Exploring cultural differences in seeking professional help for Depression
Individuals from an African or Caribbean background within the UK are estimated to experience depression more frequently than White British individuals. However, evidence suggests that they are less likely to seek professional help from mental health services.
By Mariam Adeniji, Featured Writer.
I conducted a quantitative research project (2019) to explore the cultural differences in seeking professional help for depression in Black African/Caribbean and White British individuals and its predictive factors.
LITERATURE
Ethnicity has been found to correlate with attitudes, perceptions, and help-seeking behaviours for mental health (Ojeda & McGuire, 2006). Individuals from an African/Caribbean background are less likely to consult their GP concerning psychological problems compared to individuals from a White British background (Maginn et al., 2004). This results in higher rates of compulsory secondary care admission in these individuals as the disorder can become severe and disabling (Oluwatayo & Gater, 2004). Therefore, it is important to identify the potential barriers that that African/Caribbean individuals face when seeking help from healthcare professionals.
Memon et al. (2016) explored the potential barriers that individuals from a Black or Minority Ethnic background could face when accessing mental health services in the UK. The authors found that stigma, low mental health literacy and seeking support from social networks were key indicators of this community’s unwillingness to seek professional help.
However, due to the restricted inclusion criteria of this study, it is not known whether these barriers are also present in individuals from White British backgrounds. Evidence has suggested that both Black British Caribbean and White British individuals face personal barriers when seeking professional help for their mental health (Tanskenen et al., 2011). These barriers mirrored those found in Memon et al. (2016) study. Thus, showing inconsistences within the literature.
Nonetheless, it is clear that stigma, mental health literature and seeking support from social networks are reoccurring barriers to seeking professional help for African and Caribbean individuals. Each barrier will now be further discussed:
Mental Health Stigma
Stigmatisation of mental health can be conceptualised in two ways; perceived and personal stigma. Perceived stigma is one’s belief that society upholds negative attitudes towards those with mental health diagnoses e.g., ‘people with mental illnesses are dangerous’ (Corrigan, 2004). Personal stigma is one’s personal negative attitudes towards those with mental health diagnoses (DeFreitas, Crone, DeLeon & Ajayi, 2018). Those who hold personal stigmatising attitudes are more likely to refuse treatment for their mental health (Vogel, Wade, & Hackler, 2007). This is to avoid feelings of low self-esteem which derives from internalising these negative attitudes (Corrigan, 2004; Brown et al., 2010).
Within the literature, cultural differences in perceived and personal stigma are inconsistent. Evidence has found that Black individuals have more stigmatising attitudes towards mental health than White individuals (Brown et al., 2010; De Freitas et al., 2018). While Diala et al. (2000) found that these individuals have more positive attitudes towards mental health treatment than White individuals.
Mental Health Literacy
Mental health literacy has been defined as “understanding how to obtain and maintain positive mental health, understanding mental disorders and their treatments; decreasing stigma related to mental disorders; and enhancing help-seeking efficacy” (Kutcher, Wei, & Coniglio, 2016). This enables individuals to recognise symptoms early and encourages appropriate help-seeking (Kelly, Jorm & Wright, 2007). This suggests that low mental health literacy can be a barrier to seeking help for mental health.
It has been found that individuals from BAME backgrounds tend to perceive mental health symptoms from a cultural and/or religious perspective in comparison to those from White European backgrounds that tend to hold a medical perspective (Bignall, Jacquez, & Vaughn, 2015; Stone & Finlay, 2008). To my knowledge, studies exploring mental health literacy within the UK utilise qualitative methods with limited sample sizes, therefore it can only be inferred that the BAME community has low mental health literacy.
Non-professional help
Due to stigmatisation, individuals within the African/Caribbean community often refer to other sources when seeking help for mental health e.g., family, friends, or clergy (Neighbours, Caldwell, Williams & Nesse, 2007; Brown et al., 2014; Woodward et al., 2015). However, evidence also indicates that those from White backgrounds also use social help seeking strategies at the same rate as African/Caribbean individuals for common mental health disorders (Brown et al., 2010).
AIMS OF THE PROJECT
Investigate whether African/Caribbean individuals are less likely to seek professional help than White British individuals for depression.
Explore whether personal stigmatisation, mental health literacy and non-professional help act as barriers for African/Caribbean individuals in seeking professional help for depression.
Identify which of these factors predict African/Caribbean individuals unwillingness to seek professional help.
HYPOTHESES
African/Caribbean participants are less likely to seek professional help than White British participants
African/Caribbean participants are more likely to seek non-professional help than White British participants
African/Caribbean participants will have higher personal stigma towards depression than White British participants
White British participants will have higher mental health literacy than African/Caribbean participants
METHOD
122 participants from a White British (48), Black British – African/Caribbean (74) completed the General Help Seeking Questionnaire (Wilson, Deane, Ciarroachi & Rickwood, 2005), Mental Health Knowledge Scale (Evans-Lacko et al., 2010) and the Depression Stigma Scale (Griffiths, Christensen, Jorm, Evans & Groves, 2004). They were also required to provide their sociodemographic information including age, gender, ethnicity, education level and origin of birth.
Data was analysed using independent t-tests to compare African/Caribbean and White British on their total scores of the Mental Health Knowledge Scale and Depression Stigma Scale. Independent t-tests were also used to compare African/Caribbean and White British on their total score of two items of the General Help Seeking Questionnaire (seeking help from a mental health professional and a Doctor/GP) and their total score of seven items of the GHSQ (partner, friend, parent, other relative, phone helpline, religious leader, or another person not listed).
A multiple regression was conducted with personal stigma, mental health literacy and seeking non-professional help as simultaneous predictors of willingness to seek professional help.
FINDINGS
African/Caribbean individuals are less likely to seek professional help for depression than White British individuals.
No ethnic differences were found in seeking non-professional help between African/Caribbean and White British individuals.
White British individuals have a higher personal stigmatisation towards depression than African/Caribbean individuals.
No ethnic differences were found in mental health literacy between African/Caribbean and White British individuals.
The strongest predictor of African/Caribbean individuals’ unwillingness to seek professional is seeking non-professional help.
DISCUSSION
Strengths
UK research tends to focus on psychosis diagnoses within African/Caribbean individuals however, the findings of the current study provides a better understanding of African/Caribbean individuals perception of depression and their willingness to seek professional help for this disorder.
This study was able to examine quantitatively the level of mental health literacy in African/Caribbean individuals as to our knowledge this has only been studied qualitatively.
Limitations
Religion could be considered a confounder that was not explored nor controlled for. Religion can influence our beliefs about mental health including how we perceive symptoms and treatment (Bignall et al., 2015; Mantovani et al., 2016). Therefore, this may have influenced an individual’s personal stigmatisation of depression and their mental health literacy.
Non-response bias may have occurred (responders may have differed from individuals who did respond) due to the sensitivity of disclosing their attitudes about mental health conditions.
The sample was not representative of the target population:
The sample consisted largely of the younger adult population (18-25 years old) - Evidence suggests that older individuals, particularly those of African/Caribbean heritage often display lower levels of mental health literacy therefore may not feel the need to speak to a professional about their mental health (Marwaha & Livingston, 2002).
The sample consisted largely of second generation African/Caribbean individuals that were born in the UK – Evidence suggests that help-seeking behaviours and the perception of mental health symptoms in individuals born in the UK are likely to be different to those born in their native country (Rait, 1999). For example, BME individuals born in their native country had lower mental health literacy (Memon et al., 2016).
IMPLICATIONS
Family interventions could be used to encourage those of African/Caribbean descent to seek professional help and improve treatment outcomes.
Primary care services and GPs should explore holistic perceptions of mental health e.g., psychological, and somatic symptoms as this may increase awareness therefore lowering the prevalence of compulsory secondary care admissions for those of African/Caribbean descent.
Future research:
Direct exploration of the cultural differences in perceived and personal stigmatisation of depression
Possible effects of religion on individuals seeking professional help for mental health disorders.
Implementation of mixed methods in this area of research to enrich our understanding of African/Caribbean individuals experiences of perceptions of mental health disorders and seeking professional help.
References
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