Adolescents' Help-Seeking Behavior and Intentions Following Adolescent Dating Violence - A Systematic Review

Adolescents’ Help-Seeking Behavior and Intentions Following Adolescent Dating Violence
Author(s): Kerrie Bundock, Carmen Chan and Olivia Hewitt

Source: Trauma, Violence & Abuse , April 2020, Vol. 21, No. 2 (April 2020), pp. 350-366
Published by: Sage Publications, Inc.
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Review Manuscript
TRAUMA, VIOLENCE, & ABUSE
2020, Vol. 21(2) 350-366
Adolescents’ Help-Seeking Behavior and ª The Author(s) 2018
Article reuse guidelines:
sagepub.com/journals-permissions
Intentions Following Adolescent Dating DOI: 10.1177/1524838018770412
journals.sagepub.com/home/tva
Violence: A Systematic Review
Kerrie Bundock1, Carmen Chan2, and Olivia Hewitt1
Abstract
The review aimed to systematically identify and summarize empirical work examining adolescent victims’ help-seeking behaviors
and intentions in relation to their own experience of adolescent dating violence (ADV) and to critically evaluate the literature.
Three main objectives were addressed: identify factors associated with help seeking, identify help-seeking source (who adoles-
cents disclose to), and explore the barriers and facilitators for help seeking. Results were separated into actual help seeking and
help-seeking intentions. A systematic search was conducted via an electronic search on February 10, 2017. Studies were identified
by systematically searching the following electronic databases: Amed, BNI, CINAHL, EMBASE, Health Business Elite, HMIC,
Medline, PsychINFO, and PubMed. Nineteen studies were included in the review. Adolescents were more likely to go to informal
sources of support, with friends being the most commonly reported source. The majority of studies found females were more
likely than males to seek help; however, inconsistencies in gender differences emerged. The variation in measurement and
definition of ADV and help seeking included in this review impacts on its conclusions. Adolescents identify a number of barriers to
help seeking for ADV. Emotional factors were identified as important barriers to seeking help; however, very little research in this
review explored this area. Further research is required on age and cultural differences, use of the Internet, and preference for
different sources for different types of abuse. There is a need for a greater focus on help seeking to ensure government campaigns
are appropriately meeting the needs of young people experiencing ADV.
Keywords
dating violence, domestic violence, cultural contexts, disclosure of domestic violence, domestic violence, cultural contexts,
domestic violence, youth violence
Adolescent Dating Violence A recent meta-analysis of 101 studies on DV in 13- to

18–year-olds found overall 20% of adolescents reported
Adolescence is an important developmental stage involving the
experiencing physical DV (ranged from 1% to 61%), and 9%
transition from childhood. The World Health Organization
reported experiencing sexual DV (ranged from <1% to 54%;
(WHO) recommends using a broad age range of 10–24 years,
Wincentak, Connolloy, & Card, 2017). This study found sim-
as the end of adolescence may depend on cultural views and
ilar victimization rates for physical abuse for adolescent males
differing expectations for independence (WHO, 1986). The
and females. Females reported more perpetration of physical
Center for Disease Control and Prevention (CDC) defines dat-
abuse (25%) than males (13%). Females reported lower perpe-
ing violence (DV) as physical, sexual, or psychological vio-
tration of sexual abuse (3%) than males (10%), and females had
lence within a dating relationship and can occur in person or
higher victimization rates of sexual abuse (14%) than males
electronically (CDC, 2016). There are many different terms
(8%; Wincentak et al., 2017). Risk factors associated with
used to define DV including intimate partner violence, adoles-
ADV perpetration have been found to be mental health
cent dating violence, interpersonal violence, and teen DV.
Inconsistent definitions are challenging as without a universal
definition, there may be variation in what is classed as DV, 1
Oxford Institute of Clinical Psychology Training, Isis Education Centre,
difficulty monitoring incidence and prevalence, and also in Oxford, England
evaluating prevention programs (CDC, 2015). The term ado- 2
Oxford Health NHS Foundation Trust, Oxford, England
lescent dating violence (ADV) will be used throughout this
Corresponding Author:
review to refer to any form of violence in the context of an
Kerrie Bundock, Oxford Institute of Clinical Psychology Training, Isis Education
adolescent dating relationship and to capture the broad age Centre, Warneford Hospital, Oxford OX3 7JX, England.
range as recommended by the WHO (1986). Email: [email protected]

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Bundock et al. 351
problems (depression and anxiety), aggressive thoughts (i.e., Regarding adolescents, family and peers are the most widely
attitudes accepting of violence in dating relationships), youth used sources of help for a range of problems (Boldero & Fallon,
violence, substance use, risky sexual behavior, involvement 1995) as well as mental health problems (Rickwood, Deane,
with antisocial peers, and use of aggressive media (Vagi Wilson, & Ciarrochi, 2005) and specific problems such as self-
et al., 2013). harm (Rowe et al., 2014). With regard to help seeking from
Around 70% of females and 52% of males have sustained an parents, it has been found that parents continue to be a major
injury following violence in a dating relationship (Foshee, source of support even when there is adolescent–parent conflict
1996), including scratches, sprains, bruises, and black eyes (WHO, 2007). Adolescents may trust or rely on parents for
(Amar & Gennaro, 2005). ADV is associated with higher men- certain needs; however, they may prefer other sources of help
tal health difficulties (including depression and anxiety; Amar (such as extended family members) for problems such as con-
& Gennaro, 2005) and with suicidal ideation, poor quality of flict within the family, sexual relationships, and sexual health
life, poor self-concept, and difficulties in school (Teten, Ball, (WHO, 2007). Research suggests that if adolescents perceive
Anne Valle, Noonan, & Rosenbluth, 2009). Adolescent female formal sources as supportive, they are more likely to endorse
victims of physical DV have been found to be more likely to positive attitudes toward seeking help for bullying and threats
misuse substances, engage in unhealthy weight control (e.g., of violence (Eliot, Cornell, Gregory, & Fan, 2010).
laxative use), engage in risky sexual behavior (e.g., sexual Female adolescents are more likely to ask for help than
intercourse before 15 years old; Silverman, Raj, Mucci, & males for a range of problems (Boldero & Fallon, 1995) and
Hathaway, 2001), and to experience sexual health risk (e.g., for mental health issues (Rickwood et al., 2005). Females are
vulnerability to sexually transmitted diseases; Silverman, Raj, also more likely to report problems associated with families,
& Clements, 2004). In both male and female adolescents, psy- interpersonal relationships, and health, whereas males are
chological DV victimization has been found to predict more likely to report educational problems (Boldero & Fallon,
increased alcohol use and physical DV victimization has been 1995). This has been linked to gender role norms, where
found to predict increased cigarette use (Foshee, Reyes, Gott- needing help is less compatible with the masculine role (Ash-
fredson, Chang, & Ennett, 2013).
ley & Foshee, 2005). Findings from an international literature
review indicate inconsistent gender differences across cul-
Relevant Policy (United Kingdom) tures and contexts (WHO, 2007). Research from North Amer-
ica, Latin America, Australia, and Western Europe indicate
The National Institute for Health and Care Excellence (NICE)
boys were more likely to deny problems and manage on their
guidelines have identified ADV as a gap in the research liter-
own, whereas girls were more likely to use social support
ature (NICE, 2014). National campaigns aim to prevent ado-
systems (WHO, 2007). In other parts of the world, however,
lescents from becoming victims and perpetrators of abusive
boys were more likely to access social support outside the
relationships (Home Office, 2016). The “This is Abuse” cam-
home. Research conducted in Asia, parts of the Middle East,
paign targets 13- to 18-year-olds and aims to encourage ado-
lescents to rethink views on violence, abuse, controlling and Africa indicated cultural views may limit a young
behaviors, and consent and directs to help and advice (Home women’s access to support (WHO, 2007).
Office, 2016). This campaign evolved to the “Disrespect Barriers for adolescent help seeking for mental health prob-
Nobody” campaign (targeting 12- to 18-year-olds) which lems include stigma, embarrassment, and preference for self-
includes new issues such as “sexting” (Home Office, 2016). reliance (Gulliver et al., 2010). Positive past experiences, social
support, encouragement from others, assurance of confidenti-
ality, respect, a trustworthy source, and option of talking to
Help Seeking someone of similar age and background have been found to
Adolescent help-seeking behavior is “any action or activity facilitate help seeking for general and specific problems (Gul-
carried out by an adolescent who perceives herself/himself as liver et al., 2010; Rowe et al., 2014). Use of the Internet for help
needing personal, psychological, affective assistance, or health seeking and self-harm has been found to have both positive and
or social services” (WHO, 2007, p. 2). This can be from a negative influences. Adolescents reported online resources
formal (e.g., health-care professional) or informal source would be anonymous and less judgmental and however also
(e.g., friends and family; WHO, 2007). There is a substantial reported they may be discouraged from seeking treatment from
amount of research exploring adult victims’ experience of DV other online users (Rowe et al., 2014).
and adult victims’ help seeking. Informal sources of support Previous research into adolescent help seeking is dated, and
(e.g., friends and family) are most often used with fewer adult there is a need to consider societal changes, such as the rise in
women using formal sources (e.g., police and health-care pro- use of the Internet. Young people are now reliant on technology
viders; Fanslow & Robinson, 2010). In the adult literature, the for communication and socializing (e.g., social media). The
following themes are identified as important barriers to dis- potential role of the Internet needs to be considered for ADV
cussing DV: upholding traditional gender roles, preserving the and adolescent help seeking, as there may be changes in the
family unity, and feelings of shame and self-blame (Othman, types of abuse experienced (e.g., revenge porn and cyber bully-
Goddard, & Piterman, 2014). ing) and also in how adolescents seek information and support.

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352 TRAUMA, VIOLENCE, & ABUSE 21(2)
Reviews to Date Journal of Adolescent Health). Search terms were grouped into
three main areas and combined: violence related, age related,
Most reviews on ADV have focused on risk and protective
and help seeking related. The terms aimed to represent the
factors associated with perpetration of ADV (Vagi et al.,
concept of help seeking and were chosen based on terms used
2013) and ADV prevention programs (Lundgren & Amin,
in the help-seeking literature. Terms included:
2015). One review on ADV and supports and barriers to acces-
sing services has been published (Moore, Sargenton, Ferranti, “intimate partner violence”, “interpersonal violence”,
& Gonzalez-Guarda, 2015), which identified 10 articles. “dating violence”, “teen violence”, “partner violence”,
Moore et al. (2015) identified adolescents preferred informal “teen dating violence”, “relationship violence”
sources of help, a lack of protocols for screening for ADV, and Adolescen*, “young people”, youth, teen*
the main barrier identified was stigma. Moore et al.’s (2015) “decision to leave”, help-seeking, “decision-making”,
review was restricted to articles since 2002 and focused on the disclosure
supports and barriers to accessing services. It included profes-
sional perspectives (e.g., school counselors and nurses), train-
ing, and protocols for screening for ADV. The current review is Inclusion and Exclusion Criteria
interested in help seeking specifically and will include only
studies focused on adolescents’ own experiences of help seek- Studies were included if they were published in peer-reviewed
ing. Studies focused on professional experiences of ADV will journals and written in English. Articles included participants
be excluded from the current review to enable exploration of aged 10–24 years in line with the WHO recommendation
the specific experiences of ADV from the young person’s per- (WHO, 1986). One study did not report age range and mean
spective. The current study also separates help seeking into (Fry et al., 2014). The author was contacted (no response);
actual behaviors and intentions. It is hoped this will allow however, as participants were recruited from secondary schools
further understanding of help seeking as a process (i.e., explor- in the United States, it was expected they would fall into the
ing intentions may provide understanding of future attitudes specified age range, and the study was included. No limits were
toward help seeking). placed on study design or on date. Studies published up to
February 10, 2017, were included. The following exclusion
criteria were applied (i) participants outside the specified age
Rationale and Objectives range, (ii) review articles and dissertation abstracts, (iii) studies
With increased attention on campaigns to target adolescents, focused on ADV intervention programs with no reference to
this review will provide a timely contribution to understanding help seeking, (iv) articles focused on perpetrators’ help seeking
adolescent help-seeking behavior for ADV. The current review only (not victims), (v) studies not focused on adolescents’ own
aims to systematically identify and summarize empirical work experience of ADV (e.g., witnessing domestic abuse), and (vi)
examining adolescent victims’ help-seeking behaviors and studies not focused on adolescents’ own disclosure or help
intentions in relation to their own experience of ADV. The seeking (e.g., professionals’ experience of adolescent disclo-
review will aim to critically evaluate the literature and consider sure). In studies where victims and perpetrators were separated
clinical, research, policy, and theoretical implications. Three in analyses, only the victim sample characteristics were used.
main objectives will be addressed—(1) identify factors associ-
ated with help seeking, (2) identify help seeking source (who Selection of Studies and Data Extraction
adolescents disclose to), and (3) explore the barriers and facil-
itators for help seeking. The structure and content of this review was guided by the
Preferred Reporting Items for Systematic Reviews and Meta-
Analysis (Liberati et al., 2009). Initial searching identified 251
Method possible studies after removing duplicates. Titles and abstracts
were reviewed, which left 56 articles for full-text review. Of
Search Criteria these, 19 articles were included in the review. Authors were
A systematic search was conducted using an electronic search contacted to collect missing information (e.g., age range of
using NHS evidence (electronic resource of information, participants). The details of the search findings are presented
research, evidence, and best practice for health and social care). in Figure 1.
The search was conducted on February 10, 2017, by searching Guidance by the Cochrane Collaboration (Version 5.1.0;
the following electronic databases: Amed, BNI, CINAHL, Higgins & Green, 2011) was used to guide critical appraisal
EMBASE, Health Business Elite, HMIC, Medline, Psy- of the included studies. The checklist developed by Downs and
chINFO, and PubMed. These health-care databases were cho- Black (1998) was used to guide critique of quantitative studies
sen, as they allow for an advanced search of relevant articles. (including external validity, appropriateness of statistical anal-
Secondary searches were completed by manually scanning ysis, outcome measures used, and power). Qualitative studies
references of relevant articles, contacting researchers, and were critiqued using the Relevancy, Appropriateness, Trans-
manual searches of the following key journals (Trauma, Vio- parency, Soundness (RATS) qualitative review guidelines
lence and Abuse, Journal of Interpersonal Violence, and (Clark, 2003). This included appraisal of the studies in terms

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Bundock et al. 353
Records identified through Potential references found through

database search (n= 366) secondary sources (n= 2)
Identification
Duplicates removed (n= 117)
Records screened after duplicates

removed (n= 251)
Records excluded based on title/abstract review

(n=195)
Over 24 years old (n=21)
Screening
Not related to help-seeking (n=86)

Not related to ADV (n=27)
Not adolescent (own) help-seeking/experience of
ADV (n=19)
Review (n=7)
Intervention only (n=18)
Perpetration only (n=10)
Eligibility
Dissertation abstracts (n=4)

Not peer reviewed (n=3)
Full text articles assessed for inclusion (n=56)
Records excluded based on full text

review (n=37)
Over 24 years old (n=27)
Not related to help-seeking (n=3)
Included
Not adolescent (own) help-

seeking/experience of ADV (n=4)
Not ADV specifically, e.g. sexual assault,
Papers included (n=2)
in the review
(n=19) Used same participants (n=1)
Figure 1. A flow diagram of the search process. Adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis
guidelines (Gonzalez-Guarda et al., 2016).
of appropriateness of design, transparency of procedures (sam- study characteristics and critique and (2) main findings. Sum-
pling, recruitment, data collection, role of researchers, and mary of critical findings are provided in Table 1. Implications
ethics), and data analysis. A predetermined data extraction tool for practice, policy, and research are provided in Table 2.
was developed by the researcher using guidance by the
Cochrane Collaboration, incorporating guidelines listed above.
Summary of Study Characteristics and Critique of Studies
Participants. Eighteen studies were conducted in the United
Results States and one in New Zealand, limiting generalizability. One
study did not report age range or mean (Fry et al., 2014). The
Overview percentage of females ranged from 31.6% to 100%. Three
The search yielded 19 articles. Four articles used qualitative studies used female-only samples, and while there was a ratio-
designs, two used mixed-method designs, and the remaining nale provided for this in one study (Gonzalez-Guarda, Ferranti,
13 used quantitative methods. A total of 22,372 participants Halstead, & Ilias, 2016), it was less clear in others (Miller et al.,
(aged 10–24 years) were included across the studies. The 2010; Zeitler et al., 2006). The percentage of participants iden-
findings are organized into two sections: (1) summary of tifying as Black/African American ranged from 0% to 100%

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354
Table 1. Summary of Critical Findings.
First Author, Study Design; Context; ADV and Help-Seeking

Year Measure Sample (N, Gender, Sexuality), Age, Ethnicity Main Findings
Actual HS
Alleyne-Green Quantitative, cross-sectional; N ¼ 11,570 (52.8% female, 47.2% male, 81% 16.9% reported seeking professional help. Logistic regression analysis
et al. (2015) self-report survey. Data from NYC Youth Risk heterosexual); School-years aged 14–18 (9th containing the 7 predictors was significant, w2(7, N ¼ 11,570) ¼ 454.19,
Behavior Surveillance System, 2011, USA; to 12th grade); 26.2% AfA, 25.2% H/L, 18.7% p < .001, and explained between 4.9% and 8.3% of the variance.
ADV: No formal measure, two questions on Multiple Hispanic, 11.1% W Gender: Females were 1.78 times more likely to seek professional help
physical and sexual abuse than males (p < .001) Ethnicity: Overall, 50% of all HS were Hispanic or
HS: Retrospective from multiple Hispanic origin. Multiracial or Hispanic were most likely
to seek professional help, Asian were least likely (p < .001)
Type: Hit or slapped by partner was 1.00 times more likely to seek
professional help (p < .005). Physically forced to have sexual
intercourse was 1.76 times more likely to seek professional help
(p < .001) Age: Older adolescents were significantly less likely to seek
professional help than younger adolescents (p < .001)
Ashley and Quantitative, cross-sectional self-report survey; Full sample (N ¼ 1,814) 14–17 years; Victim Victim HS: 60% did not seek help for DV
Foshee (2005) Part of wider study exploring ADV sample:(n ¼ 225): 72% female, 28% male, No sociodemographic variables were significantly associated with victim’s
prevention program (explored effects of 49.3% 15 years, 75.6% C, 19.6% B, 4.9% O HS; 93% reported seeking help from informal sources and 40% from
program), 52% of victims received program formal sources. Gender: Male victims were significantly more likely
1996, North Carolina, United States; ADV: than females to seek help from formal sources (OR ¼ 3.36; 95% CI
No formal measure, Question asking if [1.20, 10.09])
anyone that they had been on a date with had
ever used physical force; HS: Retrospective
Black et al. Quantitative, cross-sectional self-report survey; n ¼ 57 (who had experienced DV), 56% female, 67% of students reported they talked to someone about the DV. Gender:
(2008) Data from wider study that examined ADV in 44% male; School years aged 14–18 (9th– Significant gender difference (52% male, 78.1% female talked to
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an urban public high school, No year 12th grade); 7% AfA, 41% EA, of the someone), w2 (1, N ¼ 57) ¼ 4.311, p ¼ .038. Source: Of those who
reported (published 2008), United States remaining 12% (3 H/L, 1 A, 3 did not identifytalked to someone, all reported they talked to a friend, 13% reported
(Michigan); ADV: Modified version of the racial background) they talked to a parent or other adult in addition to a friend. Someone

CTS2 to measure prevalence and severity of seeing the violence (p < .001) or attaching anger and/or jealousy
ADV; HS: Retrospective (based on worst (p < .05) to the violence were significantly associated with talking to
situation of physical/violence—“Who did you someone about the violence. Having someone see the violence
turn to?”) (OR ¼ 7.31, p < .001) and attaching anger or jealousy increased odds
of talking to someone (OR ¼ 7.31, p ¼ .015).
Dank et al. Quantitative, cross-sectional, self-report; N ¼ 3,745 (52.3%female, 47.2% male, 6% LGB youth had significantly higher rates of all types of DV victimization,
(2014) Schools had antibullying program (some with identified as LGB, 94% heterosexual); 12–19 including cyber dating abuse (37%). Significant association between
teen DV component), no year reported years (46.7% 12–15, 53.3% 16–19); 73.7% C/ sexuality and HS (p <.001), with higher proportions of LGB victims
(published 2014) United States (New York, W, 10.2% Mixed race, 8.2% H/L, 5% AfA/ sought help (18%) compared to heterosexual victims (8%)
Pennsylvania, New Jersey); ADV: Physical, Black, 2.2% AsA, 0.7% NA
psychological and sexual coercion—
questions from Foshee (1996). Cyber dating
abuse—16 questions created for survey; HS:
Retrospective (based on current/most recent
relationship)
(continued)
Table 1. (continued)

Elias-Lambert Quantitative, cross-sectional, self-report n ¼ 380 (in dating relationship), 51% female, Age: Significantly more 6th graders than 7th, w2 (1, n ¼ 142) ¼ 4.22,
et al. (2014) survey; Data from DV and sexual assault 49% male; School years age 11–13 years p < .05, and 8th, w2 (1, n ¼ 215) ¼ 8.86, p < .05 reported seeking help
prevention program conducted by author (6th–8th grade); 99% AfA from an adult. Significantly more 6th, w2 (1, n ¼ 195) ¼ 6.67, p < .05,
(baseline data used), 2002–2006, United and 7th graders, w2 (1, n ¼ 273) ¼ 4.41, p < .05 (than 8th) reported
States; ADV: Controlling Behaviour Scale seeking help from peers. Source: Overall youth reported they would
developed based on PMWI seek help from a friend (64%), siblings (50%) or talk out the problem
HS: Retrospective with their dating partner (58%). Also spoke to teacher (17%) and
minister (13%); Gender: Females significantly more likely than males to
talk to a friend, w2 (1, n ¼ 223) ¼ 6.82, p < .001, males significantly
more likely to talk to their father, w2 (1, n ¼ 106) ¼ 17.44, p < .001
Fry et al. Quantitative, cross-sectional, self-report survey Full sample ¼ N ¼ 1,312, 56% female, 44% male; 61% told someone
(2014) (2 computer, 2 pen and paper); 2006–2007, Age range and mean not reported (author Gender: Male significantly less likely than female victims to seek help
United States (Manhattan and Brooklyn); contacted, no response): 18% 14 or younger, (OR ¼ 0.27, 95% CI [0.13, 0.60]). Ethnicity: No significant differences in
ADV: Physical and sexual abuse measured 48% 15–16, 34% 17 and older; 48% B, 7% W, HS by ethnicity or nativity. Source: Victims more likely to choose
using the DV Inventory and Family Abuse 4% AsA 32% O, 9% Mixed friends for informal support. 72% of victims initially disclosed to a
Scale (Symons et al., 1994); HS: Retrospective friend. Gender and nativity not associated with type of people
disclosed to
Gonzalez- Qualitative, cross-sectional, semistructured N ¼ 11 (100% female); 18–24 years (M ¼ 20.8, Conflict, culture, and context influences Hispanic couples.: Participants
Guardaet al. interview; SD ¼ 2.3); (n ¼ 9) 18.2% B/AfA, 63.6% W believed Hispanic women were at greater risk of DV. Missed
(2016) 2014–2015, United States (Florida); ADV: No opportunities: Lack of knowledge, loss of agency as a barrier, lack of
formal measure intervention from formal and informal sources. Pivotal moments are
HS: Retrospective needed to access services: Individual breaking points, interventions
from others. Family matters: Important role of mothers, women
survivors in the family, helpful and hurtful involvement from family
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Jackson et al. Quantitative, cross-sectional, self-report survey N ¼ 373, (54% female, 46% male; 16–20 years Type:
(2000) developed from focus group; Part of wider (M ¼ 16.7); 54.7% C, 17.5% A, 8.4% Maori, Emotional: Both males and females reported feeling angry, confused, and
study, no year reported (published 2000), 9.4% Pacific Island embarrassed. Males less likely to talk to someone (p < .001). Sexual:

New Zealand; ADV: No formal measure. Significantly more females than males reported they “felt dirty”
Violence measured using a frequency scale (p < .001). 46.8% male and 46.1% female “talked to nobody.” 53% of
measuring emotional violence, sexual females and 43.2% of males talked to friends. Physical: Females
coercion, and physical violence; HS: reported feeling anger and fear. Males reported feeling “not bothered”
Retrospective and anger. 52.2% females and 45.5% males did not tell anyone. Of those
that did talk to someone, 41.4% females and 18.2% males talked to a
friend
Miller et al. Quantitative, cross-sectional, self-report N ¼ 448, 100% female; 14–20 years (M ¼ 17 Barriers: Reasons for nondisclosure: none of providers business (34%),
(2010) survey; 2006, United States (Greater years); 34% non-Hispanic White, 26% AA, embarrassment (32%), fear of partner’s anger (20%), fear of provider
Boston); ADV: Physical and sexual violence. 34% Hispanic, 3% Asian telling parents (19%), feeling it was not a big deal (24%) and fear
Items modified from the CTS-2 and the providers would report to child protection services (12%)
sexual experiences survey; HS: Retrospective
Molidor and Quantitative, cross-sectional, self-report N ¼ 635, 48% female, 52% male; 13–18 years; Gender: No significant gender differences on who they told. Source: 61%
Tolman (1998) survey; Year not reported (published 1998), 49% W, 30% B/AfA, 6.9% A, 3.5% NA, 9% L went to friends, 3% authority figure, 6% family
United States; ADV: CTS, 3 items added (hair
pulled, intentionally scratched, painfully
pinched); HS: Retrospective (who was told
355
about the abuse)
(continued)
356

Sabina et al. Quantitative, cross-sectional, Phone survey; 1. Full sample (N¼ 1,525), 50.7% female, 93.1% Source: More likely to seek help from informal sources (60.7%) than
(2014) Data from DAVILA study (phone survey), heterosexual; 12–18 years (M ¼ 14.85, SD ¼ formal (15.6%). Friends’ most common source of informal help (42.9%),
2011–2012, United States; ADV: Modified 1.88); 100% L, 76.1% born in United States. 2. school staff most common form of formal help (9.2%). Gender: Females
versions of the JVC and the CTS2 SF Victim: n¼ 95, 31.6% female, 90.4% more likely than males to seek help from formal sources, w2 ¼ 12.08,
HS: Retrospective (how they responded to heterosexual, 5.3% gay/lesbian/bisexual, 4.3% p < .001. Females 18.38 times increase in odds of seeking formal help
the most severe forms of ADV) not sure/transitioning; 12–18 years (M ¼ than boys (OR ¼ 18.38, p < .001). Barriers: “Not thinking of it” most
15.68, SD ¼ 1.71). 100% L, 82.2% born in common response. Other reasons included “wanting to keep it
United States private,” perceiving it as too minor, shame, not wanting help, and
concerns about confidentiality
Watson et al. Quantitative, cross-sectional; self-report Full sample: N ¼ 476 (56% m, 44% f); M ¼ 16.63 Source: Overall adolescents were not likely to use formal help-seeking
(2001) survey; Year not reported (published 2001), years; n ¼ 183 (reported physical aggression sources nor access adult figures. Informal HS (43%), formal HS (8%).
New York, United States, Part of wider study in dating relationship); No age range or mean Gender: Females (M ¼ 2.68) engaged in more actions than males
evaluating efficacy of ADV prevention given for victim sample; 43% H, 31.5% C, (M ¼ 2.44), F(1,183) ¼ 3.66, p ¼ .057. Males more likely than females
program (baseline data used); ADV: Modified 15.8% AfA, 1.1% A, 6.1% O to “do nothing” (z ¼ 3.27, p < .001). Ethnicity: No significant race
CTS, only those reporting physical aggression difference in frequency of actions taken (p ¼ .375). Students were
used in analysis; HS: checklist of 15 possible significantly more likely to predict they would use formal HS sources in
actions the future, namely, police
Retrospective: actions actually taken in
response to ADV and also which actions
would take in the future
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Zeitleret al. Mixed design; 1. Audio computer–assisted self- 1. N ¼ 645, 100% female, 15–24 years; 33% H, Facilitators: When asked what would make it easier to disclose—86%

(2006) interview and 2. focus groups; cross- 28% non-Hispanic B, 22% non-Hispanic W, reported if knew provider would not take any action without
sectional; 2004, United States (Manhattan, 12% A, 5% Other. permission, 84% if was totally confidential, 85% if environment was

Bronx, Brooklyn); ADV: RV measured using 2. N ¼ 120, all female; 3 groups (15–18, 19–21 friendly and understanding
the CADRI (physical, sexual, and emotional and 22–24 years); 30% H, 31% non-Hispanic
abuse); HS: Retrospective (“did you B, 22% non-Hispanic W, 11% A, 6% Other
disclose?”)
HS intentions
Black and Quantitative, descriptive exploratory study, N ¼ 165 (55% female, 45% male); 7th grade Few students reported DV experiences.; 148/165 (89%) would seek help
Weisz (2003) cross-sectional; self-report survey; part of students (M ¼ 12.68). All AfA with exception from parents; 51% of females and 35% of males reported they would
wider study evaluating effectiveness of sexual of one EA male seek help from a friend at their school. Gender: Significantly more
assault and DV prevention program (baseline females than males reported they would seek help from mothers
data used), 1998–2000, United States; ADV: (p ¼ .008), grandmothers (p ¼ .008) whereas significantly more males
Questions similar to those on the CTS; HS: than females reported they would turn to their fathers (p ¼ .035)
Intentions (who would you seek help from in
sexual assault and ADV situations
(continued)

Hedge et al. Quantitative, longitudinal (first 3 waves included N ¼ 589, (52.5% female); 10–18 years (39%Source: More willing to seek informal help (M ¼ 2.82) than formal help (M
(2016) in study), South Carolina, United States, part 10–12, 58% 13–15, 3% 16–18); 45.6% AfA, ¼ 2.24), t(513) ¼ 12.17, p < .001. Gender: Females had significantly
of 4-year research initiative examining DV 38.6% W, 13.7% H/O higher intentions than males to seek informal, F(1, 522) ¼ 49.87, p <
victimization and perpetration (2012–2015); .001, and formal help, F(1, 504) ¼ 5.25, p ¼ .02. Ethnicity: No
ADV: No formal measures, asked about statistically significant differences for HS intentions by ethnicity. Age:
experience of being victim or perpetrator of Those in 9th grade were more likely than 11th grade to say they would
emotional, physical, and sexual violence seek formal help. Type: More willing to seek formal help for physical (p
HS: Intentions, Hypothetical, for example, “If < .001) and sexual (p < .001) than for emotional. More willing to talk to
someone you dated humiliated you, how a parent than a friend for sexual (p ¼ .003). More willing to talk to a
likely would you be to tell . . . ” using rating doctor about sexual DV than a teacher (p < .001), a minister (p < .001)
scale (higher scores indicate better likelihood or a counsellor (p ¼ .021). Slightly higher preference to speak with a
of help seeking) counsellor than a doctor (p < .001) or minister (p < .001)
Love and Qualitative, cross-sectional; focus groups, 22 N ¼ 25, 13 females (52%), 12 males (48%); Definition: Male and female participants reported IPV meant physical
Richards question, semistructured, open-ended 15–19 years (M ¼ 16.7 years); 88% AfA, abuse. HS: Most males would not tell, majority of females reported
(2013) protocol; 2011–2012, United States; ADV: 12% “other” they would tell someone (to close friend, best friend, or sister,
No formal measure; HS: Hypothetical (e.g., followed by mother). Source: All participants indicated they would not
“Would you tell anyone if you were getting tell Student resource officers. Some participants revealed that some
abused in a romantic relationship?) victims disclosed on Facebook
Martin et al. Qualitative, cross-sectional; semistructured N ¼ 32, mixed sample (breakdown of gender Definition: Held different meaning for drama ¼ from normative
(2012) focus groups 2012, United States; ADV: not reported), 5–9 participants per group disagreement between partners to physical fighting. Source: Preference
Focus groups designed to elicit general (four groups); 13–24 years, All AfA for peers, older siblings and family members. Barriers: Women’s
perceptions rather than personal information barriers for reaching out to family—Fear of further violence and
HS: Hypothetical (where might they turn if shame, friends—female friends in similar relationships, formal—little
faced with abuse) hesitation
Men’s barriers for friends and family—no barriers; however, formal
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services were seen as a threat to masculinity. Desired center: empathic
staff, safety, confidentiality, peer referral

Ocampoet al. Mixed design: 1. Self-administered survey and 2. 1. N ¼ 1,655, (split evenly between boys and Source: Most likely to seek informal sources of support (parents, siblings,
(2007) focus group; cross-sectional 2001–2002, girls); M ¼ 14.53 years (SD ¼ 1.1); 91% L, other relatives or friends). Informal sources reported as most helpful,
United States (Los Angeles); 2. Students who 3.4% AsA, 1.5% AfA or B, 2% non-Latino. 2. especially parents (81.76% males, 81.97% females reporting “quite a bit
had received the Break the Cycle Ending N ¼ 43, (n ¼ 22 males, n ¼ 21 females); 9th or extremely helpful”). Focus groups reported that they do not trust or
Violence curriculum, 2002, United States grade (13–14 years); Predominantly L feel close to adults in professional roles. Barriers: “Think the partner
(Los Angeles); ADV: Questions: “If you loves them,” “what they have seen at home”
experienced violence with a date.” No formal
measures used; HS: Hypothetical (“how likely
would you be to talk about it”)
Rueda et al. Qualitative, cross-sectional; Focus groups; Part N ¼ 64, (62.5% female, 37.5% male); 15–17 Barriers: (1) Adolescents did not want to leave the relationship, (2) HS
(2015) of wider study, MATR study (online), 2010– years; 100% MA, 31% born in Mexico viewed as a weakness, and (3) fear of partner retaliation. Source: Family
2012, United States; ADV: CADRI; HS: and friends
Hypothetical (“what would you do”)
Note. DV ¼ dating violence; ADV ¼ adolescent dating violence; RV ¼ relationship violence; HS ¼ help seeking; NYC ¼ New York City; DAVILA ¼ Dating Violence among Latino Adolescents; MATR ¼ Mexican American
Teen Relationship; Ethnicity: A ¼ Asian; Af ¼ African; AfA ¼ African American; Afn ¼ North African; AsA ¼ Asian American; AI ¼ African Indian; AP ¼ Asian Pacific-Islander; B ¼ Black; BC ¼ Black Caribbean; C ¼
Caucasian; Ch ¼ Chinese; EA ¼ European American; H ¼ Hispanic; Hispanic American; I ¼ Indian; L ¼ Latino; MA ¼ Mexican American; ME ¼ Middle Eastern; NA ¼ Native American; O ¼ Other; OM ¼ other or
multiracial; P ¼ Pakistani; W ¼ White. Measures: CTS ¼ Conflict Tactics Scale (CTS; Straus, 1979); CTS2 ¼ Revised Conflict Tactics Scale (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996); PMWI ¼ Psychological
Maltreatment of Women Inventory (Tolman, 1989); CADRI ¼ Conflict in Adolescent Dating Relationships Inventory (Wolfe, Scott, Reitzel-jaffe, & Wekerle, 2001); JVC ¼ Juvenile Victimization Questionnaire (Finkelhor,
357
Ormrod, Turner, & Hamby, 2005); CTS2 SF ¼ Revised conflict scale short form (Straus & Douglas, 2004); Dating Violence Inventory and Family Abuse Scale (Symons, Groer, Kepler-youngblood, & Slater, 1994).
Table 2. Implications for Practice, Policy and Research.
Practice Policy Research
Professionals to involve parents and Greater focus on help seeking Longitudinal prospective designs to
peers Educate peers and parents on help- explore process of help seeking
Improve knowledge and awareness of giving (e.g., referral process, how to Research in countries outside of the
services (inform about role and service) intervene safely) United States
Aware of importance of confidentiality Up to date with technology (e.g., More research in the United Kingdom
and be clear on limits to this include cyber bullying, how to use Clear definitions of ADV and
Challenge assumption that help seeking Internet for giving advice, inclusion of consistency of measurement
is a weakness, ADV only includes social media) Include all types of abuse (i.e.,
physical abuse, and clarify language of Ensure campaigns give age appropriate emotional and coercive control) to
adolescent information challenge assumptions that ADV is
Information on services for adolescents Include adolescents in national physical abuse only
who are new to the area or from statistics Collect data prior to prevention
different cultural background Early intervention—to reach youth as programs and give more information
Training for professionals on young as possible on content of these programs
developmental needs in adolescence Aim to reduce stigma for both Age differences and help seeking
(e.g., understanding of relationships) genders. For example, including media LGBT and learning disability groups
Support and educate adolescents about campaigns with both male and female Which forms of help are perceived as
help-giving and professional help victims most helpful
Involve parents in prevention programs Internal (e.g., attitudes) barriers and
Training for school staff emotional responses
Training for staff on ADV in More research on the Internet and
organizations such as sexual abuse ADV (e.g., positive and negative impact
referral centers and domestic abuse of disclosure on Internet)
charities
Note. ADV ¼ adolescent dating violence; LGBT ¼ lesbian, gay, bisexual, and transgender.
and White/Caucasian ranged from 0% to 74%. Two studies had findings and limit conclusions regarding external validity. Five
91% (Ocampo, Shelley, & Jaycox, 2007) and 100% (Sabina, studies recruited individuals who were already accessing ser-
Cuevas, & Rodriguez, 2014) participants identifying as Latino, vices. This included a social service agency providing a service
and one study had all Mexican American participants (Rueda, to victims of ADV (Gonzalez-Guarda et al., 2016), urban ado-
Williams, & Nagoshi, 2015). Three studies included samples lescent center (Martin et al., 2012), health-care clinic (Miller
with all (Martin, Houston, Mmari, & Decker, 2012) or high et al., 2010), clinics providing confidential services to adoles-
percentages of participants identifying as African American cents (Molidor & Tolman, 1998), and a family planning service
(Black & Weisz, 2003; Elias-Lambert, Black, & Chigbu, (Zeitler et al., 2006). This limits generalizability, as these stud-
2014). Findings from these studies cannot be generalized to ies utilized samples from treatment/help-seeking services,
adolescents of differing ethnicities. Only three studies reported which may represent a unique subgroup. One study employed
sexual orientation of participants (Alleyne-Green, Fernandes, a convenience sample of participants attending a city-
& Clark, 2015; Dank, Lachman, Zweig, & Yahner, 2014; sponsored driver education class (Love & Richards, 2013). The
Sabina et al., 2014). One study (Miller et al., 2010) asked remaining 13 studies recruited participants through schools in a
females about male partners (assuming heterosexuality), mak- range of classes (e.g., health classes and physical education).
ing results less applicable to homosexual youth. No studies
explored experiences of help seeking from marginalized groups
(e.g., learning disabilities, transgender). Study design. All studies were observational/nonexperimental
designs. Eighteen studies utilized cross-sectional designs. One
study was part of a longitudinal study (Hedge, Sianko, &
Context. Although eight studies were conducted within the last McDonell, 2016) and used the first three waves of data. Twelve
five years, many ranged from 10 to 23 years old. Despite studies were part of wider studies—five exploring DV preven-
important developments in technology, only two studies tion programs (Ashley & Foshee, 2005; Black & Weisz, 2003;
included use of the Internet (Love & Richards, 2013) or asked Elias-Lambert et al., 2014; Ocampo et al., 2007; Watson, Cas-
participants about cyberdating abuse (Dank et al., 2014). cardi, Avery-Leaf, & O’Leary, 2001). In addition, Dank et al.
(2014) recruited schools providing an antibullying program to
Recruitment and sampling. Challenges and ethical constraints to students which included information on ADV. Of those explor-
researching hard-to-reach populations, such as those experien- ing ADV prevention programs, there was minimal information
cing ADV, result in the majority of studies using convenience provided on what students were taught as part of the program,
sampling. This may limit the representativeness of review and therefore, it is unclear whether this would impact on help-

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Bundock et al. 359
seeking responses. Three of these studies reported data collec- Analysis—quantitative. Only one study reported power calcula-
tion for the research study took place prior to the prevention tions (Hedge et al., 2016). Although statistical analyses cho-
program (Black & Weis, 2003; Elias-Lambert et al., 2014; sen were considered appropriate in relation to study aims and
Watson et al., 2001). For the remaining two studies, one hypotheses, no studies reported test assumptions and normal-
explored the effects of the program on help seeking (Ashley ity of data. Two studies used logistic regression analyses with
& Foshee, 2005). It is unclear from Ocampo et al.’s (2007) small sample sizes (N ¼ 57; Black et al., 2008; N ¼ 95; Sabina
study whether information in the program influenced partici- et al., 2014), possibly impacting on power. One study set a
pant responses on help seeking, necessitating caution when higher significance value (p > .10), however, gave rationale
generalizing to adolescents not involved in prevention for this due to exploratory nature of the study (Black & Weisz,
programs. 2003).
Design—qualitative. Qualitative articles mainly utilized focus Analysis—qualitative. Qualitative designs used a range of meth-
groups (Love & Richards, 2013; Martin et al., 2012; Rueda ods to analyze data, including thematic analysis (Gonzalez-
et al., 2015) with the exception of one, adopting the use of Guarda et al., 2016), content analysis (Love & Richards,
semi-structured interviews (Gonzalez-Guarda et al., 2016). The 2013; Rueda et al., 2015), and long table approach (Martin
two articles using mixed-method designs, utilized focus groups et al., 2012). All four articles supported interpretations of the
to define terms and concepts (Zeitler et al., 2006) and to data by use of appropriate verbatim quotes. The basis on which
explore unexpected findings and check language used in sur- quotations were selected was unclear (Clark, 2003), with the
veys (Ocampo et al., 2007). All four qualitative articles and exception of Love and Richards (2013) who utilized a data
both mixed-method articles were not transparent in the role of management package (Atlis.ti version 5.0) with a quotations
researchers. Reflexivity was not discussed, and the researchers tool. With regard to mixed-method designs, one study used
did not report their own possible influence on the formulation grounded theory (Zeitler et al., 2006) and one study did not
of the research question, data collection, or interpretation report method used for analysis of qualitative data (Ocampo
(Clark, 2003). et al., 2007). All four qualitative articles gave appropriate
descriptions of how themes were derived from the data. The
mixed-method articles lacked description of how data were
Measure of ADV. Only four studies reported measuring severity
transformed to themes and rationale for the development of
of DV (Black & Weis, 2003; Black, Tolman, Callahan, Saun-
themes. Two qualitative articles employed credibility checks
ders, & Weisz, 2008; Dank et al., 2014; Molidor & Tolman,
including peer debriefing (Gonzalez-Guarda et al., 2016) and
1998). Only two studies used measures developed specifically
analytic triangulation in development of a coding scheme and
for ADV (Rueda et al., 2015; Zeitler et al., 2006). No studies
an audit trail (Rueda et al., 2015).
included in the review reported time since abuse. Questions
were restricted to the past 12 months (Alleyne-Green et al.,
Ethical considerations. Eight studies failed to report ethical
2015; Dank et al., 2014; Sabina et al., 2014) and the past
approval (Alleyne-Green et al., 2015; Black et al., 2008; Dank
six months (Black & Weis, 2003). Therefore, time since abuse
et al., 2014; Hedge et al., 2016; Molidor & Tolman, 1998;
may have varied widely between studies potentially impacting
Ocampo et al., 2007; Sabina et al., 2014; Watson et al.,
on help seeking.
2001). Four studies did not report whether informed consent
had been obtained (Gonzalez-Guarda et al., 2016; Hedge et al.,
Definition of ADV. Two studies explored physical and sexual 2016; Jackson, Cram, & Seymour, 2000; Molidor & Tolman,
violence only (Alleyne-Green et al., 2015; Miller et al., 1998). Two studies waived parental consent which is appropri-
2010), two studies explored physical force/aggression only ate for young people over 16 years (NHS Choices, 2017).
(Ashley & Foshee, 2005; Watson et al., 2001), and one study However, this poses ethical questions, as these studies included
(Ocampo et al., 2007) asked about experience of “violence on a children as young as 13 (Martin et al., 2012) and 14 years old
date". Two studies (Black et al., 2008; Sabina et al., 2014) (Miller et al., 2010).
asked participants about help-seeking behaviors in relation to
the worst situation/most severe abuse. The remaining studies Main findings. The results will be presented in line with the main
explored ADV in terms of physical, sexual, and emotional objective of the review and will be separated into actual and
abuse. intended help seeking (as six studies explored hypothetical
scenarios/help-seeking intentions).
Measure of help seeking. Six studies (Black & Weisz, 2003;
Hedge et al., 2016; Love & Richards, 2013; Martin et al.,
2012; Ocampo et al., 2007; Rueda et al., 2015) used hypothe-
Actual Help Seeking
tical scenarios (i.e., Would you tell anyone if you were getting Factors associated with help seeking
abused in a romantic relationship?) rather than real life (i.e., Gender. Four studies (Black et al., 2008; Fry et al., 2014; Jack-
Who did you tell?). This indicates they were measuring antici- son et al., 2000; Watson et al., 2001) found significantly more
pated rather than actual behaviors. females than males seek help regarding ADV.

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Cultural factors. Four studies explored race/ethnicity differ- reported ADV to an authority figure (including police, social
ences in relation to help-seeking behaviors. Three studies worker, counselor, and teacher). There was variation in the
noted no significant differences for race, ethnicity, or place types of formal help seeking included in the studies. For exam-
of birth on help-seeking behaviors (Ashley & Foshee, 2005; ple, Watson et al. (2001) included teachers as an informal
Fry et al., 2014; Watson et al., 2001). One study found 50% of source, whereas other articles included teachers in formal help
all help seekers were Hispanic or multiple Hispanic origin seeking (e.g., Sabina et al., 2014). The criteria for authority
(43.9% of whole sample were Hispanic or multiple Hispanic). figures also varied between studies. Love and Richards
They also found 24% of Black adolescents sought help (2013) included teachers, counselors, and student resource offi-
(26.2% of whole sample were Black or African American; cers, whereas Molidor and Tolman (1998) included police,
Alleyne-Green et al., 2015). social workers, counselors, and teachers. Furthermore, two
studies (Alleyne-Green et al., 2015; Watson et al., 2001) did
Other relevant factors. One study found higher proportions of
not include emotional abuse; therefore, it is unclear whether
lesbian, gay, and bisexual (LGB) victims sought help (18%)
similar results would be true for all types of abuse and limits
compared to heterosexual victims (8%; Dank et al., 2014). Two
comparison across studies.
studies explored emotional responses and ADV (Black et al.,
2008; Jackson et al., 2000). Black et al. (2008) found attaching Informal. Of the eight studies exploring actual informal help
anger and/or jealousy to the violence was significantly associ- seeking, seven studies found informal sources to be important,
ated with talking to someone. reporting between 60.7% (Sabina et al., 2014) and 93% (Ashley
& Foshee, 2005) of adolescents seek help from informal
Help-seeking source sources. Five of these studies found friends/peers were the most
Formal. Studies found between 8% (Watson et al., 2001) and likely sources of support (Black et al., 2008; Elias-Lambertet
40% (Ashley & Foshee, 2005) of adolescents seek help from al., 2014; Fry et al., 2014; Molidor & Tolman, 1998; Sabina
formal sources. Of the 11 studies exploring actual formal help et al., 2014). Findings indicated between 42.9% (Sabina et al.,
seeking, four studies found low numbers of youth reported 2014) and 72% (Fry et al., 2014) of adolescents seek help from
seeking help from formal sources. Formal sources included a friend. With regard to parents, one study found 13% of ado-
counselors, social workers, and therapists (Alleyne-Greenet lescents sought help from their parents in addition to their
al., 2015); teachers, counselors, minister, and hotline (Elias- friends (Black et al., 2008). Furthermore, Gonzalez-Guarda
Lambert et al., 2014); police, school, social care, and counse- et al.’s (2016) qualitative study on female adolescents found
lors (Sabina et al., 2014); and hotline and police (Watson et al., family influences were important, and many adolescents
2001). In contrast, one study found 40% of youth seek help reported their mothers were the first person they reached out
from formal sources, including teacher, school worker, school to. In contrast to this, Molidor and Tolman (1998) found only
nurse, social worker, lawyer, police, hotline, therapist, health- 6% of adolescents reported seeking help from family for the
care professional from hospital, or minister (Ashley & Foshee, most severe incident of sexual or physical DV incident.
2005). It should be noted this study explored physical abuse Gender differences. In line with the gender differences
only (therefore, it is unclear whether this percentage would be described earlier for overall help seeking, two studies
true for other types of abuse). It is also interesting to note this (Alleyne-Green et al., 2015; Sabina et al., 2014) found females
study was part of an ADV prevention program; however, the were more likely than males to seek help from formal sources,
authors explored the impact of the program and concluded and one study found females were more likely than males to go
exposure to the program was not a significant predictor of help to informal sources (Watson et al., 2001). In contrast, one study
seeking. There were some differences in ethnicity of partici- found males were significantly more likely than females to
pants across these studies. For example, Sabina et al. (2014) seek help from formal sources (Ashley & Foshee, 2005), and
found 15.6% went to formal sources in a sample of all Latino one study found no gender differences for informal sources
adolescents. Ashley and Foshee (2005) found 40% went to (Molidor & Tolman, 1998). Ashley and Foshee (2005) included
formal sources in a sample consisting of 75.6% of Caucasian physical abuse only, and it is therefore not clear whether these
adolescents. gender differences would be apparent for other forms of abuse.
Watson et al. (2001) found adolescents were not likely to One study found significantly more males than females would
use formal help-seeking sources, however, and were signifi- seek help from their fathers (Elias-Lambert et al., 2014). It
cantly more likely to predict they would use formal sources should be noted this study included nearly all African Amer-
in the future (namely, police). This indicates there may be ican participants.
differences in help-seeking intentions compared to actual
help-seeking behaviors. When adolescents used formal Age differences. Elias-Lambert et al. (2014) found signifi-
sources, school staff were the most common source (compared cantly more students around 10 years old (compared to 12- to
to social services, police and medical sources; Sabina et al., 13-year-olds) reported seeking help from their mothers, and
2014). Between 9.2% and 17% of adolescents reported seeking those aged 10–12 years were more likely to seek help from a
help from school staff (Elias-Lambert et al., 2014; Sabina et al., relative and their peers. It should be noted that this study
2014). Molidor and Tolman (1998) found only 3% of youth included nearly all African American participants, limiting

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Bundock et al. 361
generalization. Due to the small number of studies exploring if they knew the provider would not take action without per-
this area, conclusions on age and help seeking for ADV remain mission, if it was totally confidential, and if the environment
tentative. was friendly and understanding (Zeitler et al., 2006).
Type of abuse. Two studies explored how the type of abuse
impacts on help seeking. Adolescents were more willing to
seek formal help for physical and sexual abuse than emotional Help-Seeking Intentions
abuse (Alleyne-Green et al., 2015). Jackson et al. (2000) found Factors associated with help seeking
adolescents sought help from their friends markedly less for Gender. Two studies found females were more likely to
sexual and physical abuse than for emotional abuse. Again, intend to seek help than males (Hedge et al., 2016; Love &
only a small number of studies explored differences in help Richards, 2013). It is important to note, one study did not
seeking and type of abuse. separate victims and perpetrators in the analysis (Hedge
et al., 2016), which makes it difficult to generalize to ADV
Cultural differences. Alleyne-Green et al. (2015) found for
victims specifically.
adolescents with a past history of DV and suicidal ideation,
those identifying as multiracial or Hispanic were most likely Cultural factors. Hedge et al. (2016) found no differences in
to seek professional help. Those identifying as Asian were least help-seeking intentions by ethnicity.
likely to seek formal help.
Help-seeking source
Barriers and facilitators to help seeking Formal. Of the five studies exploring formal help-seeking
Factors associated with the abuser/relationship. Barriers to help intentions, two studies found low number of youth reported
seeking included being isolated by the abuser (Gonzalez- they would seek help from formal sources (Love & Richards,
Guarda et al., 2016) and their partner’s anger (Miller et al., 2013; Ocampo et al., 2007). Similar to actual help-seeking
2010). It should be noted Miller et al. (2010) did not explore findings, one study found only 3% of adolescents would go
emotional abuse; therefore, it is not clear whether similar bar- to an authority figure (e.g., police officer; Ocampo et al., 2007).
riers would be reported for all types of abuse. Informal. Of the five studies exploring informal help-
seeking intentions, two studies found adolescents intended to
Concerns with professionals/services. Reasons for nondisclo-
seek help from peers (Martin et al., 2012; Rueda et al., 2015).
sure included wishing to keep the abuse private and concerns
One study found some victims would prefer to disclose using
around confidentiality (Sabina et al., 2014), reporting it was
social media via Facebook (Love & Richards, 2013). Partici-
none of the providers business, fear of the provider telling
pants discussed potential problems with using the Internet,
parents (Miller et al., 2010), lack of knowledge of existing
including believing victims disclose to “get attention”, how-
services, and reluctance from health-care providers to screen
ever, and also reported it could be useful due to fear of disclos-
for DV (Gonzalez-Guarda et al., 2016).
ing in person (Love & Richards, 2013). Two studies found
Cultural differences, definitions, and language. In contrast to between 81.8% and 89% of adolescents intend to seek help
research finding Hispanic adolescents were most likely to seek from their parents (Black & Weis, 2003; Ocampo et al.,
formal help (Alleyne-Green et al., 2015), one study found 2007). Interestingly, both these studies explored help seeking
Hispanic females reported a lack of knowledge, and those who in slightly younger adolescents which fits with age differences
were immigrants reported less knowledge of services and pro- mentioned earlier.
tection provided to victims in the United States as reasons for Gender differences. One study (Love & Richards, 2013)
not reaching out to services (Gonzalez-Guarda et al., 2016). found females were more likely than males to intend to seek
help from informal sources. Significantly more females than
Psychological and other relevant factors. Adolescents reported
males reported they would seek help from their mothers and
embarrassment and believing the ADV was not a big deal
grandmothers, and significantly more males than females
(Miller et al., 2010), shame (Sabina et al., 2014; Martin
reported they would seek help from their fathers (Black &
et al., 2012), and viewing help seeking as a weakness (Rueda
Weisz, 2003). This study had all African American partici-
et al. (2015) as reasons for nondisclosure.
pants. It is interesting to note this is similar to the gender
Facilitators. One study found someone witnessing the vio- differences found for actual help seeking in a sample of
lence was significantly associated with talking to someone nearly all African American participants (in Elias-Lambert
(Black et al., 2008). Gonzalez-Guarda et al. (2016) found when et al., 2014).
family involvement was helpful, it allowed participants to be
Age differences. Hedge et al. (2016) found adolescents aged
open to help and to access services. If other women in the
14–15 years were more likely to intend to seek formal help
family had similar traumas, victims felt less alone and family
(compared to 16- to 17-year-olds).
could refer to services (Gonzalez-Guarda et al., 2016). Adoles-
cents also reported individual breaking points leading to formal Type of abuse. One study found adolescents intended to seek
help seeking (e.g., child witnessing abuse; Gonzalez-Guarda formal help for physical and sexual abuse than emotional abuse
et al., 2016). Adolescents reported it would be easier to disclose (Hedge et al., 2016). Adolescents were more willing to talk to a

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doctor about sexual abuse, with a counselor or teacher regard- help-seeking intentions. Studies also varied in the types of
ing emotional abuse, and to talk to a parent than a friend abuse included and in the sources defined as formal or infor-
regarding sexual abuse (Hedge et al., 2016). mal. It is also important to note that the following findings were
based on a small number of studies. With regard to actual help-
Barriers and facilitators to help seeking seeking behaviors, findings from the current review indicate
Factors associated with the abuser/relationship. Barriers to adolescents were more likely to go to informal sources of sup-
help-seeking intentions included not wanting to leave the rela- port for ADV (60.7–93%), with friends being the most com-
tionship (Rueda et al., 2015), thinking their partner loves them monly reported source (43–72%). Percentages of adolescents
(Ocampo et al., 2007), fear of partner retaliation (Rueda et al., seeking formal support were lower (8–40%), with 9–17% seek-
2015), and fear of further violence (Martin et al., 2012). Rueda ing help from school staff (based on two studies). This is con-
et al. (2015) did not distinguish between bystander and per- sistent with a previous review (Moore et al., 2015), with the
sonal situation or between victims and perpetrators. adolescent help-seeking literature and also with the adult liter-
Gender differences. Martin et al. (2012) explored gender ature on help seeking for DV (Fanslow & Robinson, 2010).
differences in African American adolescents help seeking for Overall, females were more likely than males to seek help for
ADV using focus groups. Barriers for females in reaching out ADV, which is consistent with the adolescent help-seeking
to family included fear of further violence and shame and for literature (Boldero & Fallon, 1995; Rickwood et al., 2005).
reaching out to friends were concerns that their friends would There were some inconsistencies in gender differences and
also be in abusive relationships and therefore assume they help seeking for specific sources (i.e., informal or formal),
could not help. Males reported no barriers in going to friends which may be due to variation in type of violence explored.
and family, which contradicts the gender differences found for Similarities were found across actual help seeking and help-
informal help seeking described earlier. Females described seeking intentions, with regard to gender differences, with
little hesitation to go to formal sources, whereas males females more likely to seek help than males or intending to
reported formal services were seen as a threat to masculinity seek help. Contrasts were found in seeking help from parents.
(Martin et al., 2012). In actual help seeking, one study found 13% of adolescents
went to parents in addition to friends, and one study found only
Concerns with professionals/services. Similar to actual help-
6% went to their parents. In contrast, two studies exploring
seeking behaviors, adolescents reported not trusting adults in
help-seeking intentions found between 81% and 89% of ado-
professional roles (Ocampo et al., 2007) as reasons for not
lescents intended to seek help from their parents. This is based
intending to seek help.
on a small number of studies; however, help-seeking intentions
Definitions and language. Two studies found adolescents’
and help seeking from parents warrant further research.
understanding of ADV did not include emotional abuse or
With regard to the barriers to actual help seeking, adoles-
controlling behaviors. Studies found adolescents’ understand-
cents reported concerns around confidentiality and fear of iso-
ing of ADV consisted primarily of physical violence (Love &
lation and their partner’s anger. Barriers to help-seeking
Richards, 2013) or physical and sexual violence (Martin et al.,
intentions included lack of trust in professionals and fear of
2012). Although researchers did not directly explore how this
partner’s retaliation and further violence. Emotional barriers
impacts help seeking, this may be an important area for future
included embarrassment (actual help seeking) and viewing
research. Intentions to seek help may be influenced by what
help seeking as a weakness (help-seeking intentions). Shame
the adolescent perceives to be ADV.
was identified in both actual and help-seeking intentions as a
Psychological and other relevant factors. Adolescents
barrier to seeking help. Feelings of shame have also been iden-
reported shame (Martin et al., 2012) and viewing help seeking
tified as a barrier in the adult DV literature (Othman et al.,
as a weakness (Rueda et al., 2015) as reasons for not intending
2014). Adolescents report they would find it helpful if services
to seek help.
were confidential, staff were empathetic and understanding,
Facilitators. Adolescents reported the following qualities of a and there was peer referral. This is similar to findings for
hypothetical ADV resource center would encourage them to facilitators for mental health problems and specific problems
use it: empathetic staff, safety, confidentiality, and peer referral in adolescence (Gulliver et al., 2010; Rowe et al., 2014). The
(Martin et al., 2012). Internet was viewed as both positive and negative for help
seeking, which is consistent with research on Internet use for
help seeking for specific mental health problems in adoles-
Discussion cence (Rowe et al., 2014). However, this was based on only
one study exploring the Internet and help-seeking intentions.
Summary of Findings
Limitations of research studies published in this area impacts
on the quality of the overall research and conclusions that can
Limitations
be drawn. This includes convenience sampling, cross-sectional The current review included a relatively small number of
designs (hard to determine causality), almost all studies being studies, with the majority conducted in the United States. The
conducted in the United States, and many studies exploring age range used was broad, which may impact on conclusions

3.108.85.85 on Fri, 27 Sep 2024 09:02:44 UTC
Bundock et al. 363
drawn and limits comparison across studies due to develop- Research. Research utilizing longitudinal and prospective
mental considerations. There may be variation in experiences designs to explore the process of help seeking is needed to
and understanding of ADV across ages. The review also used a inform policy. Future research should be conducted in studies
broad definition of ADV, with some studies exploring physical outside the United States. Clear definitions of ADV and con-
abuse only. This may lead to variation in severity of abuse. The sistency on measurement are needed to allow comparisons
measures of help seeking also varied with many studies using across studies. Future research needs to include all types of
hypothetical situations, resulting in conclusions being drawn abuse (including emotional and coercive control) and to chal-
on anticipated behaviors rather than actual behaviors. This lim- lenge the assumption that ADV is restricted to physical abuse.
its the conclusions that can be drawn from the current review. Studies conducted in schools receiving prevention programs
To address these issues, future reviews should seek to categor- should aim to collect data before the programs begin or com-
ize results by type of abuse or by age range. pare results with those not receiving the program. Future
The review included only published studies, perhaps indi- research should aim to explore actual help-seeking behaviors
cating a publication and reporting bias. There was also no rather than using hypothetical scenarios.
restriction on publication date. This resulted in many studies Further research is required on age differences and help
being between 10- and 23-year-olds. Furthermore, only two seeking and exploration for whether adolescents seek different
studies included either the Internet or cyberdating abuse. As support for different types of abuse. As adolescence is peer
there has been a rise in the use of the Internet, this review may focused and an important stage for group acceptance, there may
not reflect up-to-date help-seeking behaviors of adolescents. be barriers such as shame and embarrassment to discussing
Convenience sampling led to many studies included in the certain types of abuse with peers. It would also be interesting
review including participants already accessing services or part to explore whether help-seeking varies according to develop-
mental needs and to explore when adolescents are most likely
of ADV prevention programs.
to seek support from parents. There is a need for further
research on the help-seeking behaviors of lesbian, gay, bisex-
ual, and transgender and learning disability groups, as there is a
Implications lack of research in this area. The current review also high-
Clinical. Professionals should consider how to encourage ado- lighted a lack of research in cultural differences and help seek-
lescents to go to formal sources by addressing the barriers to ing for ADV. It would be helpful to explore which forms of
help seeking. Professionals need to be aware of the importance help are perceived as most helpful, rather than only focusing on
of confidentiality, however, and also being clear on the limits to who adolescents disclose to. More research is also needed on
this (i.e., duty to report). There is a need to consider how to the internal barriers (e.g., attitudes) and the emotional
responses to ADV. This will help inform how clinicians can
allow adolescents to feel in control of information they disclose
help with these emotional responses. Research needs to be up to
(i.e., give clear advice on what will happen to the information)
date with technology to reflect current help-seeking behaviors
and to feel safe following disclosure (as a barrier was fear of
of adolescents and to reflect the CDC (2016) definition of DV
partner retaliation). There is also a need to challenge the
(stating that DV can occur in person or electronically).
assumption that help seeking is a weakness, that ADV only
includes physical abuse, and to ensure both professional and
Policy. National campaigns attempt to prevent ADV and provide
adolescent are using similar definitions for ADV. This is essen-
advice on who to turn to. At present, these campaigns often
tial due to the stigma associated with ADV and adolescents give professional contact details; however, the current review
reporting shame and embarrassment as reasons for nondisclo- suggests adolescents are more likely to go to informal sources.
sure. It would be important to ensure adolescents who are new It is important to educate peers and parents on appropriate help
to the area or from a different cultural background have access giving (e.g., referral process). A small number of articles in the
to information on the available services. This is to ensure ado- review found adolescents intended to seek help from parents;
lescents have appropriate information in a culturally appropri- however, studies on actual help seeking did not indicate parents
ate way. Due to age of the majority of the studies, there may be as common help-seeking sources. Parents should be involved in
a gap in our knowledge of how adolescents currently seek help DV prevention programs to ensure they are aware of how to
for ADV (e.g., the use of the Internet). approach young people and discuss ADV. However, adoles-
School staff were the most commonly reported source of cents also need to know who to seek help from if they do not
formal help (based on a small number of studies). Professionals wish to tell parents, as this review found a barrier to seeking
in education need training on ADV and where to signpost for formal help was a fear of professionals telling their parents.
help, as they may be important sources of help for adolescents. Campaigns need to be up to date with technology, for example,
Professionals in organizations, such as sexual abuse referral including cyberbullying and exploring how to use the Internet
centers and domestic abuse shelters, require further training to provide advice. The current review found males were less
on DV specific to adolescents. This may include developmen- likely to seek help. Reducing the stigma associated with
tal needs of adolescents, language used, how to identify ADV, seeking help and normalizing ADV for both genders may
and resources for support. empower males to seek help. At present, many campaigns

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(e.g., television adverts) show a male abusing a female in elements. National centre for injury prevention and control,
romantic relationships in adolescence. Campaigns need to Atlanta, GA, Retrieved September 9, 2016, http://from http://
advertise both male and female victims in an attempt to reduce www.cdc.gov/violenceprevention/pdf/intimatepartnerviolence.pdf
stigma for male victims of ADV. This review highlights the Centers for disease control and prevention (2016). Understanding teen
need for early intervention and also for younger adolescents to dating violence. national centre for injury prevention and control,
be included in national statistics, as youth as young as 10 years Atlanta, GA, Retrieved September 9, 2016, from https://
old were included in the studies. www.cdc.gov/violenceprevention/pdf/teen-dating-violence-fact
sheet-a.pdf
Conclusion Clark, J. (2003). How to peer review a qualitative manuscript. In F.
Godlee., & T. Jefferson (Eds.), Peer review in health sciences
Adolescents identify a number of barriers to help seeking (2nd ed, pp. 219–235). London, England: BMJ Books.
for ADV and those who do seek help mainly go to informal Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating
sources. Research to date has mainly focused on who ado- violence experiences of lesbian, gay, bisexual, and transgender
lescents disclose to, gender differences, and type of vio-
youth. Journal of Youth and Adolescence, 43, 846–857. doi:10.
lence. Very little research explored emotional responses.
1007/s10964-013-9975-8
Shame was identified as a barrier, and this may be an
Downs, S. H., & Black, N. (1998). The feasibility of creating a check-
important topic for future research, especially as adolescents
list for the assessment of the methodological quality both of ran-
are focused on peer group membership. Further research is
domised and non-randomised studies of health care interventions.
required on age differences and use of the Internet. It is
Journal of Epidemiology Community Health, 52, 377–384.
hoped the results of the current review will inform future
Elias-Lambert, N., Black, B. M., & Chigbu, K. U. (2014). Controlling
government campaigns to appropriately meet the needs of
behaviors in middle school youth’s dating relationships: Reactions
young people experiencing ADV.
and help-seeking behaviors. Journal of Early Adolescence, 34,
Declaration of Conflicting Interests 841–865. doi:10.1177/0272431613510405
Eliot, M., Cornell, D., Gregory, A., & Fan, X. (2010).Supportive
The author(s) declared no potential conflict of interest with respect to
school climate and student willingness to seek help for bullying
the research, authorship, and/or publication of this article.
and threats of violence. Journal of School Psychology, 48, 533–553
Funding Fanslow, J. L., & Robinson, E. M. (2010). Help-seeking behaviors and
reasons for help seeking reported by a representative sample of
The author(s) received no financial support for the research, author-
ship, and/or publication of this article. women victims of intimate partner violence in New Zealand. Jour-
nal of Interpersonal Violence, 25, 929–951. doi:10.1177/
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Kerrie Bundock has recently completed her doctoral training at the
for society.report of a study group on young people and health for
Oxford Institute of Clinical Psychology training. She is currently
all by the year 2000. Geneva, Switzerland: Author. Retrieved June working as a clinical psychologist in Cambridgshire and Peterborough
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9789241595711/en/ Psychology training. Hewitt also works as a clinical psychologist in
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Stevens, L., & Davidson, L. L. (2006). Attitudes about intimate disabilities.

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Adolescents' Help-Seeking Behavior and Intentions Following Adolescent Dating Violence - A Systematic Review

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Adolescents’ Help-Seeking Behavior and Intentions Following Adolescent Dating Violence

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Kerrie Bundock1, Carmen Chan2, and Olivia Hewitt1

Adolescent Dating Violence A recent meta-analysis of 101 studies on DV in 13- to

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Records identified through Potential references found through

Records screened after duplicates

Records excluded based on title/abstract review

Not related to help-seeking (n=86)

Dissertation abstracts (n=4)

Full text articles assessed for inclusion (n=56)

Records excluded based on full text

Not adolescent (own) help-

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First Author, Study Design; Context; ADV and Help-Seeking

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First Author, Study Design; Context; ADV and Help-Seeking

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First Author, Study Design; Context; ADV and Help-Seeking

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First Author, Study Design; Context; ADV and Help-Seeking

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Table 2. Implications for Practice, Policy and Research.

Practice Policy Research

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