**Background:** The COVID-19 pandemic severely impacted adolescent mental health globally, with Austrian youth experiencing increased depression, anxiety, insomnia, and stress. Despite high levels of psychological distress, professional help-seeking remained low (3.3% of students in 2021). Little is known about what types of support young people themselves desire. This study aimed to assess Austrian school students' mental health, their wishes for support, and how mental health status and gender relate to those wishes.
**Methods:** Between April 26 and May 24, 2022, a cross-sectional online survey was conducted among Austrian students aged 14–20. The final sample comprised 616 participants (77.4% female, 19.8% male, 2.8% non-binary; mean age 16.63 years, SD=1.49). Mental health was assessed using validated German versions of the PHQ-9 (depression; cut-off ≥10 for ages 18+, ≥11 for ages 14–17), GAD-7 (anxiety; cut-off ≥11 for ages 14–17, ≥10 for ages 18–20), ISI (insomnia; cut-off ≥15), PSS-10 (high stress; cut-off ≥27), SCOFF (eating disorders; cut-off ≥2), and CAGE (alcohol abuse; cut-off ≥2). Wish for support was assessed with a dichotomous yes/no question. Those answering "yes" were asked an open-ended question about the type of support desired. Qualitative content analysis was performed on 245 responses, yielding 12 categories. Inter-coder agreement was 92%. Two categories ("professional help," n=124; "someone to talk to," n=64) met the threshold for quantitative analysis. Chi-squared tests examined differences in mental health by gender and age group, and differences in support wishes by gender, age, and mental health status.
**Key Results:** Overall, 46.6% (n=287) of students expressed a wish for support. The most common support category was "professional help" (20.1% of total sample, 43.2% of those wanting support), followed by "someone to talk to" (10.4% of total sample, 22.3% of those wanting support). Other categories included counseling (2.9%), information (2.8%), help with eating disorder/weight (2.6%), less pressure to perform at school (2.6%), support from an educational institution (2.4%), family/friend support (2.3%), consideration/understanding from others (2.1%), and destigmatization (1.8%).
Significant gender differences were found for all mental health indicators except alcohol abuse. Female and diverse students had higher rates of clinically relevant depression, anxiety, insomnia, high stress, and eating disorders compared to male students. Bonferroni-corrected post-hoc tests showed significant differences between male and female students for depression, anxiety, insomnia, eating disorders, and high stress, and between male and diverse students for depression, anxiety, and high stress. No significant differences were found between female and diverse students. Students aged 14–17 had significantly higher rates of clinically relevant anxiety and insomnia than those aged 18–20.
Wish for support was expressed by 69% of diverse students, 51.4% of female students, and 28.9% of male students. Significant differences were found between male and female students (p<0.001) and between male and diverse students (p=0.002). Students with a wish for support had significantly higher rates of clinically relevant depression, anxiety, insomnia, high stress, and eating disorders compared to those without a wish for support. Students who wished for professional help were significantly more likely to be aged 14–17 and to have clinically relevant depression, anxiety, and high stress. Students who wished for someone to talk to were significantly more likely to be aged 14–17 and to have clinically relevant eating disorders.
**Clinical Implications:** The study reveals a substantial gap between adolescents' desire for mental health support and the available services in Austria. In 2021, only 181 school psychologists served approximately 1.1 million students. Child and adolescent psychiatric outpatient clinics had an estimated deficit of over 50% in 2022 (13 actual vs. 36 target). Psychotherapeutic treatment reaches only 0.8% of the Austrian population, with waiting times of 1–6 months (approximately 4 months for children and adolescents). The annual psychotherapy session contingent would need an increase of 107,000 hours to meet demand. Only 5 of 1,204 psychotherapists with child/adolescent qualifications offer fully health-insurance-funded treatment. The authors recommend implementing multi-professional health teams in educational settings, providing low-threshold access to counseling and information in schools, ensuring timely and free regional therapy, securing health insurance funding for psychotherapy, and developing targeted services for boys/young men and students with eating disorders. Peer support programs and teacher-based support could help meet the desire for "someone to talk to." Limitations include the convenience sample (overrepresentation of females, potential self-selection bias toward higher mental health problems), low internal consistency for CAGE (α=0.55) and SCOFF (α=0.56), and the online survey format limiting depth of qualitative responses.