Adolescents In Crisis: A Geographic Exploration Of Help-Seeking Behavior Using Data From Crisis Text Line

Prior research has demonstrated that a variety of contextual factors, including age, gender, and socioeconomic status, influence the prevalence and severity of mental distress and help-seeking behaviors. Behavioral health research has been limited to survey data, but advances in technology have provided increased opportunities to continuously capture data and learn about the help-seeking habits of its contributors. In response to the growing prevalence of technologically mediated crisis counseling services, this study evaluated whether these same disparities exist for help-seeking via Crisis Text Line, a free, ubiquitous, technology-based counseling service. To date, this is the first national study to examine text-based help-seeking behavior among adolescents. Results identify several factors associated with increased or reduced help-seeking behavior among adolescents in the U.S. Increased CTL usage rates occur in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for reduced help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Low rates of help-seeking compound ongoing rural-urban disparities in traditional mental health services, and this finding suggests that increased suicide risk in rural areas cannot be explained by mental health professional shortages alone.