Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public

The Australian public's beliefs about the harmfulness of antipsychotics: associated factors and change over 16 years

Negative views of psychiatric medications are common in many countries. Relatively little is known about beliefs about antipsychotic medications. A 2011 national survey of 2024 Australian adults assessed beliefs about their helpfulness or harmfulness for a person with either early or chronic schizophrenia and the associations with sociodemographic characteristics, exposure to schizophrenia, recognition of schizophrenia, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes since previous surveys (conducted in 1995 and 2003/4) were also assessed. Results showed that 19% of Australian adults believe that antipsychotics would be harmful for a person with early schizophrenia and 14% for chronic schizophrenia. This group was more likely to be male, born overseas, have less exposure to schizophrenia, show poorer schizophrenia recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antipsychotics for schizophrenia decreased between 1995 and 2003/4 and between 1995 and 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antipsychotics in the treatment of schizophrenia should focus on these groups.

Improving patients' beliefs about antidepressants in primary care: a cluster-randomized controlled trial of the effect of a depression care program

OBJECTIVE

Many depressed patients have negative beliefs about antidepressants, leading to poor adherence, unfavorable depression outcome, and low perceived well-being, role functioning, and quality of life. Interventions to ameliorate beliefs are therefore needed.

METHOD

In a cluster-randomized controlled trial conducted from September 1999 to January 2001, 2 interventions to improve management of major depressive disorder in primary care were compared: (1) a depression care program (DCP), providing enhanced patient education, stimulation of active participation of general practitioners and patients in the treatment process, discussion of benefits and costs of taking antidepressant medication, and systematic follow-up and (2) a systematic follow-up program (SFP). Thirty general practitioners were randomly assigned, and 211 patients with current major depressive disorder (diagnosed according to DSM-IV) were included. All patients were prescribed a selective serotonin reuptake inhibitor. Beliefs were assessed at baseline, at week 10, and at week 26. Differences in change of beliefs between DCP and SFP groups were analyzed.

RESULTS

Changes in patients' beliefs were more favorable in the DCP condition at week 10 and week 26, compared with SFP only (beliefs concerning appropriate medication-taking, week 10: effect size = 0.39, p = .012; week 26: effect size = 0.55, p = .001; beliefs concerning harmfulness, week 10: effect size = 0.45, p = .011; week 26: effect size = 0.62, p = .002).

CONCLUSION

The depression care program ameliorates beliefs about antidepressants in primary care patients with major depressive disorder. The study results encourage the implementation of a depression care program in order to improve beliefs about antidepressant medication in primary care patients diagnosed with major depressive disorder.

Depression literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong

OBJECTIVE

The study reported in this paper was aimed at developing understanding of depression-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China.

METHODS

A multi-stage cluster sampling method in which participants were taken from 6 of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with depression before being asked questions designed to assess both their understanding of depression and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia, and Hong Kong, respectively.

RESULTS

A similarly low percentage of Chinese people in each of Shanghai, Hong Kong, and Australia recognized depression. Fewer Shanghai Chinese than Chinese living in Hong Kong and Australia ascribed the 'anxiety/stress' label to the depression vignette and endorsed professionals and informal network members as helpful. Although a far lower percentage of Shanghai Chinese endorsed the use of counseling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for combating depression than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' and 'qigong' than among the other two groups of Chinese.

CONCLUSIONS

This study underlines the need for campaigns aimed at improving the mental health literacy of Chinese in Shanghai. Such campaigns must take into consideration the socially and culturally driven beliefs to facilitate the development of specific education programs.

Belief in the harmfulness of antidepressants: associated factors and change over 16 years

BACKGROUND

Negative views of psychiatric medications are a common in many countries and efforts have been made to improve these. Relatively little is known of the changes in beliefs about harmfulness of antidepressant medications.

METHODS

A 2011 national survey of 2024 Australian adults assessed beliefs about the helpfulness or harmfulness of antidepressants for a person who is depressed or depressed/suicidal and the associations with sociodemographic characteristics, exposure to depression, recognition of depression, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes in attitudes since previous surveys (conducted in 1995 and 2003/2004) were also assessed.

RESULTS

Approximately 20% of Australian adults believe that antidepressants would be harmful for a person who is depressed or depressed/suicidal. This group was more likely to be male, born overseas, have less exposure to depression, show poorer depression recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antidepressants for depression decreased between 1995 and 2003/2004 and between 1995 and 2011, particularly in young people and in those with a lower level of education.

LIMITATIONS

The study did not explore the reasons for belief in harmfulness.

CONCLUSIONS

Belief in the harmfulness of antidepressants for depression fell in the 16 years prior to 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antidepressants in the treatment of depression should focus on these groups.

Cognitive behavioural therapy self-help for depression: an overview

BACKGROUND

The World Health Organisation suggests that 60-80% of those affected by depression can be effectively treated using medication or psychotherapy within primary care. However, less than 50% of those affected actually receive such treatments. In practice, it remains a challenge to provide access to psychotherapy due to limited numbers of therapists combined with a growing number of treatment guidelines recommending the delivery of evidence-based psychological therapies such as cognitive behavioural therapy (CBT). One way to overcome this problem is to offer therapy in different ways - with so-called low-intensity (LI) working. One example of LI working is CBT self-help (CBT-SH).

AIMS

To provide an overview of the current literature surrounding the effectiveness of CBT-SH with a particular focus on depression and discuss the future directions for both research and policy implementation.

CONCLUSIONS

It is clear that self-help has a place within a healthcare framework but more work is needed to clarify where and how it should be delivered. The paper concludes that there appears to be enough benefits and sufficient evidence to argue for the introduction of LI working as an appropriate first step for most people facing depression and anxiety.

Gender differences in mental health literacy among Chinese-speaking Australians in Melbourne, Australia

OBJECTIVE

This study attempted to understand gender differences in knowledge of mental illness, preference for professional help, and medications and treatment methods among Australians of Chinese-speaking background.

METHODS

This study adopted a cluster convenience sampling method in which subjects were taken from the four major areas in cosmopolitan Melbourne where most Chinese people are living. A total of 200 Chinese-speaking Australians participated in the study. They were presented with two vignettes describing an individual with acute depression or acute schizophrenia and then questions were asked to assess their understanding of the conditions, preference for professional help, medications and treatment methods.

RESULTS

More female than male respondents could correctly identify the conditions in the two vignettes. Female participants also perceived medications to be relatively more harmful than their male counterparts. In contrast, there were significantly more males than females who adhered to traditional views on the causation of mental illness; had significantly higher percentages of endorsement of 'deal with it alone'; believed 'traditional Chinese medical doctor' and 'Chinese herbal medicines' to be helpful to the person in the schizophrenia vignette; and significantly endorsed 'psychiatric ward', 'electro-convulsive treatment', 'changing fungshui' and 'traditional Chinese worship' to be helpful for the persons in both vignettes. A combination of factors, which included age, duration of migration and traditional Chinese cultural values, were put forward to explain the above differences.

CONCLUSIONS

Campaigns to improve the mental health literacy of Chinese-speaking Australians must take into account the gender differences between male and female Chinese-speaking Australians so that culturally relevant and gender-specific education programmes can be developed.

Depression treatment preferences among Japanese undergraduates: using conjoint analysis

BACKGROUND

Treatment preferences may contribute to seeking and adhering to professional help for depression. Few studies have considered practical barriers and controlled for individual difference factors.

OBJECTIVE

To clarify depression treatment preferences among Japanese undergraduates while considering practical barriers and controlling for individual difference factors.

METHODS

This was a cross-sectional study of 985 undergraduates. Depression treatment preferences were assessed by presenting them with nine hypothetical clinics. Conjoint analysis was performed using a random effect ordered probit model, controlling for the effects of gender, age, department, lifetime use of healthcare services, perceived etiology of depression, stigma towards depression, transportation time, opening hours, and treatment options.

RESULTS

Transportation time and treatment options had the greatest average discrete changes than other factors. Although information is presented about treatment costs in the order medication (3,000 yen), psychotherapy (7,000 yen) and combination (10,000 yen), the order of predicted probabilities for positive ratings was combination (61.4%), psychotherapy (54.9%) and medication (23.2%). Sensitivity analyses showed similar results.

CONCLUSION

Transportation time and treatment options have greater utility than other factors, and a combination of psychotherapy and medication is the most preferred treatment option despite having the highest treatment costs. Efforts to overcome these effects could help increase depression treatment preferences.

'Your good days and your bad days' an exploration and consideration of how lay people conceptualize depression

Depression remains a significant public health issue globally; 121 million people are affected by depression health education campaigns. Regardless of the prevalence of depression and recent health education campaigns to reduce the burden of depression, many people are still stigmatized and sometimes excluded from the society in which they live. Using qualitative research, the aim of this study was to explore lay people's perceptions and attitudes of mental disorder and in particular depression. A purposive sample of 22 lay people were each asked to read a case scenario which was then followed up by the researcher using open-ended questions to explore their knowledge and attitudes and beliefs relating to depression. The data was analysed using Braun & Clarke's strategy of thematic analysis. The results revealed that many of the participants were familiar with the concept of depression, either through their own experiences of the disorder or through knowing people with depression. The participants also drew from psychosocial explanations of depression and located depression as part of the human condition. The paper suggests that lay people's concepts of depression offer rich complex and diverse perspectives that enhance professional views and may lead to a greater understanding of uptake and acceptance of care for depression.

Recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey of mental health literacy and stigma

OBJECTIVE

The aim of the study was to carry out a national survey in order to assess recognition and beliefs about treatment for affective disorders, anxiety disorders and schizophrenia/psychosis.

METHOD

In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia or post-traumatic stress disorder (PTSD). Questions were asked about what was wrong with the person, the likely helpfulness of a broad range of interventions and the likely outcomes for the person with and without appropriate treatment.

RESULTS

Rates of recognition of depression were relatively high, with almost 75% of respondents using the correct label. Rates of recognition for the schizophrenia vignettes and PTSD were similar, with around one third of respondents using the correct labels. Only 9.2% of respondents were able to correctly label social phobia. Respondents gave the highest helpfulness ratings to GPs, counsellors, antidepressants, antipsychotics (for schizophrenia) and lifestyle interventions such as physical activity, relaxation and getting out more. Respondents were generally optimistic about recovery following treatment, although relapse was seen as likely.

CONCLUSIONS

While Australians' beliefs about effective medications and interventions for mental disorders have moved closer to those of health professionals since surveys conducted in 1995 and 2003/4, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders. This is particularly the case for schizophrenia and anxiety disorders, which are less well recognized and, in the case of social phobia, generally perceived as having less need for professional help.

Causes and psychosocial consequences of schizophrenia: the opinions of Italian population

Summary

Objective – Description of opinions on schizophrenia and its psychosocial consequences in a sample of general population. Methods – The study has been carried out in 29 GP units stratified by geographic area and population density of their catchment areas and randomly selected. Each respondent was asked to read a case-vignette describing a patient who met ICD-10 criteria for schizophrenia, and then to fill the Questionnaire on the Opinions about Mental Illness General Population's version (QO-GP). Results – Data on 714 respondents were collected. 21% of the sample identified a case of schizophrenia, 66% of depression/anxiety disorder, and 13% of “nervous breakdown”. Factors most frequently mentioned as causes of detected disorder were stress (72%), heredity (62%), family difficulties and psychological traumas (45%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among respondents with lower educational level and older age. Respondents who referred the case-vignette to schizophrenia reported more pessimistic opinions about psychosocial consequences of detected disorder. Conclusions – The results of this study outline the need to plan educational campaigns on mental illnesses, which take into account the socio-cultural characteristics of the target populations.

Declaration of interest: none of the seven authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.

Psychoeducational methods for patients suffering from depression: the knowledge seeking instrument (KSI)

OBJECTIVE

To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression.

METHOD

We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale.

RESULTS

In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (p<0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbach's alpha) was 0.67 for the instrument.

CONCLUSION AND SIGNIFICANCE

The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.

The costs of guideline-concordant care and of care according to patients' needs in anxiety and depression

AIM

To describe the direct and indirect costs for people with anxiety and depressive disorders where guidelines are adhered to and patients' perceived needs are fully met.

METHOD

Data were derived from the Netherlands Study of Depression and Anxiety. At baseline, adult patients were interviewed and they completed questionnaires to measure DSM-IV diagnoses, socio-demographic characteristics and perceived need for care. Actual care data were also derived from electronic medical records. Criteria for guideline adherence were based on general practice guidelines, issued by the Dutch College of General Practitioners. Direct and indirect costs were inferred from the Perceived Need for Care Questionnaire administered at baseline, and the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness administered at 1-year follow-up.

RESULTS

For 568 patients with a current anxiety or depressive disorder a complete dataset on health care use and absenteeism was available. Guideline adherence was significantly associated with increased care use and corresponding costs, while fully met perceived need was unrelated to costs. Socio-demographic characteristics, severity of symptoms and guideline adherence all affected the societal costs of patients with fully met perceived needs compared with patients with perceived unmet needs.

CONCLUSION

It appears that guideline-concordant care for anxiety and depression costs more than non-concordant care, while care that has fulfilled all of a patient's needs seems not to be more expensive than care that has not met all perceived needs. However, randomized controlled trials should first confirm this conclusion.

Impact of mental health first aid training on pharmacy students' knowledge, attitudes and self-reported behaviour: a controlled trial

OBJECTIVE

The aim of this study was to assess the impact of delivering Mental Health First Aid (MHFA) training for pharmacy students on their mental health literacy and stigma towards mental illness.

METHODS

A non-randomized controlled design was used, with all third year pharmacy students at the University of Sydney (n = 272) in 2009 invited to participate in one of two MHFA training courses, each of 12 hours duration. Of these, 174 students applied for MHFA training, of whom 60 were randomly selected and offered MHFA training. Outcome measures that were completed by all participants in the MHFA and non-MHFA groups before and after the MHFA training included an evaluation of mental health literacy, the 7-item social distance scale, and 16 items related to self-reported behaviour.

RESULTS

The survey instrument was completed by 258 participants at baseline (59 MHFA and 199 non-MHFA) and 223 participants at follow up (53 MHFA and 170 non-MHFA). The MHFA training improved the participants' ability to correctly identify a mental illness (p = 0.004). There was a significant mean decrease in total social distance of 2.18 (SD 3.35) p <0.001 for the MHFA group, indicating less stigmatizing attitudes. There were improvements in recognition of helpful interventions with participants' views becoming more concordant with health professional views about treatments for depression (p = 0.009) and schizophrenia (p = 0.08), and participants were significantly more confident (p < 0.01) to provide pharmaceutical services to consumers with a mental illness following the training.

CONCLUSION

This study demonstrated that MHFA training can reduce pharmacy students' mental health stigma, improve recognition of mental disorders and improve confidence in providing services to consumers with a mental illness in the pharmacy setting.

Schizophrenia literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong

OBJECTIVE

The study reported in this paper was aimed at developing understanding of schizophrenia-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China.

METHOD

A multi-stage cluster sampling method in which participants were taken from six of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with schizophrenia before being asked questions designed to assess both their understanding of schizophrenia and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia and Hong Kong, respectively.

RESULTS

A lower percentage of Shanghai Chinese than Hong Kong Chinese and Australian Chinese could correctly identify the condition described in the vignette as a case of acute schizophrenia. Although a far lower percentage of Shanghai Chinese endorsed the use of counselling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for dealing with schizophrenia than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' than among the other two groups of Chinese.

CONCLUSIONS

This study highlights the need for educating Chinese in Shanghai to improve their schizophrenia literacy. The contents of the education programmes will need to take into consideration the socially and culturally driven beliefs that may have been influencing the knowledge and preferences of Shanghai Chinese concerning professional help, medication, and treatment methods for people suffering from schizophrenia.

A survey of psychiatrists' and registered nurses' levels of mental health literacy in a Chinese general hospital

BACKGROUND

Mental health literacy (MHL) is the term used to describe people's knowledge and beliefs about mental disorders which aid in the recognition, management or the prevention of illness. Health professionals' levels of MHL will shape the therapeutic relationship in which they work in partnership with patients. Studies have been conducted in Australia and Singapore to determine levels of MHL among members of the general public and health professionals. To date, no such studies have been published in Chinese populations.

AIM

The study aims to compare levels of MHL between registered nurses and psychiatrists in a Chinese general hospital. The paper reports participants' diagnosis and beliefs about interventions used to manage depression and schizophrenia.

METHODS

A descriptive cross-sectional survey was undertaken among a group of psychiatrists and registered nurses in the psychiatric department of one large teaching hospital in China (n=70). Participants completed the survey by rating written vignettes related to depression and schizophrenia.

RESULTS

The psychiatrists were highly accurate in correctly diagnosing both depression and schizophrenia; the registered nurses were less so for diagnosing depression. In terms of treatment options, the two groups reached a broad agreement on beliefs about the use of mental health interventions, but differed significantly in the use of some specific mental health interventions.

CONCLUSIONS

This study provides preliminary information about levels of MHL among Chinese mental health professionals and describes their attitudes towards the helpfulness of interventions used to restore mental health and well-being. Future large-scale studies are required to identify factors that influence beliefs about the use of mental health interventions. The findings have implications for further education of registered nurses in the specialization of mental health nursing in China.

Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan

Little is known about possible differences in the attitudes toward schizophrenia between the general public and various healthcare professionals. After screening for the study enrollment, 197 subjects in the general population, 100 psychiatric staff (other than psychiatrists), 112 physicians (other than psychiatrists) and 36 psychiatrists were enrolled in a web-based survey using an Internet-based questionnaire format. To assess subjects' attitudes toward schizophrenia, we used a 13-item questionnaire created by Uçok et al. (2006), to which five items were added. These 18 items were subjected to exploratory factor analysis, which yielded three factors classified as "stigma," "underestimation of patients' abilities," and "skepticism regarding treatment." These factors were compared between the four groups using analysis of covariance (ANCOVA), controlling for potential confounders. The ANCOVA for the "stigma" factor showed that psychiatrists scored significantly lower than the other three groups. The ANCOVA for the "underestimation of patients' abilities" factor revealed that psychiatric staff scored significantly lower than the general population. The present results indicated that attitudes toward schizophrenia consist of at least three separable factors. Psychiatrists had the least negative attitudes toward schizophrenia, which was followed by the psychiatric staff, and attitudes of the general population and of physicians were equally stigmatizing.

Mental health first aid training by e-learning: a randomized controlled trial

OBJECTIVE

Mental Health First Aid training is a course for the public that teaches how to give initial help to a person developing a mental health problem or in a mental health crisis. The present study evaluated the effects of Mental Health First Aid training delivered by e-learning on knowledge about mental disorders, stigmatizing attitudes and helping behaviour.

METHOD

A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health.

RESULTS

Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to waiting list. E-learning also improved first aid actions taken more than waiting list, and was superior to the printed manual in reducing stigma and disability due to mental ill health.

CONCLUSIONS

Mental Health First Aid information received by either e-learning or printed manual had positive effects, but e-learning was better at reducing stigma.

Pharmacists' beliefs about treatments and outcomes of mental disorders: a mental health literacy survey

OBJECTIVES

To assess the beliefs of pharmacists about the helpfulness of interventions for schizophrenia and depression.

METHODS

A survey instrument containing a measure of mental health literacy was mailed to a random sample of 2000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Vignettes of a person with either depression or psychosis were presented, followed by questions related to the recognition of the disorder, the helpfulness of various interventions, prognosis with and without professional help, the person's long-term functioning in various social roles and the likelihood of the person being discriminated against.

RESULTS

A total of 391 responses were received (response rate 19.5%). The majority of pharmacists correctly identified depression (92%) with fewer recognizing schizophrenia (79%). Pharmacists rated medicine use highly for both schizophrenia and depression but were also positive about the use of psychological therapies and lifestyle interventions. Pharmacists had negative views about admission to a psychiatric ward and the use of electroconvulsive therapy (ECT). However, younger pharmacists had significantly more positive views on the use of ECT (p = 0.001). The majority of pharmacists (74%) thought discrimination by the community was highly likely and rated long-term prognosis as poor without appropriate professional help. Their views on the likelihood of specific negative outcomes were mixed, with many pharmacists not recognizing the risk of suicide in schizophrenia and depression. However, both female (p = 0.002) and younger pharmacists (p < 0.001) were significantly more inclined to rate the likelihood of suicide as more likely in a person with schizophrenia or depression.

CONCLUSIONS

The majority of pharmacists had a high degree of mental health literacy as indicated by the correct identification of, and support for evidence-based interventions for mental illnesses. Pharmacists should be aware that their attitudes and stigma towards mental illness may impact on the patient care they provide.

Mental Health Literacy in Hmong and Cambodian Elderly Refugees: A Barrier to Understanding, Recognizing, and Responding to Depression

This study aims to explore mental health literacy, specifically focusing on depression, among Southeast Asian (SEA) elderly refugees residing in the Twin Cities of St. Paul and Minneapolis, Minnesota. Three focus groups were held with nine mental health professionals who work with SEA elders. Jorm's mental health literacy framework guided the study theoretically. For data analysis, grounded theory was employed by utilizing MAX QDA2. Four themes emerged from the analysis: 1) lack of knowledge about specific mental disorders, 2) culture-specific knowledge and beliefs on the causes of depression, 3) lack of awareness about professional help, and 4) cultural attitudes toward seeking mental health services. The findings indicated that cultural beliefs of SEA elders impact their ability to understand, recognize, and respond to depression. Barriers to treatment were identified and recommendations were made to reduce mental health disparity in this elderly population.

Knowledge and preferences regarding schizophrenia among Chinese-speaking Australians in Melbourne, Australia

OBJECTIVE

The aim of this study was to better understand the knowledge of schizophrenia, preferences regarding professional help, medication and treatment methods among Australians of a Chinese-speaking background.

METHODS

A cluster convenience sampling method was adopted in which subjects were taken from the four main areas in cosmopolitan Melbourne where most Chinese people live. A total of 200 Chinese-speaking Australians participated in the study. They were presented with a vignette describing an individual with schizophrenia and were then asked questions to assess their understanding of schizophrenia and their preferences regarding professional help, medication and treatment methods. A comparative approach was used to compare our findings with those of a previous study on the mental health literacy of Australian and Japanese adults.

RESULTS

Compared with the Australian and Japanese samples, a much lower percentage of Chinese-speaking Australians (15.5%) was able to identify the vignette as a case of schizophrenia/psychosis. A higher percentage of the Chinese-speaking Australians believed that professionals, and particularly counselling professionals, could be helpful for the person in the vignette. A higher percentage of the Chinese-speaking Australian and Japanese samples believed that close family members could be helpful, and expressed more uncertainty about the usefulness or harmfulness of certain medications than the Australian sample. A higher percentage of the Chinese-speaking Australians than the Australian and Japanese samples endorsed inpatient treatment for the person in the vignette. About 22, 17, 19 and 28% of the Chinese-speaking Australian participants, respectively, rated 'traditional Chinese medical doctors', 'Chinese herbal medications', 'taking Chinese nutritional foods/supplements' and 'qiqong' as helpful. Many perceived 'changing fungshui' and 'traditional Chinese prayer' to be harmful.

CONCLUSIONS

Campaigns to increase the schizophrenia literacy of Chinese-speaking Australians are needed and must take into consideration the aforementioned socially and culturally driven beliefs so that culturally relevant education programmes can be developed.

The development and psychometric assessment of an instrument to measure attitudes towards depression and its treatments in patients suffering from non-psychotic depression

OBJECTIVE

To develop and psychometrically assess an instrument to measure patients' attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression.

METHOD

A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression.

RESULTS

Internal consistency reliability for the instrument was 0.79 (Cronbach's alpha) and there was 88% overall agreement between experts about the relevance of the instruments' items to test patients' attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy.

CONCLUSION

The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.

Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness

Background

The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.

Methods

Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.

Results

Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.

Conclusion

The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.

Lay theories of bipolar disorder: the causes, manifestations and cures for perceived bipolar disorder

This study aimed to investigate lay theories of the cause and treatment of bipolar disorder, and the recognition of its symptoms. This questionnaire-based study included vignette descriptions of mental disorders and 70 items relating to bipolar disorder. It was completed by 173 participants. Bipolar disorder was recognized less than depression but at the same rate as schizophrenia. Contrary to previous research, analysis showed that lay beliefs of the causes of bipolar disorder generally concur with scientific academic theories. Drug treatment was favoured as a cure rather than psychotherapy. Theories of cause and treatment were logically correlated. Overall, the results suggest that lay people have reasonably informed beliefs about the causes and treatments of bipolar disorder, however recognition of the symptoms is poor.

Attitudes towards people with mental disorders: the psychometric characteristics of a Finnish questionnaire

BACKGROUND

The prevalence of mental disorders, especially depression, increasingly creates concern for our mental, social and economic well-being. The public has insufficient knowledge about mental disorders and their treatment. A stigma is attached to mental disorders, which has a multifaceted impact on the lives of patients and their families. A Finnish general population survey studied knowledge of and attitudes towards mental health problems. This study examines the background dimensions of the attitude items used in the survey.

METHODS

An eight-page health survey questionnaire with 16 items on attitudes to mental health and depression was sent to a randomly selected sample of 10,000 persons aged 15-80 years. The overall response rate was 55.2%. The data were submitted to a principal component analysis (PCA). Two components were extracted by means of this analysis and submitted to further reliability analyses as well as to a preliminary validity analysis.

RESULTS

The PCA identified four components: (1) depression is a matter of will, (2) mental problems have negative consequences, (3) one should be careful with antidepressants and (4) you never recover from mental problems.

CONCLUSION

The internal consistencies of the first two components were sufficient to build dimension scales for future analyses. The extracted components fit consistently with the leading stigma theories and earlier studies measuring public attitudes.

Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders

OBJECTIVE

To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems.

METHOD

Data were derived from the European Study of Epidemiology of Mental Disorders, a survey representative of the adult population of six countries: Belgium, France, Germany, Italy, the Netherlands and Spain (n = 8,796). The World Mental Health Composite International Diagnostic Interview was used to assess attitudes and DSM-IV diagnoses. The attitudes referred to beliefs that the respondents would seek professional help when faced with a serious emotional problem, would feel comfortable talking about personal problems with a professional, would not be embarrassed if friends knew about the professional help, and respondents' perceived effectiveness of mental health care.

RESULTS

Almost a third of the respondents held the view that professional care was worse than or equal to no help when faced with serious emotional problems. Female gender, being younger than 65 years of age, high income, living in Spain or Italy, presence of mood disorder and previous service use were associated with at least two of the four assessed attitudes towards mental health help-seeking. All four attitudes were significantly associated with mental health care use, also after adjustment for previous service use.

CONCLUSION

The low perceived effectiveness of professional care calls for serious action aiming to improve the visibility and credibility of the mental health care sector.

Depression literacy among Australians of Chinese-speaking background in Melbourne, Australia

BACKGROUND

This study investigated the knowledge of depression and preference for professional help, medications and treatment methods among Australians of Chinese-speaking background, and the perceptions of this population of the causes of mental illness.

METHODS

Adopting a cluster convenience sampling method, the study recruited 200 Chinese-speaking subjects from four major areas in metropolitan Melbourne where many Chinese live. The respondents were presented with a vignette describing an individual with depression and then asked questions to assess their understanding of depression and preference for professional help, medications and treatment methods. A comparative approach was used to compare the findings with those of a previous study of the mental health literacy of Australian and Japanese adults.

RESULTS

Compared to the Australian and Japanese samples, a much lower percentage of Chinese-speaking Australians (14%) could correctly identify major depression described in the vignette, and a higher percentage believed that counseling professionals could be helpful. Higher percentages of those who believed that close family members could be helpful were found in the Chinese-speaking Australian and Japanese samples, and these two groups also expressed more uncertainty about the usefulness or harmfulness of certain medications compared to the Australian sample. Higher percentages of respondents in both the Chinese-speaking Australian and the Australian sample considered "lifestyle changes" to be helpful compared to the Japanese sample. In the Chinese-speaking sample, 30%, 17.4%, 33% and 27% of the respondents rated "traditional Chinese medicine doctors," "Chinese herbal medications," "taking Chinese nutritional foods/supplements" and "qiqong" as helpful. Many perceived "changing fungshui" and "traditional Chinese worship" to be harmful. Regarding the perception of causes of mental illness, items related to psychosocial perspectives including "life stress" and "interpersonal conflict" were rated highly by the respondents, whereas traditional beliefs including "punishment for misdeeds conducted by ancestors" and "demon possession" had the lowest ratings.

CONCLUSIONS

Campaigns to increase the mental health literacy of Chinese-speaking Australians are needed. The above-mentioned socially and culturally driven beliefs need to be taken into consideration in the development of culturally relevant education programs.

Primary care patients with anxiety and depression: need for care from the patient's perspective

BACKGROUND

Many anxiety and depression patients receive no care, resulting in unnecessary suffering and high costs. Specific beliefs and the absence of a perceived need for care are major reasons for not receiving care. This study aims to determine the specific perceived need for care in primary care patients with anxiety and depression, and examine to what extent these different needs are met.

METHODS

Cross-sectional data were derived from The Netherlands Study of Depression and Anxiety (NESDA). In 622 primary care patients with a current (6-month recency) diagnosis of depression and/or anxiety disorder who recognised their mental health problem themselves, the perceived need for mental health care was measured by the Perceived Need for Care Questionnaire (PNCQ). Possible determinants were measured in the same interview by means of a questionnaire.

RESULTS

Most patients with anxiety or depression expressed a need for counselling or information. Medication, practical support, skills training and a referral were less often perceived to be needed. Multiple logistic regression analyses revealed that after controlling for age, clinical status and disability, patients' confidence in professional help and their evaluation of received care positively influenced their perception of a need for medication and counselling.

CONCLUSIONS

Although no conclusions can be made about what type of care was specifically not wanted, patients with anxiety or depression mostly want to receive information and counselling. Health professionals should be aware of the fact that there are differences in perceived need for care between subgroups of patients, based on their beliefs and their evaluation of care.

Psychiatric and psychotherapeutic literacy: attitudes to, and knowledge of, psychotherapy

BACKGROUND

Whereas there is now a rapidly emerging literature on psychiatric literacy (Jorm, 2000), there is much less work on the public's knowledge of, and beliefs about the purpose of, and processes involved in, psychotherapy. This study looked at what lay people think happens during psychotherapy; what the processes and aims are; and the aetiology, treatment and prognosis for a mood and psychotic (bipolar, schizophrenia) and two neurotic (depression, obsessive-compulsive) disorders.

METHODS

In total 185 British adults, recruited by a market research company, completed a four-part questionnaire, lasting about 20 minutes.

RESULTS

Participants were generally very positive about psychotherapy believing the experience to be highly beneficial. Schizophrenia was seen to have a biological basis; depression and bipolar disorder were perceived to have family, work and other stress-related causal issues; obsessive-compulsive disorder was seen to be caused by stress and family-related issues. Participants thought psychotherapy a very effective treatment but drug treatments more effective for schizophrenia and bipolar disorder. 'Talking it over' was judged highly relevant, specifically to depression. Participants believed that depression had a good chance of cure, and remission, but that neither schizophrenia nor bipolar disorder had much chance of an effective cure.

CONCLUSION

Lay people show a curious pattern on insight, ignorance and naivety with regard to the cause and cure of mental disorders. They appear to have a modestly realistic but somewhat naive view of the process and efficacy of psychotherapy. This may influence how they react to their own and others' mental illness. It has clear implications for education in psychiatric literacy.

Exploring attitudes of the general public to stress, depression and help seeking

Many people delay or never seek professional help for stress and depression. There is limited research on this topic using qualitative methodologies, but even less exploring the attitudes of the general population.This study explores the attitudes and preferences of the general population about when and where help is sought for stress and depression through the Somerset Health Panels. These comprised 12 two‐hour panels held across Somerset, England, involving a total of 96 people. This study reveals that a positive and non‐judgemental view of depression and stress exists within the general population. The response and support from friends and family is critical in seeking other sources of help, for which the GP is perceived as a gatekeeper. A preferred hierarchy of professional and nonprofessional sources of help exists, which is not entirely consistent with the arrangement of current services. This research adds to our understanding of how to engage with communities more generally and helps understand a general population perspective on mental health issues ‐ in particular, the way services are currently arranged does not always reflect the hierarchy in which people would prefer to seek help, and that stigma is evident but does not always act as a barrier to eventual help‐seeking.

Gender and self-reported mental health problems: predictors of help seeking from a general practitioner

OBJECTIVES

Findings have shown that many people do not seek help when experiencing psychological distress. The main aim of this paper is to examine the socio-demographic and health status factors that predict help seeking for self-reported mental health problems for males and females from a general practitioner (GP).

DESIGN

The analysis used data from the HRB National Psychological Wellbeing and Distress Survey - a telephone survey of the population aged 18 years and over.

METHODS

Telephone numbers were selected on a random probability basis. An initial set of random clusters was selected from the Geodirectory. Using these sampling areas, random digit dialling was used to generate a random telephone sample. Data were weighted on key variables. Respondents who reported mental health problems in the previous year were included in the current study (382/2,674).

RESULTS

The findings showed gender differences in the models of predictors between males and females with more factors influencing attendance at the GP for males than for females. While only social limitations and access to free health care predicted female attendance, a range of socio-demographic and psychological factors influenced male attendance.

CONCLUSIONS

Findings suggest that a 'gender sensitive approach' should be applied to mental health policies and mental health promotion and prevention programmes. Acknowledgement and awareness of the factors that influence help seeking will aid the design of gender specific promotion, prevention, and treatment programmes at primary care level.

Patients' explanations for depression: a factor analytic study

OBJECTIVES

Previous questionnaire studies have attempted to explore the factor structure of lay beliefs about the causes of depression. These studies have tended to either fail to sample the full range of possible causal explanations or extract too many factors, thereby producing complex solutions. The main objective of the present study was to obtain a more complete and robust factor structure of lay theories of depression while more adequately sampling from the full range of hypothesized causes of depression. A second objective of the study was to explore the relationship between respondents' explanations for depression and their perceptions of the helpfulness of different treatments received.

METHOD AND DESIGN

A 77-item questionnaire comprising possible reasons for 'why a person might get depressed' was mailed out to members of a large self-help organization. Also included was a short questionnaire inviting respondents to note treatments received and their perceptions of the helpfulness of these treatments. Data from the 77-item questionnaire were subjected to a principal components analysis.

RESULTS

The reasons rated as most important causes of depression related to recent bereavement, imbalance in brain chemistry and having suffered sexual assault/abuse. The data were best described by a two-factor solution, with the first factor clearly representing stress and the second factor depressogenic beliefs, the latter corresponding to a cognitive-behavioural formulation of depression aetiology. The two scales thus derived did not, however, correspond substantially with rated helpfulness for different treatments received.

CONCLUSIONS

The factor structure obtained was in contrast to more complex models from previous studies, comprising two factors. It is likely to be more robust and meaningful. It accords with previous research on lay theories of depression, which highlight 'stress' as a key cause for depression. Possible limitations in the study are discussed, and it is suggested that using the questionnaire with more recently depressed people might yield clearer findings in relation to perceptions of treatment helpfulness.

The relationship between mental health literacy, personal contacts and personal stigma against depression

OBJECTIVES

To estimate and compare the percentages of personal stigma by levels of depression literacy and exposure to persons with depression, overall and by gender.

METHODS

Data were collected in a probability sampled population-based survey of 3047 adults in Alberta, Canada. Measures included a 9-item depression stigma scale. Personal stigma was examined using bi-variate analyses and logistic regression modeling separately for men and women.

RESULTS

Over 45% of participants considered that people with depression were unpredictable. Over 20% reported that people with depression were dangerous. However, the percentages did not differ by levels of depression literacy and whether having a family/friend with depression. Multivariate analyses showed that the associations between depression case recognition, agreement with health professionals about treatment, personal contact with depression and stigma varied by gender.

LIMITATIONS

This was a cross-sectional survey which relied on self-report. Therefore, causal inferences could not be made. The findings may be affected by recall and reporting biases. The results could not provide definitive evidence about whether improving mental health literacy and personal contact with depression could reduce stigma.

CONCLUSIONS

In the highly educated population, the attitudes of considering individuals with depression as being unpredictable and dangerous were prevalent. Educational campaigns may have some positive effects on stigma against depression, but should be carefully designed and pay attention on the target populations.

Attitudes of ward attendants towards mental illness: comparisons and predictors

BACKGROUND

In India few studies exist that explore attitudes of mental health professionals, especially psychiatric ward attendants, towards psychiatric illnesses. This study aimed to explore attitudes of psychiatric ward attendants since they work closely with psychiatric patients in the hospital ward, and which may differ given their cultural and social background.

METHODS

Five hundred psychiatric ward attendants were targeted and a 100 sample size chosen based on systematic random sampling. A control group from guardians attending the outpatient department of Central Institute of Psychiatry was selected using the same methods. Attitudes of both groups were assessed using Community Attitudes towards Mental Illness (CAMI) after written informed consent.

RESULTS

There were no significant differences noted in Authoritarianism and Benevolence domains of CAMI. However, there were significant differences in the domains of Social Restrictiveness and Community Mental Health Ideology with psychiatric ward attendants scoring higher than the general attendants. Among the socio-demographic variables, there was significant correlation between age, duration of contact and educational background and various domains of CAMI.

CONCLUSIONS

Psychiatric ward attendants had more positive attitudes than general attendants towards psychiatric illnesses. Socio-demographic variables like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

BACKGROUND

Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.

METHODS

To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12-25 years and 2005 of their parents, which included questions about the same strategies.

RESULTS

A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.

CONCLUSION

Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.

Mental health literacy and attitudes in a Swedish community sample - investigating the role of personal experience of mental health care

BACKGROUND

Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact.

METHOD

A postal screening questionnaire was sent to a random sample of the general population aged 20-64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).

RESULTS

Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic.

CONCLUSION

Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.

Increasing mental health literacy via narrative advertising

This research explored the effectiveness of narrative advertising and argument advertising in increasing mental illness (depression) literacy. Results showed that narrative advertising was more effective than argument advertising at engaging participants in experiential immersion, resulting in greater sympathy toward those suffering from depression. In addition, narrative advertising better involved participants in issue elaboration and increased willingness to seek professional help. Finally, in comparison with argument advertising, narrative advertisements were rated higher in providing vivid information, resulting in an increase in participants' perceived efficacy in recognizing friends or family suffering from depression.

Can People Read Self-Help Manuals for Depression? A Challenge for the Stepped Care Model and Book Prescription Schemes

Self help approaches are increasingly being used in healthcare settings through over 100 book prescription schemes in the UK. The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is advocated as part of stepped care service models. This study assesses how the reading ages of the most recommended self-help books for depression compare to British literacy levels. A cross sectional survey was carried out. The most recommended self-help books for depression were identified; seven CBT based self-help books were included in this study as well as a widely used booklet for depression. Readability scores and reading ages were calculated for a randomly generated selection representing 15% of each selected book using the Readability Studio® software to generate a wide range of key readability and comprehension scores. The reading ages of the selected books were between 12.6 and 15.4. Reading ease varied amongst the texts, and their complexity (percentage of unfamiliar words, range: 14.8% – 22.6%). A significant proportion of the UK population would struggle to use some of the current CBT-based self-help books recommended. For some patient groups, non text based self-help materials as well as shorter and more easily read written materials may be more appropriate. To our knowledge, this is the first study to address this question. Publication of the reading ages of the recommended books within the book prescription schemes may allow for a more accurate match between the book and the reader.

Gender specific correlates of stigma toward depression in a Canadian general population sample

OBJECTIVES

To identify gender specific demographic, clinical, knowledge and attitudinal factors associated with stigma related to depression.

METHODS

Data were collected between February and June 2006 in a probability sampled population-based survey of 3047 adults in Alberta, Canada. Measures included a depression stigma scale. Correlates of stigma were examined using bivariate analyses and linear regression modeling methods separately for men and women.

RESULTS

In multivariate linear regression models, correct identification of depression in a case description and agreement with health professionals about treatments were associated with lower stigma scores, regardless of gender. Endorsing GP/family doctors and taking medications as being the best help for depression was negatively associated with stigma scores in women. In men, endorsing family/friends as the best help for depression or "don't know" the best help for depression was positively associated with stigma scores. Women who had family/friends with depression had less stigma than women who did not have. This was not observed in men. Among male participants, significant interactions between being a health professional, having close family/friends with depression and reporting "weakness of character" as a causal factor for depression were found.

CONCLUSIONS

Improving mental health literacy may be one of the promising ways to reduce stigma associated with depression. Personal contacts with individuals with depression may have positive effects on stigma in women. Mental health education and promotion should clarify misconceptions about causes, treatments and risk factors for depression. Gender differences related to stigma should be considered in stigma reduction initiatives.

The assessment of depression awareness and help-seeking behaviour: experiences with the International Depression Literacy Survey

BACKGROUND

Depression causes substantial disease burden in both developed and developing countries. To reduce this burden, we need to promote understanding of depression as a major health condition. The International Depression Literacy Survey (IDLS) has been developed to assess understanding of depression in different cultural and health care settings.

METHODS

Four groups of Australian university students completed the survey: medical students in second (n = 103) and fourth (n = 82) years of a graduate course, ethnic Chinese students (n = 184) and general undergraduate students (n = 38).

RESULTS

Differences between the student groups were evident, with fourth year medical students demonstrating greater general health and depression literacy than second year medical students. Australian undergraduate students demonstrated better depression literacy than those from ethnic Chinese backgrounds. Ethnicity also influenced help seeking and treatment preferences (with more Chinese students being inclined to seek help from pharmacists), beliefs about discrimination and perceptions regarding stigma.

CONCLUSION

The IDLS does detect significant differences in understanding of depression among groups from different ethnic backgrounds and between those who differ in terms of prior health training. These preliminary results suggest that it may be well suited for use in a wider international context. Further investigation of the utility of the IDLS is required before these results could be extrapolated to other populations.