Rodgers' Evolutionary Concept Analysis: Mental Health Help-seeking for Adolescents
Article information
Abstract
Purpose
This study conducted a concept analysis of mental health help-seeking among adolescents using Rodgers’ evolutionary approach to analyze the concept.
Methods
This concept analysis employed Rodgers' evolutionary framework and conducted a comprehensive literature review across multiple databases including PubMed, Web of Science, CINAHL, PsycARTICLES, EMBASE, and RISS spanning from 1991 to 2025. The search strategy utilized population-related terms ('adolescent' OR 'school-aged student') combined with concept-related terms('mental health help-seeking' OR 'mental health help-seeking behavior') to identify relevant literature. Finally, 24 relevant literatures were selected.
Results
Mental health help-seeking is a psychological construct encompassing several attributes, including facing difficulty in seeking help, disclosure to reference group, selection of help sources, and engagement with the service. This trait is influenced by various antecedents, including emotional crisis, recognition of the need for help and awareness of mental health resources. The consequences of mental health help-seeking are improved coping skills, social support and stigma.
Conclusion
This study presents a definition of the concept by deriving attributes and indicators and providing basic data for future scale development and organizing nursing intervention programs for adolescent mental health.
INTRODUCTION
Mental health challenges significantly impact adolescent development by contributing to impairments across psychological, academic, social, and family domains, yet despite their prevalence and serious consequences, these conditions frequently remain untreated [1]. Adolescents worldwide demonstrate considerable reluctance to pursue professional mental health services when experiencing psychological distress and mental health disorders [2]. Adolescent and adult mental health help-seeking behaviors differ significantly across developmental dimensions. Emotional maturity disparities create fundamental differences in how adolescents approach help-seeking, as they exhibit greater emotional volatility in their relationships with authority figures, including mental health professionals, and tend toward crisis-driven rather than preventive help-seeking due to ongoing prefrontal cortex development [3]. Institutional and legal constraints require adolescents to obtain parental or guardian consent for long-term treatment or medication prescriptions, creating additional steps and potential barriers for those seeking help. Independent access also shows significant differences. While mental health services for adolescents include school coun-seling offices, youth counseling and welfare centers, and Wee centers, actual utilization rates remain limited due to a lack of awareness about services, accessibility issues, and concerns about stigma [4]. Research indicates that while approximately 20% of adolescents experience significant mental health problems, only about 60% of these individuals receive any treatment, compared to roughly 75% of adults with similar severity conditions [5].
The collectivist nature of Korean society has a complex impact on adolescents’ help-seeking [6]. While support from family or community can be a strength, cultural norms such as the belief that “family problems should not be disclosed outside” and concerns about saving face may cause hesitation in seeking help [7].
Concept analysis provides a foundation for developing theories about phenomena and developing the knowledge base of academics by defining the complex and ambiguous real world more clearly [8]. To understand a new concept that is little known, concept analysis is useful, but the subject of this study, mental health help-seeking for adolescents, is thought to be a concept that was mainly used for adults and applied to adolescents according to the trend of the times. The concept of adolescent mental health help-seeking continues to evolve with changing times. This is due to the emergence of new help-seeking methods in the digital age, including online counseling, telehealth, and mobile apps [9]. Additionally, the meaning and scope of the concept are expanding alongside changes in social awareness. Since adolescence itself is a period of rapid change and growth, the concept also changes according to developmental stages. Furthermore, social perceptions of mental health are gradually shifting.
Rodgers [10] stated that nursing phenomena are not static but constantly changing, and that concepts should be defined flexibly according to the times because they are contextual rather than universal and absolute. Thus, Rodgers' evolutionary concept analysis method was judged to be more appropriate in this study.
This study aims to present a definition of the concept by deriving attributes and indicators through concept analysis using Rodgers' evolutionary concept analysis method, and to provide basic data for future tool development and organizing nursing intervention programs for adolescent mental health.
METHODS
1. Study Design
This study attempted a concept analysis of mental health help-seeking by applying the method described by Rodgers’ evolutionary approach [10].
2. Concept Analysis Process
To confirm the content agreed upon in the concept of mental health help-seeking behavior for adolescents, we proceeded sequentially according to the procedure suggested by Rodgers [10] and repeated each step if necessary. The specific process is as follows.
• Check the concept of interest and related expressions including proxy terms.
• Check and select an appropriate scope for data collection.
• Collect related data to identify the properties and contextual basis of the concept.
• Analyze data in relation to the characteristics of the concept.
• Identify cases in which the properties, antecedents, and consequent factors of the concept appear.
• Suggest hypotheses and implications of the concept for concept development.
To confirm the properties and contextual basis of the concept according to these steps, the concept of ‘mental health help-seeking’ was included and ‘help-seeking’ was determined as a related term and search term. The reason for determining ‘help-seeking’ as a related term is that the intention and behavior for asking for help were mentioned together when defining help-seeking, so it was determined to be an appropriate related term for this study. Additionally, there are several concepts closely related to mental health help-seeking. Still, the results of the literature review show that these concepts also appear as attributes, antecedents, and outcomes. Hence, this study aimed to approach the attributes by focusing on the essence and the context in which these concepts are connected to the attributes of mental health help-seeking.
3. Data Sources and Data Collection
This study was limited to literature from 1991 to December 2025 based on the time when the term related to ageism was first used, and the concept that has evolved based on multidisciplinary literature was confirmed [11]. For the analysis, the literature search was conducted from March 20 to April 20, 2025, using all fields in the following databases: PubMed, Web of Science, CINAHL, PsycARTICLES, EMBASE, and RISS. Terms related to population are ‘adolescent’ OR ‘school-aged student’. And terms related to the concept are ‘mental health help-seeking’ OR ‘mental health help-seeking behavior’. Initial codes were generated inductively through line-by-line analysis of articles. Three researchers independently coded the articles, then met to compare codes, discuss discrepancies, and establish consistent coding criteria. Through consensus discussions, the research team refined code definitions and boundaries. Inter-rater reliability was maintained through ongoing double-coding articles throughout the analysis. Weekly team meetings were held to discuss emerging codes and resolve discrepancies through consensus. Researcher triangulation was achieved by incorporating perspectives from team members with different disciplinary backgrounds (Nursing, Education) with each researcher independently developing preliminary themes before collaborative synthesis sessions. A formal codebook was developed containing definitions and inclusion criteria for each code. Additionally, a thematic matrix was created to map the relationships between codes and themes, illustrating how individual codes contributed to the themes and their connections to the conceptual framework of mental health help-seeking.
The inclusion criteria for the literature in this study consisted of the following: (1) were written in Korean or English, (2) provided full text, and (3) detailed the concept and characteristics of mental health help-seeking for adolescents. The exclusion criteria were: (1) did not explain the concept, and (2) were conference presentation materials.
Literature selection was performed by sequentially reviewing the search terms, titles, abstracts, and full texts. In total, 842 abstracts were identified during the initial search. Among these, 408 duplicate papers were removed, resulting in 434 extracted literature sources. Next, 229 non-academic papers including books, dissertations, and poster presentations were excluded, yielding 205 papers. Subsequently, through examination of titles and abstracts, 102 literature sources judged to diminish the representativeness of the concept were excluded, extracting 103 literature sources. Finally, after thoroughly reading the 103 literature sources and excluding 79 papers whose conceptual attributes could not be identified, a total of 24 articles were finally selected, comprising 11 Korean and 13 English literature sources (Figure 1). The final sample of publications consisted of 24 articles (Table 1).
Flow of study selection.
A Matrix of Reviewed Literature Related to Mental Health Help-Seeking for Adolescents
RESULTS
1. Definition of the Concept
Clarifying meaning enhances conceptual understanding, but this meaning must be situated within its historical and cultural context. Rodgers' evolutionary concept analysis was developed by nurses to advance nursing knowledge and has a sound philosophical foundation. Its frequent use in nursing research over time establishes a solid methodological foundation for this study [10].
Mental health help-seeking refers to the process by which individuals seek assistance or support for mental health concerns, either from professional sources like psychologists, psychiatrists, counselors or informal sources like family, friends, or peer support groups. Especially for adolescents, it can be defined as a complex, multi-dimensional, and developmentally influenced process whereby adolescents recognize a mental health problem, make decisions about addressing the problem, select and access potential sources of support, disclose their concerns, and engage with services to address their mental health needs [12].
2. Defining Attributes
Defining the attributes of a concept can establish a clear definition, which is essential for its characteristics [9]. Moreover, defining attributes is fundamental to concept analysis because it provides the insight for a concept [10]. The identified attributes of mental health help-seeking were Recognition of the need for help, Selection of help source and Engagement with service (Figure 2).
Mental health help-seeking for adolescent concept components.
1) Facing difficulty in seeking help
The antecedent of mental health help-seeking is Facing difficulty for seeking help. Seeking help for mental health issues is often hindered by a variety of barriers. While some obstacles are common across age groups, notable differences exist in how adolescents and adults experience and respond to these barriers [13]. Social prejudice and stigma from peers represent significant barriers that prevent young people from accessing mental health services when they need them most [14]. In literature, norms and attitudes within the larger cultural context, gender norms, uncomfortable sharing personal information with strangers are attributes mostly related to peer relationships [1,15,16]. It is thought that an important reason why peer group prejudice appears as a characteristic more than in adults is because the peer group is an important factor for adolescents. Adolescents face unique challenges in seeking mental health help, including fear of being judged or labeled by peers [16], as well as internalized shame. Individuals often prefer to handle problems on their own and may see help-seeking as a sign of weakness [2,16], compared to adults who believe their issues are not serious enough to warrant professional help, comparing themselves to others perceived as worse off. Furthermore, adolescents worry about whether their disclosures will remain confidential, which can prevent individuals from seeking help [17]. And they struggle to identify or articulate their mental health problems [3], leading to delays in seeking help while adults encounter many of the same barriers, their experiences are shaped more by self-stigma, practical constraints, and broader cultural or workplace influences [18].
2) Disclosure to the reference group
Adolescents often first share their mental health concerns with trusted individuals before approaching professionals, especially for issues like self-injury or emotional distress [19]. The response from reference groups can either encourage or discourage further help-seeking depending on its supportiveness and understanding. Positive disclosure experiences can reduce feelings of shame and stigma, making formal help-seeking more acceptable [15]. The attributes of disclosure to reference groups are specifically who is told, the quality of the relationship, perceived support, and anticipated outcomes [1,16].
3) Selection of help sources
The Selection of help sources is an attribute of mental health help-seeking. The selection of help sources is a complex decision-making process influenced by multiple factors including accessibility, relationships, cultural considerations, and perceived effectiveness [16,17]. It is crucial to support adolescents in making informed choices about their mental health care. This attribute involves complex evaluations of preferred informal sources, informal networks, selecting a source for help, adolescents’ preferences, and assistance specialist agencies [1]. The types of services that adolescents mainly use can be classified into internal and external resources. Internal resources include peers, parents, and teachers, while external resources include school counseling classes, hospitals, and mental healthcare centers [20]. In the literature, adolescents were found to select service organizations based on their preferences, and their counseling experience and information were found to be important factors in making choices [2].
4) Engagement with service
Engagement with service is an attribute of mental health help-seeking. This means putting into action what they decide. This attribute involves obtaining external assistance to deal with mental health concerns, accessing care, attitude toward receiving help, professional assistance system, getting help from a professional organization, getting professional help, asking a professional for help [17,20,21]. In the case of adolescents, even if they make decisions to seek mental health help, there are many cases where they do not actually take action, so whether they actually use mental health services is an important factor that shows differences in the outcome factors [6,7]. In addition, the content, frequency, and quality of service use, such as programs and counseling, were found to be included in these attributes [17].
3. Antecedents of Mental Health Help-seeking
Antecedents are events that occur prior to the concept [10]. They were classified into emotional crisis, recognition of the need for help, and positive perceptions of help-seeking based on the question, “What events occur before mental health help-seeking?” (Figure 2).
1) Emotional crisis
The antecedent of mental health help-seeking is Emotional crisis. It involves experienced mental health problems [2], urgent and serious mental health difficulties [6,15], personal problems felt when making decisions on one's own [6], the situation no longer improving and difficulty in resolving the problem on one's own [3]. In the literature, crises were found to be related to mental health and included various mental health difficulties that can occur during the process of growth and development into adulthood.
2) Recognition of the need for help
The first attribute of mental health help-seeking is Recognition of the need for help. This was commonly referred to in most literature as a process through which adolescents discover their own problems and select resources available to them. The recognition stage is the critical step in the mental health help-seeking process for adolescents [22]. In the literature, it was identified as Perceptions and definitions of mental health status, an individual’s intentions, recognizing the problem, deciding to seek help, and willingness to seek mental health help [1,16]. When adolescents experience a mental health crisis, recognition has a major impact on whether they decide to seek help or not, leading to action. For adolescents, this cognitive process meant that in more cases, they became aware of their crisis situations involuntarily, through the recommendation of friends, parents, or teachers, rather than through their own learning [6].
3) Awareness of mental health resources
The antecedent of mental health help-seeking is Awareness of mental health resources. Adolescents' experiences with mental health services can serve as a source of information for seeking mental health help [1]. The process of collecting necessary information through media and information searches was shown as attributes [6,15]. Mental health literacy encompasses the ability to understand and apply information necessary to seek mental health help, as outlined in the literature [16,17].
4. Consequences of Mental Health Help-seeking
In evolutionary concept analysis, the results refer to the phenomenon after the concept was created, and this makes the scope of the concept clearer [10], so the analysis was conducted by asking the question, “What are the phenomena that appear because of seeking mental health help?” (Figure 2).
1) Improved coping skills
The consequence of mental health help-seeking is improved coping skills. It has positive consequences because of its building resilience and emotional regulation abilities [23]. Also, improved coping skills prevent mental health condition progression and reduce the risk of developing additional mental health problems [24]. Through mental health help-seeking, adolescents are more likely to predict health behavior, adopt a coping process, try to do self-disclosure, increase use of counseling services and be confident in mental health practitioners [1,6,16].
2) Social support
Mental health help-seeking was found to be linked to adolescents' access to social support [20]. For adolescents, social support means encouragement from school personnel and peers [2], getting help from others and emotional support [12]. Social support represents one of the most powerful protective factors in adolescent mental health [2].
3) Stigma
The consequence of mental health help-seeking is stigma. Stigma represents one of the most formidable barriers to mental health help-seeking among adolescents [14]. Despite the availability of effective treatments, many adolescents experiencing mental health difficulties avoid seeking professional help due to fear of judgment, discrimination, and social rejection [16]. Mental health stigma refers to the negative attitudes, beliefs, and stereotypes that society holds about mental health conditions and those who experience them [17]. For adolescents, this stigma can create significant barriers to seeking the help they need [17].
5. Surrogate Terms and Related Concepts
1) Professional help-seeking
Surrogate terms are terms that can be replaced with terms, and the meaning does not change even if the term is replaced with a similar or identical meaning [10]. In this study, the surrogate term for mental health help-seeking is professional help-seeking. Professional help-seeking refers to the process of actively seeking assistance from individuals with recognized qualifications, specialized training, and formal expertise to address specific problems or concerns within established systems of care. In the process of seeking help, the scope of professional help is expressed more specifically.
2) Mental health literacy
Related concepts are related to the analyzed concept, but do not share the same properties, so there are subtle differences when examined closely [9]. In this study, the related concept for mental health help-seeking is mental health literacy. Mental health literacy refers to knowledge and beliefs about mental disorders that aid their recognition, management, or prevention [25]. For adolescents, this encompasses recognition of specific disorders and psychological distress, knowledge about risk factors and causes, knowledge about self-help strategies, knowledge about professional help available, attitudes that facilitate recognition and appropriate help-seeking, and skills to access mental health information. Mental health literacy is a more comprehensive term than mental health help-seeking and has subtle differences that specifically express the elements needed to ask for help [26]. Thus, it can be used as a related term to mental health help-seeking in that it arises from the recognition that mental health help is needed.
6. Model Case
Alice, a 16-year-old high school student, has conflicts with her closest friend group. She has been experiencing persistent feelings of sadness, loss of interest in activities she previously enjoyed, and difficulty concentrating in school for the past two months (emotional crisis). She recognizes that these symptoms are interfering with her daily functioning and are not typical for her (recognition of the need for help). After recognizing her symptoms, she researches depression online and realizes her situation warrants professional attention (awareness of mental health resources). After a week of deliberation, she concludes that seeking help would be beneficial despite her hesitations (selection of help sources). After recognizing these experiences as problematic and deciding to seek help, she approaches his mother, disclosing her anxiety symptoms and desire for help. Together with her mother, Alice weighs several formal help sources. Alice prefers not to see the school counselor, where peers might see her entering the office (facing difficulty in seeking help). Following the mother's recommendation, Alice agrees to see a psychologist at the community mental health center (selection of help sources). She attends her intake appointment, accompanied by her mother. During sessions, Alice completes homework assignments, practices mindfulness techniques, and engages in cognitive restructuring exercises (engagement with service). Through the mental health help-seeking process, Alice gained improved problem-solving abilities under stress (improved coping skills). And her family communication patterns shifted to be more open about emotions, so she feels more comfortable discussing mental health with peers (social support). But she still concerns about being perceived as weak or unstable from peers and fear that seeking help would appear on academic records (stigma).
DISCUSSION
Although the concept of mental health help-seeking is a term widely used in nursing and other academic fields, there is still a lack of agreement or understanding of the concept. Therefore, identifying the characteristics of mental health help-seeking in adolescents in specific situations can be helpful in clarifying the concept. This study attempted to clarify the concept of mental health help-seeking and understand the contextual flow of antecedents and consequences in this phenomenon. Through this, we aim to identify the impact that mental health help-seeking can have on adolescent mental health and seek ways to ensure that professional and desirable psychiatric nursing is performed.
The antecedent factors of seeking mental health help were identified as emotional crisis, social prejudice, and knowledge about mental health. Adolescents have difficulty recognizing that they are experiencing an emotional crisis. This is because they tend to think that an emotional crisis is not something that can be helped but rather a problem that they must solve on their own [7]. In addition, even if a crisis occurs, it takes a long time to discover it, and it is discovered involuntarily by friends, teachers, and parents [14]. On the other hand, the reason for taking an involuntary stance on one's own problems was found to be due to concerns about peers looking at them negatively, which is related to social prejudice. Unlike the characteristics of adults, adolescents' social prejudice was found to be the most important factor in the antecedent factors, and since peer group recognition is important in developmental tasks, it is thought that negative evaluations or perceptions received from friends are a major factor in mental health help-seeking behavior [20]. Adolescents were found to obtain the information they need to seek mental health help through the search process [6] and previous counseling experience was found to have a positive effect on mental health help-seeking behavior [27].
The main attributes of mental health help-seeking, such as recognition of the need for help, selection of help sources, and engagement with service were able to confirm conceptual similarities through the scale developed in previous studies and were expressed as ‘desire to receive help’,‘friends, teachers, parents’ and ‘receiving professional help’ [28]. In the case of adolescents, the focus is on identifying which target they choose when they confide in their problems. This is because the person receiving the information can act as a gatekeeper. This is thought to be helpful in predicting which target will receive mental health education for adolescents in the future. In addition, it will help prevent crisis situations by educating the target who receives the request for mental health help from adolescents. Therefore, schools where adolescent mental health crises are most frequently found should be encouraged to utilize this concept positively. Rodgers' evolutionary concept analysis guided the theoretical analysis of the data. This approach aligns with heuristic inductive methods to establish its theoretical foundation [29].
The Consequences of mental health help-seeking were positive aspects such as improved coping skills and social support, and negative aspects such as stigma. As psychiatric nurses care for adolescents, we should pay close attention to both aspects. First, the positive aspects are that they can manage their own mental health, are positive about asking for help when experiencing a crisis and are effective in preventing a crisis from occurring. If we reflect these factors when providing psychiatric nursing to adolescents and educate them, it is expected that it will contribute to increasing the use of mental health services by adolescents. On the other hand, the negative aspect is that stigma needs to be improved in social awareness. Even if we can have a positive perception of asking for help through individual treatment or counseling, if adolescents are viewed negatively in society, especially by peer groups, adolescents will hesitate to use mental health services. Nurses can contribute to reducing this negative social stigma through large-group education, campaigns, and development of awareness-raising content for adolescents.
This study is limited in that it does not have complete cases that can provide clarity to the concept, so care must be taken in interpretation, the subjective judgment of the researcher cannot be completely excluded from the nursing perspective, the definition of mental health help-seeking may change in the future depending on the flow of time, the major databases in the nursing and health fields were limited and the faithful application of evolutionary concept analysis was difficult due to the very narrow scope of the literature review on mental health help-seeking for adolescents. On the other hand, this study is significant in that it attempted to broadly understand mental health help-seeking at a time when insight is required for the development of adolescent mental health, and it provided basic data for the development of nursing studies and the establishment of theories related to mental health help-seeking.
CONCLUSION
This study is a conceptual analysis study that confirmed the meaning and attributes of adolescents’ mental health help seeking using Rodgers’ [10] evolutionary method. Since the development of the concept of mental health help seeking will move toward specific verification such as clarifying the results of mental health help seeking and comparing them across disciplines, nurses should develop their capacity to sensitively identify and mediate the phenomenon of mental health help seeking with a conceptual awareness of mental health help seeking.
This study has implications for nursing research. Through clear and consistent conceptual definitions, it strengthens the theoretical foundation of research and improves research quality. It presents the need for longitudinal research designs that reflect the evolutionary nature of concepts and provides a research framework that can explore differences in help-seeking behaviors across adolescent developmental stages. Additionally, it establishes a foundation for developing valid and reliable measurement tools that reflect temporal changes and cultural contexts and promotes the development of new assessment methodologies suitable for the digital age. It emphasizes the necessity of multidisciplinary collaborative research and presents research topics that can predict future trends in adolescent mental health help-seeking. The implication for nursing practice is the ability to provide individualized nursing interventions. It helps develop customized mental health support strategies that consider adolescents' individual developmental stages, cultural backgrounds, and technology utilization capabilities. Furthermore, by understanding adolescents' changing help-seeking patterns, it strengthens the capacity to recognize risk signals early and provide proactive nursing interventions.
In terms of nurses' capacity development, this study helps understand the complex nature of adolescent mental health help-seeking and develop communication skills that consider generational characteristics and cultural diversity. Based on the concept analysis results, it provides evidence for developing mental health policies that reflect adolescents' actual needs and preferences. It provides the theoretical foundation necessary for establishing integration plans for school-based mental health programs and nursing services and can promote policy development through intergovernmental cooperation.
Notes
Han, Kuemsun has been an editorial board member since March, 2021, but has no role in the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization or/and Methodology: Han, KS, Shin, J, Shin, HJ, & Lee, SY
Data curation or/and Analysis: Han, KS, Shin, J, Shin, HJ, Lee, SY, & Song, M
Funding acquisition: Han, KS & Shin, J
Investigation: Han, KS, Shin, J, & Lee, SY
Project administration or/and Supervision: Han, KS, & Shin, HJ
Resources or/and Software: Han, KS, Shin, J, & Lee, SY
Validation: Han, KS, Shin, J, & Shin, HJ
Visualization: Shin, J, Lee, SY, Song, MJ, & Lee, N
Writing: original draft or/and review & editing: Shin, J, Lee, SY, Song, M, & Lee, N
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