Illness experience and help-seeking behaviors among patients with common mental disorders in a hospital in North 24 Parganas District, West Bengal, India

Background: Common mental disorders (CMDs) are the most frequently encountered mental health problems. A relevant cultural formulation requires consideration of how such patients understand their illness and the kind of help they prefer. We aimed to clarify patient's priority symptoms, perceived causes (PCs), and help-seeking (HS) behavior for CMDs in a psychiatry outpatient clinic in West Bengal, India. Methods: We conducted a cross-sectional survey of consecutive patients with clinically confirmed depression, anxiety, or somatoform disorders in a psychiatry outpatient department in a hospital in North 24 Parganas district. An explanatory model interview based on the Explanatory Model Interview Catalogue was used to assess qualitative and quantitative data regarding sociodemographic characteristics, pattern of distresses, PCs, and HS experience. Results: Among 124 patients, 69% were women, mean age 34.5 years. Half of the patients had monthly income less than USD 32, and 22% were illiterate. Clinically, 42% had depression, 32% somatoform disorder, 10% anxiety, and 17% mixed disorders. Most common symptoms were headache (93%), disturbed sleep (93%) and anxiety or tension (92%). Most common PCs were psychological (96%), family problems (64%), and physical injury (42%). The preferred first providers were private allopathic doctors (50%), traditional healers (28%), and public sector doctors (22%). Conclusions: Clinicians need to recognize both physical and psychological presentations of CMDs. Brief clinical assessment only for pharmacotherapy may be inadequate to address the underlying psychological impact of social and financial causes, which require clinical attention to issues associated with poverty, family, and community.