South African adolescents’ beliefs about depression

Introduction

Depression is one of the most disabling common mental health disorders, which often has its onset during adolescence; it characteristically runs a chronic course and is related to a cluster of health risk behaviours (Katon et al., 2010) and suicide (Culp, Clyman, & Culp, 1995). Mental health literacy in adolescents is important for them to access the most appropriate help when needed. This survey describes the findings from a survey conducted by South African Depression and Anxiety Group (SADAG) as part of Suicide Should Not Be a Secret (SSS) initiative to assess mental health literacy and explores the experiences and beliefs about depression and suicide in adolescents.

Methodology

As part of the SSS initiative, 2,050 school-going adolescents from the largely disadvantaged Gauteng province in the Johannesburg region participated in presentations on depression over 2 years. Trained presenters delivered these presentations of 60 minutes. The topics ranged from the pressures faced by teenagers today, signs and symptoms of depression in young, identification of early warning signs, common myths associated with depression, practical strategies for offering support, resources to get help and how to communicate with someone they are worried about. Subsequent to the presentations, participants completed a 15-minute questionnaire evaluating mental health literacy. The questionnaire consisted of socio-demographic information; five yes or no questions related to the experiences and beliefs of adolescents about depression; five open-ended questions exploring their beliefs, support options and their understanding of depressive symptoms; and the final section about feedback related to the presentation. A coding system was devised for the open-ended responses.

Results

There were 1,099 valid questionnaires. The adolescents were 13–22 years of age (mean age 15.78 years, standard deviation 1.78 years). There were 1,049 males and 950 females with no significant gender difference. A total of 46.7% had an experience of knowing someone with depression or on treatment for depression. A total of 90.9% respondents agreed that depression was an illness, while 41.4% considered it a sign of weakness. A total of 13.1% adolescents thought it to be an attention-seeking behaviour (Table 1). The participants ranked parents or siblings (35.1%) as the most preferred support option followed by friends (21.5%) and teachers (20.2%). A total of 14.7% respondents listed social workers, neighbours or professional help, whereas 6.8% considered religious support options such as pastor and priest to be preferable contacts.

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Table 1.

Depression beliefs and experiences.

Learner’s responses	Depression an experience	Depression an illness	Depression an attention-seeking behaviour	Depression a sign of weakness	Suicidal person should be left alone
No	52.1%	7.2%	86.8%	41.4%	95.8%
Yes	46.7%	90.9%	13.1%	58.4%	4.2%
Missing	1.2%	1.9%	0.1%	0.2%

The most common indicators of depression reported were sad mood (23.6%) and changes in socialisation patterns in the form of avoiding friends and avoiding participation in social activities (24.6%). A substantial proportion listed changes in sleeping and eating patterns (18.3%), angry and irritable behaviour (12.5%) and other health risk behaviours such as using illicit substances (9.7%) as the indicators of depression. A total of 1.5% respondents reported suicidal thoughts or behaviours as reflective of underlying depression. There was no significant difference in the responses between the two genders.

Discussion

Interestingly, about half the respondents had some experience with depression, and an overwhelming majority thought it to be an illness. This is in contrast to a survey conducted in adolescents in Iran where depression was considered to be part of normal ups and downs of life (78.2%) and the way the person was raised (68.2%; Essau, Olaya, Pasha, Pauli, & Bray, 2013).

In this survey, there was a strong preference for a parent, sibling or a friend as a support option when depressed as opposed to professional help. This is similar to the study by Jorm, Wright, and Morgan (2007) in Australian adolescents, in which 12–17 years old chose family (54%) as a source of help over mental health professionals or services (2%). There was a steep rise in preference for a professional help with age in this study (31% in 18–25 years old as compared to 2% in 12–17 years old). This highlights the role of the family system and community supports as the primary resources that need to be considered while devising any interventions for young people. This is in alignment to the conclusion drawn by Patel, Flisher, Hetrick, and McGorry (2007) in their series on youth mental health, of recognising families and communities as major players in determining the mental health of youth, with young people themselves at the centre of all policy-making.

The depressive symptoms identified were similar to the study by Burns and Rapee (2006) in Australian adolescents using Friends in Need questionnaire (requiring open-ended responses for depressive symptoms). A loss of interest in enjoyable activities (73.3%) followed by loss of appetite and weight loss (61.4%), sleep disturbance (59.4%), poor concentration (38.6%) and tiredness (44.1%) were the most common symptoms of depression listed by adolescents in the absence of clear signs of being suicidal or worthless.

Limitations and strengths

This survey is the first study exploring the mental health literacy in adolescents in South Africa. There are certain limitations of this survey. First, our sample was drawn from largely disadvantaged adolescent group from Gauteng region; thus, they may not be representative of all adolescents in South Africa. Furthermore, this study differed from the majority of previous research on mental health literacy in the absence of any case vignettes in the questionnaire and open-ended questions requiring the participants to answer depending on their beliefs and past experiences. This meant tapping into their declarative knowledge, thus eliminating the possible differences in what they believe will help another person in a hypothetical situation and what they might do for themselves or others in real-life scenarios (Jorm et al., 2000; Raviv, Sills, Raviv, & Wilansky, 2000). However, it made a comparison with the previous studies difficult.

Conclusion and future directions

Adolescents play a key role in their own mental health and providing mental health first aid to their peers. This study highlights the role of families in adolescent mental health and the need for support and resources for them. Any health promotion programme should aim to improve awareness about depression, especially in younger adolescents, taking into account the pre-existing cultural beliefs to avoid conflict with their belief systems (Jorm & Kelly, 2007). Further research is needed to assess mental health literacy in a more naturalistic context.