Understanding Poor Help-seeking Rates for Major Depressive Disorder

Abstract

The principal aim of this thesis was to further understanding of the factors influencing decisions to seek treatment for Major Depressive Disorder. A review of the literature (Chapter 2) revealed a number of factors associated with help-seeking for mental health disorders. However, there was no existing theoretical model of decisions to seek treatment for MDD, and there was limited understanding of the psychological and emotional processes involved in seeking treatment for depressive symptoms. In Study 1 (Chapter 3), a qualitative study explored participants’ accounts of seeking treatment for MDD, which resulted in the development of a theoretical model of help-seeking. This model highlighted the role of identity and goals in decisions to seek treatment for MDD. Subsequent studies in this thesis sought to test predictions made by this model. Study 2 (Chapter 4) explored the relationship between identity and goal conflict and depressed individuals’ acknowledgement of depressive symptoms and perceived need for treatment. Findings of this study suggested that greater identity conflict, but not goal, conflict was associated with reduced acknowledgement of depressive symptoms and less perceived need for treatment. Study 3 (Chapter 5) sought to replicate this relationship, and also tested the extent to which identity as a depressed person and socio-cognitive models of health behaviour could predict (i) intentions to seek treatment for depression and (ii) current treatment seeking. This study found that identity conflict was associated with reduced acknowledgement of depressive symptoms, but failed to replicate the relationship between identity conflict and perceived need for treatment for depression. However, greater identity as a depressed person was associated with both current treatment seeking and greater intentions to seek help. Analyses demonstrated that the Theory of Planned Behaviour and the Health Belief Model predicted current help-seeking and help-seeking intentions, but identity as a depressed person explained an additional significant proportion of the variance. A unified model, drawing on these two theories and incorporating identity was found to be the best fit in accounting for intentions to seek help for depression. The findings of Study 4 (Chapter 6) demonstrated that identity as a depressed person was also a significant predictor of prospective help-seeking behaviour for MDD. In this study, the majority of factors from the Theory of Planned Behaviour and Health Belief Model, extended to include identity, predicted help-seeking behaviour indirectly via intentions to seek help. However, intentions to seek help only predicted a small proportion of the variance in help-seeking behaviour, and the findings revealed that a subsample of factors, including identity, directly predicted help-seeking behaviour. The final study sought to use an online focus group to develop a measure of symptom avoidance in depressed individuals. This study faced methodological difficulties, and Chapter 7 reflects on the use of online focus groups to explore patient experiences of illness. The findings of this study highlighted participant experiences of using an online focus group method to discuss personal experiences of MDD, and this chapter provides specific guidance for other researchers planning to use this method in the context of health research. The implications of the findings of this thesis are discussed in Chapter 8, alongside recommendations for future help-seeking research.