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Soc Sci Med. 2018 Oct;215:69-79. doi: 10.1016/j.socscimed.2018.08.025. Epub 2018 Aug 26.

Adolescents in crisis: A geographic exploration of help-seeking behavior using data from Crisis Text Line.

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Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, United States. Electronic address:
North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, United States. Electronic address:


Nearly 3 out of 4 all lifelong mental disorders occur by the age of twenty-four. Remote crisis support holds great potential in filling a critical gap in complementing and expanding access to mental health services for acute episodes of mental distress in adolescents and young adults; yet little is understood about the individual factors that influence help-seeking behavior in this group. Recent evidence suggests technology-based mental health services have high acceptability among youth and may be used to treat anxiety and depression. The objective of this study was to examine county-level help-seeking behavior among adolescents and young adults using Crisis Text Line (CTL). CTL is a free, text-based crisis counseling service that has been available nationally since 2013. Spatial error regression was used to (1) identify the individual-level factors that correlate with help-seeking behavior for depression, anxiety, and suicidal thoughts and (2) to explore the geographic trends in text-based help-seeking behavior between adolescents and young adults across the rural-urban continuum. Increased rates of text-based help-seeking occurred in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for low rates of help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Rural communities, particularly those with low support-seeking behavior and comparatively high suicide rates, should be the target of future research and outreach.


Adolescent; Crisis hotline; Depression; Help-seeking; Mental health; Suicide; United States

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