(PS3-41) Understanding the Role of Culture and Goals in Seeking Care for Depression

Background: Depression is a pervasive and debilitating mental illness (Hasin et al., 2018). Despite the availability of effective treatments, many individuals with depression do not seek treatment (Waitzfelder et al., 2018) or drop out of treatment early (Sue & Zane, 2009). An important factor related to treatment-seeking is individuals’ goals for treatment. Current research on treatment goals focuses on treatment outcomes, such as symptom reduction or improving functioning (Battle et al., 2010; McNaughton et al., 2019). However, understanding goals that lead an individual to enter treatment is equally important, as symptom reduction is only likely to occur with extended treatment, and many individuals drop out early (Gibbons et al., 2011). Indeed, many who drop out of treatment identify as cultural minorities and may have differing goals (Zane & Sue, 2005). Therefore, this study aims to identify types of treatment goals and to understand the relationships between types of treatment goals and demographic variables, with a particular focus on culture.


Method: Participants were individuals screening positive for current depression (N = 325) via a separate online depression and suicidality screening study (Leykin et al., 2012). Participants from two broad cultural groups: Spanish speakers from Latin America (Latin: n = 194) and English speakers from Western English-speaking countries such as US, UK, or Australia (Western; n = 131) completed an online survey on preferences and opinions regarding depression treatments. Nine questions assessing the importance of various goals and priorities for seeking treatment (excluding symptom amelioration) were factor-analytically reduced into four goal domains: understanding of self, knowledge about depression, knowledge about treatment, and hope.

Results: Regarding goals related to understanding of self, depression level, past treatment seeking, and gender separately moderated the relationship between culture and goal importance. Thus, goal importance reduced with increasing depression levels for the Western sample, but the opposite effect was observed for the Latin sample (p = .002), Western participants with past treatment-seeking experience reported lower goal importance (p = .008), and Latin women reported higher goal importance as compared to other groups (p = .04). For goals related to knowledge of depression, depression scores moderated the relationship between culture and goal importance: for the Western sample, goal importance reduced with increasing depression levels, and no such relationship was observed for the Latin sample (p = .01). Regarding knowledge about treatment, gender moderated the relationship between culture and goal importance, such Western women reported markedly lower goal importance than other groups (p = 0.48). Finally, goals related to hope did not differ between the two cultures. 

Conclusions: The results suggest notable cultural differences in most goals for pursuing depression treatment; furthermore, symptom level, past treatment, and gender may affect these goals. Achieving hope, however, may be a universal goal. Gaining a better understanding of treatment goals may benefit efforts to encourage individuals to enter and complete treatment.