Depression as a Health Barrier

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Depression as a Health Barrier Essay
Depression is a disorder that causes a constant state of low mood or feeling of sadness. It affects the thoughts, feelings and behavior of an individual. It happens to people but passes after a while. However, others find that the state of equilibrium in their lives is altered due to this state. Depression may make someone feel helpless and void. It is a normal thing to feel down quite often, but at times, it takes hold of one’s life and turns things around from the expected. The temporary depression blues make it uneasy to efficiently function as usual.

Several forms of depressive disorders commonly exist, such as dysthymic disorder, psychotic depression, postpartum depression, seasonal affective disorder, and major depression. Depression as a Health Barrier Essay. These forms carry symptoms like experiencing irritability, lower levels of energy and interest in sex and change in habits in one way, or another.

When faced with depression, social isolation becomes the path to total destruction of someone’s life as discussing issues with friends or close relatives does help, but spending too much time on it increases it. Giving it a hand at exercising may also have the mind preoccupied and help in treating the low-mood state that is experienced by the individual. Exercise can help patients with depression, especially if the risks like obesity are highly expected to occur. Treatment may also be offered through a number of ways, with the most common being drugs or psychotherapy. The aim of such is to normalize the naturally occurring brain chemicals which play a significant role in stabilizing one’s mood.

Just one year after the world’s fourth biggest recorded earthquake in Japan quake, those affected are reported to be undergoing depression (Brigham Young University, 2014). The Japanese people hold so much interest and value to what they have with their neighbors and the radiation broke up many of these ties. The devastation level caused by the earthquake is hard to imagine as temporary housing was provided but still did not have to offer what their previous lives did.

The nuclear power that leaked radiation had a massive effect on the people living them with depression scars. A woman broke in tears most probably remembering the loss they all suffered sighting just a little of what they all felt. The people exhibited resilience as a symptom of depression. It may seem hard to put back things to the normal state, but it is possible.


Depression is a factor that harbors diabetes and high blood pressure, but is highly associated with heart disease too ( Washington University in St. Louis, 2014).Depression as a Health Barrier Essay. It facilitates heart attacks and the risk of heart disease becomes higher. Also, people with heart disease and issues with their thyroid glands (Endocrine Society, 2014), have a high risk of mortality and cardio-vascular attack.

According to studies, treatment has not lowered the risk of heart attack but more studies are to be made to be sure of treatments that can improve the situation It Is meant to regulate the body’s metabolism, but a link between its work and depression have been found.

Depression is indeed an experience not to be thought of as a simple situation as it may lead to death. People should look for support and help or early detection and treatment to solve issues and live a normal life again for proper societal functioning.

Brigham Young University. (2014, March 6). Japanese Town: Half the survivors of mega-earthquake, tsunami, have PTSD symptoms. Science Daily. Retrieved March 11, 2014 from

Endocrine Society. (2014, February 20). Active thyroid may raise risk of depression in older individuals. Science Daily. Retrieved March 11, 2014 from

Washington University in St. Louis. (2014, February 24). Panel recommends listing depression as a risk for heart disease. Science Daily. Retrieved March 10, 2014 from

Adolescents and young adults frequently experience mental disorders, yet tend not to seek help. Depression as a Health Barrier Essay. This systematic review aims to summarise reported barriers and facilitators of help-seeking in young people using both qualitative research from surveys, focus groups, and interviews and quantitative data from published surveys. It extends previous reviews through its systematic research methodology and by the inclusion of published studies describing what young people themselves perceive are the barriers and facilitators to help-seeking for common mental health problems.

Twenty two published studies of perceived barriers or facilitators in adolescents or young adults were identified through searches of PubMed, PsycInfo, and the Cochrane database. A thematic analysis was undertaken on the results reported in the qualitative literature and quantitative literature.

Fifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. Facilitators were comparatively under-researched. However, there was evidence that young people perceived positive past experiences, and social support and encouragement from others as aids to the help-seeking process.

Strategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance.

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The burden and prevalence of mental disorders
Depression and anxiety are highly prevalent mental disorders with estimates indicating they affect up to almost one fifth of the population in high income countries worldwide [1-3]. Prevalence of mental disorders is greatest among younger people aged 16-24 years [4] than at any other stage of the lifespan. They are also common in childhood and adolescence with 14% of those aged between 4 and 17 years affected [5]. This high susceptibility in adolescents and young adults to developing a mental disorder is coupled with a strong reluctance to seek professional help [6].

Reluctance to seek help
Studies have found that approximately 18 to 34% of young people with high levels of depression or anxiety symptoms seek professional help. For example, a school-based study of 12 to 17 year old German adolescents reported that only 18.2% of those with diagnosable anxiety disorders, and 23% of those with depressive disorders had ever used mental health services [7]. Similarly, a large study of over 11,000 Norwegian adolescents in school aged 15 to 16 years found that only 34% of those with high levels of depression and anxiety symptoms had sought professional help in the previous year [8].Depression as a Health Barrier Essay. According to an Australian national mental health survey of young people only 25% of children aged 4 to 17 years with a diagnosable mental disorder had used any health services in the 6 months prior to the survey [5]. This reluctance to seek help is not limited to children and adolescents. Adults of all ages often do not seek help for a mental illness [9], with only 35% of those surveyed with a common mental disorder seeking help during the previous year [4].

Proposed reasons for not seeking help
Many reasons have been proposed to explain why adults in the general population do not seek professional help for common mental disorders. These include negative attitudes towards seeking help generally [10], as well as concerns about cost, transportation or inconvenience, confidentiality, other people finding out, feeling like they can handle the problem on their own, and the belief that the treatment will not help [11]. Similar concerns have been found in a rural population, with the addition of worry that that the care will be unavailable when needed, about being treated unkindly, and not knowing where to go [12]. Conversely, facilitators have been proposed to include prior treatment, higher education, and greater mental disorder episode length [13], and the influence of intimate partners and general practitioners [14].

Likewise, research has sought to explain the reluctance of young people and adolescents to seek professional help when it is necessary. Friends and family are often the preferred sources of help over health professionals [6,15]. In two reviews of help-seeking studies, Rickwood and her collaborators concluded that a high reliance on self to solve problems, a lack of emotional competence, and negative attitudes about seeking professional help were barriers to help-seeking [6,16]. Conversely, the authors identified a number of possible facilitators of help-seeking. These included emotional competence, knowledge, positive attitudes towards seeking professional help, social encouragement, and the availability of established and trusted relationships with professionals such as general practitioners [6].Depression as a Health Barrier Essay. These reviews were based around a model of help-seeking [16] in which seeking professional help is conceptualised as a multi-step process beginning with the individual’s development of an awareness of the problem, followed by the expression of the problem and a need for help to others, the identification of appropriate of sources of help for the individual to access, and finally, the willingness of the individual to actually seek out and disclose to potential sources of help. In another review, Barker and colleagues [17] differentiated between structural and personal determinants of help-seeking. They maintained that individual factors, such as personal beliefs, internalised gender norms, coping skills, self-efficacy, and perceived stigma interact with structural factors including the national health system, accessibility and affordability of services, and social support. However, none of these reviews were systematic syntheses of the available quantitative and qualitative literature. Moreover, they focused primarily on quantitative cross-sectional correlational studies (e.g., primarily survey studies which measured the association between a measured barrier such as low emotional competence and the young person’s intentions to seek help [18]) and largely overlooked the qualitative research. The qualitative research in particular may provide additional and different information about the reasons that young people do not seek help to structured survey questions. Moreover, currently no review has systematically identified and synthesised the literature which asks young people themselves what they perceive are the barriers and facilitators to help-seeking. This systematic review seeks to address this gap.

Aims and scope of this study
This study is a systematic review of both the qualitative and the quantitative literature on the perceived barriers and facilitators to help-seeking for mental health problems in adolescents and young adults. In this paper ‘adolescents’ refers to those aged between 12 and 17 years and ‘young adults’ to those aged 18 to 25 years [19]. It focuses on help-seeking for the common mental health problems of depression, anxiety and general emotional distress. Depression as a Health Barrier Essay.

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Databases & Search methodology
Three databases (PubMed, PsycINFO, and Cochrane) were searched in September and October 2009 using the search terms presented in additional file 1: Search terms. These terms aimed to represent the primary concepts of ‘help-seeking’, ‘mental health’, and ‘barriers’ or ‘facilitators’. Keywords were generated for each of these concepts by examining the terminology used in review papers in the help-seeking literature and a thesaurus to locate synonyms. In addition, the keywords were combined with standard MeSH terms from the PubMed and Cochrane databases and Subject Headings for the PsycINFO database.

Study Selection
Figure ​Figure11 presents the flow chart for the selection of the included studies. The initial database search returned 3637 published English-language abstracts after removing duplicates. One of the researchers (AG) then screened the abstracts and excluded studies that did not address barriers or facilitators to help-seeking for a mental health problem. This resulted in 260 potentially relevant studies. An additional 32 studies were located through hand-searching the reference lists of reviews and key papers found through the systematic search and which were considered likely to satisfy the inclusion criteria.

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Figure 1
Study selection flow diagram.

The second stage of the study selection process involved examining each of the 292 articles and excluding those which met the following exclusion criteria.

  1. Participants were not explicitly asked what they considered were barriers or facilitators to help-seeking for mental health problems.
  2. Study participants were neither adolescents nor young adults (aged 12-25 years).Depression as a Health Barrier Essay. This criterion was considered met if more than 25% of the participants fell outside the 12 to 25 years age range, the sample mean age was 26 years or more, the sample was specifically described as “adults” with the age of the participants no further described.
  3. Study was a review.
  4. Study participants were not members of the general community, or university, or school students (e.g., studies of groups with restricted access to a range of help-seeking opportunities such as prisoners and members of the military).
  5. Study was focused on help-seeking on behalf of another person (e.g., carer seeking help for a consumer, or parent seeking help for a child).
  6. Study contained no extractable data on barriers or facilitators.
  7. Study addressed a mental health condition other than depression, or anxiety, or general “mental distress” (e.g., psychosis, obsessive compulsive disorder). Studies of pre- or post-natal depression were also excluded.

270 studies met one or more of these criteria and were excluded from further consideration. No studies were excluded on the basis of research quality. A summary of the excluded studies grouped by the primary reason for the exclusion is provided in additional file 2: List of studies excluded from the review by exclusion category. This process resulted in a total of 22 relevant studies [20-41] for inclusion into the review.

Coding of Studies
Each of the 22 included studies was coded using a pre-formulated rating sheet according to the following characteristics: Author name, year published, country (location of study), age of participants (age range or mean), population description, whether the study participants were selected regardless of mental health status or risk profile (universal) or not, sample size (for target variable), gender (male, female, both), setting (e.g., high school, community, university), research type (qualitative, quantitative), specified barriers to help-seeking (description of barrier themes or items as listed in the study), and specified facilitators of help-seeking (description of facilitator themes or items as listed by the study). Depression as a Health Barrier Essay.

Analysis strategy
Standard methods for thematic analysis [42] were conducted on participant reported barriers and facilitators in the qualitative studies. Barriers and facilitators reported in the quantitative studies were tabulated and top rated themes extracted.

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  1. Study characteristics
    The characteristics of each of the qualitative and quantitative studies of the perceived barriers and facilitators of help-seeking in young people are detailed in additional file 3: Qualitative studies included in the review; and additional file 4: Quantitative studies included in the review. The following section provides an overview of these characteristics including the year and location of the study, the methodologies employed, and the characteristics of the study participants.

Year and location of studies
The studies were published between 1990 and 2008 with most conducted in the Australia (n = 10), or the United States (n = 9). A further two studies were undertaken in the United Kingdom, and one in China.

Methodologies employed
The majority of studies were conducted using qualitative methods (n = 15), the remainder being quantitative studies. All seven quantitative studies used a survey method to collect data. However, the methodology employed in the 15 qualitative studies varied: seven involved interviews, four used focus groups, three used a survey method to collect data, and one employed both focus groups and interviews.

Sample and participant characteristics
Sample size
The number of participants in the studies varied markedly from 3 to 3746. The majority of the qualitative studies (n = 12 of 15) employed between 3 and 52 participants, and a further three involved between 326 and 3746 participants. Sample sizes for the seven quantitative studies ranged from 71 to 294.

Participant age
Data reported on the age of participants varied. Many studies provided an age range in years (11-17 to 18-31+) or the mean age of participants (15.4-21.2). However, some studies reported the grade of the participants only, and these ranged from grades 7 to 12.

Most studies included both males and females (n = 19). However, two focused exclusively on males and one on females only.

Settings and target groups
Half of the included studies (n = 11) were conducted in a high school setting. Of these, one examined Caucasian male students, and one, rural students. Five studies took place in universities. Of these, two out of five examined medical students specifically, and one recruited rural psychology undergraduates. Depression as a Health Barrier Essay. Five studies were undertaken in a community setting, of which one examined at-risk African American male adolescents, and another investigated rural adolescents. Finally, one study was undertaken in both a high school and a community setting [41]. Overall, three of the studies involved a rural population.

Mental health status of participants
Most studies (n = 14) were conducted with samples not selected on the basis of participant mental health status. However, three studies focused on participants with self reported depression, another two focused on self-reported depression and/or anxiety, and the final three included participants with general ‘mental distress’, ‘a mental health issue’, or a ‘health related problem’, the latter from which only data for participants experiencing self-reported depression were included in the present review [26].

  1. Perceived barriers and facilitators
    Analysis of qualitative studies
    Fifteen of the qualitative studies identified participant perceived barriers and facilitators to help-seeking for mental health problems. Two [30,33] studies were excluded from this formal analysis as rather than examining help-seeking more generally, they only addressed characteristics of school-based personnel that may aid or deter help-seeking. A meta-thematic analysis of the remaining 13 papers was conducted by collating and coding data into themes developed from terminology used by the reviewed literature. Topics specified as barriers or facilitators to help-seeking in the papers were coded respectively under thirteen different barrier and seven facilitator themes. For the detailed findings of this thematic analysis see additional file 5: Thematic analysis of qualitative studies.


(a). Barrier themes: Table ​Table11 summarises the key barrier themes emerging from the analysis in order of frequency of studies in which the theme was addressed. The most frequently mentioned barrier was stigma which was reported in over three-quarters of the studies. In addition, almost half of the studies cited issues related to confidentiality and trust. Over one-third of studies referred to difficulties with identifying symptoms, concern about the characteristics of the provider, and reliance on self as perceived barriers to help-seeking. Depression as a Health Barrier Essay.

Table 1
Key barrier themes and number of studies (n = 13) in which theme addressed

Barrier theme Number of studies

1 Public, perceived and self-stigmatizing attitudes to mental illness 10
2 Confidentiality and trust 6
3 Difficulty identifying the symptoms of mental illness 5
4 Concern about the characteristics of the provider 5
5 Reliance on self, do not want help 5
6 Knowledge about mental health services 4
7 Fear or stress about the act of help-seeking or the source of help itself 4
8 Lack of accessibility, e.g., time, transport, cost 4
9 Difficulty or an unwillingness to express emotion 3
10 Do not want to burden someone else 2
11 Prefer other sources of help (e.g., family, friends) 2
12 Worry about effect on career 1
13 Others not recognising the need for help or not having the skills to cope 1
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(b). Facilitator themes: Few of the qualitative studies addressed the perceived facilitators of mental health help-seeking. Accordingly, only a limited analysis was possible. Table ​Table22 details the eight facilitator themes raised in the three studies included in this analysis. Positive past experiences were mentioned by all papers examining facilitators, and it was also the theme for which the greatest number of individual facilitators was reported. Depression as a Health Barrier Essay.