Gender specificity of psychological help-seeking among Russian adolescents

Plutov Leonid Evgen'evich ORCID: 0000-0003-1270-4227 Postgraduate student, Department of Applied and Industrial Sociology, St. Petersburg State University 199034, Russia, Saint Petersburg, Saint Petersburg, nab. University, 7/9 le.plutov@yandex.ru

Introduction.

One of the key issues of studying social practices of caring for a person's mental health is the phenomenon of appeal and non-appeal for psychological help. The acuteness of this problem is justified by a number of empirical studies, according to which social risk groups most in need of professional intervention are less likely to be able to apply and receive qualified psychological assistance ^{[17, 293]}. One of these groups is traditionally performed by teenagers aged 14-17. According to the results of various studies, on average only 25% of adolescents seek psychological help in case of psychoemotional problems ^{[14, 711]}. Approximately with the same probability (33%), adolescents with observed and diagnosed mental disorders seek professional help ^[11]. In particular, adolescents suffering from the most common disorder at this age – depression, tend to seek the help of a specialist in 15-36% of cases ^{[9, 2]}. Thus, the results of empirical studies in various societies demonstrate a negative trend in which, on average, three quarters of adolescents are not ready to seek psychological services and remain without proper assistance.

This phenomenon is becoming an urgent, social and global problem, recognized, among other things, by the World Health Organization (WHO), since the lack of external assistance and intervention is a risk factor for the further development of a teenager. The presence of unresolved psychological difficulties and mental disorders has a negative impact on the well-being and social activity of a teenager, creates risks for the realization and safety of his future life, educational and career trajectories ^[15-18]. The likelihood of suicidal behavior and suicides, which are among the three most common causes of adolescent mortality, also increases, according to WHO statistics. In response to these risks, the importance of psychological services and complex systems of psychological assistance increases, the work of which is aimed at preventive and educational activities, including an increase in the number of appeals among adolescents who face problems in the field of mental health.

The relevance of the problem of adolescents seeking psychological help can be clearly traced not only in the world, but also in the Russian context. Starting from 2019-2020, this problem has become more often in the attention of domestic researchers, in particular, who studied the problems of mental health of adolescents in the context of factors of their seeking professional help ^[6], the formation of a need for it ^[4], the specifics of certain narrow groups of adolescents in need of socio-psychological support ^[7]. In addition, a request for information and analytical research in this area is being formed and implemented, differing in a quantitative strategy using a representative gender and age sample of Russian adolescents. The issues of scaling up and improving the effectiveness of the psychological assistance system in the Russian Federation, in particular, in relation to target groups of adolescents, are also becoming the object of lawmaking and state policy.  The priority of these tasks was reflected in the statements of the President of the Russian Federation V. V. Putin during the II Congress of Young Scientists in 2022. Among other things, activities in the field of scaling up psychological services in educational institutions are being intensified, further elaboration of the Federal Law "On Psychological Assistance in the Russian Federation" is underway. In addition, the private sector also seems to be a promising source of professional psychological assistance to adolescents, which has grown in the Russian market by about 63% in 2022, according to data from services for the selection of psychologists and personnel in general.

Thus, the study of the practices of Russian adolescents in the field of psychological assistance is an urgent scientific and applied task in the Russian context. Nevertheless, at the moment there is insufficient elaboration of the problem of adolescents seeking psychological help in the domestic literature. Considering that almost all of the available works are written based on the results of studies with a private non-reproducible sample, the importance of large-scale quantitative studies that can form a comprehensive understanding of adolescent practices and attitudes in the field of mental health on the scale of the Russian Federation increases. In addition, segmentation of target groups on the basis of key factors of seeking psychological help seems to be a significant applied task necessary for subsequent work with adolescents: one of the most significant and, at the same time, observed indicators is recognized as the gender of a teenager ^[12]. According to a number of foreign studies, gender-sex differences can be traced not only in the frequency of requests for specialist help, but also in the willingness to commit it, the choice of specific sources of psychological assistance, the prevalence of gender-specific psychological problems, the level of awareness in the field of mental health, as well as traceable social attitudes towards specialists, other sources of assistance, taking care of their own psychological health ^[16][19].

The purpose of this article is to identify the gender–sexual specifics of the appeal for professional psychological help among Russian adolescents.

Theoretical framework.

The phenomenon of "seeking psychological help" is conceptualized by the generalized definition of D. Rickwood and K. Thomas, interpreting it as "an adaptive coping mechanism, which is an attempt to obtain external assistance in coping with a problem related to mental health" ^{[5, 92]}. One of the key characteristics of this dynamic process is the sources of psychological assistance – formal, represented by mental health specialists (psychologists, psychotherapists, psychiatrists) and informal, represented by parents/guardians of a teenager, his family members, friends and peers, teachers, as well as other significant adults. In addition, the use of the model developed by D. Rickwood and K. Thomas explains the importance of studying other formal characteristics of the process of seeking help (the period of the last appeal, the psycho–emotional request and the type of assistance received), as well as the variety of subjectively assessed factors, including the quality of the assistance received, the initiative of the appeal, the attitude to psychological assistance in general and others .

The empirical research is implemented within the framework of the paradigm of "constructivist structuralism" by P. Bourdieu and the theory of structuration by E. Giddens: the methodological consensus on the traditional "agent – structure" dichotomy proposed by these authors allows us to describe and explain the appeal of adolescents for psychological help as a complex social phenomenon, which is the result of both the internal "actor" of the subject (his intentions readiness to receive psychological help, the steps taken to receive it), and the influence of external structures incorporated in the form of "habitus" ^[2]. In the theory of structuration by E. Giddens, structural factors also act as an internal rather than an external condition of human activity ^[3].  Thus, this approach avoids the heuristic difficulties of measuring external, objective structural configurations, which are often inaccessible in sociological research, instead opening up the possibility of analyzing the internal manifestations of structures in adolescents' access to specialist services, internalized in the concept of their "social attitudes" in relation to psychological assistance.

The social attitudes of Russian adolescents towards the institute of psychological assistance are considered mainly in the tradition of I. Hoffman's theory of stigmatization within the framework of the sociology of mental health. The original definition of stigma as "stigma, an undesirable departure from social expectations" is used in determining the prevalence of stigmatizing attitudes towards recipients of psychological and psychiatric care that form a negative image of seeking it ^[10]. It is social stigma that is the most studied barrier of appeal in the array of literature and research, the object of which was teenagers ^{[17, 293]}. According to them, the presence of stigmatizing attitudes can not only significantly increase the time required for a teenager to contact a specialist to resolve his own psycho-emotional problems, but also form the phenomenon of "self-stigmatization" of a teenager associated with a sense of shame and fear of social condemnation in case of seeking help from a psychologist. Another conceptual model used in this study and also based on I. Hoffman's theory of stigmatization is P. Best's model of online sources of psychological help, according to which the stigma perceived by adolescents also determines their tendency to seek help on the Internet through low-threshold online psychological help services ^{[8, 1068]}.

It is important to note that, theoretically, the study is not based on a gender approach in sociology. Gender, in turn, does not act as a key perspective of analysis, but as an empirical marker demonstrating the influence of other latent variables on the appeal of adolescents for psychological help – the peculiarities of gender socialization, gender differences in the perception and resolution of their own psycho-emotional problems, the problems themselves, more characteristic of girls and boys aged 14-17, etc. Thus, the socio-demographic factor of gender does not serve as a tool for an exhaustive interpretation of the trends of adolescents seeking psychological help, but provides interesting comparative statistics: based on it, it seems possible to form new hypotheses about gender differences in the search and receipt of psychological help by Russian adolescents.

Methodology.

The empirical study of the appeal of adolescents of the Russian Federation for psychological help has become one of the tasks of the comprehensive sociological study "Teenagers 360°", implemented within the framework of the strategic program "Teenagers of Russia" of the Commissioner for the Rights of the Child under the President of the Russian Federation. The collection of field data was carried out in June-September 2022 with the participation of the Resource Center "Center of Applied Sociology" of St. Petersburg State University and the Sociological Clinic of Applied Research of St. Petersburg State University: the author of this article participated in all stages of the project, the use of data is coordinated with the research team.

The object of the quantitative study was adolescents aged 14-17 years, living on the territory of 85 subjects of the Russian Federation (at the time of the study). The subject of the study is the social practices and attitudes of adolescents in the field of taking care of their own mental health and receiving professional help. The method of data collection is an online survey. The study sample is quota-based, clustered, representative by gender, age, number of adolescents in the federal districts of the Russian Federation and types of settlements, as well as their gender and age distribution in each of the federal districts: the quota task is presented in Table 1. The distributions are based on federal population statistics data from January 1, 2022. The total sample size was 17,000 respondents (confidence interval – 1%, confidence probability – 99%).

Table 1. Quota distribution of the sample population, %

The sample is improbable, since it was formed through an online mailing list and the placement of links to the online survey. The survey was distributed by regional executive authorities and civil associations, in particular, children's public councils under the commissioners for children's rights in the constituent entities of the Russian Federation and regional ministries/committees/departments of education. The survey toolkit devoted to various aspects of adolescents' seeking psychological help contained a variety of nominal and ordinal scales. The study was conducted according to the ethical standards of conducting sociological research with the participation of children, which was voluntary and anonymous. In addition, at the stage of developing the toolkit, special attention was paid to creating a comfortable language and communication with the respondent, their orientation to the target group of adolescents.  Processing and analysis of the received data was performed in IBM SPSS Statistics. Within the framework of this article, the results of the study revealed by one-dimensional frequency analysis are presented.

Results.

First of all, coping strategies were identified, which are used by adolescents in case of personal or emotional difficulties (Fig. 1). Half of the adolescents of both sexes who participated in the study use the strategy of seeking support from relatives: parents or siblings. There is also a widespread request for support from the immediate environment: friends, classmates, - from a third of respondents (35% for girls, 28% for boys). At the same time, about a third of adolescents of both sexes do not seek support and do not use alternative ways to cope with psychoemotional difficulties without sharing their experiences. It is noteworthy that boys are more likely than girls (30% vs 25%) to choose a strategy of not turning for someone's help, and also slightly more likely to seek advice from an older environment that is not a close relative: mentors, teachers (5% for girls, 7% for boys). Girls are much more likely (10%) than boys (2%) prefer to keep a diary (in any format) as a way to cope with psychoemotional stress. On the Internet, both boys and girls are looking for support equally often (9% for both sexes); about 1/10 of the respondents use such a coping strategy.

Figure 1. Distribution of respondents' answers to the question: "If you suddenly have some personal or emotional difficulties in your life, how do you most often try to cope with them?" (in % of the number of respondents, multiple choice)

A separate coping strategy was an appeal to a specialist in the field of psychological health - in particular, to a psychologist. In this case, seeking psychological help is considered as a sustainable social practice, accepted by a teenager and a scenario available to him for resolving his psychoemotional difficulties. The differentiation of the results by gender was confirmed: girls are much more likely (5%) than boys (2%) to choose an appeal to a psychologist as a coping mechanism.  In general, the age group tends to seek support from close associates, both within the family and among friends, in a third of cases – to use a strategy of silencing and/or ignoring psychoemotional problems. The overall results demonstrate that at the moment the practice of contacting a psychologist or other specialist in the field of mental health has not found widespread use in the daily life of Russian teenagers, especially young men.

As a consequence, this thesis is supported by statistics on the experience of seeking psychological help among Russian adolescents (Fig. 2). The vast majority of respondents had no relevant experience. At the same time, girls twice as often (19%) as boys (10%) had experience of seeking psychological help at least once.

Figure 2. Distribution of respondents' answers to the question: "Have you ever asked for psychological help in your life?" (in% of the number of respondents)

With regard to the reasons for not seeking psychological help, there are a number of curious trends (Fig. 3). Thus, adolescents are more likely to assess their condition as not requiring the help of a specialist, and young men claim such a reason for not seeking psychological help more often than girls (61% for girls, 76% for boys). Also, among 1/5 teenagers, there is a widespread opinion about the need to independently resolve emerging problems of a psychoemotional nature. Boys are more likely than girls to believe that they do not need help at all, and girls, in turn, are slightly more likely than boys to be convinced of the need for self-resolution of problems (20% for girls, 19% for boys). Also, girls are much more likely (17%) than boys (6%) to declare the high cost of psychologist services as a reason for non–conversion, and more often than boys (14% for girls, 5% for boys) - ignorance of available sources and services of psychological assistance to adolescents. The stigmatization of seeking help (the variants "I will be laughed at for this" and "Then it will probably have a bad effect on my life somehow") is poorly spread among teenagers of both sexes.

Figure 3. Distribution of respondents' answers to the question: "Please tell me why you have never contacted a psychologist?" (in% of the number of respondents)

Thus, among the declared reasons for not seeking psychological help, the conviction that there is no need for professional help stands out extremely. Taking into account the low prevalence of the experience of seeking psychological help, as well as the coping strategies of modern adolescents, among whom a third is silencing and/or ignoring their problems, the question is raised about the level of self-diagnosis of adolescents – the ability to correctly identify the symptoms of a mental disorder and assess the need for external intervention by a specialist. In general, the difficulties of recognizing the need for help and self–diagnosis of deviations as a probable cause of non-recourse for help are more characteristic of young men, while girls significantly more often noted instrumental reasons for non-recourse - lack of funds, awareness of the possibilities of receiving help, the degree of freedom and control from the family.

Interestingly, among those with experience of contacting a psychologist, girls were much more likely than boys to turn to a psychologist on their own initiative (Fig. 4); 45% of boys, on the contrary, stated that the experience of external intervention and therapy was the result of the instruction or decision of another person – parents, teachers, social and medical workers, etc. The results make it obvious that the practice of seeking psychological help among girls is more widespread, including due to their greater awareness of the need for specialist help and initiative in obtaining it. In turn, young men are more often convinced that there is no need to attract the services of a psychologist. The reverse hypothesis is also likely, according to which the experience of independent, autonomous interaction with a specialist, which is more characteristic of girls, increases the success of both the treatment itself and the subsequent formation of a strategy for visiting a psychologist on a regular basis, as an accepted and implemented social practice of caring for one's own mental health.

Figure 4. Distribution of respondents' answers to the question: "Is going to a psychologist your personal initiative?" (in% of the number of respondents)

The subjective assessment of the effectiveness of contacting a specialist in the field of psychological health was also measured. Adolescents often mention that there is a different degree of improvement in their condition: for example, for a third of adolescents of both sexes, large positive changes in their initial treatment situation are obvious (31% for girls, 29% for boys), for a fifth of respondents – minor improvements in the problem situation (22% for girls, 18% for boys boys). Interestingly, boys are more likely than girls to note the complete resolution of the problem (18% for girls, 32% for boys), which may be due to many factors that cannot be reliably indicated with the help of these statistics. Despite the fact that the situation has not changed for 24% of girls and 17% of boys, and the situation has worsened for about 5% of respondents of both sexes, it is impossible not to talk about positive trends in providing psychological assistance to adolescents.

Figure 5. Distribution of respondents' answers to the question: "In your opinion, did contacting a psychologist help you" (in% of the number of respondents)

In the final block of questions devoted to the attitudes of adolescents to receive various types of psychological assistance, their attitude to its sources and role in general, respondents were asked to express their agreement or disagreement with a number of statements (Fig. 6). First of all, the results of the study suggest that there is no mass stigmatization of psychological assistance, as well as its recipients in the consciousness of Russian teenagers. At the same time, it is important to note that among adolescents who are under the negative influence of stigma, young men are much more likely to be biased towards specialists in the field of psychological health (12% for girls, 22% for boys) and people receiving psychological help (10% for girls, 22% for boys). The following is also interesting: there is an approximate parity of opinions in relation to statements about private and school psychologists, while teenagers are not inclined to consider state psychological assistance inferior in quality of services to private specialists. Girls, however, are less likely to trust school psychologists (59% for girls, 47% for boys) and state psychological assistance (45% for girls, 37% for boys) than boys. Thus, the sexual specificity of Russian adolescents is noticeable in the issues of trust and stigmatization of 4 out of 5 dimensions of psychological assistance. Neither obvious prejudices nor significant gender differences are observed in the attitude of adolescents to psychological assistance provided remotely. This trend partly refutes the conceptual model of P. Best, according to which the orientation to remote assistance is more characteristic of young men who are more often faced with situations of stigmatization of psychological assistance. However, it can also speak about equal opportunities for young men and girls to access digital tools of psychological assistance and the possibility of their dissemination among target groups of adolescents facing barriers to seeking face-to-face help: for example, low-mobility adolescents, residents of rural settlements without medical/psychological institutions, etc.

Figure 6. Distribution of respondents' responses to the question: "Below we have compiled several statements about psychological assistance. Please assess how much you can agree or disagree with them" (in % "rather agree" and "absolutely agree" to the number of respondents)

Conclusions and discussion

The results of the study demonstrated that girls and boys aged 14-17 are really characterized by different social attitudes and scenarios of seeking professional psychological help. In general, the female part of the sample demonstrates high rates of seeking help – both in the form of primary contact with psychological services, and in the form of a stable coping mechanism for the prevention and resolution of problems in the field of mental health. In addition, Russian girls aged 14-17 are also more characterized by an active position and their own initiative in seeking and receiving external assistance, signs of its destigmatization and habitualization in the framework of everyday life. The observed reasons for girls not seeking psychological help, on the contrary, are less often associated with internal factors (awareness of the need for external help, readiness to receive it, stigmatization and self–stigmatization) and more often - rather with external, instrumental reasons related to awareness of psychological services and their availability. The prevalence of seeking psychological help among young men, in turn, is significantly lower, which may correlate rather with internal, individual psychological factors of readiness for external intervention, as well as stigmatizing social attitudes towards professional psychological help.

However, the validity of these hypotheses needs to be confirmed in the course of subsequent empirical studies. It is important to understand that the comparative results obtained suggest that the sexual factor in the appeal of adolescents for psychological help, although it is a visible predictor of it, is itself determined by other latent variables. In particular, these are the factors of adolescent literacy in the field of mental health and the stigmatization of psychological care in general. Thus, the results of similar studies prove that girls are more likely to show better indicators of literacy and awareness in this area than boys ^[13]. The factor of low awareness and literacy in relation to one's own psychological health also tends to be closely intertwined with manifestations of stigma in relation to seeking psychological help. Studies of this problem on a sample of the adult population demonstrate that men in general are more negative about professional psychological assistance and are less able to determine both the manifestations of psychological/mental disorders and the moment when they need to be resolved: these phenomena are also associated with manifestations of masculinity (in particular, in the need for greater autonomy and independently solving their own difficulties) and the femininity of the individual, as well as social attitudes towards external assistance, laid down in the course of gender socialization ^[1]. Thus, the continuation of scientific research in this area may consist in a focused verification of the factors of mental literacy and stigmatization among Russian adolescents of both sexes.

In conclusion, it is also necessary to remember the applied significance of such studies to ensure equal access to psychological assistance for adolescents of the Russian Federation and the effective resolution of their psycho-emotional problems. What is important here is the subjective assessment by adolescents of the results of external intervention, which, according to the data, is also characterized by differentiation by gender. Mechanisms for improving the quality of psychological work with girls who are more often faced with unsatisfactory results of their treatment, as well as the effectiveness of preventive and educational work with young men aged 14-17 years, experiencing mainly socio-psychological difficulties in seeking help, are also recommended to be developed on the basis of future sociological and psychological studies of this issue.