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 Table of Contents  
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 116-119

Depression with and without preceding life event: Differential recognition and professional help-seeking inclination in youth?

Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India

Date of Web Publication29-Jun-2018

Correspondence Address:
Dr. Seema Mehrotra
Department of Clinical Psychology, NIMHANS, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_30_17

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Background: Low rates of professional help seeking for depression by youth is a well known global challenge. The study aimed at examining whether there might be differences in the rates of recognition of a hypothetical problem as a mental health problem when depressive symptoms are depicted as occurring in the context of a negative life event as compared to when these symptoms are depicted as occurring without any negative life event. The relationship between recognition as a mental health problem and help-seeking inclination from mental health professionals was also examined. Methods: Three hundred college youths within 18–25 years of age range formed the sample. Two vignettes describing moderate depression were used for all the participants. These two vignettes had identical content except that one of these mentioned a negative life event preceding the onset of depression. Each of these vignettes was followed by items to elicit recognition of the problem and inclination to seek help from mental health professionals if one was experiencing a similar problem. Results: Depressive symptoms arising in the context of a negative life event were less likely to be labeled as mental health problem and also less likely to be identified as depression. Accurate recognition of the problem as a mental health problem went hand in hand with significantly higher inclination to seek help from mental health professionals, but this was evident only in the vignette describing depressive symptoms without negative life event. Conclusion: The findings have implications for further research and for designing programs to improve help seeking for depression in Indian youth.

Keywords: Depression and life event, help-seeking inclination, mental health literacy, recognition of mental health problem

How to cite this article:
Fathima M A, Mehrotra S, Sudhir PM. Depression with and without preceding life event: Differential recognition and professional help-seeking inclination in youth?. Indian J Soc Psychiatry 2018;34:116-9

How to cite this URL:
Fathima M A, Mehrotra S, Sudhir PM. Depression with and without preceding life event: Differential recognition and professional help-seeking inclination in youth?. Indian J Soc Psychiatry [serial online] 2018 [cited 2019 Jul 22];34:116-9. Available from: http://www.indjsp.org/text.asp?2018/34/2/116/235661

  Introduction Top

A recent national mental health survey points to significant burden of depression in the country.[1] India is a country with a youth bulge,[2] and youth form a vulnerable section of the population as far as mental health needs are concerned.[3] In a survey conducted in South India, 57% of college-going young adults reported varying severity of depressive symptoms.[4] Yet, another study observed that about two-thirds of youths do not seek help for mental health concerns.[5] These data are in keeping with global trends and highlight the need to understand potential factors associated with help seeking for common mental health problems.[6] The association of life events with onset of depression and anxiety is well established.[7] A significant prevalence of life events preceding onset of major depression was reported in a cross-nation study of Asian outpatients that indicated the need to examine variability in help seeking related to differences in lay notions of depression.[8] Recognition of a problem as mental health problem and its accurate labeling is one of the factors that can impact professional help seeking. Accurate recognition forms an essential component of mental health literacy.[9] Various studies on mental health literacy in Indian youth have been carried out.[10],[11],[12] Despite variability in the specific findings, the overall pattern indicates low levels of recognition of depression by Indian youth. Vignettes have been one of the most popular methods for assessment of help-seeking inclinations, and mental health literacy is often assessed by asking questions related to recognition of the nature of the problem presented in the vignettes.[13] There is a dearth of literature exploring potential differences in laypersons' recognition of depression when it is accompanied by life event versus when it occurs without obvious life events.

The present study aimed at examining whether there might be differences in the rates of recognition of a hypothetical problem as a mental health problem when depressive symptoms are depicted as occurring in the context of a negative life event as compared to when these symptoms are depicted as occurring without any negative life event.

  Methods Top

The sample selection criteria involved college-going youth in Bengaluru within 18–25 years of age who were comfortable in English and were of Indian nationality. Permission was obtained from four colleges for data collection, which took place from October 2016 to January 2017. Participants from various courses were recruited based on the availability of permission and provision of written informed consent. Three hundred students were thus recruited. An average participant was about 20 years old. Youths in 18–19 years' age range formed 54% of the sample while the rest were between 20 and 25 years of age range. There was a slightly higher representation of females (59%) compared to males (41%). The participants belonged to varied regular degree and professional courses (e.g., engineering, arts, nursing, dental sciences, etc.).

A modified version of the General Help-Seeking Questionnaire-Vignette Version (GHSQ-V)[13] was used. The GHSQ contains short vignettes alongside a few questions that elicit perceptions about the nature of problem, inclination for help seeking, etc., The problem type and the questions can be modified depending on the objectives and needs of a given study. Two sets of vignettes were used with identical content in terms of depressive symptoms. Both described a hypothetical person with moderate severity of depressive symptoms that comprised of pervasive low mood of 2-month duration, ideas of worthlessness, hopelessness, concentration difficulties, difficulties in making decisions, low motivation in carrying out day-to-day activities, disturbed sleep, poor appetite, loss of weight, and death wishes. The first vignette had no mention of a life event while the second one described these symptoms as occurring in the context of failure in a semester examination. This was done so as to examine whether help-seeking inclination varies depending on the presence or absence of life event in the background of depression. Male and female characters were mentioned in the vignettes given to male and female participants, respectively. All the participants received both the vignettes. Likert type items as well as an open-ended item followed each of the vignettes as described below. Participants were enquired as to whether it is likely that the person in the vignette is suffering from a mental health problem (on a 3-point scale: likely, unsure, unlikely) and what might be the possible nature of the mental health problem, if the person did have a mental health problem (open-ended item). These items served as broad indicators of one aspect of mental health literacy (recognition of mental health problem and of depression). In addition, the participants were asked about the likelihood (7-point scale, “extremely unlikely to extremely likely”) that they would seek help from a mental health professional if they were experiencing something similar to what was depicted in the vignettes.

  Results Top

The symptoms depicted in the first vignette without preceding event were identified as a mental health problem by a significantly larger proportion of participants (41%), than the vignette containing a preceding life event (29%) (McNemar's test; χ2 = 10.14, P < 0.01). In both the vignettes, slightly more than half of the participants were unsure as to whether it was a mental health problem [Table 1].
Table 1: Pattern of responses related to recognition of depression on vignettes depicting depression (n=300)

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Responses to the subsequent open-ended question about the nature of mental health problem that the individuals described in the vignettes might be having were content analyzed jointed by the first and second authors. The responses to these items were in words/short phrases which were inspected by the researchers jointly. All occurrences of the term “depression” were placed together under the depression category as the vignette described depression. Emergent themes on the remaining responses could be categorized under two broad headings “other mental states” and “other labels.” “Other mental states” category was used for all the responses which mentioned any mental state such as anxiety/tension. There were responses which could not be placed under the “other mental states” category as these were general/broad terms or external factors, etc., These were grouped as “other labels” (for example, failure and examination fear). One-third of the participants accurately labeled the mental health problem as depression in the first vignette, while only 15% correctly identified depression in the second vignette, wherein the depressive symptoms were preceded by a negative life event (McNemar's test value: 37.81, P < 0.01) In both vignettes, slightly more than 10% of the participants gave responses which could be broadly placed in a category; we broadly labeled as mental states (included phrases such as low mood, anxiety, low self-esteem, and low self-confidence). Other labels/descriptions (<5%) tended to mention domain of distress, for example, worry about future, education, problem, and examination fear. More than half of the participants did not give any response for this item in both the scenarios [Table 1].

Gender was significantly associated with recognition as a mental health problem for one of the vignettes (χ2 = 9.05, P < 0.05), with more females than males identifying symptoms without a preceding life event as a mental health problem.

The participants who recognized depressive symptoms as a mental health problem in the first vignette (without life event) reported higher inclination to seek help from a mental health professional than those who did not recognize it as a mental health problem (Mann–Whitney U-test Z = 1.72, P < 0.05). However, recognition of the second vignette (depressive symptoms with life event) did not have differential impact on inclination to seek help from mental health professionals (Mann–Whitney U-test Z = 1.13, P > 0.05).

  Discussion Top

The pattern of findings is somewhat consisted with previous studies in similar samples in India and reflects difficulties in accurate recognition and labeling of depression in college youth.[10],[11],[12] The study additionally demonstrated a differential pattern of recognition depending on the presence or absence of accompanying life event. Distress arising in the context of a negative life event was less likely to be labeled as mental health problem and also less likely to be identified as depression. Moreover, the findings suggest that while accurate recognition may help in improving inclination to seek professional help when depression occurs without negative life event, it may not facilitate help seeking when depressive symptoms are seen as occurring following a negative life event. The present study data echo the findings of another qualitative study wherein youth described “normal” distress as universally and inevitably experienced throughout life in response to common life events and stresses. It was not regarded as serious or as illness but as a “phase” that would eventually “pass.” The opposing category was described as “real” or “proper” distress. This was regarded as abnormal, rare, and often permanent and was the category respondents perceived to be mental illness.[14] It can also be explained by the tendency to normalize “depressive symptoms,” especially when preceded by a life event and thus not requiring “professional help” for the same.[15]

Replication of these findings is needed to confirm the differential patterns of response observed in the present study. If confirmed, it would imply that a significant proportion of individuals in the community experiencing depression in the context of stressful life events are likely to be at higher risk of avoiding professional help seeking as the occurrence of depression may be explained away as “normal” and to be borne with.

Such findings need to be considered especially when disseminating information regarding depression to general public during information, education, and communication activities. Further, a focused public health campaign could be utilized, targeting youth in significant distress who may not be seeking professional help as they perceive their suffering to be “understandable” in the context of their negative life events. This suggestion does not imply medicalization of normal experiences of loss, disappointment, and distress in the face of life challenges. However, it is about improving availability and access to varied kinds of mental health services (for example, peer support, self-help groups, and technology-assisted professional advice) for distressed persons in the community for improving psychological support, assisting in the maintenance of well-being, and facilitating psychological recovery.

  Conclusion Top

The study findings suggest that depressive symptoms that arise in the context of a negative life event are less likely to be labeled as mental health problem and are also less likely to result in professional help seeking by urban Indian youth. The findings have implications for further research and practice.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: Summary, National Mental Health Survey. Bangalore: NIMHANS; 2016.  Back to cited text no. 1
Shukla R. Indian Youth: Demographics and Readership: Results from the National Youth Readership Survey. New Delhi: National Book Trust & National Council of Applied Economic Research; 2010.  Back to cited text no. 2
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: A global public-health challenge. Lancet 2007;369:1302-13.  Back to cited text no. 3
Pandian RD, Sreeranjini T, Aiman A, John S, Shishir K, Prabhu S, et al. A study on the prevalence of depression among young adults in South India, Indian J Mental Health 2017;4:24-29.  Back to cited text no. 4
Santhya KG, Prakash R, Jejeebhoy SJ, Singh SK. Accessing Adolescent Friendly Health Clinics in India: The Perspectives of Adolescents and Youth. New Delhi: Population Council; 2014.  Back to cited text no. 5
Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust 2007;187:S35-9.  Back to cited text no. 6
Kendler KS, Hettema JM, Butera F, Gardner CO, Prescott CA. Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety. Arch Gen Psychiatry 2003;60:789-96.  Back to cited text no. 7
Park S, Hatim A, Si TM, Jeon HJ, Srisurapanont M, Bautista D, et al. Stressful life events preceding the onset of depression in Asian patients with major depressive disorder. Int J Soc Psychiatry 2015;61:735-42.  Back to cited text no. 8
Jorm AF. Mental health literacy. Public knowledge and beliefs about mental disorders. Br J Psychiatry 2000;177:396-401.  Back to cited text no. 9
Ogorchukwu JM, Sekaran VC, Nair S, Ashok L. Mental health literacy among late adolescents in South India: What they know and what attitudes drive them. Indian J Psychol Med 2016;38:234-41.  Back to cited text no. 10
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Sameed S, Karkal R, Mendonsa R, Shriyan S, Thomas AM, Chandran VM. Help-seeking attitudes for depression among first year medical undergraduates. Indian J Basic Appl Med 2016;5:839-44.  Back to cited text no. 11
Grover N, Tripathi R. Mental health literacy among post graduate students. Indian J Soc Psychiatr 2010;26:138-145.  Back to cited text no. 12
Wilson CJ, Rickwood DJ, Bushnell JA, Caputi P, Thomas SJ. The effects of need for autonomy and preference for seeking help from informal sources on emerging adults' intentions to access mental health services for common mental disorders and suicidal thoughts. Adv Ment Health 2011;10:29-38.  Back to cited text no. 13
Biddle L, Donovan J, Sharp D, Gunnell D. Explaining non-help-seeking amongst young adults with mental distress: A dynamic interpretive model of illness behaviour. Sociol Health Illn 2007;29:983-1002.  Back to cited text no. 14
Martínez-Hernáez A, DiGiacomo SM, Carceller-Maicas N, Correa-Urquiza M, Martorell-Poveda MA. Non-professional-help-seeking among young people with depression: A qualitative study. BMC Psychiatry 2014;14:124.  Back to cited text no. 15


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