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BMC Psychiatry
Published in: BMC Psychiatry 1/2024

Open Access 01-12-2024 | Mood Disorders | Research

Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience

Authors: Karsten Valerius, Linnéa von Eitzen, Mirjam Göbel, Heike Ohlbrecht, Neeltje van den Berg, Henry Völzke, Hans J. Grabe, Georg Schomerus, Sven Speerforck

Published in: BMC Psychiatry | Issue 1/2024

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Abstract

Background

Seeking help for severe depressive symptoms remains a major obstacle for particular groups within the general population. Value-related attitudes might contribute to this treatment gap, particularly in rural regions with a low density of psychiatric-psychotherapeutic services. We aimed to investigate narratives of socialization, value systems, and barriers of help-seeking to better understand social milieus at increased risk for underuse of psychiatric-psychotherapeutic services in a rural area in East Germany. This could complement the explanatory power of classical socio-demographic determinants and provide guidance for possible interventions.

Method

Based on results of an analysis of a population-based German cohort study (SHIP-TREND-1), 20 individual semi-structured interviews were conducted with participants who met criteria for having been moderately or severely depressed at least once in their life. Qualitative analyses of interview data were guided by grounded theory methodology.

Results

Participants with severe symptoms of depression were more frequent among non-responders of this study. We identified key aspects that influence help-seeking for mental health problems and seem to be characteristic for rural regions: family doctors serve as initial contact points for mental health problems and are considered as alternatives for mental health professionals; norms of traditional masculinity such as being more rational than emotional, needing to endure hardships, embodying strength, and being independent were frequently mentioned as inhibiting help-seeking by middle-aged men; anticipated adverse side-effects of therapy such as worsening of symptoms; a frequently expressed desire for less pathologically perceived treatment options.

Conclusions

Our results suggest that barriers regarding help-seeking in rural regions are multifaceted and seem to be influenced by traditional norms of masculinity. We believe it is critical to strengthen existing and already utilized services such as family doctors and to implement and evaluate tailored interventions targeting the needs of the rural milieu.
Appendix
Available only for authorised users
Footnotes
1
German Democratic Republic.
 
2
Whether or not participants have sought professional help in the past was addressed by using a single and dichotomously (yes/no) scaled item (“Have you ever received medical or psychological treatment due to (a) phase(s) of sadness/fatigue/indifference?“).
 
3
The translation was kept as close as possible to the German wording.
 
4
Round brackets with three dots (…) indicate a three-second pause.
 
5
MHS…mental health services.
 
6
Interviewer comments such as „yes”, “okay”, “hm” were taken out of the quote for the purpose of reading flow.
 
7
I... interviewer
 
8
R... respondent
 
9
For a more comprehensible contextualization of some words or short statements of the interviewees, explanations in square brackets were occasionally inserted.
 
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Metadata
Title
Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience
Authors
Karsten Valerius
Linnéa von Eitzen
Mirjam Göbel
Heike Ohlbrecht
Neeltje van den Berg
Henry Völzke
Hans J. Grabe
Georg Schomerus
Sven Speerforck
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-024-05521-9

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