title: Help-seeking behaviour for internalizing problems: perceptions of adolescent girls from different ethnic backgrounds.
abstract: OBJECTIVE
  Although adolescent girls from ethnic minorities are at an increased risk of internalizing problems (e.g. depression), only a small fraction seeks formal help for these problems. To enhance help-seeking for internalizing problems among ethnic minority adolescent girls, insight into their help-seeking behaviour is required. This study explored the perceptions of adolescent girls from different ethnic backgrounds regarding their help-seeking behaviour for internalizing problems.
  
  
  METHODS
  A qualitative study using focus group discussions (FGDs) was employed. Eight ethnic-specific FGDs were conducted with 50 adolescent girls of mostly Turkish (n=23), Moroccan (n=13), and Dutch (n=10) backgrounds recruited in Rotterdam, a multicultural city in the Netherlands. FGDs were conceptually framed within a help-seeking model, facilitated by a vignette and analysed using NVivo software.
  
  
  RESULTS
  When describing the internalizing problems presented in the vignette, participants of non-Dutch FGDs tended to state the causes of the problems (e.g. lack of attention) whereas participants of Dutch FGDs mentioned the emotional state. Participants did not perceive the presented internalizing problems as severe. If participants were to face internalizing problems of their own, their decision to seek help would be hampered by negative attitudes towards professionals and school-based services. Particularly in non-Dutch FGDs the fear of parental and friend's reactions was identified as a barrier. Participants identified their mother and a good friend as primary sources of help.
  
  
  CONCLUSIONS
  In this study, adolescent girls of Turkish, Moroccan and Dutch backgrounds had difficulty recognizing the severity of internalizing problems, and various barriers could hamper their decision to seek help. To enhance utilization of mental health services by youth, promoting a change in their attitudes towards mental health/school-based services is recommended. Guaranteeing confidentiality within school-based services, and training for professionals in communicating with adolescent girls, may also prove beneficial. In ethnic minorities, tackling the negative reactions of family/friends requires attention.
authors.affiliation: a Deparment of Public Health , Erasmus University Medical Centre , Rotterdam , The Netherlands.
authors.forename: Ilse Johanna Elisabeth
authors.initials: IJ
authors.lastname: Flink
authors.forename: Tinneke Monique Josef
authors.initials: TM
authors.lastname: Beirens
authors.forename: Dick
authors.initials: D
authors.lastname: Butte
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D000293:Adolescent; D003863:Depression / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D033062:Friends / Q000208:ethnology / Q000523:psychology; D006801:Humans; D008913:Minority Groups / Q000523:psychology*; D054525:Minority Health / Q000208:ethnology*; D008960:Models, Psychological; D009018:Morocco / Q000208:ethnology; D009034:Mother-Child Relations; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D036301:Qualitative Research; D014421:Turkey / Q000208:ethnology