Barriers and facilitators to seek mental health care for adolescents with a history of sexualized violence and PTSD

Despite the high prevalence rates of trauma-related disorders caused by sexualized violence, the use of mental health services is low (Simon, Barnett, Smith, Mucka & Willis, 2017). Early treatment of trauma-related disorders is important, as non-treatment of mental disorders often leads to chronicity or increase of symptoms, an increased risk of suicide and self-harm, and a reduction in quality of life (Hawton et al., 2013; Kalafat, 1997; Lambert et al ., 2013; Merikangas et al., 2010; Simon et al., 2017). Self-stigma and the fear of public stigmatization are one of the thresholds for accepting professional help in young people with mental health problems (Aguirre-Velasco et al., 2020, Gulliver et al., 2010). Adolescents affected by sexual violence often report specific self-stigma and fear of stigmatization, which increase psychological stress as well as the risk of revictimization and inhibit the willingness to self-disclosure (Alix et al., 2017; Dworkin et al., 2017; Kennedy & Prock, 2016). There is evidence of gender differences in stigmatization of mental disorders with higher stigma scores for mental disorders in male adolescents compared to female adolescents (Chandra & Minkovitz, 2006; Gonzalez et al., 2005). So far, there is a lack of studies that assesses different types of stigma as a barrier of seeking mental health care differentiating between adolescents and young adults with and without trauma-related disorders after the event of sexual violence. In a first step we present a definition of sexualized violence and ask if participant experienced sexualized violence based on the definition. Participants without a history of sexualized violence are given a case- vignette. The vignette describes a situation in which either a male or a female protagonist experiences sexualized violence developing a post-traumatic stress disorder as a reaction of the sexualized violence. We assessed if participants identify the situation as sexualizd violence as well as the acceptance of gender specific rape myths, victim- blame and attributed shame towards the protagonist in the vignette. We also assess if participants think that the symptoms in the vignette fulfill the criteria of mental disorder and if they think that the person in the vignette needs professional help, followed by a rating of adequate help-seeking sources. Perceived public stigma and personal stigma of the PTSD symptoms described in the vignette are also assessed. We also assessed social desirability and sociodemographic variables. Participants with a history of sexualized violence are asked about their own experiences without receiving the vignette. We assessed shame and self-blame with regard to the sexualized as well as the acceptance of rape -myths. We assessed PTSD symptoms and their recovery as well as disorder specific stigmatizing attitudes (perceived public stigma, personal stigma and self-stigma). A major focus of the study is the assessment of self- stigmatizing attitudes, barriers to seek help and experienced stigma with a qualitative design (open response format). We assessed if they sought professional help, latency of help-seeking and help-seeking sources as well as sociodemographic variables and social desirability.