Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience.

BACKGROUND: Seeking help for severe depressive symptoms remains a major obstacle for particular groups within the general population. Value-related attitudes might contribute to this treatment gap, particularly in rural regions with a low density of psychiatric-psychotherapeutic services. We aimed to investigate narratives of socialization, value systems, and barriers of help-seeking to better understand social milieus at increased risk for underuse of psychiatric-psychotherapeutic services in a rural area in East Germany. This could complement the explanatory power of classical socio-demographic determinants and provide guidance for possible interventions. METHOD: Based on results of an analysis of a population-based German cohort study (SHIP-TREND-1), 20 individual semi-structured interviews were conducted with participants who met criteria for having been moderately or severely depressed at least once in their life. Qualitative analyses of interview data were guided by grounded theory methodology. RESULTS: Participants with severe symptoms of depression were more frequent among non-responders of this study. We identified key aspects that influence help-seeking for mental health problems and seem to be characteristic for rural regions: family doctors serve as initial contact points for mental health problems and are considered as alternatives for mental health professionals; norms of traditional masculinity such as being more rational than emotional, needing to endure hardships, embodying strength, and being independent were frequently mentioned as inhibiting help-seeking by middle-aged men; anticipated adverse side-effects of therapy such as worsening of symptoms; a frequently expressed desire for less pathologically perceived treatment options. CONCLUSIONS: Our results suggest that barriers regarding help-seeking in rural regions are multifaceted and seem to be influenced by traditional norms of masculinity. We believe it is critical to strengthen existing and already utilized services such as family doctors and to implement and evaluate tailored interventions targeting the needs of the rural milieu.

[Sociodemographic and Disorder-Specific Determinants for Professional Help-Seeking due to Depression in a Structurally Weak Region - The Important Role of Age]. / Soziodemografische und störungsbezogene Determinanten zur Inanspruchnahme von ärztlicher oder psychologischer Hilfe bei depressiven Episoden in einem strukturschwachen Flächenland ­ die besondere Rolle des Lebensalters.

OBJECTIVE: Study of sociodemographic and disorder-specific determinants of professional help-seeking in lifetime depression. METHODS: In the population-based SHIP-Trend-1 study (2016-2019), we assessed N = 490 adults with lifetime depression and their help-seeking behaviour. Gender, socioeconomic status and disorder-specific variables were implemented in age-stratified logistic regression models. RESULTS: Men and older adults at the time of the survey sought less help than women and younger people. In the younger and middle age group severity level was associated with professional help-seeking, in the older age group professional help-seeking was more prevalent in case of physical causes for the depression. CONCLUSION: We found age-specific differences in the determinants for professional help-seeking. Latent variables like age-specific experiences, values, and life styles may explain those differences.