Depression is a major contributor to health seeking behavior. Discuss.

Depression is an important public health issue due to its high prevalence, the substantial impact
on daily functioning, the markedly reduced quality of life in both patients and their relatives, and
the high economic burden. Effective and evidence-based treatments for depression, like
psychotherapy and pharmacological treatments, are available. However, many people do not
receive professional care for their symptoms. Estimates of the number of people with depression
that receive help range from 28 % to 60 % depending on the definition and measurement used,
Wang (2003).

According to (Beck and Alford, 2009, p3) "Although depression has been recognized as a
clinical syndrome for over 2000 years, as yet, no completely satisfactory explanation of its
puzzling and paradoxical features has been found. There are still major unresolved issues
regarding its nature, its classification and its etiology". However, the importance of depression is
recognised by everyone in the field of mental health. According to Kline, "more human suffering
has resulted from depression than from any other single disease affecting mankind." (Kline,
1964). Considering the high burden of depression and the large treatment gap, it is important to
identify reasons why people do or do not seek help for depression.

Hammen (Hammen,1997,p3) states that "the term depression is used in everyday language to
describe a range of experiences from a slightly noticeable and temporary mood decrease to a
profoundly impaired and even life-threatening disorder". The severity of depression is generally
defined according to the number of symptoms present, the severity of the symptoms and the
severity of the associated functional impairment or distress. Depression lowers quality of life,
affects socio-economic prosperity, education and employment (Lund et al., 2010) and affective
disorders are prevalent in 59% of suicides (Cavanagh et al., 2003), contributing to substantial
proportion of global morbidity and mortality (Bertolote and Fleischmann, 2002).

The definition of health seeking behaviour is often considered vague and difficult to define.
There is no common definition agreed upon by sociologists in any sociology literature. Different
definition may be used in different studies, despite referring to the same activity. According to
sociology literature, health care seeking behaviour will be influenced by the individual self,
diseases, and the availability and accessibility of health services. Depending on these
determinants and their interactions, Cunnings et al (2008), health care seeking behaviour is a
complex outcome of many factors operating at individual, family, and community level.
Treatment choices would involve many factors related to illness type and severity, socio-
demographic characteristics, preexisting lays believe about illness causation, accessibility of
treatment available and their perceived efficacy and disease profile, Kroeger, (2003).

According to Kroeger (2003), health-seeking is an activity undertaken by individuals who

perceive themselves to have a health problem or to be ill for the purpose of finding an
appropriate remedy. In exploring the databases to inform this discussion, the terms health-
seeking and help-seeking were found to be used interchangeably. Health seeking behaviour taken
in its literal sense means to seek health. The Nursing Outcomes Classification defines health-
seeking behaviour as “personal actions to promote optimum wellness, recovery and
rehabilitation.” This definition appears to propose that health-seeking behaviour can occur with
or without a health problem and covers the spectrum from potential to actual health problem.
Therefore, contained within the concept of health-seeking behaviour is the aspect of health
promotion that might be aimed at preventing a disease and includes behaviour such as lifestyle
changes. (Whisman, 2008, p66).

A variety of factors have been identified as the leading causes of poor utilization of primary
health care services: including depression, poor socio-economic status, lack of physical
accessibility, cultural beliefs and perceptions, low literacy level of the mothers and large family
size. Review of the global literature suggests that these factors can be classified as cultural
beliefs, socio-demographic status, women’s autonomy, economic conditions, physical and
financial accessibility, and disease pattern and health service issue. The factors of depression
entails that people with a depressed mood may be notably sad anxious, or empty; they may also
feel notably hopeless, helpless, dejected, or worthless.

Cornally & McCarthy (2011) reviewed the literature and concluded there is no disparity among
researchers of health-seeking behaviour that problem recognition and definition must transpire
before health-seeking behaviour can be executed. Perception is the most intrinsic factor in the
process of health-seeking behavior whereby the person themselves identifies the problem for
which help is being sought. Evidence confirms that individuals differ in their choice of treatment
sources depending on the type and perceived intensity of sickness. For example, students
perceive alcohol problems as significantly less serious than drug problems and are significantly
less willing to seek help for alcohol problems (Lowinger, 2012).

A key determinant for health seeking behaviour is the organisation of the health care system1. In
many health systems, particularly in developing countries such as Zimbabwe, illiteracy, poverty,
under funding of the health sector, inadequate water and poor sanitation facilities have a big
impact on health indicators. In addition, cost of services, limited knowledge on illness and
wellbeing, and cultural prescriptions are a barrier to the provision of health services 5. These
challenges, which are significant in Zimbabwe's health system, affect the health seeking practices
of communities.

With respect to ‘predisposing factors’, demographic factors, social structure, personality and
health beliefs are considered to be important in the help-seeking process. Research has shown
that people who are younger or middle aged and unmarried are more inclined to use health
services for their psychological problems, Thompson, Hunt and Issakidis (2004). Furthermore,
intensified health care use is associated with low perceived social support and personality
characteristics, especially with high neuroticism. Other studies identified attitudinal or personal
barriers such as the patients’ inability to recognize the problem, the belief that depression will
abate, the desire to handle problems on one’s own, and negative beliefs about the effectiveness
of treatment. Regarding ‘need factors’ in Andersons’ behavioral model, research has shown that
people with depression are more likely to experience a need for treatment when symptoms are
severe. Additionally, they were more likely to use health services when they reported a long-term
medical condition or physical symptoms or a comorbid anxiety or other mental disorders,
Sherwood, Salkovskis and Rimes (2007).

At the individual level, a person’s beliefs (e.g., attitudes towards health services), demographic
characteristics (e.g., age) and social factors (e.g., education) define his or her predisposition to
use health services. Additionally, the availability of financial resources to pay for services as
well as organizational factors (e.g., regular source of care, means of transportation to care)
enable or impede the use of health services at the individual level.

Navaneetham and Dharmalingam (2001) concurs that in view of depression which is rooted
especially in psychology, looks at health seeking behaviors more generally; drawing out the
factors which enable or prevent people from making ‘healthy choices’, in either their lifestyle
behaviors or their use of medical care and treatment. Thus whilst in the former literature health
care seeking behavior is conceptualized as a ‘sequence of remedial actions’ taken to rectify
‘perceived ill-health’ (Ahmed et al, 2000), in another approach the latter part of the definition,
responding specifically to perceived ill-health, may be dropped, as a wider perspective on
affirmative, health promoting behaviors is adopted. A number of ‘social cognition models’
(Conner and Norman, 1996) have been developed in this tradition, to predict possible behavior
patterns. These are based on a mixture of demographic, social, emotional and cognitive factors,
perceived symptoms, access to care and personality (Conner and Norman, 1996). The underlying
assumption is that behavior is best understood in terms of an individual’s perception of their
social environment, thus depression is a major contributor to health seeking behavior.

Earlier studies from Africa have identified reasons as to why people do not seek health care
when they suffer from a mental illness such as not being able to identify that the illness is a
treatable disorder and beliefs that they would recover without treatment (Trump and Hugo,
2006), not knowing where to go or feeling embarrassed (Seedat et al., 2002) and beliefs that the
mental illness is a somatic illness (Okello and Neema, 2007).

Stigma and misconceptions about the cause and severity of mental illness (Corrigan, 2004;
Sartorius, 2007) are common barriers especially in poor resource settings where local culture and
religion have a profound impact on people's lives (Ae-Ngibise et al., 2010). Crawford and
Lipsedge (2004) highlighted that Zulu people in South Africa found Western medicine useful for
treating physical illness, but not mental illness since many mental health problems were
considered to be understood only by traditional healers from their own culture.
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