Resilience and suicidality in the Taiwanese general public: a population-based study.

Major Depressive Disorder (MDD) is among the most common mental disorders globally, affecting over 250 million people. According to the World Health Organization (WHO), MDD impacts approximately 3.8% of the global population. The prevalence of MDD is approximately 5% in adults and 5.7% in older adults, and women have a 50% higher incidence than men [, ]. Epidemiological data further indicate that 3%–5% of the Iranian population is affected by MDD [, ]. The clinical presentation of MDD includes persistent depressed mood, anhedonia, sleep disturbances, psychomotor retardation, and suicidal ideation. According to DSM-5 criteria, a diagnosis requires at least five of these symptoms over a two-week period, with one symptom necessarily being depressed mood or loss of interest/pleasure []. Beyond individual suffering, MDD represents a significant global burden, resulting in severe long-term economic and social consequences []. While standard treatments—such as pharmacotherapy, psychotherapy, and electroconvulsive therapy—are effective, evidence suggests that combined psychotherapy and pharmacotherapy yield superior outcomes [–]. Despite this, only about half of individuals with depression seek professional help [, ]. This treatment gap is largely driven by barriers such as privacy concerns, fear of judgment, negative attitudes, and stigma [, ]. Among these, stigma is recognized as the primary obstacle to initiating and completing psychiatric rehabilitation []. It frequently results in patient resistance to treatment, symptom relapse, and the exacerbation of comorbidities [, ].