Exploring Gender Variations in Help-Seeking and Stigma in Major Depressive Disorder: Findings from the FASA Cohort Study

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Abstract
Introduction: Major depressive disorder (MDD) is strongly associated with suicidal ideation and significant help-seeking barriers, particularly in rural populations. This study examined MDD prevalence, help-seeking attitudes, and suicidal ideation among rural Iranian youth aged 15-34 years. Methods: This cross-sectional study included 2,923 participants from the Fasa Youth Cohort in rural Iran. MDD was assessed using the Composite International Diagnostic Interview (CIDI) 2.1. Help-seeking attitudes and suicidal ideation were evaluated using validated questionnaires. Logistic regression analyses examined associations between MDD, help-seeking attitudes, and suicidality, stratified by gender. Results: MDD prevalence was 26.2%, with significantly higher rates in males (30.4%) than females (20.5%, P < 0.001). Men with MDD showed increased willingness to seek help (adjusted OR = 1.64, 95% CI: 1.15-2.24, P = 0.005), while women with MDD experienced greater embarrassment about using services. MDD was strongly associated with suicidal outcomes, with adjusted odds ratios ranging from 4.40 for thoughts about death to 7.28 for suicide attempts. Associations were consistently stronger in females. Paradoxically, individuals with suicidal ideation demonstrated reduced help-seeking intentions and increased stigma concerns. Conclusion: Rural Iranian youth exhibit high MDD prevalence with gender-specific patterns. The help-negation paradox among individuals with suicidal ideation represents a critical treatment gap requiring targeted, culturally adapted interventions addressing stigma and improving access to mental health services.

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