Patterns and risk factors with help-seeking for common mental disorders in an urban Malaysian community

Abstract

Common mental disorders (CMD) is used to describe depressive and anxiety disorders. Community prevalence rates worldwide are estimated between 15%-30%. Mental health services however are mainly geared towards those with the more severe forms of mental disorder. Although the prevalence of CMD is high, little is known about help-seeking behaviour for people with CMD in community settings, particularly in developing countries. The main aim of this research is to investigate the patterns of help-seeking behaviour for CMD in an urban Malaysian community and identifying the determinants of helpseeking behaviour. A two-stage cross-sectional survey was conducted in a Malaysian urban community. Participants aged between 18-45 years, were randomly selected from an electoral register. A total of 614 participants were interviewed and assessed. In addition to background information and self-reported help-seeking behaviour, all participants were presented with a vignette depicting a person with depression and were questioned to assess level of recognition, causal beliefs of depression, recommended help-seeking behaviour and stigmatizing attitude towards sufferers. All were screened with the General Health Questionnaire (GHQ-12) and probable cases of CMD were further interviewed with the diagnostic Mini International Neuropsychiatric Interview (MINI). Stage 2 was conducted to carry out a descriptive study of pathways to care of participants with diagnosed CMD. Prevalence of CMD was 8.8%, and the risk factors associated with CMD were age, marital status, ethnicity, unemployment, and status as student. Following adjustment, only age remained significantly associated with CMD. About one third (33.1%) of the study sample had engaged in general help-seeking behaviour in the past 4 weeks. The types of help sought were namely biomedical and complimentary or alternative medicine (CAM). Those who sought help were more likely to be female, older and diagnosed with CMD (p<O.05). Similar factors were found to be significantly associated with seeking biomedical care (p<O.05). In relation to the study's main interest of the associations between help-seeking and CMD, the results indicated that people with CMD were more than 2 times more likely to utilize biomedical care (p = 0.016), where help-seeking may not have specifically addressed CMD in particular. Explanatory Models for CMD were investigated across domains of recognition levels, causal attributions and stigmatising attitudes. Almost all the participants recognized CMD as a problem (96.910) although only half (5 1.8%) belived CMD amounted to an illness. Six different causal attributions to CMD were generated namely psychological, physical, employment, relationship, financial and supernatural. For help-seeking specifically for CMD, the results were analysed for a hypothetical case via responses to vignette, as well as actual cases based on diagnosis. The major factors predicting biomedical help seeking for the vignette were recognition of depression as a problem, as an illness and fmancial causal attribution. Of the confinned CMD cases, only 42.6% have sought any kind of help for their problems and almost none sought specialised mental health care. Based on the findings, it is evident that a substantial number of people in the community have CMD and they generally utilize biomedical sources at the primary care level more than those not diagnosed with CMD. Although socio-demoraphic factors were predictive of help-seeking behaviour in general, they were not predictive of help-seeking for CMD. Results indicated Explanatory Models were predictive of help-seeking behaviour specifically for CMD. Help-seeking behaviour generated for CMD were mostly in line with the biomedical approach, followed by self-help and lastly CAM. Implementing policies to integrate care for CMD into primary care, promoting awareness, recognizing roles of other sectors, supporting self-help and ensuring accessibility to care would ensure people receive the appropriate care they need.