Help-Seeking Behavior of Adults with Adverse Childhood Experiences in Rural China

Adverse Childhood Experiences (ACEs), which encompass a broad range of adverse events during childhood, are prevalent in rural China. However, help-seeking among adults with ACEs remains limited and underexplored. This study aims to examine the barriers to help-seeking behaviors among adults with ACEs in rural China. Qualitative interviews were conducted with 20 adults affected by ACEs in rural mainland China between October 2024 and December 2024. Data were collected through semi-structured interviews in Mandarin, and transcripts were analyzed using the Theory of Planned Behavior (TPB) framework, focusing on behavioral beliefs, normative beliefs, and perceived behavioral control. The findings reveal barriers to help-seeking among individuals with ACEs in rural China, categorized into three key dimensions: (1) Behavioral Beliefs: Beliefs that corporal punishment is the responsibility as well as love of parents, and misconceptions attributing ACEs to personal faults significantly hindered help-seeking. (2) Normative Beliefs: Respect for parental authority in China culture context hinder help-seeking for adults with ACEs. Moreover, gender differences were evident, with men avoiding help-seeking due to perceived shame, while women were more likely to confide in friends and family. Finally, stigmatization of mental health services further inhibited help-seeking behaviors. (3) Perceived Behavioral Control: The lack of formal and informal support systems in rural areas exacerbated the issue, highlighting significant gaps in resource accessibility and cultural acceptance of mental health support. Addressing these barriers through public education, destigmatization of mental health services, and improved resource allocation could facilitate help-seeking behaviors and improve outcomes for individuals affected by ACEs.