1 - (SYM 21) Mixed Methods Analysis of Youth Mental Health Support Preferences

Background: Mismatches between preferred and received mental health support increase risk of dropout. Given 65-80% of youth experiencing mental health difficulties do not access treatment for their symptoms, research must consider youth preferences for their own mental health support. Youths’ support preferences may be especially informative in digital self-help support contexts—where reach is considerable, yet attrition is high.

Method: 281 teenagers (13–16 years) were recruited from a digital mental health trial of US youth with elevated depressive symptoms. After participating in the original trial (N=2,452), we invited a randomly selected subset of youth to participate in the present study. Youth completed questionnaires, including five free-response prompts that asked teens to describe their “ideal” mental health support: 1) who is involved, 2) where support takes place, 3) whether support is anonymous, 4) who decides if support is working, and 5) how support makes them feel.

Results: Youth wrote 1,405 responses to 5 free-response prompts. Using applied thematic analysis, we developed, revised, validated, and finalized codes for all 5 prompts. 3 coders independently reviewed youth responses and prior to developing and revising codebooks. During validation, finalized codes met a pre-registered reliability threshold (k ≥ .8), remaining codes faced further revision/validation. Themes emerged relating to desires to receive professional support, to involve (and avoid involving) family, to decide when support is working, and to feel heard. Final results will include descriptive frequencies and qualitative examples of each theme, as well as visualizations of codes by participant identities (gender, race/ethnicity, sexual orientation).

Conclusions: Results highlight variety in youths’ preferences for their own “ideal” mental health support. Even among youth who self-referred to a digital support tool for their depressive symptoms, elements of formal, in-person mental health services are desirable. Digital supports should better align with preferences, and advocates should continue to prioritize expanding access to traditional mental health supports.