Perceptions and intentions relating to seeking help for depression among medical undergraduates in Sri Lanka: a cross-sectional comparison with non-medical undergraduates

Amarasuriya et al. BMC Medical Education (2015) 15:162 DOI 10.1186/s12909-015-0453-8 RESEARCH ARTICLE Open Access Perceptions and intentions relating to seeking help for depression among medical undergraduates in Sri Lanka: a cross-sectional comparison with non-medical undergraduates Santushi D. Amarasuriya1,2*, Anthony F. Jorm2 and Nicola J. Reavley2 Abstract Background: This study attempts to understand whether medical undergraduates in Sri Lanka would seek help for depression. This was done by examining their perceptions and intentions relating to seeking help for depression, using the responses of non-medical undergraduates as the baseline for comparison. Method: Medical (n = 620) and non-medical undergraduates (n = 4050) at the University of Colombo responded to a questionnaire which included a vignette about a depressed undergraduate, a depression measure, an open-ended question examining their intentions to seek help if affected by the problem described in the vignette, and scales examining their perceptions about the helpfulness of various help-seeking options for dealing with the problem. The latter items were also administered among mental health professionals to assess expert opinion on dealing with depression. Logistic regression models were used to examine if medical undergraduates differed from non-medical undergraduates in their rates of depression, help-seeking perceptions and help-seeking intentions. These models were also used to examine if being depressed was associated with differences in the help-seeking perceptions and intentions of medical undergraduates. Results: Medical and non-medical undergraduates did not differ in their odds of being depressed. Overall, the medical undergraduates were more likely to appraise professional help positively. However, they did not differ from non-medical undergraduates in relation to their intentions to seek such help if affected by the problem personally. They were also more likely to indicate their intentions to seek help from parents and family. Furthermore, medical undergraduates who screened positive for Major Depression were less likely to appraise some of the recommended professional and informal help-seeking options as being ‘helpful’, with only 50 % considering that it was ‘unhelpful’ to deal with the problem alone. There was also no difference in their help-seeking intentions as compared to those screening negative for Major Depression. Discussion and Conclusions: Although medical training seems to be associated with better help-seeking beliefs, interventions are needed to improve these medical undergraduates’ intentions to personally seek professional help for depression. It is concerning that medical undergraduates who are depressed might be less likely to consider it beneficial to seek help and instead, deal with the problem alone. Keywords: Medical, Undergraduate, Depression, Help-seeking, Attitudes, Beliefs, Perceptions, Intentions, Sri Lanka * Correspondence: 1 Behavioural Sciences Stream, Faculty of Medicine, University of Colombo, PO Box 27125, Kynsey Road, Colombo 8, Sri Lanka 2 Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Victoria 3010, Australia © 2015 Amarasuriya et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Amarasuriya et al. BMC Medical Education (2015) 15:162 Background Several studies indicate that there is a high prevalence of depression among undergraduates [1, 2]. Studies also highlight this among medical undergraduates [3–7]. However, there is conflicting evidence as to whether the rate of depression differs between medical and nonmedical undergraduates, and if so, in which group it is higher [4, 8]. Regardless, it is necessary to examine if those in medical schools are depressed. While undergraduate medical training involves an inherently strenuous course, studies from Sweden and Norway indicate that depression and mental health problems among medical undergraduates might be associated with the stress they experience due to the medical course and the university experience [5, 9]. Furthermore, medical undergraduates suffering from such mental health problems are shown to be at risk of facing academic difficulties and potential drop-out from medical school [6, 10] and to also suffer from mental health problems in their later careers as doctors [11, 12]. Hence, medical undergraduates affected by such problems must receive the necessary assistance. Given that medical undergraduates have a greater opportunity for exposure to mental health information as compared to non-medical undergraduates, it would be expected that they possess higher levels of mental health literacy, i.e., knowledge relevant to recognition, treatment and prevention of mental disorders [13]. Indeed, studies do show that being a medical student, as well as more years of medical training, are associated with higher levels of mental health literacy [14, 15]. In light of such findings it would also be expected that medical undergraduates who are suffering from mental health problems would seek the necessary professional assistance. Contrary to this expectation, studies show that only a low proportion of these medical undergraduates actually seek such help [7, 9, 16–19]. Instead, they show preference to seek help from informal sources, such as friends and family [18, 20–23]. This trend has also been seen among doctors and psychiatrists [24–27]. Some of the reasons that medical undergraduates cite for their reluctance to seek mental health services, are their fear that disclosure of mental health problems would impact their academic record and affect their future medical career, concerns about breaches in confidentiality, fear of stigma and discrimination by others in their profession, and embarrassment about succumbing to such problems [3, 7, 18–20, 28]. Studies also indicate that medical undergraduates who are depressed are more likely to be reluctant to disclose their problems to professionals and to perceive others to hold stigma about depression [3, 29]. Given such findings, it is necessary to ascertain if medical undergraduates would seek the appropriate help for their mental health problems. Such an examination Page 2 of 10 becomes especially important in developing countries such as Sri Lanka, where the number of mental health professionals in the country is low [30], and where undergraduat (...truncated)