Biddle Lucy, Donovan Jenny, Sharp Debbie, Gunnell David
Department of Social Medicine, University of Bristol, Bristol, UK.
Sociol Health Illn. 2007 Nov;29(7):983-1002. doi: 10.1111/j.1467-9566.2007.01030.x.
Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non-help-seeking. Help-seekers and non-help-seekers were interviewed. The findings allowed development of an explanatory model - the cycle of avoidance (COA) - which contributes towards attempts to provide a dynamic understanding of help-seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non-help-seeking in terms of 'barriers' to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises help-seeking as a circular process and offers a model of 'non-help-seeking' in which lay conceptions of mental distress, the social meanings attached to 'help-seeking' and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non-help-seeking in other age groups and conditions, and other illness behaviours.
精神障碍在年轻人中很常见，且与许多不良后果相关。然而，数据表明年轻人尤其不太可能因这种痛苦而寻求帮助。本文描述了一项针对23名有精神痛苦的年轻人（年龄在16至24岁之间）的定性研究。通过访谈获取了关于疾病行为的详细叙述，并探究了不寻求帮助的原因。对寻求帮助者和不寻求帮助者都进行了访谈。研究结果促成了一个解释模型——回避循环（COA）——有助于动态理解寻求帮助的行为。主流方法往往是确定性和静态的，从获得护理的“障碍”角度来解释不寻求帮助的情况，尽管这很容易转化为政策干预的目标，但只是复杂问题的表面呈现。COA将寻求帮助概念化为一个循环过程，并提供了一个“不寻求帮助”的模型，其中对精神痛苦的外行观念、赋予“寻求帮助”和治疗的社会意义以及个人的有目的行动都具有核心重要性。尽管该模型是在年轻人和精神痛苦的背景下得出的，但作为一种理论模板，它可能在解释其他年龄组和情况中的不寻求帮助行为以及其他疾病行为方面具有更广泛的适用性。
