Impact of social networks on health-seeking behaviours among Sri Lankan migrants and Anglo-Australians with depression

Problem

Depression is a wide-spread mental health disorder not only in Australia, but indeed globally. Despite high the prevalence in the community, uptake of care is low, and care seeking is even less common in migrant communities, often occurring at a crisis point. While it is well-established that social networks and kinship play a central role in South Asian migrant communities, limited research has explored how the interactions with social networks modulate health-seeking trajectories in relation to depression. Such interactions may be particularly important in determining care trajectories for stigmatised conditions such as depression.

Understanding how care trajectories may be shaped through the influence of social networks provides insights not only into how and why people enter into care, but also how people navigate their local world to gain access to the resources they need as they progress through their care journey.

In the current study, we explored the interactions between culture, social networks and health seeking in Sri Lankan migrants and Anglo-Australians living with depression through the theoretical prism of the Network Episode Model (NEM).

Approach

Given the exploratory nature of the project, a qualitative paradigm was selected. 48 in-depth interviews were conducted between May 2012 and May 2014 with Sri Lankan-Australians as well as Anglo-Australians who self-identified as living with depression.

Thematic analysis was conducted which afforded an in-depth exploration of participants' interactions with social networks and how these moderated care seeking journeys through their depression.

Findings

Findings of the project highlighted the influence wielded by social networks in navigating care. In particular, important decisions around care initiation occurred on a continuum of choice and agency with some taking control of their care whereas others experienced coercion to engage with care services. One important finding which emerged through the study was the concept of selective activation of those perceived to understand depression-the compatriots-who frequently became key supports for participants. Many participants identified that compatriots through a shared understanding of the journey through depression were more helpful than otherwise meaningful social networks based on ethnicity, culture and kinship.

Consequences

The findings of the current study highlights the influence social networks have in the navigation and uptake of care. While social network connections may be pivotal in initial engagement with services, in some cases, in particular in younger Sri Lankan migrants, the care journey may become stymied and formal care uptake delayed. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses as well as capitalising on powerful role of compatriots may provide avenues for improving uptake of mental health services in migrant communities.