Barriers and solutions to adolescent and young male help-seeking: a qualitative systematic review and best-fit framework synthesis and; Men’s experiences of a psychoeducation course delivered in a group format, for people with experience of abuse and interpersonal trauma: an interpretative phenomenological analysis

Abstract

Research demonstrates health outcomes for boys and men fall significantly behind those of girls and women, in most areas of the world. One approach to understanding health inequality between genders is consideration of health behaviour paradigms related to masculinity. Accordingly, dominant societal expectations of masculinity promote values of strength, self-reliance and the denial of vulnerability or weakness. Adherence to these norms restrict males’ health-related behaviour, such as proactively seeking help. Help-seeking amongst adolescents and young adults is lower than at other periods of life, occurring at a time when mental health problems tend to emerge. Taken together, it is likely that young males face particular challenges when seeking help when they experience psychological distress. They may also benefit from adapted or tailored approaches which facilitate engagement. While a number of reviews have considered barriers and facilitators for adolescent and young adult help-seeking, there is an absence of gender-specific perspectives that may advance current thinking. Given the available literature focusing on young males’ perspectives of help-seeking, and those of their wider network, a systematic review was conducted to explore, collate and critique these findings. Using a best-fit framework synthesis approach, an existing conceptualisation of adolescent male help-seeking for clinical anxiety was built upon, using data from the included studies, to develop a comprehensive revised framework. The resulting framework was analysed and interpreted. For barriers, three superordinate themes were identified: Social influences and risk of stigma; Narrow view of health, and limited awareness-knowledge of what helps; and Relationships with professionals and facing uncomfortable emotional experiences. Two superordinate themes were found for facilitators: Fast access, low effort to use options that introduce mental health information/support concepts gradually; and Accessible mental health care for young males. Fifteen subthemes are described within these superordinate themes. There exists a dearth of research representing men in psychological therapy. This is especially relevant in the area of abuse and interpersonal trauma, which has predominately focused on female survivors. The international agenda for providing males with gender congruent and sensitive services aims to improve health outcomes for boys and men. A vital aspect of this agenda is gaining the perspective of males on their experience of recommended psychological interventions. An exploratory study drawing on the principles of interpretative phenomenological analysis was conducted for this purpose. Nine male completers of a manualised psychoeducational course, delivered in a group, for people with a history of abuse and interpersonal trauma were interviewed about their experience of this intervention. Analysis revealed five superordinate themes: Conditions to engage; Healthcare is relational; A containing structure to confront issues and cope; Challenging negative self-beliefs and gaining control; and, Recognising men’s needs – a huge step forward. This study adds to the limited accounts of psychological interventions with men and contributes more widely to the ongoing discussion of gender-specific approaches to mental health. Results, implications and recommendations for future research are discussed.