Recognition and Attribution of Teen Mental Health Problems in an Inner City Context

How do youth and parents in high-poverty urban environments conceptualize, recognize and respond to teen mental health problems? Mental health problems not only take an emotional toll on families, but also interfere with normal adolescent development, impeding academic success and the establishment of healthy relationships. Yet as many as two-thirds of adolescents experiencing mental health problems, including those with psychiatric disorders, are underserved by the mental health service system. Working in two New York City high schools serving low-income families, we conducted qualitative interviews with Black parents and their 9th and 10th grade adolescents(n=120). Focus groups with members of the target population of youth and parents were conducted to provide input into interview questions and interpretation of findings. Respondents were asked to consider two hypothetical vignettes; one depicted a youth exhibiting symptoms of major depression, the other a youth with symptoms of conduct disorder. Data were analyzed using ATLAS.ti to identify families' “emic” perspectives of mental health problems, their causes and what types of help or treatment might be needed. Barriers to recognition and help seeking were identified, as well as gaps between emic (i.e., public) and etic (i.e., professional) perspectives. These include parents' and youths' attribution of symptoms to situational and life stresses, including drug use, pregnancy, abuse, and economic/status pressures. There was little attribution of problems to genetic, biological, or other familial predispositions. Some felt the depicted teens could benefit from counseling and mentoring, but there was little “psychologizing” of problems, and reticence to use medication.