New Scales Assess Help-Seeking Barriers Among Suicidal Youth

Young people who have suicidal ideations (SI) are unlikely to seek help for a number of reasons. Research has shown that young adults with mental health problems such as depression or substance use issues may be concerned about the stigma associated with them and be reluctant to reach out to professionals or adults within their social network for assistance. For teens in high school, peer relationships influence their attitudes toward help seeking immensely. Teens that have accepting and supportive friends are more likely to share their burdens with adults than those who do not. Additionally, individuals with friends who have struggled themselves with mental health problems and SI are usually more willing to disclose their own SI than those individuals who do not personally know someone who has experienced similar difficulties. Another barrier to help seeking is trust. Teens who do not feel that their adult caregivers are trustworthy may avoid reaching out to other adults, such as teachers and medical professionals, in their time of need.

Karen Schmeelk-Cone of the Department of Psychiatry at the University of Rochester Medical Center in New York recognized this problem and along with her colleagues created three scales designed to measure Help Seeking Acceptability at School (HSA) and Adult Help for Suicidal Youth (AHSY) in over 6,000 teens from 22 high schools. An additional scale, the Reject Codes of Silence scale (RCS) was designed to identify how teens perceived the code of silence among peers. After evaluating the teens using all three scales, Schmeelk-Cone discovered that HSA revealed the strongest negative attitudes toward help seeking among the teens, demonstrating the importance of peer attitudes.

The teens that scored high on the HSA were also more likely to score high on the AHSY, which showed that they were less likely to share their SI concerns with adults if their peers had negative attitudes about help seeking. The researchers also found that the participants with the highest scores on all three scales had the poorest coping skills and were more likely to turn to negative strategies such as substance misuse to address their distress. Although these scales were only tested on adults and teens within a high school environment, the results provide evidence that these measures are useful in identifying barriers to help seeking for SI in teens. Schmeelk-Cone added, “These new scales can contribute to building needed models for understanding help-seeking processes among suicidal youth.”

Cone-Schmeelk, K., Pisani, A. R., Petrova, M., Wyman, P. A. (2012). Three scales assessing high school students’ attitudes and perceived norms about seeking adult help for distress and suicide concerns. Suicide & Life Threatening Behavior, 42.2, 157-172.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Emily Jane

    Emily Jane

    April 25th, 2012 at 6:24 PM

    I am not so far removed from being a teenager but I don’t remember letting other people have so much control over me, and so heavily influencing what I perceived to be right and wrong. I guess I have been lucky in that my parents aren’t divorced and overall I have had a very strong home life. I have a lot of friends just like me, and I’m not saying that we weren’t important to one another, we are and always will be. But all of us always had someone to go to at home too when we had doubts and questions. I guess I just thought that there were a lot more of us out there who were like that instead of always relying on friends and using peer pressure to make decisions about the things that we did. Maybe I am naive but I think that the way I was raised is the way it is supposed to be.

  • Laina


    April 26th, 2012 at 4:09 AM

    I am glad that there are some new measurements by which it can be predicted which tees could be the most at risk to commit suicide.
    But that in no way should replace just good old fashioned conversation with your teenager.
    they have to know that there are people that they can talk to no matter the situations and issues that they are facing.
    If they are feeling alone and like no one will understand them that is when you have to start looking very closely at their behavior to make sure they are not drowning in some place in life that they feel like they can’t be rescued from.
    Sometimes just sitting down and telling them that you care and that you understand can open those doors and keep them in a better place mentally.

  • Hans


    April 26th, 2012 at 11:26 AM

    Sometimes we get a little too caught up in the terminology. I see this as simply another tool for being able to more accurately predict those teens who could be in trouble with life and might need a helping hand. They are not being graded and graphed on a scale, but it does give some of us with very little background experience in this issue something relevant to look at when trying to determine if we have a friend in trouble who could use a little help. If we have a better idea of what things we should look for that could indicate trouble then we might make a difference for them that could help to save a life.



    April 26th, 2012 at 4:30 PM

    It very much concerns me that peers have so much of an influence over our children!
    We always think that we are doing everything that we can as parents but this is a huge wake up call that many times, if the information is not coming from someone their own age, our kids are barely paying attention to us at all.
    It is frustrating because I know how hard most of us work to be a good parent but yet it sometimes feels like with teenagers that we are talking to ourselves and banging our heads against the wall.
    I would really like to know how to get past that and have the kind of open and honest relationship with my kids that I want.

  • eric d

    eric d

    April 27th, 2012 at 8:26 AM

    sounds simple enough, the scales.but all these are the pillars of our social establishment.having friends who can lend you a shoulder to lean on when youre down are a rue gift,especially so now when almost everybody seems like they want to be friends for some benefit.

    good friends are hard to come by,so when you find one,don’t lose him/her!

  • Tara


    April 28th, 2012 at 6:24 AM

    Help seeking barriers? How when we find it okay to talk about just about anything, can there still be these sorts of barriesr to asking for help even in situations where we so clearly need it?! I know it’s hard to be an adolescemt, and you don’t want anyone thinking that you are different, but if we are the adults in these kids lives, then we really need to be the adults in their lives! We have to be willing to see what is going on and take charge when we see that there is a real problem.

  • LuAnne


    April 29th, 2012 at 4:47 AM

    Kind of depressing that lives are being lost just because there is a stigma attached to asking for help. We all need help from time to time in our lives, and the sooner we make an effort to tell everyne that it is ok to ask for that help when we need it, the sooner we can start tearing down some of the walls that prevent us from askinfg for the help that many of us so desperately need.

  • Karen Schmeelk-Cone

    Karen Schmeelk-Cone

    May 31st, 2012 at 9:41 AM

    I’m happy to see this paper getting some interest outside of suicide prevention researchers! Two clarifications: 1) we did not directly examine substance use in this sample – I believe we suggested that other research has shown that teens with SI are likely to misuse substances; 2)The sample used here were 9th-12th grade students – no adults. We have just had published online a further study with these scales examining whether SI students go to adults or peers for help, which basically shows that about half of students with SI will tell a friend, but only about a quarter will tell an adult. Additionally, those students with SI who have told an adult and tried to get help report levels of these scales similar to students without SI. (Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment. Journal of Youth and Adolescence. doi:10.1007/s10964-012-9766-7)
    For more on the intervention we’re examining to help increase help-seeking and break down codes of silence see the Sources of Strength program (

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