Introduction

Common mental health problems are highly prevalent, and yet a majority of them do not receive treatment. Apart from poor access to mental health services, low rate of help-seeking is an important factor contributing to treatment gap. Research has consistently shown that men are less likely than women to seek help for mental health concerns despite experiencing similar rates of mental health disorders in general, leading to poorer mental health outcomes.(1) Studies conducted in India have also found similar trends, with men reporting lower levels of mental health-related help-seeking compared to women.(2) This has been attributed to internalized masculine norms, which negatively affect men’s help-seeking behavior, primarily shaped by socio-cultural factors.(3) There is a severe dearth of literature on gender differences in the uptake of and response to interventions to improve help-seeking. Implementing gender-sensitive interventions may increase the uptake of mental health services and effectiveness of the treatment.(4) Thus, this study aimed to address the aforementioned gaps by examining gender differences/similarities observed in the course of implementing a help-seeking intervention (Reach Out) for distressed non-treatment-seeking young adults.

Material and Methods

Young adults currently distressed and not seeking treatment (20-35 years) were invited to participate in the study using online announcements. Participants were recruited through flyer via various modes on multiple platforms (social media, word-of-mouth publicity). The flyer aimed to target young adults in distress not seeking professional help by asking self-reflective questions on experience of depressive mood/anxiety symptoms for two weeks or more. It also highlighted the prevalence of common mental health problems and potential benefits of participation. It provided assurance of confidentiality, participation link and researcher contact details. Distress was assessed using the Kessler Psychological Distress Scale.(5) Those who scored below the cut-off were excluded from the study.

Reach Out, a simple technology-based multi-component intervention to improve professional help-seeking, developed based on relevant theoretical frameworks and a priori guidelines, was used.(6) The intervention included eight core components intending to enhance awareness about common mental health problems, utility of self-help and support from significant others, and to increase participants’ skills at understanding when it may be appropriate to step up to professional help-seeking.

The intervention was delivered over eight weeks to responders who met the eligibility criteria, provided consent and completed baseline assessments (N=172). PS, a registered clinical psychologist, was the facilitator to deliver the intervention. Distress, barriers, inclination to seek help and help-seeking from professional sources were assessed at baseline, post and follow-up. Participants were assessed using the Barriers to Seek Professional Help for Mental Health Scale developed for this study. Help-seeking inclination was assessed using the General Help Seeking Questionnaire.(7) A single item yes/no question assessed help-seeking behaviour from mental health professionals.

The study was initiated after approval from the Institute Ethics Committee (Approval no.: NO.NIMH/DO/IEC (BEH. Sc. DIV)/2019). The intervention trial was registered in the ISRCTN registry (ISRCTN14504454). Written informed consent was sought from all participants before initiating the study.

Results

Table 1 describes gender differences on key study variables. Amongst those who indicated an expression of interest, about one-third were men, and two-thirds were women. A significantly higher proportion of women initiated (66%) online baseline assessment than men. Out of 201 participants who completed baseline assessment, 60.8% were women. Gender differences were not evident in most of the parameters examined in the study. Mean scores on overall barriers were significantly higher for women than men at baseline. There was no difference in the proportion of men and women respondents who were excluded due to distress scores being below the cut-off. Both groups in the intervention did not differ on distress or help-seeking inclination from mental health professionals at baseline. No significant gender differences were observed once the intervention delivery began. There were no significant differences in the proportions of men and women who initiated the intervention and engaged in more than four components. As far as the outcomes of the help-seeking intervention are concerned, both the subgroups exhibited significant reduction in barriers to seek professional help and in distress, and improvement in inclination to seek help from mental health professionals at follow-up. There was also no difference in the proportion of men and women participants who sought professional help by follow-up.

Discussion

Symptoms of depression, anxiety, and unspecified psychological distress are two–three times higher among women.(8) This study primarily focused on help-seeking for common mental health concerns, and the announcements focused on low mood and anxiety symptoms, which could partly explain the differential enrolment rates of men and women. However, this may not completely explain the difference in uptake of the intervention by distressed young adults. The approach used in the present study entailed soliciting participation of distressed non-treatment seekers, which is a hard-to-access population in the general community. The recruitment rates in this approach depend on the proactive expression of interest by the potential intervention participants. The sampling bias that is inherent in this approach could have resulted in lower enrolment of men (as well as women) who may have relatively strong levels of reluctance to seek help for common mental health concerns. Tendency towards help negation in young adults has been documented in previous research and is likely to be more evident in samples of distressed men.(9)

Significantly higher barriers in women to seek professional help in the present study may be understandable in the background of studies that highlight the role of factors such as socio-cultural power differentials between genders in the Indian context, related to access to resources, sense of autonomy, engagement in caregiving roles, importance accorded to health, and stigma associated with utilization of mental health services.(8,10)

The distressed young women who responded to the present study announcement were similar to their men counterparts on help-seeking inclination despite higher levels of self-reported barriers to seeking professional help. It is important to note that these comparisons reflect differences between responders to the study announcements. It is plausible that distressed men who were exposed to the study announcements but did not engage with it had relatively higher barriers and lower help-seeking inclination, resulting in lower uptake of the intervention.

Overall, it appears that though the intervention uptake was lower in men than women, both men and women respondents who enrolled in the study began with similar levels of distress and inclination and were equally likely to benefit from the intervention. The findings point to the need for further research to examine various approaches to increase the appeal and uptake of help-seeking interventions in distressed young men for common mental health concerns.

Conclusion

The findings of the present study reveal that efforts need to be invested in research on strategies that may be applied at the initial stage of recruitment and uptake of help-seeking for distress in non-treatment-seeking young men. Using separate male-centric messaging in terms of content and depiction of appropriate role models that could have a higher appeal for men may be useful for increasing the recruitment rates of men participants at the outset. Besides the differential prevalence of common mental health concerns across genders and the potential role of the nature of study announcements, other factors like self-selection/proactive enrolment vs. screening method for recruitment could also play a role in the gender composition of the sample, which need to be explored.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Acknowledgement: The first author gratefully acknowledges support from the Indian Council of Medical Research, New Delhi, India, for fellowship support for her doctoral work on help-seeking in young adults.

References

1. Oliffe JL, Phillips MJ. Men, depression and masculinities: A review and recommendations. J Mens Health. 2008 Sep;5(3):194–202.
2. Beck AM. Help-Seeking Attitudes in India: The Role of Collective Self-Esteem, and Emotional Intelligence. Eastern Illinois University; 2014. Available from: https://thekeep.eiu.edu/theses/1286
3. Staiger T, Stiawa M, Mueller-Stierlin AS, Kilian R, Beschoner P, Gündel H, et al. Masculinity and Help-Seeking Among Men With Depression: A Qualitative Study. Front Psychiatry. 2020;11:599039.
4. Oliffe JL, Hannan-Leith MN, Ogrodniczuk JS, Black N, Mackenzie CS, Lohan M, et al. Men’s depression and suicide literacy: a nationally representative Canadian survey. J Ment Heal. 2016 Nov 29;25(6):520–6. Available from: https://www.tandfonline.com/doi/full/10.1080/09638237.2016.1177770
5. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SLT, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76.
6. Sanghvi P, Mehrotra S, Sharma MK. Development of a Technology-Based Intervention to Improve Help-Seeking in Distressed Non-Treatment-Seeking Young Adults With Common Mental Health Concerns. Cureus. 2023;15(5):e39108.
7. Wilson CJ, Deane FP, Rickwood D. Measuring help seeking intentions: Properties of the General Help Seeking Questionnaire. Can J Couns. 2005;39(1):15–28.
8. Malhotra S, Shah R. Women and mental health in India: An overview. Indian J Psychiatry. 2015;57(6):205.
9. Dey M, Jorm AF. Reluctance to seek professional help among suicidal people: results from the Swiss Health Survey. Int J Public Health. 2016 May 30;61(4):495–504.
10. Bhattacharya A, Camacho D, Kimberly LL, Lukens EP. Women’s Experiences and Perceptions of Depression in India: A Metaethnography. Qual Health Res. 2019 Jan 12;29(1):80–95. Available from: https://journals.lww.com/10.4103/0019-5545.161479