(PS1-97) Reasons for reluctance to seek treatment for depression: predictors and cultural differences

Abstract Text:

Background: Depression is one of the most prevalent mental health disorders worldwide. Though effective treatments for depression exist (Cuijpers et al., 2020), some individuals choose not to pursue treatment. Reasons for forgoing care may include systemic barriers, stigma, poor mental health literacy, or personal preference (Curland et al., 2020; Cuijpers et al., 2020; Waumans et al., 2022). In addition, some individuals may forgo treatments because they perceive that recovery may carry undesirable consequences (Curland et al., 2020). Furthermore, hesitance towards treatment may vary between cultures (Lorenzo-Blanco & Delva, 2011). Thus, the purpose of this in study was to understand predictors of beliefs about undesirable consequences of treatment among treatment-naive individuals with symptoms of depression and to understand whether culture influences these beliefs.

Methods: Participants were recruited from an international multilingual study on depression and suicide (Leykin et al., 2012). Individuals included in these analyses screened positive for depression, indicated that they never sought depression treatment, and spoke either English or Spanish. To compare cultural groups, two groups were created based on language and country of residence (see Goodmann et al., 2021): Spanish speakers from Latin America (“Latin”; n = 36) and English speakers from English-speaking Western countries (“Western”; n = 22). Participants completed measures including demographics, Depression Self-Stigma (Kanter et al., 2008), Quick Inventory of Depressive Symptomatology (Rush et al., 2000), Social Support (Zimet et al., 1988), and other measures not relevant to the present study. Participants also responded to eight questions assessing negative beliefs associated with recovery.

Results: Three questions assessed apprehension about self-reinvention: “#2. I will have to reinvent myself as someone without depression,” “#5. I will have to restart my life,” and “#8. It will be too strange to appear to others as someone else.” Higher stigma scores were associated with stronger beliefs (ps = .001, .016, .015, respectively). Additionally, for #5, a culture*gender interaction (p = .036) suggested that Western men reported far lower belief than other groups. For #8, culture*social support interaction (p = 0.28) revealed that Western participants with higher social support did not hold this belief. Two questions assessed a sense of loss: “#4. I will lose people’s sympathy and/or care” and “#6. I will lose a part of myself.” For #4, culture interacted with depression level (p = .42), such that Latin participants with higher depression levels reported high belief. For #6, higher stigma was related to greater belief strength (p = .045). Finally, for the question assessing self-understanding (#1. “I know what it’s like to be depressed, but I don’t know what it’s like to be well”), higher stigma was related to greater belief strength (p = .025)

Conclusion: Culture moderates several negative perceptions about recovery from depression. Furthermore, stigma of depression appears to be a consistent predictor of negative effects of recovery. Targeted psychoeducation campaigns may be needed to reduce apprehension about pursuing treatment for depression.