Problem Statement:
The mental health problem in Bangladesh is stark but invisible to most. People are surrounded by different mental health issues but don’t really realize it until or unless individuals are aware of mental health problems. Moreover that the pandemic situation showed us a mirror how severe the mental health can be. Coronavirus disease has impacted almost everyone’s life especially on mental health for students. According to a study, COVID-19 has increased the mental health problems mostly the stress and anxiety among the students. Also students had fear of getting infected of coronavirus, concentration difficulties on studies, disruption in sleeping patterns, social distancing and concerns for academic performance (Son, 2020). Similar to another report states that, students had stress on online learning, hygiene related issues, follow up the medications and getting paid with proper wages (Kecojevic, 2020). Although people are facing different mental health related issues, seeking healthcare is stigmatized even before the pandemic period. Studies reveals that due to social stigma, barriers, embracement, poor health literacy, social support, trust issues on providers and many other reasons people doesn’t show positive attitudes on health seeking behavior (Mitchell, 2017).
During the pandemic people had different experiences added along with the above mentioned factors. As per the research article inadequate transportation, cost, fear of getting infected and contact difficulties, maintaining confidentiality was also worked as factors for not seeking health care during pandemic period (Kahi, 2019). However, students who experienced very poor mental health status are more likely to seek for counseling services during COVID-19 (Liang, 2020).
The impact of pandemic on students, our future generation, cannot be neglect. The focused group for found literatures on health seeking behavior for mental health is college students, university students and others but not the postgraduate students. Less study has been conducted on this area of topic mainly in the context of Bangladesh. That is why to mitigate the gap research will play an important role. I want to come up with the idea of health seeking behavior for mental health especially among postgraduate students to know the insights of their barriers, reasons and other related factors. That is why I think novelty of this study is unique and research focusing on this issue is important.
Research Question
- How has COVID-19 affected health seeking behavior for mental health issues among post-graduate students?
Specific Research Questions
- What are the health seeking behaviors regarding mental health issues among postgraduate students?
- What are the factors influencing health seeking behavior for mental health issues during Covid-19 among post graduate students?
- What is the coping mechanism to deal with mental health issues among postgraduate students?
- What were the challenges while seeking help regarding mental health issues among postgraduate students?
Method:
The study will use qualitative design to collect data from postgraduates students enrolled in Qualitative Research Methods course at BRAC James P. Grant School of Public Health. Convenient sampling method will be use to select students from a group. For data collection, a semi-structured questionnaire is going to be used. The questionnaires will contain socio-demographic and mental health related questions. Data will be collected through online interviews via zoom, whatsapp, google meet from postgraduates’ students willing to provide information about their mental health issues during COVID- 19. The medium of the interview will be English. Data will be collected with the help of group peers. They have enough knowledge about the research topic. This research is going to be conducted under the supervision of Qualitative Research Methods Course advisors who are expertise in the field of research. The study will maintain the privacy and confidentiality of the participants by using an identification number instead of name. Consent will be taken from the study participants. Before taking the consent the goal of the study will be explained to the participants. They will be given the chance to ask any questions regarding the research if they have any. The participants also have the freedom to withdraw from the research any time they want.
Findings:
Health seeking behavior (HSB) and mental health issues is one of the critical fields in public health sector. People are surrounded by different mental health issues but don’t really realize it until or unless individuals are aware of mental health problems. Many of the individuals are stigmatized while seeking help from health professionals. Even the students are stigmatized and feel shame for seeking professional help in order to cope with their mental health issues. The present study examines the health seeking behavior regarding mental health issues among the postgraduate students. Prior study on health seeking behavior has investigated different components including mental health problems and its various affects on students. However, no study has focused previously about health seeking behavior on post-graduate students.
The total number of the sample size was 7 postgraduate students including 5 female and 2 male. Students enrolled for the course qualitative research method of MPH program at BRAC JPGPH are included in this study. Interviews were conducted following a semi-structured questionnaire. In this exploratory qualitative study, data matrix has been used to find out the association between different factors and health seeking behavior. The researchers of this study focused on coding by using Dedoose with some initial codes, later on added the sub codes for detail analysis purpose. Constantly comparing the data found from respondent, we developed links focusing on the research questions. Through a discussion session, the data were reviewed again along with the codes and sub-codes to ensure whether the data sufficiently narrated the phenomenon. Several main themes emerged after analyzing interviews including understanding health seeking behavior, coping mechanisms to deal with mental health issues and the challenges faced while seeking formal or informal help. The main theme or specific research question that has been focused in this paper is the health seeking behaviors regarding mental health issue among postgraduate students during COVID-19.
Anxiety, depression, fear, stress were prominent mental health issues during COVID-19. What we found from our study is the respondent wanted to cope with mental health issues by sharing problems with their friends/ family, involving in work and studies and by self consolation. Very few of our respondents seek help from professional and online platform. While coping with mental issues they faced social stigma and for health seeking behavior respondent faced social stigma, accessibility and financial challenges. However, we found that despite of facing challenges, they deal with their mental health issues by coping and seeking help from professionals and have a stable current mental health status.
Understanding Mental Wellbeing:
Analysis revealed few interrelated topics surrounding health seeking behavior (HSB) for mental health experienced by post-graduate students. Those are Understanding mental health well-beings, decision making, perception of HSB, different pattern of health seeking behavior.
The respondent of this study were asked to share their understanding on being mentally healthy. Most of the respondent stated mentally well-being means the condition of being stress-free and able to cope up with the ups and downs in life.
“[Researcher: what do you mean by mentally healthy?]….like life is not stable right? There are many ups and downs, to be able to cope with the positive and negative side of life. Yes I think that means we are mentally healthy….” (IDI-1)
“umm.. May be having no sad or stress kind of emotions. Peace in mind, no worries, no stress, I guess that is it…….” (IDI-3)
At the beginning of the pandemic respondents have had fear, anxiety and stress, concerning for their family mainly for parents’ health, reported by the respondents. To continue their livelihood, few respondents were working outside even during the pandemic. They had stress and fear of getting infected by virus and also not to be the reason by being a carrier of virus for their family. Here is the statement of one of the respondent about his/her stress:
“I was in so much stress because of my family members, because I was working in a COVID-19 situation [….] and I was in contact with so many people [….] so much of stress [….] that I shouldn’t be the reason to affect my family.”(IDI-3)
Health Seeking Behavior:
Main part of the research was finding out whether respondent seek for any formal or informal help while facing mental issues. Health seeking behavior referred as going to psychiatrist for counseling, medications, NGO for special course or training, attending online programs like webinar. The analysis of the findings revealed that more than half of the respondent didn’t seek any professional help despite of facing mental health issues. Among the respondent only 2 student sought professional help.
“Yes, I did, I was sharing my problem, shared reasons of depression with a professional counselor. She is a psychiatrist, she gave some kind of counseling, offered medication and assignment. I took training from NGO for positive mindset building based on depression” (IDI_4)
Perception of Health Seeking Behavior:
In terms of seeking help from professional, respondent made the decision by themselves. Although more than half of the respondent did not go for HSB, all of them think HSB to be important regarding mental health. Also the respondent thinks that awareness should be raised regarding mental health.
“…..but I didn’t go because I didn’t feel that much of a need. That’s why. I think it would be better….. We should get some professional help to share our problems because not always sharing with our friends and family is enough.” (IDI_5)
“……everyone should seek for professional health counseling I guess. Some kind of stress level, some kind of distress can be canceled out talking to people close to us as well.” (IDI_3)
Among the 7 respondents, 2 respondents went for professional help and 5 did not go to seek any professional help. Among these 5, 2 people didn’t feel the necessity of this because their mental condition was not that serious. And one respondent, despite of being much stressed about personal life and workload, didn’t go for psychological counseling. And the rest two was very worried about what people will think of them. Even one respondent got stigmatized by highly educated family members. The important findings of the study, 2 respondent who sought professional help, they were not benefited by coping strategies. One of the respondents belonging from marginalized groups, went for professional help. And the other respondent was also stigmatized initially but then he took the help using digital platform.
Discussion:
Currently mental health issues are a prominent concern of public health sector as many people are facing at least one issue in their life. In our study, it was found that most of the respondents were facing some kind of mental health issues during COVID- 19 pandemic. Similar to a report state that, students experienced moderate to extreme level depression (52.2%), anxiety (58.1%), stress (24.9%) before COVID-19 and during COVID-19 the rate increased respectively following depression (62.9%), anxiety (63.6%), stress (58.6%). The prevalence rate was 8.6% higher during COVID-19 comparing to pre-COVID- 19 period (Islam, et.al, 2020).
Although students were facing mental health issues, most of them didn’t seek any formal or informal help from anywhere found in our research similarly mentioned in Kar et.al. (2020) literature, overall 35% students didn’t seek any help from professionals. According to study the main reason for the seeking low professional treatment were being stigmatized by surroundings and trusting more in informal sources (Kerebih et.al, 2017). Also another research reported that, social stigma was the major challenge to seek professional help which identified among Ethiopia residents. Social stigma towards mental health issues in Ethiopia has association with help seeking behavior (Mascayano et.al, 2015).
However, to cope with mental health issues very few among our respondent used digital platform as a coping strategy. A study conducted among pharmacy student in Ireland mentioned the key benefits of webinar on a mindfulness course. The course organizes a calmer mind, stress reduction and recognition of thoughts as mental events (O’Driscoll, 2019).
Our study has been conducted with a small number of sample sizes that is why we had no gender differences seen in terms of mental health issues. But in the study on Ethiopia residents’ gender was found as a factor associated with professional help seeking behavior regarding mental health (Mascayano et.al, 2015). Similar to another study indicated gender as a significant predictor towards seeking formal psychological help. Additionally, cultural perspective also influences gender differences for getting professional psychological treatment (Nam, 2010).
The finding of our study also states that the respondent took decision by their own whether they have to seek professional help but the study conducted in Ethiopia residents, decision making on professional help influenced by family and friends. (Mascayano et.al, 2015).
However, respondent supports the professional health care for all whoever having severe mental health issues. Another study conducted among Chinese adults, around 80% respondent preferred to seek psychological help in serious cases, 72.4% agrees to seek help from medical organizations and only 12% knew about seeking help from professionals. (Yu et.al, 2015). Even though very few respondents seek for professional treatment in this study but everyone beliefs to seek formal/informal help for severe mental health issues which considers as an positive side in public health sector.
Limitations:
The limitations of a study are its flaws or shortcomings. Since we conducted the IDI virtually we could not observe the respondents’ non verbal cues. As a first time researcher we were not familiar with Qualitative Research. As it was an international platform, it was difficult to understand the context of the respondents. We faced some issues of familiarization (like: country, profession regarding anonymity) as we interviewed our classmates. However, our sample size was small; our findings cannot be generalized for all postgraduate students.
The focus group discussion enlighten us with wider diversities including region, country, culture, religion, believes, occupation & definitely our main theme (health seeking behaviour). This research gave us the opportunity to look at the wider aspect of COVID-19 pandemic to all sectors, identifying the effect of pandemic on mental health & various health seeking behaviors. The online interview platform showed us a new ways of interviews settings. Also the in depth view of fragile structure of health seeking behavior regarding mental health taught us various aspects of world.
Conclusions
Mental health issues gain ground during COVID-19 period. Following the study findings every respondent had at least one minor kind of mental health issue faced during pandemic. The rate of mental health seeking behavior was low. A few of the respondents with mental health issue looked to seek professional help and other respondent with minor mental health problems preferred self coping rather than professional help. Financial issues and social stigma were found to be the major challenges to seek professional help. Inadequate efforts of post graduate respondents to seek professional help, especially during a pandemic, could have long-term consequences on their mental health.
Recommendations
Extensive research can be done on different pattern of health mental issues and seeking help during COVID -19. Better access to online webinars and counseling. Promote accessible and affordable approaches for professional help. Campaigns can be arranged for recreational activities and wellness.
References:
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Kar Sujita.Kumar., Yasir Arafat S.M., Kabir R., Sharma P., Saxena S.K. (2020). “Coping with Mental Health Challenges During COVID-19.” In: Saxena S. (eds) Coronavirus Disease 2019 (COVID-19). Medical Virology: From Pathogenesis to Disease Control. Springer, Singapore. https://doi.org/10.1007/978-981-15-4814-7_16
Kerebih, Habtamu; Abera, Mubarek; Soboka, Matiwos (2017). “Pattern of Help Seeking Behavior for Common Mental Disorders among Urban Residents in Southwest Ethiopia.” Quality in Primary Care.
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O’Driscolla M., Byrnea S., Byrneb H., Lambertc S., Sahma LJ , 2019. “An online mindfulness based intervention for undergraduate pharmacy students: Results of a mixed-methods feasibility study.” CurrPharm Teach Learn, Vol. 11(9):858-875. https://pubmed.ncbi.nlm.nih.gov/31570123/
Yu, Y., Liu, Z. W., Hu, M., Liu, H. M., Yang, J. P., Zhou, L., & Xiao, S. Y. (2015). “Mental Health Help-Seeking Intentions and Preferences of Rural Chinese Adults.” PloS one, 10(11), e0141889. https://doi.org/10.1371/journal.pone.0141889