Adolescent propensity for depressed mood and help seeking: race and gender differences

Abstract

Background: Studies investigating the correlates of adolescent depression and suicidal tendencies have found that the probability of such tendencies vary by race and gender. However, while there exists evidence that most adolescents suffering from the above problems fail to seek (and obtain) help, the role of race and gender in determining the propensity to seek help for depression remains largely unexplored.

Aims of study: The study uses data from the 1996 round of Health Behavior in School-Aged Children' (HBSC), USA, which surveys a representative sample of more than 9000 adolescents enrolled in grades 6-10. Respondents are asked if they suffered from persistent depressed moods (lasting two weeks or more) over the past year, and whether they sought help while suffering from depressed mood, and if so, from whom. Questions are also asked about whether the respondent had self-injury ideation or actually attempted self-injury. Demographic and other information on respondents is also provided. The primary aim is to test whether there are significant differences between genders, and between non-Hispanic whites, non-Hispanic blacks, Hispanics and Asians in the likelihood of seeking help, and from whom, when depressed. Gender and race-ethnicity differences in the likelihood of being depressed are also explored to find if they correspond to results in the extant literature.

Methods: Multinomial logit models are used to estimate the likelihood of being depressed or at self-injury risk, and help-seeking behavior in event of depressed mood. Models are estimated for the full-sample and sub-samples who report depressed mood or are at self-injury risk. In addition to race and gender, all models control for additional demographic characteristics such as age, family structure, and family socio-economic status.

Results: Adolescent females are significantly more likely than adolescent males to suffer from depressed mood. However, adolescent males are less likely to ask for help than females (odds ratio: 0.72). All minority groups are more likely to suffer from depressed mood compared to non-Hispanic whites, but blacks are at lower self-injury risk. Blacks and Asians are especially prone not to ask for help, with the problem being particularly acute in case of black males and Asian males.

Discussion: The lower propensity of adolescent males to seek help for depression compared to females are in keeping with previous research. However, predicted values show that the majority of males and females with depressed mood or at self-injury risk do not seek help from anyone. Certain racial groups are also at greater risk for not asking for help for depression. This may have implications regarding racial differences in suicide rates, as well as racial differences in future life outcomes. The study suffers from the drawback that because the survey is confined to those enrolled in school, adolescents who are institutionalized for mental health problems or who have dropped out of school due to problems related to depression are not represented in it.

Implications for health policies: There have been efforts in the USA to educate the population about the problems of adolescent depression. However, the above results suggest that it may be useful to have additional educational efforts targeted at specific population groups, to educate them about the risks associated with depression, help overcome any stigma associated with depression and encourage help-seeking when suffering from depressed mood.

Implications for further research: A number of directions of future research are suggested. It would be useful to obtain information on the outcomes of help seeking - whether it actually led to obtaining help. It would also be useful to know the probability of an adolescent being diagnosed with depressed mood (perhaps by a primary care physician) even without actively seeking help. Regarding the racial differences, it would be useful to examine the extent to which such differences arise from immigration status, and also to have more extensive information about attitudes, familial expectations, religiosity, community ties, confidence in the medical system and other factors, so as to analyze further why some races are more prone to depression and averse to seeking help for depression than others. Finally, it would be useful to periodically revisit this topic with more contemporary data to see whether recent efforts at awareness raising has increased the odds of help-seeking among adolescents with depressed mood.