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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 33  |  Issue : 3  |  Page : 250-255

Help-seeking behaviors in the relatives of mentally Ill persons at a Tertiary Care Hospital


1 Department of Psychiatry, Malla Reddy Medical College, Hyderabad, Telangana, India
2 Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana, India

Date of Web Publication14-Sep-2017

Correspondence Address:
Korem Anusha
Flat No. 509, Kacham Diamond Residency, Praga Tools Colony, Petbasheerabad, Kompally, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.214597

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  Abstract 


Background: There are few studies in Indian context on factors affecting generalized help-seeking behaviors in the relatives of persons with mental illness. Hence, the present study was undertaken. Materials and Methods: This is a cross-sectional, purposive sampling, comparative study. Sociodemographic profile, illness details, treatment, compliance, reactions to mental illness scale, and cope inventory scores were compared between the low and high help-seeking groups on General Help-seeking Questionnaire divided on the lower 25th and upper 75th quartiles, respectively, for the groups. The data were statistically analyzed on SPSS-17. Results: Out of a total of 100 patients, 25 and 28 subjects in the low and high help-seeking groups, respectively, were included in the study. In the low help-seeking group, drug compliance was good and caregivers' education level was higher compared to the high help-seeking group. High help-seeking group was characterized by higher scores of hope and compassion on reactions to mental illness scale and the coping mechanisms of humor, denial, use of instrumental and emotional support, acceptance, and planning were frequently used. Conclusions: There is a need to develop awareness about mental illness in the general population and improve the available social support systems to the patients with mental illness and their family members. The help-seeking behaviors could be improved by training the personnel at primary health centers about the treatment of mental illness and importance of drug compliance and regular follow-up.

Keywords: Coping mechanisms, help-seeking behaviors, mental illness, reactions to mental illness


How to cite this article:
Anusha K, Bogaraju, Anand, Usha L. Help-seeking behaviors in the relatives of mentally Ill persons at a Tertiary Care Hospital. Indian J Soc Psychiatry 2017;33:250-5

How to cite this URL:
Anusha K, Bogaraju, Anand, Usha L. Help-seeking behaviors in the relatives of mentally Ill persons at a Tertiary Care Hospital. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Oct 19];33:250-5. Available from: http://www.indjsp.org/text.asp?2017/33/3/250/214597




  Introduction Top


Mental and behavioral disorders affect more than 25% of all people at some time during their life. The point prevalence of mental illness in the adult population at any given time is about 10%.[1] Lifetime prevalence rates of mental disorders in adults are 12.2–48.6% and 12-month prevalence rates are 8.4–29.1%.[2]

Help seeking is about communicating with other people to obtain help in terms of understanding, advice, information, treatment, and general support in response to a problem or distressing experience, often based on social relationships and interpersonal skills.[3]

The first stage of help seeking, “the decision to seek care,” may be negatively influenced by intrapersonal factors such as avoidant coping style and pessimistic beliefs about health services.[4] Understanding the help-seeking intentions and behavior is fundamental to the identification of factors that can be modified to increase engagement in counseling.[5]

Informal help seeking is from informal social relationships, such as friends and family.

Formal help seeking is from professional sources of help, such as mental health and health professionals, teachers, youth workers, and clergy.

The factors found to influence help-seeking behavior within the community include beliefs about the causes of mental illness, the nature of service delivery, accessibility, cost, and stigma.[6]

Help seeking is one of the “approach” styles of coping. Coping is one of the cognitive and behavioral efforts to manage specific demands that are perceived to exceed an individual's resources. Maladaptive coping strategies significantly predicted more distress and less hope in participants.[7]

Psychological distress is commonly reported by caregivers, who experience a range of stressors at different stages of the illness.[8],[9]

The lower the socioeconomic class, the greater the feelings of fear and resentment, whereas the higher the socioeconomic class, the greater the feelings of shame and guilt among the relatives of patients.[10]

There are very few studies in Indian context which have studied the factors affecting help-seeking behaviors in the relatives of mentally ill persons. One such study conducted in North India showed that psychiatrists were the most common first contact service providers sought by a group of patients with mental health problems, followed by nonpsychiatric physicians, including primary care doctors.[11]

Another study conducted in New Delhi showed that the myths and misconceptions are significantly more prevalent in rural areas than in urban areas, and among medical professionals and the people, it needs to be communicated to change their behavior and develop a positive attitude toward mental disorders so that health-seeking behavior can improve.[12]

The awareness of mental disorders in general population could address cultural myths and stigma related to psychiatric disorders, consequently enhancing the treatment-seeking attitude from mental health professionals.[13]

Most of the other studies conducted in India on help-seeking behaviors in mental illness were focused on myths about mental illness, stigma, role of faith healers, belief on supernatural forces, etc. There are no studies which have studied the factors influencing low and high help-seeking behaviors.

Hence, the present study was undertaken. The main aim is to study about factors affecting help-seeking behaviors in the relatives of mentally ill patients. The objectives are: (1,) To compare socio demographic profile, details of illness, treatment and outcome of mental illness across low and high help-seeking groups (2,) to compare the reactions of mental illness and coping strategies in low and high help-seeking groups.

There was a null hypothesis. There is no difference among the socio demographic profile, illness, duration and outcome of mental illness, reactions to mental illness, and coping strategies in the relatives of persons with mental illness, across the low and high help-seeking groups.


  Materials and Methods Top


This study was conducted in a tertiary health center, Hyderabad, Telangana. It was a cross-sectional quantitative study. A total of 100 patients presenting to outpatient, inpatient, and emergency departments were included in the study by purposive sampling, after obtaining written informed consent. Ethics committee approval has been taken from Mallareddy Institute's Ethics Committee Review Board.

All the caregivers in the present study were relatives of the patients; hence, these terms were used interchangeably. Patients aged between 18 and 60 years with any psychiatric illness (except alcohol and other substance abuse) presenting for the first time or subsequent consultations were included in the study. Patients aged <18 years and more than 60 years, alcohol or substance abuse, and those not giving informed consent were excluded from the study.

The General Help-seeking Questionnaire (GHSQ) was developed to assess intentions to seek help from different sources and for different problems. GHSQ assesses the future help-seeking behavioral intentions and has supplementary questions to assess the past help-seeking experience.[3] It appears to provide a sufficiently flexible and sensitive format for measuring help-seeking intentions.[5] (1,) Scale reliability - The GHSQ items could be scored as a single scale that included all specific help source options for suicidal and nonsuicidal problems (Cronbach's alpha = 0.85 and test-retest reliability assessed over a 3-week period = 0.92). (2,) Validity - The perceived quality of previous mental health care had significant positive correlations with intentions to seek help from a mental health professional for personal emotional problems and suicidal thoughts.[5]

Help-seeking behaviors were divided into two groups, high and low. High help-seeking group includes those who are above 75th percentile and low help-seeking group includes those who are below 25th percentile.

Based on interviews with many family members about their experiences, David Karp has defined four stages in the “caregiving” experience, including: (i) Emotional anomie (before a firm diagnosis), (ii) hope and compassion (at the time of getting a diagnosis), (iii) loss of dreams and resentment (as the family realizes the illness is likely a permanent condition), and (iv) recognition that families cannot control the consumer's illness, followed by acceptance.[14] Based on these stages, a semi-structured questionnaire is prepared to know about the reactions to mental illness. This scale is not published elsewhere. Its reliability and validity are yet to be assessed. The number of items in each category was given a point each. Total number of points added in each category gives the final score.

Family member's coping styles were measured using modified versions of the cope inventory[15] to assess a broad range of coping responses to stressful events or situations, and includes responses thought to be functional as well as dysfunctional. Carver et al.[15] reported convergent and discriminant validity, test-retest reliability, and sufficient Cronbach's alpha reliability coefficients for the cope inventory. In this scale, respondents report the extent to which they usually do the things listed, when they are stressed. The maximum score is 16 and minimum score is four for all the items.

The data collected were statistically analyzed using SPSS-17 (-233 south wacker drive, 11th floor, chicago, IL 60606-6412). Measures of mean/median/standard deviation/standard error were used for continuous variables and frequencies, percentages, proportions, and standard error for discrete variables. Chi-square test for comparing categorical variables and Mann–Whitney U-test for comparing medians were used with a level of significance set at P ≤ 0.05.


  Results Top


In the low help-seeking group, majority of the caregivers were illiterates, which is significant. This indicates that low education status could be an important contributing factor to low help seeking.

Majority of the patients belong to age group between 25 and 31 and belong to Hindu religion. The help-seeking behaviors did not differ significantly among various sociodemographic factors such as age, gender, religion, address, income, marital status, duration of stay with the caregiver, and education level of the patients [Table 1].
Table 1: Socio demographic data

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Majority of the caregivers of patients with good drug compliance are in the low help-seeking group. High drug compliance is another important factor resulting in low help seeking.

Factors such as mean duration of illness, presenting symptoms' treatment duration, faith healer consultation, and improvement with medication do not differ much in the help-seeking behaviors of both the groups [Table 2].
Table 2: Illness, Treatment and Outcome

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Among different reactions to mental illness, “hope and compassion” are significantly high in the high help-seeking group. Other reactions to mental illness did not differ significantly between the two groups [Table 3].
Table 3: Reactions to mental illness

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Coping mechanisms such as “instrumental social support,” “denial,” “humor,” “use of emotional social support,” and “planning” were high in the high help-seeking group, and acceptance was high in the low help-seeking group.

There were no significant differences between the two groups for other coping mechanisms such as positive reinterpretation and growth, mental disengagement, focus on and venting of emotions, active coping, religious coping, behavioral disengagement, restraint, substance abuse, and suppression of competing activities [Table 4].
Table 4: Cope inventory

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  Discussion Top


The present study was undertaken to study the factors affecting help-seeking behaviors in the relatives of patients with mental illness. A total of 100 patients, both male and female, in the age group of 18–60 years, attending a tertiary mental health center in Hyderabad, were taken for the study and divided into low and high help-seeking groups. Data were collected using sociodemographic profile, details of illness, treatment, drug compliance, and scales such as GHSQ, reactions to mental illness, and cope inventory.

The main findings in this study are low education status of the caregiver, high drug compliance of the patient, and acceptance as coping mechanism resulted in low help-seeking behaviors. Low education status leading to poor knowledge about the available sources of professional help could result in low help seeking. This highlights the need for more mental health awareness programs. Initiatives should be taken by mental health professionals, especially in rural areas, where the literacy level is low.

High drug compliance of the patients results in higher recovery rates, thus reducing the need for help seeking, resulting in self-efficacy and low help seeking. Coping mechanisms are used by people to cope with the illness. Acceptance of the mental illness resulted in better compliance and low help seeking. This suggests that proper information about mental illness and its treatments should be made accessible at primary level.

Hope and compassion as reaction to mental illness and coping mechanisms such as humor, denial, use of instrumental and emotional support, and planning resulted in high help-seeking behaviors. Hope and compassion is one of the reactions to mental illness by family members. It is observed in this study that family members with hope and compassion as reaction to mental illness resulted in high help seeking. Promoting positive attitudes toward mentally ill, discouraging stigma and discrimination help in reducing anger, resentment, and hostility toward mentally ill in the community, thereby improving their help-seeking behaviors.

Humor, denial, use of instrumental and emotional support, and planning are various coping mechanisms that resulted in high help seeking. Improving the available social and financial support systems in the community by providing medical aids, information about available treatments, and vocational rehabilitation could improve the long-term outcome.

Maladaptive coping strategies significantly predicted more distress and less hope in participants in the study done by Michelle et al.[7] In the present study, by using cope inventory, it was found that maladaptive coping strategies such as denial and substance use are below the median in both low and high help-seeking groups. There were few studies conducted on factors affecting help-seeking behaviors, but no previous studies have classified help seeking into low and high groups.

Factors such as education status of caregiver, drug compliance, coping mechanisms, and reactions to mental illness play an important role in determining the help-seeking behaviors. Proper measures taken to improve these factors could improve the help-seeking behaviors and thus a better outcome for mental illness treatments.

The present study also highlighted the importance of creating awareness about mental illness and its treatment in rural areas where education status is low. Proper training should be given to the staff at primary health center to recognize the symptoms of mental illness, to treat psychiatric emergencies, and to provide information about the mental health services available in various settings. There is also a need to develop social support systems at community level to ensure proper drug compliance and regular follow-up.


  Conclusions Top


High help seeking appears to be an initial stage of help seeking as the drug compliance was low and coping mechanisms such as humor and denial were prominent with the use of instrumental and emotional support.

It appears from our study that low help-seeking behavior of caregivers could be a stage next to the high help seeking, as there is higher drug compliance in the patients and caregivers using acceptance as coping mechanism, despite low education status. There is a need to identify factors responsible for low drug compliance in low help-seeking group.

Limitations

The reactions to mental illness scale require standardization. There is a need to examine whether the results and conclusion can be generalized for different segments of population. Logistic regression analysis has not been employed in the present study, examining the weight of influence of variables on dependent variable, high and low help seeking. As the number of subjects is not adequate to do this analysis, this was not attempted.

Future directions

Stratified sampling may be applied in the future studies. The factors resulting in low help seeking, whether they remain the same over time is yet to be seen. In some studies, it is shown that drug compliance reduces over time. It also remains to be seen if high help seeking changes to low help seeking.

It would be worthwhile to examine whether high help seeking would overtime change into low help seeking or not and the factors contributing to this transition. It would be beneficial to know about the factors which motivate a person to remain or change from one help seeking to another so that proper psychosocial measures can be taken to sustain their motivation at a proper time and to increase compliance to therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Skeate A, Jackson C, Birchwood M, Jones C. Duration of untreated psychosis and pathways to care in first-episode psychosis. Investigation of help-seeking behaviour in primary care. Br J Psychiatry Suppl 2002;43:s73-7.  Back to cited text no. 4
    
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Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum 2004;31:1105-17.  Back to cited text no. 8
    
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Mishra N, Nagpal SS, Chadda RK, Sood M. Help-seeking behavior of patients with mental health problems visiting a tertiary care center in North India. Indian J Psychiatry 2011;53:234-8.  Back to cited text no. 11
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Kishore J, Gupta A, Jiloha RC, Bantman P. Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian J Psychiatry 2011;53:324-9.  Back to cited text no. 12
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Karp DA, Tanarugsachock V. Mental illness, caregiving, and emotion management. Qual Health Res 2000;10:6-25.  Back to cited text no. 14
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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