A study by Nersessova et al. aimed to identify the reason why Russians do not tend to seek out mental health services. Despite many Russians struggling with depression and other mental illnesses (about 20% of people registered as disabled suffer from a mental illness), many people do not seek out treatment for mental health problems. Neressova et al. predicted that this was in part due to the factors that Russians believe to be the cause of depression. Factors which were found to be very different from those considered by Americans.

Participants were recruited from Russia and the United States using a “snowball sampling” method. Advertisements for the survey were placed on social media platforms - English ads on Facebook and Russian ads on Vkontakete. Participants were encouraged to forward the survey to their friends and acquaintances after taking it. While this was an efficient and cost effective method of sampling, Neressova et al. acknowledge that as a non-random sampling technique, it was prone to bias and self selection.

Participants who clicked on the survey were presented with two vignettes, one that depicted a man with depression and one that depicted a man with schizophrenia. They were then asked to answer questions regarding their mental health literacy, personal emotional reactions, and their attitudes towards the person described and their illness. Participants were asked to rate various potential causes of the illness by likelihood. Three of these items concerned psychosocial stress: problems with partner and/or family, stressful life event, and work related stress. The other three concerned biological causes: brain disease, hereditary defect, and chemical imbalance in the brain. The final two items were “weak will” and “immoral lifestyle.” Participants were then asked how the person in question could best be helped using a 5 point Likert scale ranging from “strongly discourage” to “strongly encourage” on a number of choices including joining a self-help group, confide in a religious leader, do something about it by himself, go to a psychotherapist, and go to a general practitioner doctor.

The results coincided with the authors’ hypothesis. Russian participants were more likely than Americans to endorse all the psychosocial causes as the root of both depression and schizophrenia rather than biological ones, with the difference for depression beliefs being particularly pronounced. Russian participants were also much more likely than Americans to endorse the belief that the depressed person describe was “weak willed” or “leading an immoral lifestyle.” As a result of these demonstrated beliefs, Americans were more likely to endorse every proposed source of help at a higher rate than Russians except for “deal with it by himself,” which was more strongly endorsed by Russians. In particular, Americans endorsed psychotherapists much more than Russians.

The results of this study are a clear demonstration of the way that Russian and American opinions on the causes of mental health differ, with Russians believing depression to be caused by personal weakness in the face of life stress and Americans believing it to be caused primarily by biological factors. This view seems to have a clear causal connection to the Russian stigma against depression and the lack of help seeking behaviors among the population.

As stated in the previous section, Russians are less likely than Americans to seek for professional help or turn to someone they trust and more likely to deal with problems on their own (Nersessova 2019), but why is this?

A commonly cited study by Jurick et al. aimed to develop strategies for treating Russian immigrants in other cultures by examining the way Russians thought about things such as emotion, mental illness, and therapeutic practices in comparison to Americans. They found that Russians tended to report lower levels of positive emotion and higher levels of negative emotions overall, but also generally expressed a sentiment that all emotions have value in a person’s life.

One Russian woman, when asked what kind of emotions she wanted her children to feel in their lives, said, “I would like my children to live rich emotional lives, to love and to hate, to respect and to feel contempt and fear. Someone may say that this is bad, may I daresay that we only have one life to live. We need to feel it fully, and not be like some soulless automatons.” This is in stark contrast to the American perspective, which found that many parents expressed the hope that their children would feel mostly happiness throughout life. Even other collectivist cultures such as East Asian societies expressed that they wanted their children to feel contentment, negating the possibility that this is merely a difference between individualistic and collectivistic values.

Additionally, the study found that due to a number of factors including historical baggage and societal stigma, there is a high level of distrust of mental health services. Psychiatric clinics experience high dropout rates in Russia, and general practitioners are sought out much more frequently, making treatment a challenge. Americans are much more likely to trust other people generally, and have higher respect for and trust in psychiatry and medical authorities specifically.

The study found that the best protective factor against depression and distressing emotions was social connection. In other words, the more social connections someone had, the less distressed feelings they reported. This finding is consistent across cultures, as the need for social connection seems to be universal. Given the findings of the study, Jurick et al. suggested a number of strategies for treating Russian individuals in contrast to American individuals, the first and foremost difference being the necessity of developing a relationship of trust between practitioner and patient. While trust is important for Americans being treated for depression as well, Russians are much slower to trust and more likely to drop out of treatment. Furthermore, although the fact that Russians experience so many negative emotions as opposed to positive ones suggests a need for greater engagement in mental health services over all, it is important to consider the different ways in which Russians think about and process negative life experiences.

Study two aimed to explain this difference by determining the purpose of self-reflection and the level of self-immersion in both populations. Participants rated themselves on a scale aimed at determining a self-immersed perspective (seeing the event replay as though you were back in the moment) vs. a self-distancing one (watching the event unfold as an observer and seeing yourself from afar). Other related factors included current emotional distress when recalling events, recounting the events as they happened, reconstructing events by thinking differently about them, and self-blame vs. blaming another.

Study two’s results extend the findings of study one by offering a potential explanation of why self-reflection seems to be negatively correlated with depression symptoms in Russians when the opposite is true for Americans. The results also offer some interesting insight about the Russian culture around depression. The fact that many Russians who ruminate on negative events are able to reconstruct them in a manner that promotes positive coping habits may offer an explanation for why there is a greater degree of skepticism towards the idea of depression as an illness. In other words, there may be a line of thinking in the culture that resembles, “everyone has problems to think about, why can't you deal with it like them?” This may also be supported by the fact that in Russia, depression is thought to be a cause of negative life events which are the subject of rumination, as opposed to chemical imbalances.