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Cited by 339Digital Mental Health InterventionsMental Health Treatment and AccessHealth Literacy and Information Accessibility

Do online mental health services improve help-seeking for young people? A systematic review

Open access
Kauer, Sylvia Deidre, Mangan, Cheryl, Sanci, Lena·2014·Journal of Medical Internet Research
DOI 10.2196/jmir.3103PMC PMC3961801
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Abstract

BACKGROUND: Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. OBJECTIVE: This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. RESULTS: Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. CONCLUSIONS: Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found little evidence that online mental health services improve help-seeking in young people: no change was found in three RCTs, while cross-sectional studies suggested only about 35% of users were helped to seek professional help. Young people used and were generally satisfied with online services, but most included studies were low quality and help-seeking was rarely measured well.

Key findings

  • Across three RCTs, no increase in help-seeking or health service utilization was found for intervention groups compared with controls.
  • One quasi-experimental study found a slight but statistically significant increase in willingness to seek help, though post-test means were low to medium on a 10-point scale (female mean 5.04, male mean 4.39).
  • Cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users; mean “yes” responses were 38.4% (range 18%-53%) for Internet help-seeking behaviors and 34.9% (range 6%-75.8%) for using the Internet to seek professional help.
  • Only 22% (4/18) of studies used adequate measures of help-seeking, and the majority of studies were of low quality and likely to be biased; user experience was generally positive, with 90% satisfied, 86% would continue to use, and 72% would recommend to a friend.

Methods

  • Systematic review conducted per PRISMA guidelines and registered on PROSPERO (CRD42013003904), searching PubMed, PsycINFO, and the Cochrane Library for peer-reviewed English citations up to February 27, 2013.
  • From 608 publications identified, 18 studies met inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years.
  • Included studies were 2 qualitative, 12 cross-sectional, 1 quasi-experimental, and 3 RCTs; no statistical analyses were conducted due to heterogeneity, so a broad qualitative overview was reported.

Limitations

  • The paper states that only three RCTs were found, so a meta-analysis was not possible; including uncontrolled studies allowed a broad overview but limited certainty.
  • The paper reports that most included studies had small sample sizes, high proportions of female participants, help-seeking often as a secondary outcome, non-validated or limited measures, and high risk of bias.
  • The text also makes evident that many studies used self-selected samples, several were conducted by intervention developers or clustered within a few research groups/countries, and some services were primarily self-help websites rather than help-seeking interventions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.3103

Cites

93 of 93 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 149 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The mean percentage of young people answering "yes" to questions about use of the Internet to seek professional help across cross-sectional studies was 34.9% (range 6% to 75.8%).

    “and 34.9% (range 6% to 75.8%) respectively.”
    Quote in the paperNot a substantial claim
  • Findingown data

    No increase in help-seeking or health utilization was found in the three RCTs for the intervention groups compared to control groups.

    “There was no change in help-seeking behavior found in the RCTs”
    • Also stated in: § Primary Outcomes · plain
      “Overall, no increase in help-seeking or health utilization was found in the three RCTs for the intervention groups compared to control groups”
    Quote in the paperSubstantial claim
  • Findingown data

    The quasi-experimental study found a statistically significant increase in willingness to seek help.

    “the quasi-experimental study found a slight but significant increase in help-seeking.”
    • Also stated in: § Primary Outcomes · plain
      “There was a statistically significant increase in willingness to seek help (as listed in Table 3)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The mean percentage of young people answering "yes" to questions about Internet help-seeking behaviors across cross-sectional studies was 38.4% (range 18% to 53%).

    “The mean percentage of young people answering “yes” to these questions across studies was low, 38.4% (range 18% to 53%)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The 18 included studies comprised two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials.

    “Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed.”
    • Also stated in: § Study Characteristics · plain
      “Eighteen publications met the inclusion criteria including two qualitative [51,55], 12 cross-sectional [53,56,60,63,64,71-77], one quasi-experimental [68], and three randomized controlled trials (RCTs) [52,78,79].”
    Quote in the paperNot a substantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 43
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking.

    “Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Eighteen studies fulfilled the inclusion criteria.

    “Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years.”
    • Also stated in: § Summary · plain
      “leaving a total of 18 studies to review.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Sample sizes ranged from 9 to 2700, with median 420 and mean 762.3 (SD 838.10).

    “The sample sizes ranged from 9 to 2700: median 420, mean 762.3 (SD 838.10).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most commonly, the use of several programs and websites was investigated.

    “Most commonly, the use of several programs and websites [56,60,71,73,74,76] were investigated, such as online information sites, chat groups, self-directed online therapy, and forums.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The majority of studies identified in this review were of low quality and likely to be biased.

    “The majority of studies identified in this review were of low quality and likely to be biased.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the quasi-experimental study, post-test mean willingness to seek help was 5.01 for females and 4.39 for males, suggesting a low to medium score on the 10-point scale.

    “the post-test mean was 5.01 for females and 4.39 for males, suggesting a low to medium score on the 10-point scale.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean age of participants ranged from 16.5 to 26.2 years.

    “The mean age of participants for the studies ranged from 16.5-26.2 years of age.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Across all studies, young people regularly used and were generally satisfied with online mental health resources.

    “Across all studies, young people regularly used and were generally satisfied with online mental health resources.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of participants were students at a university or high school.

    “The majority of participants were students at a university [55,56,60,63,74,76] or high school [73].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Facilitators to help-seeking included accessibility to online resources, ease of sharing personal information, anonymity, trust and credibility, reduction of stigma, high distress, and increase in mental health literacy.

    “Facilitators to help-seeking included accessibility to online resources [51,53,55,71,74], the ease of sharing personal information compared to face-to-face services [74-76], anonymity [51,71,74,75], trust and credibility [53], reduction of stigma [55,68,79], high distress [55,73], and an increase in mental health literacy [53,68,74-79].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Ten studies targeted young people with mild to moderate mental health problems.

    “Within these settings, 10 studies targeted young people with mild to moderate mental health problems [52,53,55,63,64,68,72,75-77]”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only four studies included help-seeking as their primary aim, two of which were RCTs and two were cross-sectional studies.

    “yet only four studies included help-seeking as their primary aim, two of which were RCTs [52,78,79] and two were cross-sectional studies [53,63].”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The proportion of females in the studies ranged from 50% to 80%, with median 68% and mean 67.1% (SD 9.73%).

    “There were a high proportion of females in the studies, ranging from 50% to 80%: median 68%, mean 67.1% (SD 9.73%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Seven studies involved all young people regardless of mental health status.

    “and seven studies involved all young people regardless of mental health status [51,56,60,71,73,74,78].”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study focused on young athletes at risk of mental health problems.

    “one study focused on young athletes at risk of mental health problems [79]”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    A range of barriers and facilitators of help-seeking were mentioned in the articles, although these were rarely measured empirically.

    “A range of barriers and facilitators of help-seeking were mentioned in the articles, although these were rarely measured empirically.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fifty-five percent (10/18) of studies focused on participants who were 18 years of age or older.

    “55% (10/18) of studies focused on participants who were 18 years of age or older.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Barriers to help-seeking included lack of awareness, being male, a preference for face-to-face services, lack of motivation, uncertainty about confidentiality, and unfavorable content.

    “Barriers to help-seeking included lack of awareness [51,56,76], being male [68,71,73], a preference for face-to-face services [73,74], lack of motivation [51], uncertainty about confidentiality [74], and unfavorable content [64,76].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Young people's experiences with online services were investigated in 50% (9/18) of the studies.

    “Young people’s experiences with online services were investigated in 50% (9/18) of the studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Kim et al found that 75.4% of students indicated that screening enhanced their decision to see a professional.

    “The majority of students (75.4%) indicated that screening enhanced their decision to see a professional.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] source

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    Findingnone given

    All of these studies used from one to six questions, which were constructed by the authors.

    “All of these studies used from one to six questions, which were constructed by the authors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    No difference was found in help-seeking knowledge, ability to recognize depression, or intentions to seek help between different information eHealth cards [78].

    “No difference was found in help-seeking knowledge, ability to recognize depression, or intentions to seek help between different information eHealth cards”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Those who had previously sought online help rated all online mental health services higher than those who had not previously sought help [76].

    “Those who had previously sought online help rated all online mental health services higher than those who had not previously sought help [76].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    A small proportion of participants (4.7%) said that they used online mental health services because they believed it would be a good place to get initial information about mental health [74].

    “A small proportion of participants (4.7%) said that they used online mental health services because they believed it would be a good place to get initial information about mental health [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] source

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    Findingcitation

    Forum users believed the forum increased their knowledge and understanding of mental problems, health care services, their rights, and what they could expect from health services [75].

    “Forum users believed the forum increased their knowledge and understanding of mental problems, health care services, their rights, and what they could expect from health services [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] source

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  • The quote only partly states this claim.

    Findingcitation

    Gulliver et al found no difference in help-seeking between any of the intervention groups and the control group over time.

    “Gulliver et al [79] investigated the effects of three conditions of an Internet-based self-help program on help-seeking attitudes, intentions, and behavior and found no difference in help-seeking between groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Being part of the forum made users feel more pro-active, prepared, and goal-oriented with seeking help [75].

    “In addition, being part of the forum made them feel more pro-active, prepared, and goal-oriented with seeking help [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] source

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  • May combine two claims.

    Findingreasoning

    There was high variability in the measures used, and therefore the results are difficult to compare between studies.

    “There was high variability in the measures used, and therefore the results are difficult to compare between studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of studies included a comprehensive list of limitations.

    “The majority of studies included a comprehensive list of limitations”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Young people generally found the services easy to use and satisfactory.

    “generally found the services easy to use and satisfactory”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingcitation

    The majority of studies reported that the majority of participants were female.

    “majority of participants were female [51,56,60,64,68,79]”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [51] Bradley, KL, 2012, International Journal of Mental Health Promotion source

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    • cites [56] Feng, XL, 2011, Journal of Technology in Human Services source

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    • cites [60] Harris, K, 2009, Australian e-Journal for the Advancement of Mental Health (AeJAMH) source

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    • cites [68] source

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    • cites [79] source

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  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    At present, there is a paucity of research exploring the relationship between online services and help-seeking behavior.

    “At present, there is a paucity of research exploring the relationship between online services and help-seeking behavior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Online services appeared to increase mental health literacy [53,74-77,79], although two studies found no change in mental health literacy [68,78].

    “Another interesting finding was that online services appeared to increase mental health literacy [53,74-77,79], although two studies found no change in mental health literacy [68,78].”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [53] Collin, PJ, 2011, Advances in Mental Health source

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    • cites [74] source

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    • cites [75] source

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    • cites [76] source

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    • cites [77] Nicholas, J, 2010, Perspect Public Health source

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    • cites [79] source

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    • cites [68] source

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    • cites [78] source

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    Study design and conductnone given

    The first two authors used the Quality Rating Scale independently.

    “The first two authors used the QRS independently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review was conducted in accordance with PRISMA guidelines and registered on PROSPERO.

    “This review was conducted in accordance with PRISMA guidelines [46] and registered on PROSPERO (Prospero Registration Number: CRD42013003904)[47].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Liberati, A, 2009, Ann Intern Med source

      Not checked in the free run.

    • cites [47] KauerSDSanciLPROSPERO201302222014-01-03York, UKNational Institute for Health ResearchDoes e-mental health aid help-seeking for adolescents? A systematic reviewhttp://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD420130039046ML3o13dD

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Interrater reliability was assessed by Cohen's absolute weighted kappa statistic.

    “Interrater reliability was assessed by Cohen’s absolute weighted kappa statistic in Stata Version 12.0.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    No statistical analyses were conducted due to the heterogeneity of study designs permitted in the inclusion criteria.

    “No statistical analyses were conducted due to the heterogeneity of study designs permitted in the inclusion criteria.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Risk of bias within each study was assessed using an adapted Quality Rating Scale that included qualitative and uncontrolled studies.

    “Risk of bias within each study was assessed using a version (Multimedia Appendix 2) of the Quality Rating Scale (QRS) [48] adapted to include qualitative and uncontrolled studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Moncrieff, J, 2006, International Journal of Methods in Psychiatric Research source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Help-seeking is an important first step in improving mental health and accessing appropriate avenues of care.

    “Help-seeking is an important first step in improving mental health and accessing appropriate avenues of care [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Rickwood, D, 2005, Advances in Mental Health source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mobile self-monitoring is a useful tool.

    “and that mobile self-monitoring is a useful tool [41-43].”
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    • cites [41] source

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    Premisecitation

    Internet services have several advantages: no geographical boundaries, generally free to the user, and largely anonymous and private, which is likely to reduce stigma and embarrassment associated with seeking help.

    “Internet services have several advantages: no geographical boundaries, services are generally free to the user, and the Internet is largely anonymous and private, which is likely to reduce the stigma and embarrassment associated with seeking help [22].”
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    • cites [22] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mental health problems affect adolescents more than any other age group.

    “Mental health problems affect adolescents more than any other age group [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Young people have a strong desire for autonomy, believing they should solve problems for themselves.

    “Wilson and colleagues [21] identified that young people have a strong desire for autonomy, believing they should solve problems for themselves.”
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    • cites [21] source

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    Premisecitation

    Existing face-to-face services pose significant barriers for young people largely due to access, availability, and high costs, as well as reluctance due to stigma and embarrassment.

    “In addition, existing face-to-face services pose significant barriers for young people [10-16] largely due to access, availability, and high costs of these services [17], as well as the reluctance of young people to seek professional help due to stigma and embarrassment [18-20].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [10] source

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    • cites [12] Cohen, A, 2009, Youth Studies Australia

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    • cites [16] Sanci, L, 2010, Curr Opin Psychiatry source

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    • cites [17] Andrews, G, 2000, J Ment Health Policy Econ source

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    • cites [19] Jorm, AF, 2000, Br J Psychiatry source

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  • May combine two claims.

    Interpretationreasoning

    Online mental health services can provide interactive solutions to engage young people in a self-directed and anonymous way, thus assisting and supporting overburdened face-to-face services.

    “Online mental health services can provide interactive solutions to engage young people in a self-directed and anonymous way, thus assisting and supporting overburdened face-to-face services.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Internet has become a predominant source of health information, particularly for young people.

    “In the last decade, the Internet has become a predominant source of health information [3,4] particularly for young people [5,6].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [3] Eysenbach, G, 2002, JAMA source

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    • cites [6] Rickwood, DJ, 2007, Med J Aust

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The lack of change in help-seeking in the RCTs may have been due to small sample sizes, an active comparison group, mild mental health problems rather than severe symptoms, or participants having previously sought help or being currently in treatment.

    “The lack of change in these studies may have been due to small sample sizes, an active comparison group [52], mild mental health problems rather than severe symptoms [79], or the fact that participants had previously sought help or were currently in treatment [78].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [52] source

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    • cites [79] source

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    • cites [78] source

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    Study design and conductown data

    The adapted QRS ranged from 6 to 37 for both raters and had similar means (Rater 1 mean 19.5 [SD 7.45]; Rater 2 mean 20.2 [SD 8.66]).

    “The adapted QRS ranged from 6 to 37 for both raters and had similar means (Rater 1 mean 19.5 [SD 7.45]; Rater 2 mean 20.2 [SD 8.66]).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Seven studies [52,53,55,63,77-79] developed the intervention that they were evaluating, which may have led to a bias towards more favorable reporting.

    “Seven studies [52,53,55,63,77-79] developed the intervention that they were evaluating, which may have led to a bias towards more favorable reporting.”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [52] source

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    • cites [53] Collin, PJ, 2011, Advances in Mental Health source

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    • cites [55] Davis-McCabe, C, 2010, Counselling Psychology Review source

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    • cites [63] source

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    • cites [77] Nicholas, J, 2010, Perspect Public Health source

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    • cites [78] source

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    • cites [79] source

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    Study design and conductown data

    There was a bias towards affiliations with four organizations, with nine studies conducted within Australia compared to three in the United States, two in Canada, and one each in Germany, Ireland, Norway, and United Kingdom.

    “There was a bias towards affiliations with four organizations, with nine studies conducted within Australia compared to three in the United States, two in Canada, and one each in Germany, Ireland, Norway, and United Kingdom.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is a plethora of online services available with the aim of facilitating help-seeking for young people with mental health problems [80].

    “There is a plethora of online services available with the aim of facilitating help-seeking for young people with mental health problems [80]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] source

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    Study design and conductown data

    Interrater agreement was higher (89.8%) than the expected agreement (76.1%) with an acceptable kappa score (κ=.57, CI 0.32-0.82, P<.001).

    “Interrater agreement was higher (89.8%) than the expected agreement (76.1%) with an acceptable kappa score (κ=.57, CI 0.32-0.82, P<.001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The RCTs scored high from 31 to 37 by both raters.

    “and the RCTs scored high from 31 to 37 by both raters.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The quasi-experimental study [68] scored 20 by rater 1 and 29 by rater 2.

    “The quasi-experimental study [68] scored 20 by rater 1 and 29 by rater 2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    This finding suggests that online services fulfil a need, although perhaps do not increase help-seeking.

    “This finding suggests that online services fulfil a need, although perhaps do not increase help-seeking.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Including uncontrolled studies in this review allowed for a broad overview of research in this area to date.

    “Including uncontrolled studies in this review allowed for a broad overview of research in this area to date”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent study indicated that young men were generally high use Internet users [82] with 55% seeking help online.

    “A recent study indicated that young men were generally high use Internet users [82] with 55% seeking help online.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Despite the general satisfaction with online services reported, evaluation of satisfaction was poor.

    “Also, despite the general satisfaction with online services reported, evaluation of satisfaction was poor.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Only three RCTs were found, so a meta-analysis was not possible.

    “as only three RCTs were found, a meta-analysis was not possible”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The review focused on both help-seeking behaviors and intentions.

    “One of the strengths of this review was the focus on both help-seeking behaviors and intentions”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Intentions do not always translate into behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Some studies included were primarily self-help websites, therefore one would hope that further help-seeking was reduced rather than increased.

    “Some studies included were primarily self-help websites, therefore one would hope that further help-seeking was reduced rather than increased.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Short user satisfaction measures are available such as the validated Client Satisfaction Questionnaire (CSQ-3 or 8) [87], which summed together gives an understanding of client's satisfaction of the service.

    “Short user satisfaction measures are available such as the validated Client Satisfaction Questionnaire (CSQ-3 or 8) [87], which summed together gives an understanding of client’s satisfaction of the service.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] Larsen, DL, 1979, Eval Program Plann source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The primary aim of these services is to give young people information about mental health as well as facilitate help-seeking and pathways to mental health care [45].

    “The primary aim of these services is to give young people information about mental health as well as facilitate help-seeking and pathways to mental health care”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Cline, RJ, 2001, Health Educ Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Improvements in mental health literacy are likely to assist young people in recognition and management of mental health and may also reduce the self-stigma associated with mental illness [84].

    “Improvements in mental health literacy are likely to assist young people in recognition and management of mental health and may also reduce the self-stigma associated with mental illness [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Jorm, AF, 1997, Med J Aust source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent meta-analysis demonstrated that interventions with a focus on mental health literacy significantly improved help-seeking intentions, although no effect was found for help-seeking behaviors [86].

    “A recent meta-analysis demonstrated that interventions with a focus on mental health literacy significantly improved help-seeking intentions, although no effect was found for help-seeking behaviors [86].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    This is not to say that there is no benefit in online services, rather, that this field has yet to be properly evaluated.

    “This is not to say that there is no benefit in online services, rather, that this field has yet to be properly evaluated.”
    Quote in the paperNot a substantial claim
66 of 66

  • The paper relies on this without support.

    The 18 included studies are representative of the available literature on online mental health services and help-seeking in young people.

    “Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years.”

  • The authors state this as an assumption.

    Help-seeking was considered a goal of the studies included in the review.

    “it can be assumed that help-seeking was considered a goal of these studies.”

  • The paper relies on this without support.

    Structured online treatment programs have high dropout rates.

    “high dropout rates”

  • The paper relies on this without support.

    Intentions do not always translate into behavior.

    “as intentions do not always translate into behavior.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Friend-recommendation percentage is incorrect

    Minor

    Thirty-six of 94 participants is about 38.30%, not 38.90%.

    Reported 38.9 · recomputed 38.297872

  • Therapist-email preference percentage is incorrect

    Minor

    The stated fraction, 336 of 994, is about 33.8%, not 38.8%.

    Reported 38.8 · recomputed 33.802817

  • Female post-test mean differs between text and table

    Minor

    The prose gives a female post-test mean of 5.01, whereas Table 3 gives 5.04 for the same quasi-experimental study.

  • Neal et al is assigned to an Australian group despite its Canadian table entry

    Minor

    The bias assessment counts Neal et al [76] among two University of Sydney studies. Table 6 instead identifies its research group as the University of Western Ontario, Canada.

  • Forum-use percentage is inconsistent with its fraction

    Minor

    Nineteen of 165 participants is about 11.5%, not 6%.

    Reported 6 · recomputed 11.515152

  • Percentage learning where to get help does not match its fraction

    Minor

    The reported 872 of 1016 participants is about 85.8%, not 77%.

    Reported 77 · recomputed 85.826772

  • The studies counted as having a primary help-seeking aim differ

    Minor

    The Help-Seeking section calls the group two RCTs but lists three, including Clarke et al [52]. The Overview instead identifies [53,63,78,79] as the four studies with a primary help-seeking outcome.

7 of 7

Cites

Flagged first, then by citations

Research works printed but not linked: 12

  1. Rickwood, DJ, 2007, Med J Aust, 187, S35
  2. Christensen, H, 2010, Med J Aust, 192, S53
  3. Cohen, A, 2009, Youth Studies Australia, 28, 13
  4. Christensen, H, 2010, Med J Aust, 192, S2
  5. van Straten, A, 2010, Med J Aust, 192, S36
  6. Macdonald, E, 2003, Marketing Bulletin, 14, 1
  7. Tarafdar, M, 2008, Journal of Computer Information Systems, 48, 16
  8. Whitten, P, 2005, J Postgrad Med, 51, 294
  9. Van Voorhees, BW, 2009, J Cogn Behav Psychother, 9, 1
  10. Burns, JM, 2010, Med J Aust, 192, S22
  11. 10.2196/jmir.1864 · DOI · Paper page
  12. Calear, AL, 2010, Med J Aust, 192, S12

Cited by

Sorted by citations

Related

Authors
Kauer, S. D., Mangan, C., & Sanci, L.
Affiliations
The University of Melbourne (AU)
Corresponding author
Kauer, Sylvia Deidre
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2014-03-04
Volume
16
Issue
3
Pages
e66
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.3103
PMC
PMC3961801
OpenAlex
W2121693378
Semantic Scholar
7e13f31a3692ad91d44d3b3888fc1ad910206e5a
Cited by
339
References
93
Citations by year
2026: 21 · 2025: 25 · 2024: 24 · 2023: 29 · 2022: 36 · 2021: 44 · 2020: 40 · 2019: 29 · 2018: 28 · 2017: 14 · 2016: 29 · 2015: 12 · 2014: 8
FWCI
2.55
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Inspire Foundation
  • Young and Well Cooperative Research Centre
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
Keywords
online mental health services, help-seeking, youth, adolescents, help-seeking barriers, online mental health resources, user satisfaction
MeSH terms
Adolescent, Adult, Female, Humans, Male, Mental Health Services, Online Systems, Patient Acceptance of Health Care, Sex Factors, Internet, Young Adult, Information Seeking Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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