Understanding adolescent psychotherapy utilization in India: A mixed methods tertiary care center study

Abstract

Background

India faces a substantial mental health treatment gap, particularly regarding the underutilization of psychotherapy among adolescents. This mixed-methods study aimed to identify the barriers and facilitators influencing the uptake of psychotherapy for mental health issues among adolescents attending a tertiary care referral center in India.

Methods

A mixed-methods design was employed. Quantitative data were collected from 74 adolescents recruited via purposive sampling using standardized scales assessing attitudes toward seeking professional psychological treatment, self-stigma, perceived barriers to seeking help, and the working alliance. Qualitative data were gathered through focus group discussions to further explore barriers and facilitators of psychotherapy.

Results

Most participants were diagnosed with neurotic spectrum disorders and had no prior psychotherapy experience. Higher self-stigma and perceived barriers were associated with less favorable attitudes toward seeking psychotherapy, while a stronger working alliance was associated with more positive attitudes. Thematic analysis identified key barriers including stigma, apprehension, poor awareness, negative social influences, and reliance on informal support. Facilitators included greater mental health literacy, perceived symptom severity, and encouragement from informal networks. Urban adolescents reported stronger working alliances compared to their rural counterparts.

Conclusion

Findings highlight the need to address stigma, enhance mental health literacy, and consider contextual factors in service delivery.

Plain language summary

This study addresses the treatment gap in India regarding psychotherapy for adolescent mental health within a tertiary care setting. The research used a mixed-methods approach to explore individual and socio-contextual factors influencing help-seeking behaviors. Quantitative analyses of data from 74 adolescents, mainly urban females from nuclear families diagnosed with neurotic disorders and largely naive to psychotherapy, revealed negative correlations between attitudes towards seeking psychological treatment and both self-stigma and perceived barriers to help. Conversely, a positive correlation was found between working alliance and treatment-seeking attitudes. Qualitative data from focus group discussions corroborated these findings, identifying key barriers such as internalized stigma, apprehension about therapy, limited mental health literacy, negative social influences, and cultural preference for informal support. Facilitators included improved mental health literacy, perceived severity of symptoms, and encouragement from informal sources to seek professional help. Factors like gender, residence, and family history of mental illness did not significantly predict attitudes towards treatment or self-stigma; urban participants reported a stronger working alliance than rural ones. These findings emphasize the need for targeted interventions to destigmatize mental health issues and improve mental health literacy among adolescents and their social networks in India. Additionally, it calls for investigations into systemic barriers in the Indian mental healthcare system. Future research should focus on community-based studies to identify specific barriers across diverse socio-economic and cultural contexts, aiding the development of culturally sensitive psychological services for adolescents. The findings also suggest potential for interventions that leverage informal support networks and strategies to strengthen therapeutic alliances, especially for rural adolescents.