Magico-religious beliefs, stigma and help-seeking for adolescent mental health at the community level – A multi-stakeholder qualitative exploration in southern India

Abstract

Background:  Almost half of all mental health disorders begin before the age of 14. However, several barriers exist to seeking help for mental health conditions among adolescents in the Indian context. The present study aimed at exploring multi-stakeholder perspectives on adolescent mental health and help-seeking behavior as well as referral.  Methods: Our study adopted a qualitative design with focus group discussions (FGDs) and in-depth interviews (IDIs) conducted over a span of one year among 70 participants using purposive sampling. Participants included parents of adolescents, adolescents aged 14–16 years, high school teachers, and mental health professionals (MHP) and a pediatrician. The study was conducted in selected educational blocks of Udupi taluk.  Parental written informed consent and assent from adolescents were obtained. Data was transcribed and thematic analysis was performed using Atlas.ti (version 8) to identify codes and code families following which themes were identified.  Results: Our findings elicited community-held beliefs and attitudes indicating pathways and barriers to seeking care. Participants perceived that increased device use, accessing pornographic material, experiencing bullying, academic stress and negative perceptions surrounding mental health with the addition of magico-religious beliefs contributed to delayed help-seeking. Barriers to help-seeking included stigmatizing cultural perceptions. A considerable proportion of families found traditional healing more acceptable in the community.  Conclusions: Stigma related to mental health continues to be one of the major barriers to early intervention. School counselors, teachers and even religious leaders in the community were found as effective liaisons in providing referrals to MHP. Recommendations for future studies and the way forward are discussed.