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Young men are particularly vulnerable to suicide, drug, and alcohol problems and yet fail to seek appropriate help. An alternative or adjunct to face-to-face services has emerged with widespread uptake of the Internet and related communication technologies, yet very little evidence exists that examines the capacity of the Internet to engage young men and promote help seeking.
To explore young people’s attitudes and behaviors in relation to mental health and technology use. The aim was to identify key gender differences to inform the development of online mental health interventions for young men.
A cross-sectional online survey of 1038 young people (aged 16 to 24 years) was used.
Young men are more likely than young women to play computer games, access online video/music content, and visit online forums. More than half of young men and women reported that they sought help for a problem online, and the majority were satisfied with the help they received. Significant gender differences were identified in relation to how young people would respond to a friend in need, with young men being less likely than young women to confront the issue directly.
Online interventions for young men need to be action-oriented, informed by young men’s views and everyday technology practices, and leverage the important role that peers play in the help-seeking process.
Young men in Australia have higher rates of completed suicide, antisocial behavior, and alcohol or other substance misuse problems than young women [
The factors associated with poorer help-seeking practices in young men are complex [
An alternative or adjunct to face-to-face services has emerged with widespread uptake of the Internet and related communication technologies, such as mobile phones, game consoles, and tablet computers [
A survey was administered online for a three-month period, from January 25 to March 27, 2010. Recruitment was achieved via snowball sampling, leveraging online social networking services. Online sampling was used as a way of reaching young people who are normally difficult to access via random-digit dialing or panel methods, and as a way of reducing social desirability effects [
This study had ethics approval from the University of Sydney Human Research Ethics Committee (Protocol No. 11209). Participants gave consent online and understood that their participation was voluntary, confidential, and non-identifiable. No incentives were offered for taking part. Participants included 1038 young people aged 16 to 24 years.
Two key questions were developed to examine young people’s use of a range of technologies. The first question asked about their use of various ICTs (eg, computers, PlayStation, Facebook, multiplayer games). The second question asked about their frequency of use of various types of media and entertainment (eg, newspapers, Internet for music, Internet for social networking, television) over the previous three months. Respondents rated this question on a six-point Likert scale (1 = “everyday” to 6 = “never”).
Two sets of questions were selected from the
The six-item Kessler Psychological Distress Scale (K6) [
A set of questions was developed to measure preferences for receiving mental health information and support through technology including: accessing a website with information and/or factsheets; a website with a question and answer service that sends short message service (SMS) or emails; a website with online clinic; interactive single-player games teaching life skills; and interactive multiplayer games teaching life skills.
The survey data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0. All surveys, both completed and uncompleted, were analyzed. Differences between young men and women were assessed using either chi-square analysis for nominal and ordinal dependent variables with two to four categories or analysis of variance (ANOVA) for ordinal dependent variables with five or more categories. A
A total of 1038 young people (aged 16 to 24 years) participated in the survey (53.2% female; n = 552/1038; mean age = 18.84 years; SD age = 2.75). The majority of participants provided complete data (completion rate = 71.9%). The survey had good national coverage with respondents from all Australian States and Territories. 41.9% (n = 432/1030) were from New South Wales and Australian Capital Territory; 24.6% (n = 254/1030) were from Victoria and Tasmania; 18.1% (n = 186/1030) were from Queensland; and 15.3% (n = 158/1030) were from Western Australia, South Australia, and the Northern Territory. Seventeen people (2.2%; n = 17/790) identified themselves as Aboriginal and/or Torres Strait Islander origin; and 21.1% (n = 168/797) spoke a language other than English at home. Most of the sample were in full-time study at school, Technical and Further Education (TAFE) or university (63.7%, n = 475/746), while 16.0% (n = 119/746) were employed full-time (30 or more hours per week), and 8.4% (n = 63/746) were employed part-time (less than 30 hours per week).
The vast majority of respondents used mobile phones (98.0%, n = 878/896), iPod/MP3 players (89.7%, n = 802/894) and computers (desktops, 77.1%, n = 691/896; laptops, 84.0%, n = 752/895). Facebook was by far the most popular social networking website (92.7%, n = 831/896), with only 37.6% (n = 337/896) of the sample using MySpace and only 22.1% (n = 198/896) using Twitter. As shown in
Gender differences in ICT use; N = 896a.
|
Males (yes) |
Females (yes) |
χ2 |
N | 403 | 493 |
|
Mobile phone | 388 (96.3) | 490 (99.4) | 10.92b |
363 (90.1) | 468 (94.9) | 7.77b | |
iPod/MP3 player | 355 (88.5) | 447 (90.7) | 1.10 |
Laptop computer | 328 (81.6) | 424 (86.0) | 3.21 |
Information websites | 320 (79.4) | 426 (86.4) | 7.81b |
Landline phone | 321 (80.0) | 394 (79.9) | 0.00 |
Desktop computer | 323 (80.1) | 368 (74.6) | 3.81 |
MSN | 310 (76.9) | 359 (72.8) | 1.97 |
Video websites | 343 (85.1) | 321 (65.1) | 46.22c |
Forums | 250 (62.0) | 255 (51.7) | 9.58b |
Interactive games | 249 (61.8) | 237 (48.1) | 16.80c |
Nintendo/Wii | 201 (49.9) | 223 (45.2) | 1.92 |
Single-player games | 268 (66.5) | 137 (27.8) | 134.16c |
PlayStation | 213 (53.0) | 191 (38.7) | 18.14c |
MySpace | 151 (37.5) | 186 (37.7) | 0.01 |
Xbox | 205 (51.0) | 117 (23.7) | 71.45c |
Multiplayer games | 220 (54.6) | 99 (20.1) | 115.18c |
Bulletin boards | 158 (39.2) | 157 (31.8) | 5.27d |
Skype | 148 (36.7) | 148 (30.0) | 4.51d |
83 (20.6) | 115 (23.3) | 0.96 | |
Bebo | 53 (13.2) | 69 (14.0) | 0.13 |
a Denominators vary due to missing data. Rows are ordered according to frequency of endorsement.
b
c
d
Respondents were also asked more broadly about the kinds of media and entertainment they use. The most popular forms of media and entertainment across the sample were the Internet for social networking or communicating (74.1% use it daily, n = 657/887), the Internet for music (62.6% use it daily, n = 556/888), and the Internet for general information (58.2% use it daily, n = 516/886). Internet use was significantly more popular than watching TV (52.7% use it daily, n = 470/892) or listening to the radio (36.1% use it daily, n = 318/881). However, as shown in
Gender differences in media and entertainment use; N = 892a.
Level of usage |
Males |
Females |
F |
Internet for social networking or communicating | 1.54 (1.19) | 1.44 (0.96) | 1.75 |
Internet for general information | 1.70 (1.19) | 1.68 (0.96) | 0.07 |
Internet for music | 1.58 (1.13) | 1.80 (1.19) | 7.55b |
TV | 1.98 (1.38) | 1.81 (1.24) | 3.64 |
Radio | 2.76 (1.74) | 2.44 (1.63) | 8.00b |
DVDs or videos | 3.00 (1.27) | 3.11 (1.21) | 1.59 |
Newspapers | 3.15 (1.63) | 3.03 (1.43) | 1.30 |
Games on a console or computer | 2.62 (1.66) | 3.91 (1.75) | 125.26c |
Internet for games | 3.06 (1.83) | 3.74 (1.86) | 29.84c |
Magazines | 3.95 (1.43) | 3.88 (1.26) | 0.54 |
Cinema | 4.14 (0.93) | 4.27 (0.87) | 4.92d |
a Rows are ordered according to frequency of endorsement.
b
c
d
Respondents were asked what they would do in the next few days if they noticed a friend was going through a tough time. The vast majority of the sample reported that they would be “likely” or “very likely” to listen to their friend and try to help them work out what to do (94.8%, n = 886/934), encourage them to focus on the positive things in life (88.3%, n = 825/934), and try to include them in social activities with other friends (87.5%, n = 812/928). However, as shown in
Gender differences in what young people would do for a friend experiencing a mental health problem; N = 934.
Likelihood |
Males |
Females |
F |
Keep out of their way to give them some space | 2.92 (1.00) | 3.04 (0.84) | 4.03a |
Listen to them and try to help them work out what to do | 1.71 (0.75) | 1.43 (0.61) | 40.32b |
Encourage them to focus on the positive things in life | 1.84 (0.88) | 1.65 (0.78) | 12.82b |
Tell them about your worries to help them put their own problems in perspective | 2.73 (1.08) | 2.98 (1.02) | 13.14b |
Tell them that things will improve soon | 2.20 (0.99) | 2.21 (1.00) | 0.00 |
Tell them about others who have got over similar problems | 2.65 (1.08) | 2.53 (1.06) | 3.35 |
Tell them to just get over it | 3.62 (0.86) | 3.91 (0.49) | 42.39b |
Try to include them in social activities with other friends | 2.04 (1.02) | 1.70 (0.80) | 31.03b |
Encourage them to avoid situations that might upset them | 2.15 (1.06) | 2.07 (1.02) | 1.42 |
Talk with someone else who knows them well about what to do | 2.17 (1.12) | 1.89 (0.96) | 16.59b |
a
a
The most “likely” or “very likely” sources of help respondents would suggest to a friend with a mental health problem would be: friends (88.0%, n = 816/927); a counselor (75.5%, n = 703/931); doctor (74.9%, n = 698/932); family member (68.5%, n = 637/930); and websites (45.9%, n = 422/920). They would be least likely to recommend posters or pamphlets, a church leader, teacher, or community member or center. However, there were significant gender differences on all variables apart from friends, with males being less likely to recommend each of the sources of help than females (see
Gender differences in sources of help young people would suggest to a friend with a mental health problem; N = 931a.
Likelihood |
Males |
Females |
F |
Friends | 1.78 (0.86) | 1.70 (0.81) | 2.20 |
Counselor | 2.21 (1.07) | 1.89 (0.98) | 22.08b |
Doctor | 2.25 (1.05) | 1.87 (0.88) | 35.21b |
Family | 2.33 (1.11) | 2.08 (1.02) | 12.52b |
Websites | 2.72 (1.02) | 2.52 (1.02) | 8.18c |
Telephone helplines | 2.89 (1.05) | 2.55 (1.02) | 25.35b |
Community center | 3.04 (0.98) | 2.72 (1.09) | 22.11b |
Trusted community member | 2.99 (0.96) | 2.78 (0.98) | 10.68c |
Teacher | 3.04 (0.98) | 2.75 (0.94) | 20.47b |
Posters or pamphlets | 3.16 (0.89) | 2.94 (0.92) | 12.70b |
Church leader | 3.26 (1.05) | 3.08 (1.05) | 6.80c |
a Rows are ordered according to frequency of endorsement.
b
c
The average time respondents spend using the Internet each day was 4.7 hours (4.4 hours for females and 5.2 hours for males). Significantly more males than females used the Internet after 11 p.m. at night (75.4% compared with 62.1%; χ2=17.53,
Of the total sample whose K6 scores were indicative of psychological distress (males: n = 130; females: n = 189), 69.4% (n = 221/318) said they had sought help for their problems online. Again, significantly more females than males had talked about their problems online (73.5% of females vs. 63.6% of males; χ2=3.60,
The survey also asked participants to indicate their preferences for receiving mental health information and support through technology (see
Gender differences in preferences for receiving mental health information and support through technology; Total samplea.
|
Males |
Females |
χ2 |
N | 486 | 552 |
|
Website with information and factsheets | 234 (48.1) | 329 (59.6) | 13.66b |
Website with online clinic | 187 (38.5) | 269 (48.7) | 11.03c |
Website with question and answer service | 140 (28.8) | 230 (41.7) | 18.63b |
Website promoting well-being | 118 (24.3) | 243 (44.0) | 44.41b |
Website with multimedia content | 144 (29.6) | 165 (29.9) | 0.01 |
Interactive single-player game teaching life skills | 87 (17.9) | 145 (26.3) | 10.43c |
Interactive multiplayer game teaching life skills | 88 (18.1) | 119 (21.6) | 1.93 |
a Denominators vary with missing data. Rows are ordered according to frequency of endorsement.
b
c
Gender differences in preferences for receiving mental health information and support through technology; Psychologically distressed samplea.
|
Males |
Females |
χ2 |
N | 130 | 189 |
|
Website with information and factsheets | 81 (62.3) | 133 (70.4) | 2.27 |
Website with online clinic | 67 (51.5) | 106 (56.1) | 0.64 |
Website with question and answer service | 55 (42.3) | 92 (48.7) | 1.26 |
Website promoting well-being | 36 (27.7) | 90 (47.6) | 12.80b |
Website with multimedia content | 50 (38.5) | 60 (31.7) | 1.54 |
Interactive single-player game teaching life skills | 29 (22.3) | 59 (31.2) | 3.06 |
Interactive multiplayer game teaching life skills | 28 (21.5) | 47 (24.9) | 0.48 |
a Denominators vary with missing data. Rows are ordered according to frequency of endorsement.
b
Despite considerable investment in mental health over the last decade, there has been no shift in national data on young men’s help-seeking [
The data provide important information on young men’s ICT preferences and use. They were drawn to websites with video/music content and were far more likely than young women to play computer games. These insights suggest that the challenge of relevancy and engagement faced by mental health services may be addressed by action-oriented (rather than information or talk-based) strategies that target young men [
Importantly, the results highlight gender differences in how young people would respond to a friend who is experiencing a mental health problem. In comparison to females who would be more likely to respond proactively and intervene, young men stated that they would be less likely to confront the issue directly. This is consistent with previous research showing that young men have limited experience relative to young women in helping someone with an emotional concern and would be less likely to offer advice [
Three potential limitations should be considered when interpreting the results of this study. First, given that we recruited participants using online methods, our sample was limited to young people with Internet access. Nevertheless, Internet access and use in Australia is very high: 97% of young people have personal access to the Internet [
Despite these limitations, the results of this study present a compelling argument for investment in ICT-based mental health initiatives that target young men. Investment should increase the visibility of already known and trusted youth mental health services as well as support the development of new interventions. The results suggest that further development of online mental health services that can respond effectively to young men’s questions with direct links to experts. Furthermore, online services that include the principles of gaming and music/video content, as well as provide opportunities to seek information and support autonomously and anonymously, could be particularly appealing to young men, although further research in this area is warranted. Social networking technology may also provide a powerful tool to promote social connectedness of young men that can support help-seeking and warrants further research. Finally, this survey was unable to account for the recent and rapid proliferation and popularity of tablets, smart phones, and mobile phone applications [
The survey was funded by an Australian Research Council Linkage Grant (LP0883035). The authors wish to thank the respondents who took part in this study and the youth-serving organizations that helped distribute the survey.
None declared.