Major depressive episode symptoms and help-seeking behavior: A network analysis in a nationally representative cohort

Valentin Scheer; Samy Argui; Mahdi Fayad; Cédric Lemogne; Carlos Blanco; Hugo Peyre; Marina Sánchez-Rico; Frédéric Limosin; Nicolas Hoertel

doi:10.1016/j.psychres.2026.117179

Major depressive episode symptoms and help-seeking behavior: A network analysis in a nationally representative cohort

Psychiatry Res. 2026 Jul:361:117179. doi: 10.1016/j.psychres.2026.117179. Epub 2026 Apr 18.

Authors

Valentin Scheer¹, Samy Argui², Mahdi Fayad³, Cédric Lemogne⁴, Carlos Blanco⁵, Hugo Peyre⁶, Marina Sánchez-Rico², Frédéric Limosin³, Nicolas Hoertel³

Affiliations

¹ Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France; AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, 92130 Issy-les-Moulineaux, France. Electronic address: valentin.scheer@aphp.fr.
² AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, 92130 Issy-les-Moulineaux, France.
³ Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France; AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, 92130 Issy-les-Moulineaux, France.
⁴ Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France.
⁵ Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA.
⁶ Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.

PMID: 42025610
DOI: 10.1016/j.psychres.2026.117179

Abstract

Background: Major depressive episode remains largely untreated, and identifying symptom-level predictors of help-seeking is a clinical priority. This study uses network analysis to examine these predictors in a longitudinal nationally representative cohort.

Methods: The population consisted of individuals who had experienced a major depressive episode in the year prior to the interview and who had not sought care during that period. We estimated a symptom network including DSM-IV major depressive episode criteria at baseline (Wave 1), depressive symptoms at three years, and help-seeking behavior at three years (Wave 2). Bridge centrality indices were computed to identify key symptoms linking depressive symptoms to help-seeking behavior. Sensitivity analyses tested robustness to adjustment for symptom burden, episode duration, and functional impairment.

Results: Among the 1900 individuals with major depressive episode at Wave 1, 16.4% (312) sought help three years later, with 81.1% (256) consulting a healthcare professional and 78.8% (244) receiving a prescription. Three symptoms at follow-up were significantly linked to help-seeking: fatigue, insomnia, and suicidal ideation. Suicidal ideation at baseline was indirectly linked to help-seeking through its persistence at three-year follow-up. Sensitivity analyses confirmed that the three key symptoms remained significantly associated with help-seeking after adjustment for symptom count, episode duration, and functional impairment.

Conclusion: Fatigue, insomnia, and suicidal ideation represent key predictors of help-seeking in individuals with untreated major depressive episode. The persistence of suicidal ideation underscores the importance of its systematic assessment in clinical practice. These findings support the development of symptom-anchored interventions to facilitate earlier engagement with care.

Keywords: Depressive disorder; Epidemiology; Help-seeking behavior; Insomnia; Network analysis; Suicidal ideation.

MeSH terms

Adult
Cohort Studies
Female
Help-Seeking Behavior*
Humans
Longitudinal Studies
Major Depressive Disorder* / epidemiology
Major Depressive Disorder* / psychology
Major Depressive Disorder* / therapy
Male
Middle Aged
Patient Acceptance of Health Care* / statistics & numerical data
Sleep Initiation and Maintenance Disorders / epidemiology
Suicidal Ideation*
Young Adult