELA p = 0.02, school p = 0.01, anxiety p = 0.006. Adolescents in this sample with clinically elevated psychiatric symptoms disproportionately reported barriers to seeking mental health treatment pertaining to not wanting to discuss their mental health concerns with a physician, depression p < 0.001 and sleep disturbance p = .005, not knowing how to access a mental health provider, anxiety p < 0.001, and feeling like their symptoms were not pathological given their current circumstances, for both depressive and anxiety symptoms p < 0.001.

CONCLUSIONS: Among at-risk youth-predominantly Hispanic/Latino-both intrinsic (normalization, fear/limited knowledge) and extrinsic (cost, transportation, physician referral) barriers shape perceived access to care, with anxiety and sleep problems most strongly tied to overall barriers. Social ecological approaches to addressing these barriers may reduce the time at-risk adolescents delay seeking support or intervention.

PMID:41194107 | DOI:10.1186/s13034-025-00978-2