Understanding adolescent psychotherapy utilization in India: A mixed methods tertiary care center study

BackgroundIndia faces a substantial mental health treatment gap, particularly regarding the underutilization of psychotherapy among adolescents. This mixed-methods study aimed to identify the barriers and facilitators influencing the uptake of psychotherapy for mental health issues among adolescents attending a tertiary care referral center in India.MethodsA mixed-methods design was employed. Quantitative data were collected from 74 adolescents recruited via purposive sampling using standardized scales assessing attitudes toward seeking professional psychological treatment, self-stigma, perceived barriers to seeking help, and the working alliance. Qualitative data were gathered through focus group discussions to further explore barriers and facilitators of psychotherapy.ResultsMost participants were diagnosed with neurotic spectrum disorders and had no prior psychotherapy experience. Higher self-stigma and perceived barriers were associated with less favorable attitudes toward seeking psychotherapy, while a stronger working alliance was associated with more positive attitudes. Thematic analysis identified key barriers including stigma, apprehension, poor awareness, negative social influences, and reliance on informal support. Facilitators included greater mental health literacy, perceived symptom severity, and encouragement from informal networks. Urban adolescents reported stronger working alliances compared to their rural counterparts.ConclusionFindings highlight the need to address stigma, enhance mental health literacy, and consider contextual factors in service delivery.