Linking Depressive Symptoms to Help-Seeking Preference among Pakistani Americans

Background & Purpose: Pakistani Americans represent the eighth largest group of Asian Americans in the United States. By 2005, their population had grown to about 210,410 representing .07% of the US population. Many Pakistani Americans are reluctant to access mental health services (Kelaher et al., 2003; Tabassum et al., 2000) mainly due to cultural norms which dictate behaviors (Kleinman & Good, 1985). The purpose of this study is to investigate factors that are related to depressive symptoms and help-seeking behaviors within the Pakistani-American population.

Method: This study included a convenience sample of 76 Pakistani respondents in Pakistani community centers and a Pakistani town in one of largest US cities in 2007-2008. Participants were interviewed by the research team or wrote responses on a validated “Asian Survey” (Author1 & Author2, 2008). The survey contained questions to measure demographics, help-seeking behaviors, family and mental health concerns (on a 4-point scale), and depressive symptoms as measured by the Hopkins Symptoms Checklist (HSCL-25) (Parloff, Kelman, & Frank, 1954). HSCL-25 is composed of 15 items on depression, with a 4-point Likert-type response scale (1="Not at all" and 4="Extremely"). HSCL-25 has been previously tested to be reliable when used with Asian populations, with a coefficient alpha of.92 in the Depression subscale (Lhewa, Banu, Rosenfeld, & Keller, 2007). Participants with average scores larger than 1.75 are considered symptomatic.

Results: Among these 76 Pakistani Americans, the prevalence of having depressive symptoms was 26.3%. When dealing with mental health problems, more than half of them sought advice from friends/relatives (51.3%) and many consulted physicians (42.1%). Some consulted mental health professionals (21.1%) and received religious consultation (19.7%). Others believed that the problem would take care of itself (19.7%) and some preferred to visit herbal doctors (9.2%). The results from the logistic regression analysis showed that four variables significantly predicted respondents' depressive symptoms. First, having concerns of public financial assistance would increase the likelihood of having depressive symptoms by 4.67 times. Second, each unit in experiencing drastic loss of income on the 4-point scale would increase the likelihood of having depressive symptoms by 4.55 times. Third, visiting physicians for mental health issues would predict an increased likelihood of having depressive symptoms by 3.18 times. Fourth, each unit increase in family or relationship concerns on the 4-point scale would increase the likelihood of having depressive symptoms by 1.43 times. These four significant variables explained about 40% of the variances (Nagelkerke R²=.399; X²=22.29, df=4, p<.001).

Conclusions: The results of this study indicated that Pakistani Americans with depression also showed concerns of family relationship issues, experienced drastic loss of income, and had concerns regarding public financial assistance. More often than not, friends or relatives and physicians were consulted for mental health problems. The four identified contributing factors to depression (concerns of public financial assistance, loss of income, physicians as mental health consultants, and family/relationship concerns) provide assessment information for mental health professionals in designing tools to assess individuals who are vulnerable to depression.