Processes of mental health service use by adolescents with depression.

PURPOSE: To begin development of a substantive theory of the processes of mental health service use by adolescents who are depressed and by their families.
DESIGN: Grounded theory.
METHODS: Open-ended interviews were conducted with 52 young adults who were depressed as adolescents, four of their parents, and eight professionals who work with adolescents who are depressed. The constant comparison method was used to analyze the data.
FINDINGS: Adolescents who are depressed and their families perceived several "treatment pitfalls" associated with formal mental health services: (a) "They'll (mental health clinicians) think I'm crazy," (b) "They'll tell my business," and (c) "They won't have a clue." The adolescents and their families interacted with the mental health care providers by engaging in the psychosocial process of "venturing through the system," that is, proceeding despite possible dangers and risks by steering clear, holding back, and letting it take hold.
CONCLUSIONS: Mental health service use by adolescents with depression involved complex and fluid interactional processes among the depressed adolescents, their parents or caretakers, and mental health care providers. Strategies are needed to avoid creating the pitfalls that concern adolescents and their families.