Help-seeking intentions and subsequent 12-month mental health service use in Chinese primary care patients with depressive symptoms

Abstract

ObjectiveTo identify the factors associated with 12-month mental health service use in primary care patients with depressive symptoms.DesignCross-sectional followed by 12-month cohort study.Setting and participants10 179 adult patients were recruited from the waiting rooms of 59 primary care clinics across Hong Kong to complete a questionnaire which screened for depression. 518 screened-positive participants formed the cohort and were telephoned at 3, 6 and 12 months to monitor mental health service use.Primary and secondary outcomes▸ Help-seeking preferences;▸ Intention to seek help from a healthcare professional;▸ 12-month mental health service use.ResultsAt baseline, when asked who they would seek help from if they thought they were depressed, respondents preferred using friends and family (46.5%) over a psychiatrist (24.9%), psychologist (22.8%) or general practitioner (GP; 19.9%). The presence of depressive symptoms was associated with a lower intention to seek help from family and friends but had no effect on intention to seek help from a healthcare professional. Over 12 months, 24.3% of the screened-positive cohort reported receiving services from a mental health professional. Factors associated with service use included identification of depression by the GP at baseline, having a past history of depression or other mental illness, and being a public sector patient. Having a positive intention to seek professional help or more severe depressive symptoms at baseline was not associated with a greater likelihood of receiving treatment.ConclusionsMental health service use appears to be very low in this setting with only one in four primary care patients with depressive symptoms receiving treatment from a psychiatrist, GP or psychologist over a year. To help reduce the burden of illness, better detection of depressive disorders is needed especially for patients who may be undertreated such as those with no prior diagnosis of depression and those with more severe symptoms.

Plasma cortisol and oxytocin levels predict help-seeking intentions for depressive symptoms

“…Our results are also consistent with previous evidence that depressive symptoms are associated with lower intentions to seek help from family and friends, but no effect on intentions to seek help from healthcare professionals (Chin et al, 2015). Chin et al(2015) interpreted their results in psychosocial terms, that a depressed mood and negative thinking may make individuals reluctant to share their problems with family and friends as they may feel burdensome or pessimistic.…”

“…Our findings with a clinically depressed sample are similar to previous ones in subclinical populations which showed that the help-negation effect does not seem to apply strongly to formal sources of help (Frost et al, 2017;Yakunina et al, 2010). Our results are also consistent with previous evidence that depressive symptoms are associated with lower intentions to seek help from family and friends, but no effect on intentions to seek help from healthcare professionals (Chin et al, 2015). Chin et al(2015) interpreted their results in psychosocial terms, that a depressed mood and negative thinking may make individuals reluctant to share their problems with family and friends as they may feel burdensome or pessimistic.…”

“…Help-seeking is not an isolated, rational action, but a process which involves influence from individuals' social network including friends and family (Lindsey et al, 2010). Informal supports may help to confirm the presence of a problem and influence help-seeking behaviour and recovery by providing emotional support, reminding and helping the depressed person to attend appointments, and promoting adherence to treatment (Chin et al, 2015;Lindsey et al, 2010). Informal sources of help have been recognised as important gateways to treatment for mental health problems, and important points of intervention in suicidal behaviour (Barnes et al, 2002).…”

“…A large-scale epidemiological study also found a general preference for informal sources of help, and that the presence of depressive symptoms was associated with lower intentions to seek help from family and friends, but no differences in formal help-seeking intentions (Chin et al, 2015). It is important to consider informal supports, because friends and family often facilitate treatment uptake and adherence in those with depressive symptoms (Chin et al, 2015;Lindsey et al, 2010), and are important points of intervention in suicidal behaviour (Barnes et al, 2002).…”

Resistance, reactance, and misinterpretation: Highlighting the challenge of persuading people with depression to seek help

“…In line with such theorizing, higher levels of depressive symptomatology are associated with less favorable attitudes toward help‐seeking (Keeler, Siegel, & Alvaro, ) and lower confidence that help‐seeking will lead to positive outcomes (Siegel et al, ). Although there are some exceptions (e.g., Chin, Chan, Lam, Lam, & Wan, ), research typically indicates a relationship between heightened depressive symptomatology and less favorable help‐seeking attitudes among children and adolescents (Garland & Zigler, ), college students (Huntley & Fisher, ), and adults (Lienemann & Siegel, ). Research has also identified this relationship across cultures (e.g., Chinese undergraduates, Wang, Peng, Li, & Peng, ; Spanish‐Dominant Hispanics, Keeler & Siegel, ).…”