Seeking Help for Mental Health Problems in Hong Kong: The Role of Family

Utilization of Cultural Formulation Interview to understand the factors affecting treatment adherence and help-seeking in mood disorders: A qualitative study from Western India

Introduction

Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same.

Methodology

The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3.

Results

A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings.

Conclusion

The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior.

Stigma and its impact on disclosure and mental health secrecy in young people with clinical depression symptoms: A qualitative analysis

BACKGROUND

Clinical depression ranks as a leading cause of disease and disability in young people worldwide, but it is widely stigmatized. The aim of this qualitative research was to gather young people's experiences of depression stigma and its impact on loneliness, social isolation, and mental health disclosure and secrecy. This novel information can then be used to guide psychosocial interventions for young people with depression.

METHODS

This qualitative study included N = 28 young people aged 18-25 years (Mage = 21.30). Participants were recruited from the community who had high symptoms of depression (assessed through a pre-screen using the Mood and Feelings Questionnaire (MFQ) with a benchmark score > 27) or had been recently diagnosed with depression by a medical professional. Semi-structured interviews were based on conceptual model drawings created by participants and analyzed using thematic analysis.

RESULTS

Four main themes emerged: 1) Depression secrecy: positive and negative aspects; 2) Depression disclosure: positive and negative aspects; 3) The solution is selective disclosure; and 4) Participants' recommendations do not align with personal preferences. In particular, the young people described non-disclosure as a way to be in control, but that secrecy prevented authentic engagement with others. Young people also described disclosure as eliciting more stigma but as necessary to gain help. Finally, the young people described struggling with knowing how much to disclose in relation to their mental health and with whom they could disclose.

CONCLUSIONS

This study provides new evidence of how young people with depression experience stigma and its effects on disclosure and mental health secrecy. Knowing how young people struggle with these issues can allow us to develop interventions to encourage them to come forward and discuss their mental health in order to receive appropriate support and treatment. We recommend young people be signposted and have access to mental health champions or nominated teachers in their schools or universities.

Brief Intervention to Promote Physical Activity and Mental Well-Being in Community Adults: A Pilot Cluster Randomized Controlled Trial

OBJECTIVES

We aimed to evaluate the feasibility and effectiveness of a brief community-based intervention to promote physical activity (PA) and the mental well-being of adults in Hong Kong.

METHODS

A pilot cluster randomized controlled trial was conducted in 15 family service centers. The intervention group (N = 162, 8 centers) received two 2-h interventions uniquely combining "Sharing, Mind and Enjoyment (SME)," Zero-time Exercises (ZTEx), positive psychology, and simple family games. "Sharing" involved promoting PA among families and peers, "Mind" captured positive emotions during PA, and "Enjoyment" assessed engagement of PA. ZTEx are simple PAs to reduce sedentary behaviors and enhancing PA and fitness and require minimal time and no cost or equipment. The control group (N = 152, 7 centers) received interventions unrelated to SME. Primary outcomes were PA-related SME at a 3-month follow-up after completing the baseline questionnaire. Secondary outcomes included subjective happiness, well-being, and family-related outcomes. Participants reported self-perceived changes at 1- and 3-month. Nine focus group discussions with the participants and 4 individual in-depth interviews with community service providers were conducted.

RESULTS

The retention rate at1 month was 90.1% for the intervention group and 95.4% for the control group, while at 3 months, it was 83.3% and 92.8%, respectively. The intervention group showed significantly greater positive changes in PA-related outcomes than the control group at 3-month follow-up (Cohen's d = 0.33-0.42, all P < .05). Most secondary outcomes were non-significantly different between the 2 groups. However, more than 90% of participants in the intervention group reported self-perceived positive changes at 1- and 3-month follow-ups. The qualitative data showed that ZTEx was popular with families due to its simplicity.

CONCLUSIONS

Our trial showed the feasibility of implementing the brief interventions and the potential benefits for promoting physical activity in community adults.

CLINICALTRIALS.GOV IDENTIFIER

NCT03332810 (date of registration: November 6, 2017).

Predictors of Attitude Toward Seeking Professional Psychological Help in Hong Kong

The present study examined predictors of attitude toward professional psychological help-seeking in Hong Kong. A cross-sectional approach was adopted and a total of 166 participants (120 female) ranging in age from 20 to 60 years were recruited online. The relationship between attitudes toward professional help-seeking, self-stigma, and perceived accessibility and affordability of services were examined, gender differences were also examined. Findings revealed that self-stigma was significantly negatively associated with attitude toward professional psychological help-seeking, while perceived affordability was positively associated with attitudes. The current study demonstrates that stigma is still an ever-present obstacle, which could contribute to low utilization of services in Hong Kong.

Level and relationships of academic skills and family functions with academic performance during Covid 19 pandemic

Background

The research indicates that academic skills and family function may influence academic achievement. The Covid 19 epidemic has impacted regular academic and family function. However, there is a dearth of studies evaluating the relevance of academic skills and family function on college students' academic achievement. This research was done to determine the levels and relationships between academic achievement and study skills and family functions. Two hundred seventy-nine college students were assessed with Sociodemographic and academic proforma, Study Skills Assessment Questionnaire (SSAQ), and The McMaster Family Functioning Scale (MFFS).

Results

Results revealed that the mean score of SSAQ and MFFS were 179.92 and 17.88, respectively. Multiple regression analysis showed that the score of reading skills and the MFFS score statistically significantly predicted the score of the exam.

Conclusions

On the basis of this study's results, it is possible to conclude that reading skills and family functioning may influence academic success.

Neighborhood collective efficacy in stressful events: The stress-buffering effect

Although research on neighborhood effects has shown positive outcomes of collective efficacy in mental health, few studies have examined whether its protective role is universally applicable to all residents or the vulnerable population. Building on a stress-buffering model, this study examines whether or not neighborhood collective efficacy serves as a stress buffer to ameliorate the deleterious effects of exposure to stressful events across different population groups. Analyses are conducted based on a city-wide representative sample in Hong Kong linked to suicide events through spatial and temporal information. Neighborhood-level collective efficacy is constructed by the aggregated mean score of individual perceived collective efficacy within the same residential neighborhoods. Results from the logistic regression models show that individuals exposed to suicide in the residential surroundings have a higher risk of mental distress symptoms. Moreover, neighborhood-level collective efficacy tends to alleviate the mental distress upon exposure, but such a stress-buffering effect is only observed in older adults. Our findings provide a new perspective informed by the variation of stress-buffering effect across population groups. Thus, this study contributes to the understandings of neighborhood collective by demonstrating the stress-buffering effects among the vulnerable population.

Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation

This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05-3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18-2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85-3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14-2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.

“I Personally Wouldn’t Know Where to Go”: Adolescents’ Perceptions of Mental Health Services

The aim of this study was to explore perceptions of mental health services from the perspectives of adolescents with no prior service experience. Thirty students in the Transition Year (fourth year) of secondary school participated in this study: 22 females and 8 males, aged 15 to 16. There was equal distribution across rural and urban settings. Participants had no prior experience of accessing mental health services. Data were collected in secondary school settings in the Republic of Ireland. An interpretive description approach guided this study. Data were collected through individual interviews. To complement interviews, participants drew images of mental health care environments and mental health staff members; drawings were not subjected to analysis. Data (participant interviews) were analyzed using qualitative content analysis. Three themes were identified. Participants suggested that “mental health services” differed from “psychiatric services,” with the latter term perceived more negatively. Uncertainty about how to access these services was voiced. Considering the vulnerability of adolescents to the experience of mental distress, education around mental health services is warranted. It is expected that provision of education in this area would enhance service delivery, improve adolescents’ help-seeking behaviors for mental distress, and reduce stigma.

Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry

BACKGROUND

Depressive disorders are a serious public health concern. Left untreated, further clinical distress and impairment in important life domains may arise. Yet, the treatment gap remains large. Prior research has shown that individuals with depressive disorders prefer seeking help from informal sources such as family and friends ahead of formal sources. However, this preference has its disadvantages such as experiencing actual, perceived and internalized stigmatizing responses from them which may delay or deter help-seeking. This paper aimed to determine the role of perceived stigma among family and friends in an individual's help-seeking behavior.

METHODS

Data were collected using semi-structured interviews with patients with depressive disorders from a tertiary psychiatric hospital in Singapore to capture individuals' self-reported experience with depression and stigmatization among family and friends. Interviews were audio recorded and transcribed verbatim. Data of 33 young adults (mean age = 26 years, SD =4.6; 18 female, 15 male) were analyzed using thematic analysis.

RESULTS

In all, four broad themes were developed: (1) absence of support, (2) provision of unhelpful support, (3) preference for non-disclosure, and (4) opposition towards formal help-seeking. Lack of awareness of depression and perpetuation of stigma manifests as barriers towards help-seeking in the form of absence of support and provision of unhelpful support which subsequently leads to a preference for non-disclosure, as well as opposition by family and friends towards formal help-seeking.

CONCLUSIONS

Data from this study can contribute to the development of public health programs aimed at improving awareness and support from family and friends and facilitating earlier help-seeking among young people with depressive disorders.

Knowledge and Attitude of Pharmacy Students toward People with Mental Illnesses and Help-Seeking: A Cross-Sectional Study from Saudi Arabia

People with mental illnesses (MIs) face several challenges in addition to their disease. People’s negative views of those with MIs impact patients’ decisions to seek professional help. The aims of this study were to assess pharmacy students’ attitudes toward people with MIs and seeking help for mental health, as well as their knowledge about the causes of MIs. A cross-sectional survey was conducted on pharmacy students at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Out of the 460 distributed questionnaires, 330 complete questionnaires were received, giving a response rate of 71.7%. Overall, the mean total score for attitude towards people with MIs was 60.16 ± 10.48 (maximum attainable score: 105). In this study, 51.12% believed that people with MIs are more likely to harm others than a person without MIs and 66.9% mentioned that they did not trust the work of a mentally ill person as part of their work team. However, only 35.45% believed that it is difficult for mentally ill individuals to follow social rules. In terms of attitudes toward help-seeking, the mean total score of was 12.83 ± 3.16 out of the maximum score of 25. In addition, the mean total score for knowledge about causes of mental illness was 2.92 ± 1.76 out of the maximum score of 8. The participants reported that MIs could be due to genetic inheritance (56%), substance abuse (54.5%), or brain disease (66.1%). The findings showed that there are some negative attitudes toward people with MIs and negative attitudes towards seeking help for mental health. In addition, some misconceptions about the causes of MIs are prevalent. Consequently, the incorporation of more topics concerning mental health in pharmacy curricula could help improve the awareness of and knowledge about mental health.

Lower Health Literacy of Mania Than Depression Among Older People: A Random Survey of a Community Healthcare Service Center

Purpose: This study examines health literacy among older outpatients in two Community Healthcare Service Centers in Shanghai, China to facilitate the design of public education programs for the aged population on mood disorders (both depression and mania). Patients and Methods: A total of 173 outpatients aged 60 years or more with a chronic physical illness were randomly sampled. A health literacy questionnaire was used to assess participants' awareness of depression and mania. Participants were then asked to label two vignettes depicting depression and mania and to give their recommendations for how to seek help for those in the vignettes and how mood disorders should be managed. Results: In all, 86.1 and 36.4% of participants had heard of depression and mania, respectively, with the most common source of information being relatives and friends. Over half of the participants attributed the possible causes of mood disorders to psychological trauma, pressure or stress in daily life, taking things too hard, and personality problems. Almost two-thirds of participants correctly labeled the depression vignette, but only 26.6% correctly labeled the mania vignette. The most common methods recommended by the participants as being helpful for the individuals portrayed in the vignettes were "traveling" and help-seeking from a psychological therapist/counselor, a psychiatrist, or a close family member or friend. Conclusion: The older individuals attending community healthcare service settings in Shanghai have good depression literacy but relatively poor mania literacy. However, most participants had a positive attitude toward psychiatric treatment for mood disorders.

Barriers to Professional Mental Health Help-Seeking Among Chinese Adults: A Systematic Review

BACKGROUND

A large number of Chinese suffer from common mental disorders (e.g., depression, anxiety, stress, and post-traumatic stress disorder), but treatment seeking is typically low in this population. It is unclear what barriers influence professional mental health help-seeking behavior within the Chinese population. Identifying these barriers could assist in implementation science efforts to reach this population.

OBJECTIVE

This review systematically synthesizes findings related to the barriers to professional mental health help-seeking among Chinese adults.

METHODS

Two English language databases (PubMed and PsycINFO) and two Chinese databases (WANFANGDATA and CNKI) were searched to find relevant studies. Quality assessment was conducted in identified studies. Quantitative findings were tabulated and frequently reported barriers were ranked. Primary data obtained from qualitative studies were thematically analyzed.

RESULTS

Of 6,933 citations identified, 17 met inclusion criteria. There were 11 (64%) studies that reported quantitative methods; 3 (18%) employed qualitative research, and 3 (18%) mixed methods. Results indicated that frequently reported barriers to mental health help seeking among Chinese adults included a preference on self-reliance, seeking help from alternative sources, low perceived need toward help-seeking, a lack of affordability, negative attitude toward, or poor experiences with help-seeking. Less frequently mentioned barriers included stigma, families' opposition, limited knowledge about mental illness, a lack of accessibility, unwillingness to disclose mental illness, and fear of burdening family.

CONCLUSIONS

The current review identified a number of key barriers to help-seeking behavior. Effective strategies are needed to promote professional help-seeking among Chinese adults. Additional factors influencing professional mental health help-seeking need to be further investigated, as they may contribute to a better understanding the help-seeking behavior among Chinese.

Effects of Neighborhood Discrimination Towards Mainland Immigrants on Mental Health in Hong Kong

Using data from a representative sample of Chinese adults who were surveyed in the Hong Kong Panel Study of Social Dynamics (HKPSSD), we estimate the effects of neighborhood discrimination towards immigrants from Mainland China on the mental health of Chinese residents in Hong Kong. Contrary to our expectations, discrimination towards immigrants from Mainland China measured at the neighborhood level is not associated with the poor mental health of post-1997 immigrants; instead, a higher level of immigrant discrimination is associated with a lower level of psychological distress for both post-1997 Mainland immigrants and other Chinese residents in Hong Kong. A functional family also appears to be a consistent predictor of better mental health for both groups. Our findings, therefore, suggest that immigrant discrimination can signify a prejudice that leads to social distance or avoidance and that the post-1997 Mainland immigrants do not have extensive contact with other local residents in Hong Kong. Although local residents’ discriminatory attitudes may not result in aggressive behaviors that have a negative impact on newcomers’ mental health, the social distance between the immigrants and the local residents is still an issue that requires further research and practical attention.