Youth knowledge and awareness of clinical depression
TABLE OF CONTENT
LIST OF TABLES ............................................................................................................. 2
LIST OF FIGURES ........................................................................................................... 2
ACKNOWLEDGEMENT ................................................................................................ 3
ACRONYMS ...................................................................................................................... 3
ABSTRACT ....................................................................................................................... 4
CHAPTER 1: INTRODUCTION .................................................................................... 5
BACKGROUND OF THE STUDY ................................................................................. 5
PROBLEM STATEMENT ............................................................................................... 6
RESEARCH OBJECTIVES ............................................................................................. 7
RESEARCH QUESTION ................................................................................................. 7
SIGNIFICANCE OF THE RESEARCH ........................................................................ 7
CHAPTER 2: LITERATURE REVIEW ........................................................................ 8
CHAPTER 3: RESEARCH METHODOLOGY .......................................................... 12
RESEARCH DESIGN ..................................................................................................... 12
SAMPLING DESIGN ..................................................................................................... 12
DATA COLLECTION AND ANALYSIS PROCEDURE .......................................... 13
CONCEPTUAL FRAMEWORK OF THE STUDY .................................................... 14
LIMITATIONS OF THE STUDY ................................................................................. 16
ETHICAL CONSIDERATIONS ................................................................................... 16
CHAPTER 4: FINDINGS, ANALYSIS AND DISCUSSION ..................................... 17
PROFILE OF THE RESPONDENTS ........................................................................... 17
REFERENCES ................................................................................................................ 35
ANNEXURE..................................................................................................................... 37
FOCUS GROUP STUDY OF THOSE WHO HAVE BEEN CLINICALLY
DEPRESSED IN THEIR LIFE. ..................................................................................... 37
QUESTIONNAIRE ......................................................................................................... 39
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Youth knowledge and awareness of clinical depression
LIST OF TABLES
TABLE 1: CALCULATION OF SAMPLE SIZE ...................................................................................... 13
TABLE 2: AGE OF THE RESPONDENTS............................................................................................. 17
TABLE 3 : QUALIFICATION OF THE RESPONDENTS .......................................................................... 18
TABLE 4: CROSS TABULATION OF EXPERIENCE OF CLINICAL DEPRESSION AND CONSULTING AN
EXPERT OR REFERRING TO A PSYCHIATRIST. ........................................................................... 19
TABLE 5: CROSS TABULATION OF EXPERIENCE OF CLINICAL DEPRESSION WITH RELATIONSHIP WITH
FRIENDS ................................................................................................................................. 20
TABLE 6: RESPONDENTS OPINION ON THE LEVEL OF SUPPORT FROM THE SOCIETY TOWARDS PEOPLE
SUFFERING FROM CLINICAL DEPRESSION ................................................................................ 21
TABLE 7: CREATION OF AWARENESS FROM GOVERNMENT ............................................................ 27
LIST OF FIGURES
FIGURE 1: RESPONDENTS WHO HAVE EXPERIENCED CLINICAL DEPRESSION, ................................. 18
FIGURE 2: SENSE OF AWARENESS ABOUT CLINICAL DEPRESSION ................................................. 20
FIGURE 3: ACCEPTANCE OF CLINICAL DEPRESSION ....................................................................... 22
FIGURE 4: SERVICES OFFERED BY HOSPITALS AND OTHER AGENCIES FOR CLINICAL DEPRESSION 23
FIGURE 5: OPINION ON THE ROLE OF RELIGION IN HELPING CLINICALLY DEPRESSED PATIENTS .... 24
FIGURE 6: CAUSES OF CLINICAL DEPRESSION ................................................................................ 24
FIGURE 7: REASONS THAT BEST ACCOUNT FOR SUICIDE CASES AMONGST BHUTANESE YOUTH ...... 25
FIGURE 8: REASONS FOR CREATING MORE AWARENESS BY THE GOVERNMENT ............................. 27
FIGURE 9: HOW TO BEST ASSIST THOSE WITH CLINICAL DEPRESSION .............................................. 28
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Youth knowledge and awareness of clinical depression
Acknowledgement
I would like to extend my sincere gratitude to the following individuals and groups who have
guided me to complete my study within the span of three months, and without whom I would not
have been able to complete it on time.
1. Professor Kayrooz for being very supportive supervisor who guided me with necessary
feedbacks and comment to improve my study and also assuring us with encouraging
words.
2. Mr. Ugyen Lhendup for helping us with words of encouragement, which has indelibly
helped us to be confident with our topics.
3. Madam Karma Tshomo for giving us timely information regarding the research and
helping us with printing our drafts.
4. My colleague, Miss Kuenzang Choden for helping me with my data collection and also
assisting me with SPSS.
5. The study would not have been completed without the help of the respondents who have
been such a sport in devoting their precious time to fill up the questionnaire.
6. Royal Institute of Management and (reprographic unit of RIM) for supporting us with
funds for photocopying our questionnaires and also helping us with consent to carry out
our study.
7. Lastly, to all my fellow PGDPA’s for sharing ideas and necessary feedbacks on my topic.
Acronyms
ADAP- Adolescent Depression Awareness Program
DSM-1V- Diagnostic and Statistical Manual of Mental Disorder
STOPS- Strategies to Prevent Suicide
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Youth knowledge and awareness of clinical depression
Abstract
The study intended to understand the level of awareness of clinical depression amongst the
youth in Thimphu, explore the causes of clinical depression and also, the reasons that account
for suicide cases in Bhutan, and determine the effectiveness of the level of support from society,
religious bodies and hospitals. The study was based on the non-probability convenience sample
of youth in Thimphu (between the ages of 15 to 25).
The results show that youth are familiar with clinical depression but not well aware of the issue.
The majorities of youth who have experienced clinical depression do not seek proper help or are
referred to an expert or a psychiatrist. Religion seems to provide support to a number of youth
according to the findings of the study. Further unemployment and relationship issues are the
main cause of clinical depression amongst Bhutanese youth, and sense of hopelessness and lack
of family support are the major reasons for growing number of suicide cases in Bhutan.
The absence of a wider awareness of clinical depression, and the issues that the youth of Bhutan
face has an adverse effect on the prospect of being subjected to clinical depression. This calls for
the government to create awareness on a wider scale and provide a solution to the issues that the
youth of Bhutan are currently facing and will also face in the future.
Key words: Awareness on clinical depression causes of clinical depression, reasons for suicide
cases, support, psychiatrist and society.
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Youth knowledge and awareness of clinical depression
Chapter 1: Introduction
Background of the study
“Depression is a major contributor to the global burden of disease and influences people in all
societies across the world” (Marcus et.al, n.d, p.1). The most notable effect of clinical depression
is suicide, and according to (Lopez et al., 2006 as cited in Nam et al., n.d), suicide and
depression are interconnected and accounts for large proportion of the overall global burden of
disease. Community knowledge and awareness of clinical depression should assist a youth to
work through problems and should prevent suicide due to a sense of hopelessness, lack of family
support and isolation. According to Pedersen (2011), depression is known as major depressive
disorder or clinical depression which is usually identified as a mental illness, where the patient as
a result is sad, hopeless, and is not able to function normally in life. Clinical depression often
leads to psychotic depression and will encompass the symptom of recurring thoughts of suicide
(Daniel & Flavin, 2011).
Knowledge and awareness of clinical depression (major depressive disorder) provides insight
into the reasons behind the cause of clinical depression amongst the youth and the major factors
that leads them to commit suicide in Bhutan.
Youth awareness of Clinical Depression, in particular, is a major focus of the study as the
majority of the suicide cases that have been reported in recent times have mostly been youth. The
awareness of Clinical depression, causes, and the reasons for youth committing suicide are also
examined.
There are many factors which inhibit youth from getting treatment, such as, unavailability of
appropriate treatment, primary care physicians and lack of appropriate professional care.
However, lack of public understanding of depression, lack of family support, unemployment,
increasing drug use, family problem, fear, sense of hopelessness and stigma associated with
psychological mental disorder prevents youth with risk of clinical depression from gaining
5
Youth knowledge and awareness of clinical depression
desired care. Pelzang (2008, p.2) “argues that the poor and improper view concerning mental
illness and negative attitude towards the person suffering from mental illness will not be able to
seek help and provide proper holistic care”. Therefore, this research will attempt to uncover the
youth knowledge and attitude of clinical depression, causes of clinical depression and reasons
that propel the youth to commit suicide.
Problem Statement
This research acknowledges the importance of level of awareness of clinical depression amongst
the youth in Thimphu, intending to draw out the causes of clinical depression and suicide cases
amongst Bhutanese youth.
Creation of awareness of clinical depression amongst youth is very important for a number of
reasons. Firstly, awareness of clinical depression will help youth to be well informed about the
disorder and will help them to receive appropriate professional care as according to the findings
of (Goldney & Fisher, 2008,p.43 as cited in scheerder, 2009) that “many years of intensive
public and professional education programs, do increase mental health literacy and treatment
seeking in the general public”. Secondly, the study will further improve our perception of this
illness as a life threatening disorder in the context of inadequate and proper care which is also
true to findings of (Ormel et al., 2008; The WHO World Mental Health Survey Consortium,
2004, p.25 as cited in Scheerder, 2009), that “the national surveys carried out in western
countries constantly point out that majority of the people with mental illness do not receive any
proper professional help”. More importantly, this research will help to examine the causes of
clinical depression and reasons for growing rate of suicide cases amongst Bhutanese youth.
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Youth knowledge and awareness of clinical depression
Research Objectives
The objectives of the research are:
1. To find out the level of awareness of clinical depression amongst youth in Thimphu.
2. To determine the level of support from society, hospitals and religious bodies towards
people suffering from clinical depression.
3. To uncover the causes of clinical depression and reasons for suicide cases amongst
Bhutanese youth.
Research Question
1. What is level of awareness of clinical depression amongst youth in Thimphu?
2. What are the causes of clinical depression and reasons for suicide amongst Bhutanese
youth?
Significance of the Research
This research will allow us to understand how clinical depression is perceived by the youth in
Thimphu and give us an indication of the level of support system towards clinical depression in
Bhutan. The study is intended to educate youth about clinical depression, reduce negative
attitudes and acknowledge clinical depression as a serious mental illness that requires
professional help.
The information obtained from this research will enable the policy makers to create wider
awareness of clinical depression, integrate mental health care policy into mainstream policy,
establish programs that focuses on educating people of the importance of seeking professional
help and establish centers that will help the clinically depressed with counseling and guidance.
The study will also enable policy makers to make policies regarding pertinent issues that cause
clinical depression amongst youth in Bhutan. The study is also expected to give an understanding
of the reasons for growing number of suicide cases amongst Bhutanese youth. The information
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Youth knowledge and awareness of clinical depression
obtained from this research will also enable the future researcher to explore more on this field in
a broader context.
Chapter 2: Literature Review
The total strength of youth in Bhutan as of 2012 stands at 2,22,577 from the age group 15-29
(The Bhutanese, 2013). Bhutan has also been deemed as a youthful country as 56% of its
population comprises of youth under the age of 25 (Bhutan Foundation, n.d). However, the
country has been experiencing a growing rate of suicide cases, majority being the youth.
According to Kuensel (September 10, 2013), in the last five years, 364 deaths and 77 cases of
attempted suicide were reported by the Royal Bhutan Police, mostly comprising youth.
Scheerder (2009, p.5) states that “Suicide is the leading cause of premature death in the younger
age groups and is strongly associated with depression”. Thus, there is a need for awareness and
understanding on the association of suicide and clinical depression amongst Bhutanese youth.
“Suicide and depression are serious, inter-related public health problems, accounting for a
significant proportion of the overall global burden of disease” (Lopez et al., 2006 as cited in Nam
et al., p.1, n.d). However, the rapid increase of depression can be reduced if people suffering
from it receive proper treatment (Scheerder, 2009). Globally, majority of persons with clinical
depression and mental disorders connected to suicide do not acquire appropriate treatment, as
this incidence can be significantly decreased if more people with depression and related disorder
receive proper treatment (Nam et al., n.d). Moreover, Ju and Wu (2010) stated that the study
conducted by Yang Hao-jan explained lack of family support and reduced peer support as
unfavorable to mental health of those at risk, which might exacerbate the chances of suicide.
Lack of public understanding of depression and stigma associated with psychological mental
disorder prevents individual with risk of clinical depression from acquiring desired care. Pelzang
(2008, p.2) “supports that the poor and improper view about mental illness and negative attitude
towards the person suffering from mental illness will not be able to seek help and provide proper
holistic care”. The poor and improper view about mental illness and the negativity surrounding it
has a notable effect amongst the young adolescents. Pelzang (2008) further explains that in
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Youth knowledge and awareness of clinical depression
Bhutan people’s perception of mental illness is mainly influenced by traditional beliefs and
considers mental illness to be caused by black magic or evil spirits and resulting in
discrimination of people with mental illness. Traditional beliefs also contribute towards negative
attitude of people with clinical depression in Bhutan, hence, tradition and culture also influences
perception of clinical depression.
According to the ADAP (n.d), (Adolescent Depression Awareness Program), ADAP was started
in 1999 to combat the increasing number of suicide cases in Baltimore area. The program was
incepted to educate young people on major depression as a medical illness. According to ADAP
(n.d, p.2), “Major Depression is a common medical illness experienced by at least 5% of
American teenagers. With 1 in 20 teenagers experiencing depression which is potentially fatal
illness”. The ADAP program further explains that a survey of high school suicide prevention
programs illustrated that 95% of the youth in high school underpinned youth suicide as “response
to extreme stress or pressure that could happen to anyone, only 4% of the programs viewed
suicide as a consequence of mental illness” (ADAP, n.d, p.2). The response presented by the
youth in America clearly indicates that there is lack of knowledge of clinical depression that can
contribute to suicide. Thus, it becomes essential for the youth to know about the connection
between suicide and depression (clinical depression).
This scenario in America is similar to many other countries including Bhutanese youth too. In
the last two years, majority of the suicide occurred among youth and farmers according to the
Kuensel. This account given by the kuensel indicates that Bhutanese youth are prone to clinical
depression and there is lack of knowledge towards clinical depression. Bhutan Foundation (n.d),
states that Bhutan is currently facing the problem of increasing drug and alcohol usage, but more
importantly unemployment is increasingly becoming a youth phenomenon as “80% of the youth
between 15 to 25 are unemployed” (Bhutan Foundation, n.d). According to Depression
awareness guide (n.d), alcohol and drug use can also cause depression. Jefferis et al, (2010), also
stated that unemployed individuals have poorer mental health than the employed. Thus, it can be
attributed that unemployment, increasing alcohol and drug usage amongst youth are the cause of
clinical depression in Bhutan. Gottlieb (2006) also supports that low societal support, troubled
family environment; loss of a parent (family problems), and relationship issues, for the most part
are likely to cause major depression. These issues if experienced, youth are likely to be affected.
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Youth knowledge and awareness of clinical depression
Borchard (2010) also supports that youth are more likely to be “overwhelmed with hopelessness,
if they experience psychological pain and will feel that they have no power over their lives.”
According to (Scheerder, 2009, p. 31), “the main barriers to depression care are normally found
at the level of the general population, negative attitudes and inadequate knowledge concerning
mental health (care)”. This indicates that the ‘mental health literacy’ is not present in the society.
The knowledge of depression amongst the general population is an important measure to help
those youth to seek help. The concept of ‘mental health literacy’ centers on “knowledge and
beliefs about mental disorder which supports their recognition, management and prevention and
has found to be an important determinant of help seeking” ( Jorm 2000, Jorm et.al, 2008,p. 31 as
cited in Scheerder, 2009). “Majorities of the countries have conducted activities to educate the
public about suicide and depression that is, improving their ‘mental health literacy’” (Jorm et al.,
1997, p.31, as cited in Nam et.al., n.d) and has also found significant improvement on the issue.
According to (Goldney & Fisher, 2008,p.43, as cited in scheerder, 2009) “it was found that years
of intensive public and professional education programs, such as ‘Healthy Minds’ and beyond
blue (Australia), do increase mental health literacy and treatment seeking in the general public”
but this is not the case with Bhutan. Pelzang (2008) is also of the view that improving mental
health literacy and awareness must be given importance among the Bhutanese public as mental
health care entails active cooperation from the society. Therefore, the institution of program,
which caters towards educating people on mental illness like that of ‘mental health literacy’ in
Bhutan, will help young adolescents to seek help.
Although stigma against depression is considered as an obstacle for individuals who wish to
acquire appropriate help, a number of studies recommend that stigma may not be the most
dominant negative interpreter of mental health care use (Jorm et al., 2000a; Roeloffs et al., 2003
as cited in Sheerder, 2008). However, “the strongest associations of care use appear to be
severity of the disorder, patients’ lack of knowledge and own attitudes toward treatment seeking
and toward causes of depression” (Andrews, Issakidis & Carter, 2001; Komiti, Judd &Jackson,
2006; Mojtabai, Olfson & Mechanic, 2002; Thompson, Hunt & Issakidis, 2004; Van Voorhees et
al., 2006 as cited in Scheerder, p. 36, 2009). Patient’s reluctance to accept depression as a
disorder inhibits one to receive desired care. “Individuals at risk not recognizing depression as a
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Youth knowledge and awareness of clinical depression
disorder, not in need of a treatment and difficulty accepting a psychiatric diagnosis” (Andrews,
Henderson & Hall, 2001; Bebbington, 1999; Gask et al., 2003; Jorm, 2000; Parashos et al.,2002;
Sareen et al., 2007; Sirey et al., 2001a; Vanheusden et al., 2008; Wittkampf et al., 2008 as cited
in Scheerder, p.37, 2008). Hence, these factors inhibit individuals from getting required help.
This scenario can be found in the Bhutanese context as individuals suffering from depression
normally have the attitude that the mental illness is not severe and regard it as just a changing
frame of mind. They usually believe depression can be treated without consulting medical
professionals. It can also be due to the fact that a “large number of suicide cases are not reported
due to shame, stigma and fear” (Kuensel, September 10, 2013).
According to Eisenberg, et al; (2007, as cited in Scheerder, 2009) in some countries factors such
as convenience to services, availability and affordability can also play a critical role in seeking
help. Bhutan has only limited psychiatric assistance which puts a strain on the accessibility of
services for all the youth at risk. Pelzang (2008, p.5) also supports that, “Bhutan has only limited
psychiatric assistance which puts a strain on the accessibility of services for all the youth at
risk”. Therefore, those suffering from clinical depression in Bhutan are also faced with lack of
trained professionals to meet the required help.
Majority of the countries have taken a serious measure in creating awareness amongst the
general public about depression. Hendin et al, (n.d) points that majority of the Asian countries
are involved in the STOPS project; the project is aimed at creating awareness about depression
and suicide. Similarly, in United States, program called ADAP (Adolescent Depression
Awareness Program) was started in 1999 in response to several youth suicide cases in Baltimore
area. The ADAP program essentially intends to enhance a school-based curriculum to advocate
high school students, teachers, and parents concerning teenage depression on a national level
(ADAP, n.d). Nam et.al, (n.d ,p.4) further explains that in Singapore, in order to raise awareness
about depression, “the Institute of Mental Health has conducted studies about the incidence of
depression which have helped raise knowledge on the issue as a common mental disorder and
provided the drive for public education activities co-ordinated by the Ministry of Health and the
Health Promotion Board”. These programs which are initiated in Asian countries basically
centers around that depression is treatable and there is nothing wrong in seeking medical advice.
These programs which are initiated in Asian countries basically centers around that depression is
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Youth knowledge and awareness of clinical depression
treatable and there is nothing wrong in seeking medical advice (Pelzang, 2008, p.2). Apart from
this, Bhutan should also consider these programs initiated by other Asian countries to propagate
awareness of depression and help individuals at risk to seek proper help and at the same time
educate people on the fact that depression can have adverse effect if left without appropriate
help.
Chapter 3: Research Methodology
Research Design
The study is qualitative in nature and employs descriptive method to analyze the data. Secondary
research included assessing related literatures, news paper publications, reports, surveys, books
on relevant topics and journals which basically encompassed the first segment of the research.
The second part of the research involved the primary data collection by means of distributing
structured questionnaire to the respondents (copy of the questionnaire is attached).
Sampling Design
The study was carried out within the area of Thimphu and the sampling was employed using
convenience random sampling amongst the youth in Thimphu. The samples in the study
basically involved;
1. Students,
2. Trainees, and
3. Young employed youths.
According to the Bhutanese (November, 2013) from the data obtained from National Statistical
Bureau, Bhutan has 2,22,577 youth aged between 15 to 29 in total from which 146,743 are
within the age range of 20-29 and 75,834 are from 14 to 19. Thimphu, the capital has majority of
the youth in the country. However, the exact data on the number of youth that reside in Thimphu
cannot be determined as youth are always on the move due to their education and hunt for
employment. Therefore, the sample size for the study is determined through the help of Kothari’s
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Youth knowledge and awareness of clinical depression
equation for unknown population. Thus, using the equation derived by Kothari for unknown
population (Kothari, 2008).
𝐭 𝟐 × 𝐩𝟐 × (𝟏 − 𝐩)𝟐
𝐧=
𝐞𝟐
Where ‘n’ is the sample size, ‘t’ is the table value of t-distribution (selected at 95% confidence
interval for this study), ‘p’ is the probability of selecting the right person, and ‘e’ is the
acceptable margin of error (selected at ±4% error for this study) (Kothari, 2008).Therefore,
sample size is calculated as:
Table 1: Calculation of sample size
Components Values
T
1.96
P
0.5
(1-p)
0.5
E
0.04
Product
0.2401
n
150.06
0.0016
Therefore, for unknown population, sample size is 150 as depicted from the above table.
Data collection and Analysis Procedure
For this study, before the collection of primary data, focus group study was conducted mainly to
get the idea of constructing the questionnaire. For the focus group, there were two groups; one
group comprised of the members who have experienced clinical depression and the other group
comprised of those who have not experienced. Each group consisted of three members. The
members of the group were asked to narrate each other’s experience on the issue and for those
who have not experienced they were asked to give their opinions on the issue. Through their
narration, similarities and differences were noted down. These points were then incorporated into
the questionnaire (focus group narration is attached at the annexure).
Primary data was collected through the structured questionnaire which was distributed to the
youth in Thimphu. The data collected from the structured questionnaire were summarized and
tabulated through the means of Statistical Software called Statistical Package for Social Science
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Youth knowledge and awareness of clinical depression
(SPSS). SPSS, software that allows the researchers to, interpret, summarize and operate
statistical tests if necessary. For this study, mean, median and mode were employed and the
findings were interpreted in the form of frequency and percentage. Cross tabulations was used
between two questions to trace out the links. Microsoft Excel was also used in this study to
illustrate the findings in the form of charts and graphs.
Conceptual Framework of the Study
The first two objectives of the research are to study the level of awareness of youth in Thimphu
of clinical depression, and the level of support from the society, and determine the effectiveness
of the services offered by hospitals and other agencies are helpful or not. For these objectives,
there are no definite indicators but the conclusion has been drawn from the question:
1. Perception of youth on whether they are aware of any differences between ordinary day
to day and clinical depression.
2. Awareness about clinical depression amongst the youth in Thimphu.
3. Support from the society towards people suffering from clinical depression.
4. Whether services offered by religious personnel are helpful.
5. Whether the services offered by hospitals for the clinically depressed are helpful.
The final objective of the research is to study the causes of clinical depression and reasons that
best account for suicide cases amongst Bhutanese youth. The causes of clinical depression and
reasons that best account for suicide cases amongst Bhutanese youth is confined to the following
aspect of work in this research in line with summarization from the literature review, firstly, the
causes of clinical depression amongst youth. The findings of Depression Awareness guide (n.d)
states that increasing alcohol and drug use are the causes of clinical depression. While the study
of Jefferis et al, (2010), states that unemployed individuals have poorer mental health than the
employed, indicating that unemployment can also cause clinical depression. Gottlieb (2006) also
underpins that low social support, disturbed family environment; loss of a parent (family
problems), relationship problems and low social support are most likely to cause major
depression. Board (n.d) stated that the experience of school related stress and negative feedbacks
14
Youth knowledge and awareness of clinical depression
from parents and teachers about academic work leads to increase in depression and gradually
turning into major depression. Therefore, the findings on the causes of clinical depression are
examined using these indicators as presented by the literature of other works.
1. Peer Pressure
2. Unemployment
3. Increasing Alcohol Use
4. Increasing Drug Use
5. Family Problems
6. Relationship Issues
7. Work Related
8. Study Related
Second, the reasons that best account for suicide cases amongst Bhutanese youth. The report by
Kuensel and the study conducted by Scheerder (2009) underpinned stigma, fear and shame, as
the reasons that contribute towards suicide. Scheerder (2009) further stated that patients’
reluctance to seek proper help and lack of appropriate agencies can also contribute towards
suicide cases. On the other hand, the findings of Borchard (2010) in his study states that when
the youth face psychological pain they are more likely to be overwhelmed with sense of
hopelessness and also belief that they have no power over their lives. Ju and Wu (2013) also
noted that lack of family support and reduced peer support as critical to the mental health of
those at danger. Therefore, the reasons presented by the findings of other work in the literature
were used to determine the reasons that best accounted for suicide cases amongst Bhutanese
youth.
1. Patients reluctance to seek professional help
2. Stigma and shame attached
3. Lack of peer/group support
4. Lack of appropriate agencies for asserting help
5. Lack of family support
6. Sense of hopelessness
7. Fear
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Youth knowledge and awareness of clinical depression
The above mentioned points were employed in this study as the indicators to generalize the
causes of clinical depression amongst youth and the reasons that best account for suicide cases
amongst Bhutanese youth. Therefore, the causes of clinical depression and reasons for suicide
are assessed, and analyzed using these indicators.
Limitations of the Study
1. In this research, clinical depression is not covered from the epidemiological or biological
view but only covered from the awareness perspective and the causes and reasons that
account for it. Therefore, this study does not represent the biological base of clinical
depression.
2. The findings of the research will not be representative to youth in other Dzongkhags.
3. The non-probability convenience sample does not look at the background of the
respondents and might have excluded respondents with knowledge on clinical depression.
Ethical Considerations
1. While collecting primary data, respondents were assured that their identities will not be
disclosed and will be kept confidential.
2. The views expressed in the study will not harm the institution and respondents of the
study.
3. The respondents in the study were all based on voluntary basis and no respondents were
forced to give their views.
4. The respondents were also alerted on the sensitive issues before they started filling up the
questionnaire.
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Youth knowledge and awareness of clinical depression
Chapter 4: Findings, Analysis and Discussion
Profile of the Respondents
In order to carry out the survey, 150 youths in Thimphu were taken as respondents mainly aged
between, 15 to 25. This was largely to determine the level of awareness and knowledge of
clinical depression amongst youth in Thimphu.
In determining the age of respondents, it is found that there are 93 (62%) of the respondents who
fall in the age group 20-25; 42 (28%) respondents under the age group 15-20; 14 (9.3%) of the
respondents under the age group above 25; and 1(.7%) of the respondents under the age group
below 15. The respondents profile for the demographic category of age is shown in table 1.
Table 2: Age of the Respondents
Age
Group
Frequency
Percent
below 15
15-20
20-25
above 25
Total
1
42
93
14
150
.7
28.0
62.0
9.3
100.0
From the total respondents, youths having the high school qualification form the larger
respondent group. They comprise around (99) forming 66 percent of the total respondents.
Second larger group of the respondents have bachelors degree, comprising (23) accounting to
15.3 percent of the total respondents. Third group of respondents have middle school as their
qualification, constituting (14) forming 9.3 percent of the total respondents. Next, is those
respondents having post graduate and above as their qualification, (13) accounting to 8.7 percent
of the total respondents. There is only one respondent having primary school comprising 0.7
percent of the total respondents.
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Youth knowledge and awareness of clinical depression
Table 3 : Qualification of the Respondents
Qualification
Frequency Percent
1
.7
14
9.3
99
66.0
23
15.3
13
8.7
primary school
middle school
high school
Undergraduate
post-graduate and
above
Total
150
100.0
Figure 1: Respondents who have experienced Clinical Depression, the level of awareness
between Ordinary day to day depression and the number of respondents who have
consulted experts or referred to psychiatrists
Yes
No
133
80
77
73
70
14
experienced clinical
depression?
Aware of differences
between ordinary day to
day depression and clinical
depression
Have you consulted any
experts or referred to
psychiatrists
The above diagram illustrates 80 respondents have stated that they have experienced clinical
depression and 70 respondents have stated that they have not been subjected to clinical
depression.
The diagram also demonstrates that more than half of the respondents were aware of the
differences between ordinary day to day depression and clinical depression which accounts to 77
18
Youth knowledge and awareness of clinical depression
respondents declaring that they were aware of the differences; however, 73 respondents stated
that they were not aware of the differences. This illustration confirms that there is a poor level of
awareness on differences between the two depressions amongst the respondents in the study.
When the respondents were asked about referring to an expert or a psychiatrist, a large 133 of the
respondents stated that they have never consulted or referred to a psychiatrist. Only a small
number of respondents (14) stated that they have consulted an expert or referred to a psychiatrist.
There was also a need to examine the connection between the experience of clinical depression
and referring to a psychiatrist. Table 4, in the form of a cross tabulation shows the relationship or
connection of those experiencing clinical depression and referring to a psychiatrists. The table
below draws out that from the 80 respondents who have stated that they have experienced
clinical depression; only 13 (16.25%) of the total respondents have established that they have
consulted an expert or referred to a psychiatrist while experiencing clinical depression, while
83.75 of the respondents who have experienced clinical depression have not consulted an expert
or referred to a psychiatrists. From the 70 respondents who have stated that they have not
experienced clinical depression, 1 respondents stated that he/she consulted to an expert or
referred to a psychiatrist despite not having any experience of clinical depression.
Therefore, the findings presented by the table below demonstrates that many of the respondents
who have experienced clinical depression do not necessarily seek help form experts and medical
professional. Hence, this finding from the table 3 affirms with the findings in the literature where
Scheerder (2009), also states that individuals at risk have a difficulty accepting psychiatric
diagnosis and prefers informal help over formal help.
Table 4: Cross tabulation of experience of clinical depression and
consulting an expert or referring to a psychiatrist.
If you have experienced
clinical depression, have
you consulted any experts or
referred to psychiatrists.
Yes
Have you ever
experienced clinical
depression
Total
No
Yes
13
67
80
No
1
69
70
14
136
150
Total
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Youth knowledge and awareness of clinical depression
Relationship with friends and Clinical Depression
The effect of relationship with friends and experience of clinical depression is examined using
cross tabulation. The findings in the table will explain on how one’s relationship with friends
associates with clinical depression. The cross tabulation illustrated below the table explains that
form the 80 respondents, who have experienced clinical depression, 29 respondents stated that
they have ‘very good’ relationship with their friends, and in fact, 23 respondents have even said
that they have an ‘excellent’ relationship with their friends. Another 19 stated that they have
‘good’ relationship with their friends, despite, experiencing clinical depression.
Therefore, the finding provided by the table below from the response obtained from the
respondents in the study, clearly indicates that relationship with friends does not necessarily have
an impact on clinical depression. As only 1 out of 80 respondents have said that his/her
relationship with friends is ‘poor’.
Table 5: Cross tabulation of experience of clinical depression with relationship with friends
How is your relationship with your friends?
Poor
Have you ever
experienced clinical
depression?
Total
Yes
No
Average
1
8
1
1
2
9
Good
19
15
34
Very
good
Excellent
29
23
16
37
45
Total
80
70
60
150
Figure 2: Sense of Awareness about Clinical Depression amongst the youth in Thimphu
Figure 2, represents the level of awareness of clinical depression amongst the youth in Thimphu.
Out of 150 respondents, 117 respondents are of the view that the level of awareness of clinical
depression amongst the youth in Thimphu is only ‘to some extent’, 23 respondents were of the
view that there is ‘no’ sense of awareness on clinical depression amongst the youth in Thimphu.
However,only 10 respondents were of the notion that the youth in Thimphu were ‘fully aware’ of
clinical depression.
20
Youth knowledge and awareness of clinical depression
The above findings provide a backdrop that the level of awareness of clinical depression is at the
average level. It was justified with the responses that awareness created through Medias, and the
recent spates of suicide amongst the youth in Bhutan have created certain sense of awareness of
clinical depression. However, the youth in Bhutan are not fully aware of clinical depression
according to the above figure.
Youth's Awareness on Clinical
Depression
117
23
10
not at all
to some extent
fully aware
Table 6: Respondents opinion on the level of support from the society towards people
suffering from clinical depression
Level of Support
NOT AT ALL
Poor
Average
Good
Very good
Excellent
Total
Frequency Percentage
11
7.3
35
23.3
68
45.3
26
17.3
8
2
150
5.3
1.3
100.0
Table 6 explains that, out of the 150 respondents, (68) accounting to 45.3 percent of the total
respondents has agreed that the level of support from the society towards people suffering from
21
Youth knowledge and awareness of clinical depression
clinical depression is at ‘average’, similarly, 26 respondents which accounts to 17.3 percent
stated that the level of support is ‘good’, 8 respondents accounting to 5.3 percent has indicated
that the level of support from the society is ‘very good’. Only 2 respondents have affirmed that
the level of support from the society is ‘excellent’. However, 35 respondents accounting to 23.3
percent of the total respondents were of the opinion that the level of support from the society is
‘poor’ and 11 respondents which accounts to 7.3 percent of the respondents stated that there is
‘no’ sense of support from the society towards patients with clinical depression.
This table provides an understanding that the society needs to be more supportive to the person
suffering from clinical depression.
Figure 3: Acceptance of Clinical Depression amongst the Bhutanese as a serious mental
illness
Acceptance of Clinical Depression
2%
7%
21%
Never
Sometimes
Most of the time
always
70%
The above figure depicts that, 70 percent of the total respondents were of the opinion that,
Bhutanese are ‘sometimes’ accepting clinical depression as a serious mental illness rather than
just a normal mental stress. Contrary to it, 21 percent of the respondents stated that clinical
depression is accepted as a major depressive disorder ‘most of the time’. 7 percent of the
respondents were of the opinion that Bhutanese are ‘never’ of the belief that clinical depression
22
Youth knowledge and awareness of clinical depression
is a serious mental illness. Out of 150 respondents, only 2 percent responded that Bhutanese are
‘always’ accepting clinical depression to be a serious mental illness.
Thus, the above figure shows that clinical depression is still not completely recognized as a
serious mental illness and most importantly a disorder that could lead to a loss of life. These
comes in line with Scheerder (2009) that individuals at risk not recognizing depression as a
disorder, considering depression as a normal reaction to adversity not in need of a treatment or as
a personal weakness to be resolved by oneself.
Figure 4: Services offered by Hospitals and other agencies for Clinical Depression
Services offered by Hospitals and agencies for Clinical
Depression
45.0
40.0
40.0
35.0
30.7
30.0
Series1
25.0
20.0
15.3
15.0
10.0
7.3
5.0
4.7
2.0
.0
not helpful at all poor
average
good
very good
excellent
Figure 4, here; in the form of a graph illustrates that 40 percent of the total respondents were of
the view that the effectiveness of the services offered by hospitals and other agencies were
‘average’. 30.7 percent responded that the services offered from hospitals and other agencies
towards curing clinical depression were ‘good’, again 15.7 percent of the respondents felt that
the help provided from hospitals and other agencies were ‘very good’. Furthermore, 4.7 percent
of the respondents felt that the help provided from the hospitals and other agencies were
23
Youth knowledge and awareness of clinical depression
‘excellent’. However, 7.3 percent of the respondents felt that it was ‘poor’ and another 2.0
percent were of the view that it was ‘not helpful at all’. Hence, from the above figure we can
draw out that the services offered by hospitals and other agencies form the responses given by
the respondents stands at average level, however, there is still some room for improvement.
Figure 5: Opinion on the role of religion in helping Clinically Depressed Patients
Role of Religion
No
14%
Yes
86%
The effectiveness of the role of religion or the services offered by religious personnel to those
patients with clinically depressed is being depicted by the above pie chart from the responses
obtained from the 150 respondents. 86 percent of the total respondents agreed that the services
offered by religious personnel were helpful in dealing with clinical depression. However, only 14
percent of the respondents opined that religion does not have any help in dealing with clinical
depression.
The illustration depicted by the above figure, clearly indicates that religion is still highly revered
by the responses obtained from the respondents in this research.
Figure 6: Causes of Clinical Depression
The figure below in the form of a column graph shows the causes of clinical depression amongst
the youth in Thimphu. From the above listed causes, ‘unemployment’ is strongly underpinned as
one of the major causes of clinical depression from the response given by the respondents. 116
24
Youth knowledge and awareness of clinical depression
respondents affirmed that unemployment causes clinical depression. ‘Relationship issues’
experienced by youths comes in second with 97 respondents stating that it causes clinical
depression amongst the youth in Bhutan. ‘Family problems’ come at third with 94 respondents
stating that it also contributes towards clinical depression. ‘Increasing drug use’ comes in after
family problem as one of the reasons contributing to clinical depression with 74 saying it also
causes clinical depression. 69 of the respondents also stated that ‘increasing alcohol use’ causes
clinical depression. 66 respondents also stated that youths get into clinical depression due to
pressure from academics. 52 said, pressure from work also attributes to clinical depression, and
similarly, 40 respondents also stated that ‘peer pressure’ experienced by youth also correlates
with clinical depression.
Hence, it can be drawn that unemployment, relationship issues and family problem encompasses
Frequency
the main causes of clinical depression amongst the youth in Bhutan.
160
140
120
100
80
60
40
20
0
34
81
110
76
56
53
98
84
144
116
40
69
74
94
97
52
66
No
6
Yes
Causes of clinical depression
Figure 7: Reasons that best account for suicide cases amongst Bhutanese youth
The figure below illustrates the reasons that account for suicide cases amongst Bhutanese youth.
From the reasons mentioned in the figure below, ‘lack of family support’ and ‘sense of
hopelessness’ are the reasons that mostly account for suicide cases in Bhutan according to the
responses given by the respondents. 96 respondents stated lack of family support as one of the
reasons that best account for suicide cases in Bhutan. 92 respondents also stated sense of
25
Youth knowledge and awareness of clinical depression
hopelessness as the second best reason for youth in Bhutan to commit suicide. Fear, stigma and
shame attached to clinical depression and lack of peer/group support were also indicated by the
respondents as the reasons for committing suicide.
160
140
120
100
80
60
40
20
0
147
120
30
130
108 111
42
96
54
39
92
58
101
49
20
3
Yes
No
Reasons for Suicide Cases
Creation of Awareness of Clinical Depression from the Government
When the respondents in the study were asked about government’s role in creating more
awareness of clinical depression, 134 (89.3%) of the total respondents agreed, that government
needs to play a bigger role in creating more awareness. Thus, it provides an understanding that
the respondents were not satisfied with the awareness created by the government of clinical
depression. However, (15) accounting to 10 percent of the total respondents felt that the
government does not have to create more awareness. Only 1 respondent did not state the view.
To further explore on this inquiry, respondents were asked to give the reasons as to why
government needs to create more awareness. The findings are given in the figure 8.
26
Youth knowledge and awareness of clinical depression
Table 7: Creation of Awareness from Government
Opinion
Valid
Yes
No
Total
Missin System
g
Total
Frequency Percentage
134
89.3
15
149
1
10.0
99.3
.7
150
100.0
Figure 8: Reasons for creating more awareness by the Government
The findings in figure 8 show that, out of 150 respondents, 125 respondents expressed the
reasons for creating more awareness and 25 respondents did not mention any reasons. 63
respondents were of the view that there is a lack of awareness of clinical depression and wanted
government to be more active in creating awareness. 25 respondents wanted government to
create more awareness because there is a growing rate of suicide cases in the country. 23
respondents stated that by providing jobs government can help to control and create awareness of
clinical depression. 13 respondents were of the opinion that the knowledge of clinical depression
is useful to all and hence, needed government to create more awareness. Only 1 respondent was
of the view that clinical depression is a serious issue and needed government to create more
awareness. Thus, the findings in the figure indicate that government needs to create more
awareness of clinical depression.
27
Youth knowledge and awareness of clinical depression
Reasons for creating awareness
140
120
100
80
125
60
40
20
0
63
23
25
1
25
13
Series1
The above reasons were streamlined into five reasons through the responses given by the
respondents.
Figure 9: Opinion of the respondents on how to best assist those with clinical depression
The Pie chart below shows that, 22 percent of the total respondents felt that the best way to assist
clinical depression is through encouraging the patient, being a good friend and through strong
family support. 12.7 percent of the total respondents opined that the best way to assist clinical
depression is by providing a strong sense of support to the clinically depressed. 10.7 percent of
the respondents felt that counseling and guidance will best help the clinically depressed patients.
9.3 percent felt that by creating awareness of clinical depression would best help those with
clinical depression. 3.3 percent of the respondents were of the view that performing religious
rituals will help those with clinical depression. 1.3 percent of the total respondents felt that
avoiding stigma against those suffering from clinical depression will best assist. However, 40.7
percent of the total respondents ignored the question or did not respond to the question.
28
Youth knowledge and awareness of clinical depression
do not stigmatise
encourage, be a good
friend and family support
1.3
22.0
40.7
creating awareness
9.3
10.7
12.7
3.3
Counselling and guidance
religious rituals
support
missing system
Discussions
1. The study revealed that majority of the respondents who have experienced clinical
depression have not consulted an expert or referred to a psychiatrist as mentioned in the
above finding. This finding supports the finding of Scheerder (2009) who also stated that
individuals at risk have a difficulty accepting a psychiatric diagnosis or professional help.
The finding also aligns with Ormel et al., 2008; The WHO World Mental Health Survey
Consortium, 2004 as cited in Scheerder, 2009) that National surveys in western countries
consistently point out that majority of the people with mental health problems do not
receive any formal professional help. This finding is significant because most of the
mental health problems in Bhutan also do not receive any professional help. Thus, it will
allow other researchers to explore on ways to make individuals with mental health
problems to come forward and seek professional help.
2. The study also found that the level of awareness of clinical depression amongst the youth
in Thimphu is only to some extent and indicated that there is no complete awareness. This
comes in line with the findings of Scheerder (2009), who stated that mental health
29
Youth knowledge and awareness of clinical depression
literacy is important as it supports their recognition, management and prevention. Pelzang
(2008) was also of the view that improving mental health literacy and awareness should
be given importance as it requires active cooperation from the society. Thus, this finding
with the help of the findings in literature calls for creating wider awareness. The findings
of (Goldney & Fisher, 2008,p.43 as cited in scheerder, 2009) found that “ intensive public
and professional education programs, such as ‘Healthy Minds’ and beyond blue
(Australia), and Defeat Depression (United Kingdom) do increase mental health literacy
and treatment seeking in the general public”. Thus, Bhutan should also consider programs
aimed at creating wider awareness of clinical depression.
3. The study uncovered that the level of support from the society, and hospitals towards
people suffering from clinical depression is average and the support level is not
completely there. It can be attributed to the findings of Scheerder (2009) who stated that
the most important obstacle to depression care normally reported at the level of general
population, are negative attitudes and inadequate knowledge about mental health care.
Therefore, it probes other researchers to look at the reasons for having poor support from
the society and hospitals towards clinical depression and help those individuals to receive
maximum support.
4. The study also discovered that services offered by religious bodies were helpful in
dealing with clinical depression despite it being a biological base. This finding can be
attributed to the difference in culture and religion that Bhutan have, as through the
Buddhist philosophy and Bhutanese traditional culture ,mental illness is caused by “black
magic or evil spirits and the mental illness is also considered not curable thus resorting to
religion for healing purposes” (Pelzang, 2008, p.5). Hence, these perceptions can also be
attributed to the finding of religion being helpful. Thus, it calls for the policy makers to
combine the traditional and religious care in mental health services that could help to
improve misconceptions and myth about clinical depression and give a more holistic
approach to mental health care (Pelzang, 2008).
5. From this study, Unemployment, relationship issues and family problems were
considered as the main causes of clinical depression amongst the Bhutanese youth. The
30
Youth knowledge and awareness of clinical depression
findings support the report by Bhutan Foundation (n.d), where more than 80 percent of
the youth are unemployed between the ages of 15 to 25. Hence, unemployment amongst
youth is a major cause of clinical depression in Bhutan. This finding is significant
because majority of the Bhutanese youth are unemployed. Jefferis et al, (2010), also
stated that unemployed individuals have poorer mental health than the employed. Family
problems and relationship issues were also found to be causes of major depression
according to the findings of Gottlieb (2006). Therefore, this finding provides a room for
future researchers to explore on these issues in a broader context pertaining to clinical
depression.
6. Lack of family support and sense of hopelessness were found to be reasons that best
account for suicide cases amongst Bhutanese youth. Ju and Wu (2013) also noted that
lack of family support and reduced peer support as detrimental to the mental health of
those at risk. Thus, family support is important for those suffering from clinical
depression as the respondents in the study also felt that family support as one of the ways
to assist those with clinical depression. Sense of hopelessness as one of the reasons for
suicide also supports with the findings of Borchard (2010) who stated that when the
youth face psychological pain they are more likely to be overwhelmed by hopelessness
and also belief that they have no control over their lives. This finding provides an
indication that government should institute program that would educate parents about the
importance of family support to their children if their children are suffering from clinical
depression and encourage them with proper care.
31
Youth knowledge and awareness of clinical depression
Chapter 5: Conclusion and Recommendations
Conclusion
The World Health Organization (WHO) estimates that by 2020 as cited in (Nam et al, n.d),
depression is projected to be the single most important source of disability in both the developed
and the developing world, and the findings of Nam et.al (n.d) and other related literature
determines that globally, majority of the persons with depression and other mental disorders
related to suicide do not receive treatment and the findings from the study also indicated that
those with clinical depression do not receive or seek professional help in Bhutan.
The paper highlighted that the level of awareness amongst the youth of clinical depression is at
average level. This is because the findings above showed that youth awareness of clinical
depression is to some extent and indicating that the youth were not fully aware on the issue. It
was also found that half of the respondents were aware of the differences between ordinary day
to day depression and clinical depression. Thus, proving to an extent with our assumption that
there needs to be more awareness of clinical depression as there is an average level of
understanding of clinical depression. However, it was explained from the study that in Bhutan,
having a poor relationship with friends is not necessarily a cause of clinical depression. In fact,
youth with clinical depression had excellent rapport with their friends.
Not only was the support from the society average but the services offered by hospitals and other
agencies regarding clinical depression were also average according to the majority of the
respondents. Also showing some alignment with the literature as there is an average sense of
support and view of clinical depression. Thus, it shows that there is no full support from the
society and agencies towards patients with clinical depression. Moreover, it was also found that
religion seems to provide a sense of satisfaction and help clinically depressed.
According to the findings, unemployment and relationship issues were considered as the top
issues causing clinical depression amongst the youth in Bhutan. It was also uncovered that lack
of family support and sense of hopelessness were the best reasons that accounted for suicide
cases amongst the Bhutanese youth. The study also underpinned that government needs to step
32
Youth knowledge and awareness of clinical depression
up and create more awareness on issues regarding clinical depression. Through this study, it was
discovered that the level of awareness is not completely there despite the increasing number of
clinical depression cases and also the growing rate of suicide cases.
Recommendations
Under the significance of research, it is explicitly mentioned that the findings from this study is
anticipated to create wider awareness amongst the youth on the issue of clinical depression as a
serious mental disorder and trace out the level of support from the society and hospitals
pertaining to clinical depression, and also the causes of clinical depression amongst the youth of
Bhutan and reasons that attributes towards the suicide cases in Bhutan. Therefore, keeping these
points as a backdrop, the following recommendations are proposed for consideration based on
the findings from the study.
1. Creating wider awareness on clinical depression
The recent phenomenon of globalization and modernization has increased the cases of clinical
depression and more and more people, particularly, the youth are affected by this disorder.
However, there has not been full scale coverage or awareness carried out regarding the issue on a
big magnitude. Therefore, it becomes very important for the government in collaboration with
the media houses to create wider awareness of clinical depression amongst the youth and general
population too on the importance of seeking appropriate care and proper help, as it potentially is
like any other life threatening disease.
2. Establishing centers that provide trained counselors to help those with clinical
depression
This calls for the establishment of centers which would train counselors and professional help
that could help the clinically depressed with motivation, support and also instill in them the sense
of hope as many of the respondents in the study highlighted; ‘sense of hopelessness’ as one of
the top reasons that best accounted for suicide cases amongst Bhutanese youth.
33
Youth knowledge and awareness of clinical depression
3. Government should make policies regarding youth related issues that Bhutanese youth
are currently facing
As mentioned in the literature, 80 percent of the youth in Bhutan are unemployed and other
sources like Bhutan Foundation also suggest that Bhutanese youth are facing the increasing drug
and alcohol usage problem. Thus, the government needs to create more jobs for the youth or
provide entrepreneurship training for the youth to be meaningfully engaged. On the other hand,
there is also a need for establishing a rehabilitation center that mainly caters toward drug and
alcohol recovery programs that could help the youth to come on track and also instill in them the
sense of hope and confidence.
4. Educating the general population on the importance of providing necessary support to
the clinically depressed
The findings of the study also presented that the level of support from the society towards
clinical depression is only average or poor. However, it is vital for the general population to be
educated on the importance of providing support, providing courage and love and care to the
clinically depressed. According to the response of the respondents in the study, there seem to be
a lack of family support regarding the issue and hence, accounting to suicide cases. Therefore,
educating the general population on the importance of showing support will also facilitate greater
family support towards the clinically depressed.
5. The youth centers in Bhutan should also provide relationship advices to the youth
Relationship issues amongst the youth are found to cause clinical depression. Hence, creating a
program that helps the youth to deal with their relationship issues will greatly help the youth
form being subjected to clinical depression.
34
Youth knowledge and awareness of clinical depression
References
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Bhutan Foundation (n.d). Bhutan’s population is young. Retrieved on 5/11/13 from http://www.b
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Kuensel. (September 10, 2013). World Suicide Prevention Day. Retrieved on 10/1013 from
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Nam, Y.Y, Bertolote, M.J, Chia, H.B, Maniam, T, Philips, R.M, Pirkis, J & Hendin, H. (n.d)
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Youth knowledge and awareness of clinical depression
Annexure
Focus Group Study of those who have been clinically depressed in their life.
Narration of the first participant
Like every ordinary stress, he felt that his stress was just ordinary and didn’t think about
consulting to anyone. However, as days passed by, his mind was still clouded with the stress that
he thought was ordinary. Therefore, he felt that there is something wrong with his mental stress
and so he browsed the net to find out about the symptoms of depression. It was only after
looking through the internet that he came to know about ‘Clinical Depression’, as his symptoms
were identical with those mentioned about clinical depression. After finding out about the
symptoms, he consulted a psychiatrist who prescribed him medicine, but to no avail those
medicines didn’t seem to help him and the doctor deemed him as suffering from ‘mental
illnesses. He still had the recurring thoughts of committing suicide and feeling of hopelessness.
He wanted to express his ongoing mental state to his friend but was not able to express it due to
the feeling that he will recover soon. However, his friends noticed his state and were supportive
of his conditions and helped him to deal with clinical depression. With the help of his friends and
professionals, he was able to recover form it although it took him six months to completely
recover.
When asked about the other youths committing suicide, he responded that most of them will
commit suicide due to their reluctance to seek help and consult close ones. According to him, he
said that most of the youths are unable to express their problems due to shame, fear and stigma.
Second Participant
As soon as the she heard about the incident, it completely changed her state of mind. At first,
there was outpour of emotions, and it then gradually made her not able to sleep properly leading
to insufficient amount of sleep. The eating habit of the person gradually decreased, the food that
she previously loved eating became not so interesting. Even though she drank before, but after
the incident, she had the urge to drink everyday as she felt that it made her forget about the
incident. At one point, she seriously had the intention to commit suicide as she felt that there was
37
Youth knowledge and awareness of clinical depression
no hope for her and it was not worth living. Her friends knew about her condition and helped her.
However, she never consulted any experts or psychiatrists as she felt that it would not change
anything.
Third Participant
His case is also similar to that of the second participant, loss of interest in eating, unable to get
good amount of sleep, taking on alcohol as a means to escape the reality, thinking of jumping off
the bridge and not consulting any of the friends and psychiatrists. He was alone in dealing with
his problems and never occurred to him that he might be ‘clinically depressed’. However, he was
strong enough to deal with it and finally was able to get over it.
Similarities
 Committing suicide occurred to all three of them
 Feeling of hopelessness
 Opening up to friends and close ones was difficult
 Friends were able to recognize their conditions
 All three of them had the notion that their mental state would be solved as time passes by
Differences
 The first participant took the effort to find out about his depression
 The first participant was aware of his mental illness, he consulted an expert and was also
supported by his friends
 Second and third participant didn’t feel the need to consult an expert, and took on alcohol
to escape the problem.
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Youth knowledge and awareness of clinical depression
Youth’s Knowledge and Attitude on Clinical Depression (Questionnaire)
Dear Respondent,
This study is conducted as a partial fulfillment of the Post Graduate Diploma course at the Royal
Institute of Management, Simtokha. The objective of the study is to investigate the “Youths
Knowledge and Attitude on Clinical Depression in Thimphu.”
Please share your opinions on Clinical Depression. I guarantee that the information acquired will be
only used for academic purpose and no individual identity of the respondent will be revealed.
If you would like to have a brief summary of the findings, please email me.
Thanking you for your kind information,
Karma Tenzin
PGDPA
e-mail# tenxinkarma@gmail.com
PART A: DEMOGRAPHIC DETAILS
Please place a cross (X) mark wherever appropriate
1. Gender
i. Male
ii. Female
2. Age
Below 15
15-20
20-25
above 25
3. Qualification
Primary School
Middle School
High School
Undergraduate
Post-graduate and above
4. How is your relationship with your friends?
Poor
Average
Good
Very Good
39
Excellent
Youth knowledge and awareness of clinical depression
PART B
“Clinical Depression is a “major depressive disorder” characterized by feelings of hopelessness,
fatigue, sense of worthlessness, indecisiveness, and insomnia, lack of pleasure in life and
recurring thoughts of suicide.” (DSM-W). Ordinary depression is the normal mood swings of
everyday life that a person goes through.
5. Have you ever experienced clinical depression?
Yes
No
6. How often do you experience clinical depression?
Never
Sometimes
Often
Most of the time
Always
7. Are you aware of any differences between ordinary day to day depression and clinical depression?
Yes
No
8. If you have experienced clinical depression, have you consulted any experts or referred to
psychiatrists?
Yes
No
If yes, please answer the following question no.9 and 10. If No, leave question no.9 and 10.
9. Was it your own decision to consult an expert or refer to psychiatrists or consult religious
personnel?
Own
Family
(specify)………………
Members
Friends
Others
10. While suffering from clinical depression, how long did it take you to openly communicate the
experience or feeling to your close ones?
Not at all
year
within one week or two
1-2 months
40
6months-1 year
More than 1
Youth knowledge and awareness of clinical depression
11. Do you think that there is a sense of awareness about clinical depression amongst the youths in
Thimphu?
Not at all
To some extent
Fully aware
Please explain your response
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________
12. Is there a sense of support from the society towards people suffering from clinical depression?
Not at all
Poor
Average
Good
Very Good
Excellent
13. Do you think that the Bhutanese are accepting clinical depression to be serious illness or just a
normal mental stress?
Never
Sometimes
Most of the times
Always
14. Do you think that the services offered by the hospitals and other agencies for the patients
suffering from clinical depression are helpful?
Not helpful at all
Excellent
Poor
Average
Good
Very Good
15. Do you think that services offered by religious personnel are helpful?
Yes
No
16. What do you think is the cause(s) of clinical depression cases amongst Bhutanese youth?
i. Peer Pressure
vi. Relationship Issues
ii. Unemployment
vii. Work Related
41
Youth knowledge and awareness of clinical depression
iii. Increasing Alcohol Use
viii. Study Related
iv. Increasing Drug Use
xi. Other (please specify)
…………………………
v. Family Problems
17. Which reasons best account for suicide cases amongst Bhutanese youth?
i. Patients reluctance to seek professional help
v. Lack of family support
ii. Stigma and shame attached
vi. Sense of hopelessness
iii. Lack of peer/group support
vii. Fear
iv. Lack of appropriate agencies for asserting help
viii. Other (Please specify)………..
18. Do you think that the government needs to create more awareness about clinical depression to the
public?
Yes
No
If Yes, Why?
______________________________________________________________________
______________________________________________________________________
19. How can we best assist those with clinical depression? Any comments
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
THANK YOU!
42