Barriers and facilitators to identifying depression in adolescents: A cross-cultural qualitative study in Brazil, Nepal, and Nigeria

There is growing global interest in early detection and engagement with care for adolescents experiencing depression. However, there is limited information on perceived barriers and facilitators to engagement with adolescent mental health care in low- and middle-income countries. Accordingly, this study examined perceived barriers and facilitators to the identification of depression in adolescents in Brazil, Nepal, and Nigeria. Key informant interviews (n = 153) and focus group discussions (n = 31) were conducted in Brazil, Nepal, and Nigeria with adolescents, parents, health care workers, social workers, teachers, and other stakeholders to explore perceived barriers to identifying depression in adolescents. This study employed a deductive theory-informed codebook enhanced with inductive codes and analyzed using constant comparison by a team of 8 multi-site researchers. The framework approach was used to construct overarching themes and to synthesize a theoretical model. Stigma and a lack of knowledge about the signs and symptoms of depression were perceived as major barriers to the identification of depression across all three settings. Three other themes emerged:(1) role of stakeholders in identifying depression, (2) training or education as a facilitator to identifying depression, and, (3) the role of technology as barrier or facilitator depending on its specific application. Teachers and parents were the primary stakeholders identified as being able to recognize early signs and symptoms of depression in adolescents. Respondents described training through public awareness campaigns, school policy, or social media as interventions to improve depression identification, but noted that social media could also contribute to exacerbating symptoms of depression. These findings suggest there are common perceived barriers and facilitators to the identification of depression in adolescents across diverse cultural contexts. These findings can inform the development of culturally sensitive strategies to address stigma and increase mental health literacy, and ultimately, to improve engagement with treatment and prevention for adolescents experiencing depression.