The prevalence of emotional distress (in other words, percentage of people in the population who have subjectively experienced anxiety, sadness, unease or disappointment) in the adolescent and young adult population has increased in recent years and is situated between 20% and 60%, according to different studies (Sánchez Ledesma et al., 2021; Rens et al., 2021; Daly & Macchia, 2023). 

Suicide rates have also increased in this population, to the point that suicide is one of the main causes of mortality for this age group (World Health Organisation, 2021). However, under 35% of young people with emotional distress contact social, health, or mental health services in search of help (Mitchell et al., 2017). 

Although research has been conducted around the factors responsible for the limited access of young people to health services, as well as perceived barriers and facilitators in the search for professional help, there is no updated research on help-seeking behaviour among the young population with emotional distress (Gulliver et al., 2010). 

This research analyses how (through which channels) and where (in which places or from which persons) help is sought by adolescents and young adults when they are experiencing emotional distress. For this, an analytical cross-sectional observational cohorts study was conducted, which evaluated 4,008 people (2,013 people aged 16 to 32 and 1,995 people aged 33 to 48) representative of the Spanish population (2,008 men and 2,000 women, resident in all the autonomous communities and from urban and rural areas alike). The survey was conducted through an online questionnaire that included questions designed for this study and the validated Spanish adaptation of the General Health Questionnaire-12 items (GHQ-12) (Sánchez López & Dresch, 2008). 

The GHQ-12 questionnaire is a self-administered instrument (filled in by participants themselves) that consists of 12 questions, and its aim is to detect psychological problems and possible instances of psychiatric disorders in primary healthcare or among the population in general. Each question is accompanied by four possible answers. Some examples of the questions are: “Have you recently felt that you couldn’t overcome your difficulties?” or “Have you recently been thinking of yourself as a worthless person?”. Based on previous studies (Anjara et al., 2020), it was considered that a person is experiencing emotional distress when, on the scale of the GHQ-12 questionnaire, they obtain a score over 12, and that the emotional distress is serious (equivalent to depression) when the score is over 24 (the range of punctuation of the scale on the GHQ-12 questionnaire goes from 0 to 36, with 36 being the score that reflects the worst emotional state). The sampling and administering of the questionnaire were carried out by the company Kantar Public. The data analysis and writing up of the report were carried out by the study authors. 

In this article, the expressions young population, younger age group, young people and similar refer to people aged between 16 and 32. 
 

Almost half (45.8%) of the young people had experienced emotional distress. In 6.3% of the young people, the emotional distress was serious (equivalent to depression, with the need for clinical intervention). 

The main factors or circumstances that young people related to emotional distress were: a) everyday worries (69% considered everyday worries to be a relevant reason for emotional distress); b) problems related to work or studies; c) arguments; d) feeling lonely; e) financial problems; f) dissatisfaction with self-image; g) the death of a loved one, and h) separation from a partner. 

The main indicator of emotional distress for the young population group was “Feeling sad” (around 75% said that they detect their emotional distress because they feel sad), followed by “Having pessimistic thoughts” (around 60%) and “Problems falling or staying asleep” (around 30%). It is interesting to note that most of the participants placed emotional distress in the sphere of sadness and pessimism. Just over half of young people (almost 60%) considered that experiencing emotional distress is equivalent to “Going through a rough patch”. This response suggests that, for two out of three young people, emotional distress is a temporary phenomenon, inscribed in the usual ups and downs of everyday life and at the mercy of everyday adversities. 

The most frequent response of young people to emotional distress was “Isolate myself.” The second most common response (the responses were not mutually exclusive; i.e., participants could indicate one or more behaviours in response to emotional distress) was “Request help from family members, friends, or professionals”. It was followed by “Look for solutions online”, “Restrict food or binge eat”, “Pray”, “Take drugs” and “Self-harm”. In a quarter of young people, emotional distress was not accompanied by a significant change in behaviour. 

These data emphasize the importance of isolation, due to its high frequency and its negative impact on young people’s health (Vasan et al., 2023). For this reason, intervention plans and programmes for young people with emotional distress should include interventions to reduce loneliness and isolation.   

Over half of young people seeking help said they turn to “Friends and family”. A quarter decide to “Consult a professional” (primarily a health or mental health professional), while around 15% stated that they look for “Solutions and advice online” (both on search engines such as Google and on social media). The answer options were compatible and not mutually exclusive.

These data indicate that young people experiencing emotional distress do not resort to asking for help as the main option to resolve or alleviate this distress. The request for help implies, at least in part, an acknowledgement of the distress, and is sometimes experienced with shame, as if it represented revealing a fault or a stigma, or returning to a position of dependence and weakness.

Moreover, perhaps the choice of young people (and also of people aged 33 to 48) not to trust in requesting help is a sign that the value of requesting help is limited, or that a significant proportion of people have little confidence in its usefulness. For this reason, the data from this study highlight the need for further studies on the value of asking for help in case of emotional distress and on the factors that hinder or favour it. 

The preferred option for young people seeking help from friends and family was face-to-face contact with friends, followed by face-to-face contact with family members, and contact through phone messages with friends. Over 80% of young people who seek help from health professionals do so face to face, while around 30% do so online. Both response options (face to face and online) were compatible. 

Face-to-face help is not only the main way used, but also the preferred way of contact for all participants, both young people and people aged 33 to 48. It is important to highlight this finding, as it indicates that, despite the social changes of recent years and the favouring of the use of telematic means of communication, face-to-face contact stands as the preferred way to offer and receive help. This data is a vindication of face-to-face contact and should be taken into account in the design of intervention strategies for young people − and not so young people − with emotional distress. 

Figure 5 reflects the percentages of methods or channels used by young people with emotional distress when seeking help.

Of the support received from other people (friends, family or professionals), young people valued being listened to (three out of four considered this to be one of the most helpful contributions), being given advice (around 50%), people dedicating time to them (just over 40%), being told how to get over it (around 35%), an explanation of the reasons for their distress (just over 30%), being offered words of comfort (just over 20%), and people monitoring their progress over the medium-long term (around 20%). The main factors that, in the opinion of young people, facilitate requesting professional help in case of emotional distress were, in the following order: a) that it is affordable (rated with an average score of 8.7 on a scale of 0 to 10, with 10 being the best rating); b) that the offer is adapted to the needs of each person (8.1); c) that the request for help (attention or consultation with the professional) is simple and quick to access (8.0); d) that time availability is flexible and wide-ranging (7.9), and e) that anonymity is guaranteed (7.5).

Emotional distress was experienced by 45.8% of young people and 35.3% of people aged 33 to 48. Severe emotional distress (equivalent to depression) affected 6.3% of young people and 5.2% of people aged 33 to 48. Young people, compared to people aged 33 to 48, attached more importance, as the main factors causing or related to emotional distress, to: a) Everyday worries (69% vs. 62%); b) Problems related with work or studies (46% vs. 38%); c) Arguments (44% vs. 38%); d) Feeling lonely (35% vs. 24%), and e) Dissatisfaction with personal image (30% vs. 16%). In contrast, people aged 33 to 48 attached more importance to: a) Personal illness (19% vs. 12%) and b) The illness of a loved one (18% vs. 5%). Figure 6 shows the most frequent answers or attitudes towards emotional distress in both age groups. 

The comparison between the two age groups revealed that over 50% of young people seeking help turn to “Friends and family”, compared to 42% of people aged 33 to 48, and that around 15% of young people look for “Solutions and advice online”, compared to 10% of people aged 33 to 48. There were no significant differences (i.e. the results were equivalent) between the two age groups in seeking help by “Consulting a health professional” (around 25% in both groups). With regard to channels used to seek help, the comparison between the groups showed that both groups turn equally to family and friends in person and through voice calls. However, young people more frequently use instant text messages with friends than people aged 33 to 48 (around 50% vs. just over 25%) and with family members (16% vs. 13%), and video calls with friends (12% vs. 6%) and family members (10% vs. 6%). 

In other words, friends and family are the chosen option in both age groups, although more significantly in young people. This result underscores the importance of including family and friends in intervention programmes. Moreover, the data suggest that in recent generations there has been an increase in the use of the internet as a source of information and for searching for solutions to emotional distress, as well as in the use of instant text messages (e.g., the WhatsApp and Telegram platforms) as a means of communication with family and friends.  

More than 80% of young people asked for help from health professionals in person. This figure rose to almost 90% in people aged 33 to 48. However, 30% of young people use online means for asking and receiving help, compared to just over 20% of people aged 33 to 48. Young people, compared to those aged 33-48, considered that the most helpful contributions are: a) Being listened to (74% vs. 66%), b) Being given time (41% vs. 25%), and c) Being offered words of comfort (22% vs. 17%).  

An analysis was carried out to detect which variables are related to the decision to ask for help (versus not asking for it) when experiencing emotional distress. The variables significantly related to the request for help from family, friends or professionals were: a) age (40% more frequent in the younger age group than among people aged 33 to 48); b) female gender (50% more frequent than male gender), living in a city of over 500,000 inhabitants (30% more frequent than living in a smaller town) and maintaining habitual contact with friends or family members (40% more frequent in people who usually maintain quite a lot or a lot of contact with friends or family members). Contrary to expectations, the score on the GHQ-12 questionnaire scale, which determines the severity of the emotional distress, was not significantly related with the request for help. In other words, the people with the greatest severity of emotional distress were not the ones who asked for the most help (nor the least). 

Almost half of young people (aged 16-32) had experienced emotional distress, compared to 35% of people aged 33-48, and most reported that when they experience emotional distress they isolate themselves or ask for help from family, friends, or professionals. The next option is to “Do nothing” (no change or stay the same). A smaller percentage of young people, but higher than those aged 33 to 48, said they seek help online or through text or voice messages on their phones. The preferred form of help was face to face, regardless of age group, although young people indicated that they use instant text and voice messages over mobile phones more than people aged 33 to 48. These findings show a shift in the pattern of phone use, with younger generations (relative to previous generations) increasing the use of text or voice instant messaging. Moreover, young people attributed emotional distress to specific causes – such as, in particular: a) Everyday worries; b) Problems related with work or studies; c) Arguments; d) Feeling lonely, and e) Dissatisfaction with personal image – more frequently than people aged 33 to 48. 

The main limitations of the study were as follows: 

1. The assessment was not based on an individualised face-to-face or telephone interview, but only on a brief online questionnaire, which limited the identification of personalised (or at least stratified) factors related to seeking help in case of emotional distress. This also restricted the sample to people who use (and know how to use) electronic devices online. Although the use of these devices is widespread among the Spanish population in the age group evaluated (over 95%, according to the National Institute of Statistics, 2022), this could limit the generalisation of the results to the population that does not regularly use online electronic media.

2. The assessment of emotional distress was performed with a single instrument administered online, which could detract from the validity of the construct of emotional distress, given that the questionnaire used (GHQ-12) does not only assess emotional distress. However, this questionnaire has been validated for the Spanish population in general and has been used in numerous national and international studies as an indicator of emotional distress.

3. The sample has an overrepresentation of people with university studies: 62% compared to 39% of the Spanish population − in the age group evaluated − according to the National Institute of Statistics, 2022, which could limit the generalisation of the results. Despite this, in the study, level of education was not significantly related to requesting help in people experiencing emotional distress.

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