Early identification of mental health problems is key to ensuring adolescents receive timely and appropriate support and strengthen their long-term mental health. The current study uses a population-based state survey to answer two research questions: (1) Do adolescents with elevated levels of psychological distress perceive that they need mental health help? and (2) Which adolescent groups are most vulnerable to high levels of distress and perceived need for help? Using data from the 2019 California Health Interview Survey (CHIS), the estimated population-based sample was 3.1 million adolescents. Half were female (50.9%); sample was racially and ethnically diverse (Latinx, 40.1%; white, 38%; Asian, 12.8%). CHIS included social determinants of health questions, the Kessler-6 psychological distress measure, and a question on perceived need for mental health help.

Findings: Among youth with moderate or serious psychological distress, 45.5% denied needing mental health help. Adolescents with moderate to distress had higher odds of perceived need than youth with subclinical distress levels. Compared to males, females had higher odds of having moderate or serious psychological distress, and a perceived need for help. White youth had higher odds of serious psychological distress than Asian adolescents, and of perceived need compared to Latinx, Asian, and multiracial adolescents. Although distress and need were seemingly concordant, discrepancies existed as some adolescents experienced clinical-level distress but denied need. Comprehensive screening is critical for systems to connect all adolescents to appropriate supports.