Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression

The association between different traumatic life events and suicidality

Background: Traumatic life events have been associated with increased risk of various psychiatric disorders, even suicidality. Our aim was to investigate the association between different traumatic life events and suicidality, by type of event and gender. Methods: Women attending a cancer screening programme in Iceland (n = 689) and a random sample of men from the general population (n = 709) were invited to participate. In a web-based questionnaire, life events were assessed with the Life Stressor Checklist - Revised, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criterion was used to identify traumatic life events. Reports of lifetime suicidal thoughts, self-harm with suicidal intent and suicide attempt were considered as lifetime suicidality. We used Poisson regression, adjusted for demographic factors, to express relative risks (RRs) as a measure of the associations between traumatic events and suicidality. Results: Response rate was 66% (922/1398). The prevalence of lifetime traumatic events was 76% among women and 77% among men. Lifetime suicidality was 11% among women and 16% among men. An overall association of having experienced traumatic life events with suicidality was observed [RR 2.05, 95% confidence interval (CI) 1.21-3.75], with a stronger association for men (RR 3.14, 95% CI 1.25-7.89) than for women (RR 1.45, 95% CI 0.70-2.99). Increased likelihood for suicidality was observed among those who had experienced interpersonal trauma (RR 2.97, 95% CI 1.67-5.67), childhood trauma (RR 4.09, 95% CI 2.27-7.36) and sexual trauma (RR 3.44, 95% CI 1.85-6.37), with a higher likelihood for men. In addition, an association between non-interpersonal trauma and suicidality was noted among men (RR 3.27, 95% CI 1.30-8.25) but not women (RR 1.27, 95% CI 0.59-2.70). Conclusion: Findings indicate that traumatic life events are associated with suicidality, especially among men, with the strongest association for interpersonal trauma.

Google and suicides: what can we learn about the use of internet to prevent suicides?

OBJECTIVES

This article studies the statistical relationship between the search propensity of suicide-related terms on Google and the number of suicides.

STUDY DESIGN

Suicide mortality data from all American states from January 2006 to November 2014 (n = 5372) and data on Google search intensity for the same period was collected.

METHODS

Regression analysis with dynamic components was performed to determine the relationship between search intensity and the number of suicides.

RESULTS

First, this article finds a positive simultaneous correlation between search intensity and the number of suicides. The magnitude of this relationship has grown from 2006 to 2014 suggesting an increased reliance on the internet for suicide-related information. Second, search propensity is a significant predictor for the number of suicides for youth and for males.

CONCLUSIONS

Suicide prevention websites should therefore be designed knowing that at-risk individuals in both groups are probably more prone to look for suicide-related information online.

Gender-specific factors associated with the use of mental health services for suicidal ideation: Results from the 2013 Korean Community Health Survey

This study examined gender-specific factors associated with the use of mental health services (MHS) for suicidal ideation (SI). We included data on 6,768 males and 12,475 females who had experienced SI over the past year from the nationwide 2013 Korean Community Health Survey. These individuals were grouped as MHS users for SI if they had received professional counseling at medical institutions, professional counseling agencies, or community health centers for SI-related problems. Their information on sociodemographic factors, socio-familial relationships, health behaviors, and health status were included as exposures in a logistic regression analysis. Of the 19,243 individuals, 7.0% of the males and 10.5% of the females used MHS for SI treatment. For males with SI, living in an urban area, being a widower, and having unhealthy behaviors (frequent alcohol consumption and infrequent walking) were associated with underuse of MHS. For females with SI, frequent contact with friends, low level of religious activity, and good self-rated health were associated with underuse of MHS. For both males and females, those who were younger, completed higher education, and experienced depression/suicide attempts in the past year were more likely to use MHS for SI. These findings suggest that gender-specific factors should be used to inform suicide prevention strategies.

Intimate Partner Violence Victimization and Cognitive Function in a Mixed-Sex Epidemiological Sample of Urban Adults

Intimate partner violence (IPV) victimization is associated with a wide range of mental and physical health problems, but little is known about the effect of IPV on cognitive decline. Previous research suggests an association between IPV victimization and cognitive dysfunction, but the few studies that have examined this phenomenon were cross-sectional in design and focused only on female victims of IPV. This study examined cognitive function over time among a diverse population of both male and female victims of IPV. Regression analyses indicated increased completion time on Trail Making Test (TMT) A for both male and female victims of IPV living below poverty as well as for female victims of IPV without previously depressive symptomatology. Results also indicated increased completion time on TMT B for male victims of IPV. Our findings support an association between IPV victimization and increased cognitive decline that is moderated by poverty status and previous depressive symptomatology.

Improving the effectiveness of psychotherapy in two public hospitals in Nairobi

This paper is the first in a planned series of papers studying the effectiveness of psychotherapy and counselling in Nairobi. It describes a method for checking the effectiveness of psychotherapy and improving service quality in a Kenyan context. Rather than prematurely imposing psychotherapy protocols developed in Western countries in another cultural context, we believe that first studying psychological interventions as they are practised may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems. The initial step is to assess outcome of psychological treatments as they are conducted. This is followed by statistical analyses aimed at identifying patient groups who are not improving at acceptable rates. Therapists will then be trained in a ‘best practice’ approach, and controlled trials are used in a final step, testing new interventions specifically targeted at patient groups with sub-optimal outcomes.

Silence is deadly: a cluster-randomised controlled trial of a mental health help-seeking intervention for young men

Background

Young men are consistently less likely to seek help for mental health problems than their female peers. This is particularly concerning given the high rates of suicide among male adolescents. The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for young people. The current trial aims to determine the effectiveness of the Silence is Deadly program in increasing positive help-seeking intentions for mental health problems and suicide among male secondary school students.

Methods

This study is a two-arm, cluster-randomised, controlled trial that will compare the Silence is Deadly program to a wait-list control condition. Eight Australian high schools will be recruited to the trial, with male students in grades 11 and 12 (16 to 18 years of age) targeted for participation. The program is an innovative male-tailored suicide prevention intervention, comprising a presentation that emphasises role-modelling and legitimises help-seeking for personal and emotional problems, and a brief video that features celebrity athletes who counter existing male norms around help-seeking and encourage communication about personal and emotional issues. The program also includes a discussion of how to help a friend in distress and ends with a question and answer session. The primary outcome measure for the current study is help-seeking intentions. Secondary outcomes include help-seeking behaviour, help-seeking attitudes, help-seeking stigma, mental health symptoms, and suicidal ideation. Data will be collected pre-intervention, post-intervention, and at 3-month follow-up. Primary analyses will compare changes in help-seeking intentions for the intervention condition relative to the wait-list control condition using mixed-effects repeated-measures analyses that account for clustering within schools.

Discussion

If proven to be effective, this targeted help-seeking intervention for adolescent males, which is currently only delivered in one jurisdiction, could be more widely delivered in Australian high schools. The Silence is Deadly program has the potential to significantly contribute to the mental health of young men in Australia by improving help-seeking for suicidality and mental health problems, allowing this population to better access treatment and support sooner.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12617000658314. Registered on 8 May 2017.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4845-z) contains supplementary material, which is available to authorized users.

Community social support as a protective factor against suicide: A gender-specific ecological study of 75 regions of 23 European countries

By studying differences in suicide rates among different geographical regions one may identify factors connected to suicidal behaviour on a regional level. Many studies have focused on risk factors, whereas less is known about protective factors, such as social support. Using suicide rates and data from the European Social Survey (ESS) we explore the association between regional level social support indicator and suicide rates in 23 European countries in 2012. Linear multiple regression analyses using region as the unit of analysis revealed inverse relationships between mean respondent valuing of social support and suicide rates for both genders, with some indication of a stronger relationship among men. Social support may have a protective effect against suicide on a regional level. Thus, increasing social support could be an effective focus of preventive activities, resulting in lowering suicide rates, with greater expected results among men.

"It just made me feel so desolate": Patients' narratives of weight gain following laparoscopic insertion of a gastric band

AIMS AND OBJECTIVES

To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity.

BACKGROUND

Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people's longer-term experiences following LAGB insertion.

DESIGN

A narrative-based qualitative interview study.

METHODS

A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants' experiences.

FINDINGS

Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery.

CONCLUSION

Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long-term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction.

RELEVANCE TO CLINICAL PRACTICE

Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients' needs when weight loss plateaus or weight is regained and intensify support during these periods.

Antidepressant use and associated factors among the elderly: the Bambuí Project

This study examined the factors associated with antidepressant use among community-dwelling elderly individuals. Data collected from the Bambuí Project, a population-based study on aging and health with a cohort of 1,606 elderly individuals, were used. Gender, age, education, marital status, household income and cohabitation status were the sociodemographic characteristics investigated. Health conditions included self-reported health, number of chronic diseases, depressive symptoms, cognitive impairment and functional disability. Poisson regression with robust variance was used to test associations and to estimate prevalence ratios with 95% confidence intervals. The prevalence of antidepressant use was 8.4%. After multivariate analysis, antidepressant use was associated with the female gender (PR = 2.96; 95%CI 1.82-4.81), being single or divorced (PR = 0.48; 95%CI 0.25-0.91), cognitive impairment (PR = 0.44; 95%CI 0.24-0.84) and worse self-reported health (poor/very poor) (PR=1.86; 95%CI 1.11-3.10). The results are similar to those observed in several other studies conducted in higher-income countries and suggest that self-reported health in the elderly population of Bambuí is a key factor in the decision to use antidepressants.

Mental health among single and partnered parents in South Korea

Objective

This study compares the mental health of single parents relative to partnered parents and assesses the contribution of the social and demographic factors to this difference, examining the gender difference in it.

Methods

We analyzed 12,024 single and partnered subjects, aged 30–59 years, living with children, aged 0–19 years, drawn from the 4^th, 5^th, and 6^th Korea National Health and Nutrition Examination Survey (KNHANES) dataset in South Korea conducted from 2007–2013. Mental health was evaluated by self-reported questionnaires including depressive mood for recent two weeks, presence of suicidal ideation, and the Korean version of the Alcohol Use Disorder Identification Test. Covariates included age, physical illness, socioeconomic status (family income, recipient of national basic livelihood guarantees, educational level, house ownership, job, and residential area), family structure, and support (co-residence of another adult). Multiple logistic regression was carried out and the explained fractions of each covariate was calculated.

Results

Single parents had significantly poorer mental health than their partnered counterparts, with odds ratio (OR) of 2.02 (95% confidence interval (CI) 1.56–2.63) for depressive symptoms, 1.69 (95% CI 1.27–2.25) for suicidal ideation, and 1.74 (95% CI 1.38–2.20) for any of the three mental health statuses (suspicious depression, suicidal ideation, and alcohol dependence) after controlling for the covariates. The odds of depressive symptoms (OR = 3.13, 95% CI 2.50–3.93) and suicidal ideation (OR = 2.50, 95% CI 1.97–3.17) among both single fathers and mothers were higher than partnered parents. However, the odds of alcohol dependence were 3.6 times higher among single mothers than partnered mothers (OR = 3.58, 95% CI 1.81–7.08) and were 1.4 times greater among single fathers than partnered fathers (OR = 1.35, 95% CI 0.81–2.25). Socio-economic status explained more than 50% (except for substance use disorders) of the poorer mental health in single parents. These results were more remarkable for single fathers than for single mothers except for alcohol dependence. However, physical illness, family structure, and support made only minor contributions to single parents’ mental health.

Conclusions

This study demonstrates that single parents have poorer mental health than partnered parents. Although lower SES is an important factor explaining poorer mental health in single parents, there are other factors we cannot explain about their poor mental health. Therefore, we should pay proper regard to identifying other factors affecting mental health and to establishing policies to support single parents.

Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants

OBJECTIVE

Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC).

DESIGN

Community partnered, cluster, randomized trial.

SETTING

Hollywood-Metropolitan and South Los Angeles, California.

PARTICIPANTS

423 adult male clients with modified depression (PHQ-8 score≥10).

INTERVENTIONS

Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS).

MAIN OUTCOME MEASURES

Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings.

RESULTS

At screening, levels of probable depression were moderate to high (17.5%-47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00-3.42) and reduced hospitalizations (OR .40, 95% CI .16-.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15-.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99-8.45).

CONCLUSIONS

Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multi-sector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.

Factors associated with help-seeking behaviour among individuals with major depression: A systematic review

Psychological models can help to understand why many people suffering from major depression do not seek help. Using the 'Behavioral Model of Health Services Use', this study systematically reviewed the literature on the characteristics associated with help-seeking behaviour in adults with major depression. Articles were identified by systematically searching the MEDLINE, EMBASE and PsycInfo databases and relevant reference lists. Observational studies investigating the associations between individual or contextual characteristics and professional help-seeking behaviour for emotional problems in adults formally diagnosed with major depression were included. The quality of the included studies was assessed, and factors associated with help-seeking behaviour were qualitatively synthesized. In total, 40 studies based on 26 datasets were included. Several studies investigated predisposing (age (N = 17), gender (N = 16), ethnicity (N = 9), education (N = 11), marital status (N = 12)), enabling (income (N = 12)), need (severity (N = 14), duration (N = 9), number of depressive episodes (N = 6), psychiatric comorbidity (N = 10)) and contextual factors (area (N = 8)). Socio-demographic and need factors appeared to influence help-seeking behaviour. Although existing studies provide insight into the characteristics associated with help seeking for major depression, cohort studies and research on beliefs about, barriers to and perceived need for treatment are lacking. Based on this review, interventions to increase help-seeking behaviour can be designed.

Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities

OBJECTIVE

Anxiety is common among older adults and is associated with multiple negative outcomes. Late-life anxiety is usually unrecognized by providers and undertreated, although evidence supports the effectiveness of psychosocial treatment. Access to mental health care is especially poor among African American seniors. New treatment models are needed to expand the reach of mental health care to minority elders.

METHODS

Our article outlines a study designed to test the effectiveness and implementation potential of Calmer Life (CL), a community-based, person-centered, flexible and culturally tailored intervention for late-life anxiety and worry, offered in low-income, mental health-underserved and predominantly African American communities. CL is skills-based, but also includes resource counseling and an option to integrate religion/spirituality. The study population includes individuals 50 years of age and older who are experiencing high levels of worry. The program was developed in the context of a community-academic partnership with organizations that provide services for seniors in underserved communities, and it trains nontraditional community providers to deliver the intervention.

RESULTS

Study progress to date, challenges, and lessons learned are discussed. Data collection is ongoing, and study findings will be available in late 2017.

CONCLUSIONS

CL will offer valuable information to help expand the reach of anxiety treatment among minority seniors living in underserved neighborhoods.

The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males

PURPOSE

To explore perceptions of facilitators/barriers to sexual and reproductive health (SRH) care use among an urban sample of African-American and Hispanic young men aged 15-24 years, including sexual minorities.

METHODS

Focus groups were conducted between April 2013 and May 2014 in one mid-Atlantic U.S. city. Young men aged 15-24 years were recruited from eight community settings to participate in 12 groups. Moderator guide explored facilitators/barriers to SRH care use. A brief pregroup self-administered survey assessed participants' sociodemographics and SRH information sources. Content analysis was conducted, and three investigators independently verified the themes that emerged.

RESULTS

Participants included 70 males: 70% were aged 15-19 years, 66% African-American, 34% Hispanic, 83% heterosexual, and 16% gay/bisexual. Results indicated young men's perceptions of facilitators/barriers to their SRH care use come from multiple levels of their socioecology, including cultural, structural, social, and personal contexts, and dynamic inter-relationships existed across contexts. A health care culture focused on women's health and traditional masculinity scripts provided an overall background. Structural level concerns included cost, long visits, and confidentiality; social level concerns included stigma of being seen by community members and needs regarding health care provider interactions; and personal level concerns included self-risk assessments on decisions to seek care and fears/anxieties about sexually transmitted infection/HIV testing. Young men also discussed SRH care help-seeking sometimes involved family and/or other social network members and needs related to patient-provider interactions about SRH care.

CONCLUSIONS

Study findings provide a foundation for better understanding young men's SRH care use and considering ways to engage them in care.

Disability and Psychiatric Symptoms in Men Referred for Treatment with Work-Related Problems to Primary Mental Health Care

The relationship between male sex and employment as barriers to accessing mental health care is unclear. The aim of this research was to examine (1) whether the clinical features of men referred to a shared mental health care (SMHC) service through primary care differed when symptoms were affecting them in the work domain; and (2) empirically re-evaluate the effectiveness of a SMHC model for work-related disability using a pre-post chart review of N = 3960 referrals to SMHC. ANOVA and logistic regression were performed to examine symptoms (Patient Health Questionnaire, PHQ) and disability (World Health Organization Disability Assessment Schedule, WHODAS 2) at entry and discharge. Men were RR (relative risk) = 1.8 (95% C.I.: 1.60–2.05) times more likely to be referred to SMHC with work problems than women. Having greater disability and more severe somatic symptoms increased the likelihood of a work-related referral. There were no significant differences after treatment. Problems in the work domain may play an important role in men’s treatment seeking and clinicians’ recognition of a mental health care need. This study is relevant because men are underrepresented in mental health (MH) treatment and primary care is the main gateway to accessing MH care. Asking men about functioning in the work domain may increase access to helpful psychiatric services.

Different Patterns in Health Care Use Among Immigrants in Spain

This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16-64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population.

Masculinity and suicidal thinking

PURPOSE

Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.

METHODS

We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.

RESULTS

After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).

CONCLUSIONS

It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence.

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff

Background

One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals’ responses to women and their families who ‘speak up’ about early warning signs and symptoms.

Methods

A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant.

Results

Following thematic analysis, three themes were identified; 1: Women’s understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families’; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from ‘normal’ pregnancy changes.

Conclusions

Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.

Respondents' report of a clinician-diagnosed depression in health surveys: comparison with DSM-IV mental disorders in the general adult population in Germany

BACKGROUND

Respondents' report of a previously diagnosed depression by a health professional is frequently used to estimate depression prevalence. This study contributes to a better understanding of survey results based on this measure by comparing it with a comprehensive standardized diagnostic interview.

METHODS

Data came from the cross-sectional nationwide German Health Interview and Examination Survey for Adults (DEGS1) and its mental health module (DEGS1-MH, n = 4483). In DEGS1, participants were asked whether they have been diagnosed with depression by a physician or psychotherapist (last 12-month). DSM-IV-based 12-month major depressive disorder (MDD) and other mental disorders were assessed with the German version of the Composite International Diagnostic Interview (CIDI). Time lag between both assessments was 6 weeks (median).

RESULTS

73.4% of participants reporting clinician-diagnosed depression met criteria for any mental disorder in the CIDI (any affective disorder: 51.8%, any anxiety disorder: 54.7%). The proportion of participants reporting a clinician-diagnosed depression who met MDD criteria was highest among those aged 18-29 years (62.6%) and decreased with age (65-79 years: 29.8%). Among participants with MDD, the proportion with clinician-diagnosed depression was 33.0%, highest among those aged 45-64 years (49.3%) and lowest among those aged 18-29 years (22.7%) and 30-44 years (20.3%). MDD severity was positively associated with clinician-diagnosed depression.

CONCLUSIONS

Respondents' report of a clinician-diagnosed depression and major depression assessed with the CIDI substantially differ. Concordance of both measures varies with age and severity of depressive symptoms. Health surveys should assess a range of depression indicators in order to cover a wide spectrum.

Gender-related patterns and determinants of recent help-seeking for past-year affective, anxiety and substance use disorders: findings from a national epidemiological survey

AIMS

To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care.

METHOD

Analyses focused on 689 males and 1075 females aged 16-85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests.

RESULTS

Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost).

CONCLUSIONS

Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).

Towards a preventive strategy for complaints of arm, neck and/or shoulder (CANS): the role of help seeking behaviour

Background

When developing an effective early preventive strategy for employees and students with CANS (Complaints of Arm, Neck or Shoulder, not caused by acute trauma or systemic disease), insight in help seeking behaviour and knowledge of factors associated with help seeking behaviour within the target population, is a prerequisite. The aim of this study was to examine whether perceived hindrance is associated with help seeking behaviour, specifically in employees and students identified with CANS. Additionally, the associations of factors related to functioning and participation, work-environment and demographics with help seeking behaviour were explored in these groups.

Methods

A cross-sectional survey was conducted among employees and students of two universities in the South of the Netherlands. The questionnaire included questions to assess (1) demographics, work/study and activity related factors (2) experience of CANS (3) perceived hindrance (4) help seeking behaviour. A subpopulation of the survey, consisting of those employees and students with self-reported CANS, received additional questionnaires to examine the impact of (1) participant characteristics (2) complaint and health related variables (3) functioning and participation (4) work-environment and social support, on help seeking behaviour.

Results

37.3% of the employees and 41.4% of the students reported CANS. Of these, respectively 43.3% and 45.5%, did not seek help and had no intention to seek help either. Employees and students who had not sought help reported less hindrance, less perceived disabilities and shorter duration of complaints, compared those who did seek help. Employees and students within this group who had also no intention to seek help, perceived fewer disabilities and reported shorter duration of complaints.

Conclusion

The absence of help seeking behaviour in respondents with CANS is a bottleneck for implementation of preventive strategies. In employees and students with CANS, help seeking behaviour is primarily determined by factors related to experienced hindrance. Our findings emphasize the need to tailor preventive strategies, in order to optimize screening and participation in early interventions for CANS.

Why do men go to the doctor? Socio-demographic and lifestyle factors associated with healthcare utilisation among a cohort of Australian men

BACKGROUND

Men use health services less often than women and frequently delay seeking help even if experiencing serious health problems. This may put men at higher risk for developing serious health problems which, in part, may explain men's higher rates of some serious illnesses and shorter life span relative to women. This paper identifies factors that contribute to health care utilisation in a cohort of Australian men by exploring associations between socio-economic, health and lifestyle factors and the use of general practitioner (GP) services.

METHODS

We used data from Ten to Men, the Australian Longitudinal Study on Male Health. Health care utilisation was defined in two ways: at least one GP visit in the past 12 months and having at least yearly health check-ups with a doctor. Associations between these two measures and a range of contextual socio demographic factors (education, location, marital status, country of birth, employment, financial problems etc.) as well as individual health and lifestyle factors (self-rated health, smoking, drinking, healthy weight, pain medication) were examined using logistic regression analysis. The sample included 13,763 adult men aged 18 to 55 years. Analysis was stratified by age (18 to 34 year versus 35 to 55 years).

RESULTS

Overall, 81 % (95 % CI: 80.3-81.6) of men saw a GP for consultation in the 12 months prior to the study. The odds of visiting a GP increased with increasing age (p < 0.01), but decreased with increasing remoteness of residence (p < 0.01). Older men, smokers and those who rate their health as excellent were less likely to visit a GP in the last 12 months, but those on daily pain medication or with co-morbidities were more likely to have visited a GP. However, these factors were not associated with consulting a GP in the last 12 months among young men. Overall, 39 % (95 % CI: 38.3-39.9) reported having an annual health check. The odds of having an annual health check increased with increasing age (p < 0.01), but showed no association with area of residence (p = 0.60). Across both age groups, the odds of a regular health check increased with obesity and daily pain medication, but decreased with harmful levels of alcohol consumption.

CONCLUSION

The majority of men (61 %) did not engage in regular health check-up visits, representing a missed opportunity for preventative health care discussions. Lower consultation rates may translate into lost opportunities to detect and intervene with problems early and this is where men may be missing out compared to women.

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

Development of a Suicidal Ideation Detection Tool for Primary Healthcare Settings: Using Open Access Online Psychosocial Data

BACKGROUND

Suicidal patients often visit healthcare professionals in their last month before suicide, but medical practitioners are unlikely to raise the issue of suicide with patients because of time constraints and uncertainty regarding an appropriate approach.

INTRODUCTION

A brief tool called the e-PASS Suicidal Ideation Detector (eSID) was developed for medical practitioners to help detect the presence of suicidal ideation (SI) in their clients. If SI is detected, the system alerts medical practitioners to address this issue with a client. The eSID tool was developed due to the absence of an easy-to-use, evidence-based SI detection tool for general practice.

MATERIAL AND METHODS

The tool was developed using binary logistic regression analyses of data provided by clients accessing an online psychological assessment function. Ten primary healthcare professionals provided advice regarding the use of the tool.

RESULTS

The analysis identified eleven factors in addition to the Kessler-6 for inclusion in the model used to predict the probability of recent SI. The model performed well across gender and age groups 18-64 (AUR 0.834, 95% CI 0.828-0.841, N = 16,703). Healthcare professionals were interviewed; they recommended that the tool be incorporated into existing medical software systems and that additional resources be supplied, tailored to the level of risk identified.

CONCLUSION

The eSID is expected to trigger risk assessments by healthcare professionals when this is necessary. Initial reactions of healthcare professionals to the tool were favorable, but further testing and in situ development are required.

The role of masculinity in men's help-seeking for depression: A systematic review

AIM

Conformity to traditional masculine gender norms may deter men's help-seeking and/or impact the services men engage. Despite proliferating research, current evidence has not been evaluated systematically. This review summarises findings related to the role of masculinity on men's help-seeking for depression.

METHOD

Six electronic databases were searched using terms related to masculinity, depression and help-seeking. Titles and abstracts were reviewed and data systematically extracted and examined for methodological quality.

RESULTS

Of 1927 citations identified, 37 met inclusion criteria. Seventeen (46%) studies reported qualitative research; eighteen (49%) employed quantitative methods, and two (5%) mixed methods. Findings suggest conformity to traditional masculine norms has a threefold effect on men experiencing depression, impacting: i) their symptoms and expression of symptoms; ii) their attitudes to, intention, and, actual help-seeking behaviour; and, iii) their symptom management.

CONCLUSION

Results demonstrate the problematic impact of conformity to traditional masculine norms on the way men experience and seek help for depression. Tailoring and targeting clinical interventions may increase men's service uptake and the efficacy of treatments. Future research examining factors associated with men's access to, and engagement with depression care will be critical to increasing help-seeking, treatment uptake, and effectual self-management among men experiencing depression.

Family history and perceived risk of diabetes, cardiovascular disease, cancer, and depression

BACKGROUND

Family history is a useful and inexpensive tool to assess risks of multifactorial diseases. Family history enables individualized disease prevention, but its effects on perceived risks of various diseases need to be understood in more detail. We examined how family history relates to perceived risk of diabetes mellitus, cardiovascular disease (CVD), cancer, and depression, and whether these associations are independent of or moderated by sociodemographic factors, health behavior/weight status (smoking, alcohol consumption, physical activity, BMI [kg/m(2)]), or depressive symptoms.

METHODS

Participants were Finnish 25-74-year-olds (N=6258) from a population-based FINRISK 2007 study. Perceived absolute lifetime risks (Brewer et al., 2004; Becker, 1974; Weinstein and Nicolich, 1993; Guttmacher et al., 2004; Yoon et al., 2002) and first-degree family history of CVD, diabetes, cancer and depression, and health behaviors were self-reported. Weight and height were measured in a health examination.

RESULTS

Family history was most prevalent for cancer (36.7%), least for depression (19.6%). Perceived risk mean was highest for CVD (2.8), lowest for depression (2.0). Association between family history and perceived risk was strongest for diabetes (β=0.34, P<0.001), weakest for depression (β=0.19, P<0.001). Adjusting for sociodemographics, health behavior, and depressive symptoms did not change these associations. The association between family history and perceived risk tended to be stronger among younger than among older adults, but similar regardless of health behaviors or depressive symptoms.

DISCUSSION

Association between family history and perceived risk varies across diseases. People's current understandings on heritability need to be acknowledged in risk communication practices. Future research should seek to identify effective strategies to combine familial and genetic risk communication in disease prevention.

Association among Items from the Self-Report Version of the Hamilton Depression Scale (Carroll Rating Scale) and Respondents' Sex

The association among items of the self-reported version of the Hamilton Depression Scale (Carroll Rating Scale), answered according to a memory of a maximally disturbing event experienced, and respondents' sex was examined in a nonclinical sample of 320 college students, 164 women ( M age = 21.7 yr., SD = 3.6) and 156 men ( M age = 23.5 yr., SD = 5.8). An assessment of sex bias was also evaluated. Multiple regression analysis showed that statements regarding unhappiness, urge to cry, dizziness and faintness, and waking in the middle of the night were significantly associated with women. Removal of these items from the Carroll Rating Scale Total scores eliminated the sex differences in depression rates. Items that displayed significant sex bias were those regarding behavior and emotions commonly attributed to women within the general population.

Diverse and Dynamic Interactions: A Model of Suicidal Men's Help Seeking as It Relates to Health Services

There is a striking gender difference in suicide rates worldwide, with men accounting for approximately 80% of all suicide deaths. In contradictory public discussions, suicidal men are presented sometimes as victims of "poor" health services and sometimes as irremediable, "poor" help seekers. A more substantive theory of suicidal men's help seeking, which moves beyond homogenizing accounts to examine the complex interplay between help seeking and health services, is now required. Eighteen life history interviews were undertaken with men who had engaged in nonfatal suicide. Interviews were analyzed within a theoretical framework of gender relations. The findings challenge static and uniform notions of suicidal men's help seeking. While a few men actively avoided health services, others actively sought help, and in many cases help-seeking practices were triggered by unsolicited encounters with health services. Responsibility for help-seeking behavior did not rest solely with suicidal men. Men's help-seeking practices could either be facilitated or blocked by the character of the professional support that was available. Men in this study overwhelmingly rejected services that framed emotional distress and suicidal behavior as mental illness.

Latino Immigrant Men's Perceptions of Depression and Attitudes Toward Help Seeking

Perceptions of depression, attitudes toward depression treatments, help-seeking preferences, and perceived barriers to care were examined in a sample of 56 Latino immigrant men recruited from a primary health care clinic. Each participant was presented a vignette depicting an individual with major depression. Men described the vignette as a debilitating condition caused by social stressors that would improve with time. Men preferred counseling over medications and reported misconceptions about antidepressants. Faith in God and seeking help from family members were seen as important help-seeking strategies. Structural and financial barriers were prevalent among this sample of men. Implications for improving depression care for Latino immigrant men are discussed.

Masculinity and Race-Related Factors as Barriers to Health Help-Seeking Among African American Men

Men's tendency to delay health help-seeking is largely attributed to masculinity, but findings scarcely focus on African American men who face additional race-related, help-seeking barriers. Building principally on reactance theory, we test a hypothesized model situating racial discrimination, masculinity norms salience (MNS), everyday racism (ERD), racial identity, sense of control (SOC), and depressive symptomatology as key barriers to African American men's health help-seeking. A total of 458 African American men were recruited primarily from US barbershops in the Western and Southern regions. The primary outcome was Barriers to Help-Seeking Scale (BHSS) scores. The hypothesized model was investigated with confirmatory factor and path analysis with tests for measurement invariance. Our model fit was excellent [Formula: see text] CFI = 0.99; TLI = 1.00; RMSEA = 0.00, and 90% CI [0.00, 0.07] and operated equivalently across different age, income, and education strata. Frequent ERD and higher MNS contributed to higher BHHS scores. The relationship between ERD exposure and BHHS scores was partially mediated by diminished SOC and greater depressive symptomatology. Interventions aimed at addressing African American men's health help-seeking should not only address masculinity norms but also threats to sense of control, and negative psychological sequelae induced by everyday racism.

Differences in quality of life of women and men with drug-resistant epilepsy in Poland

PURPOSE

The aim of the study was to assess the differences in health-related quality of life in groups of men and women suffering with drug-resistant epilepsy and to determine which factors influence quality of life.

METHODS

The examined group consisted of 64 subjects with drug-resistant epilepsy - 31 men and 33 women. The mean duration of epilepsy was 17.56±8.92 and 19±9.56years, respectively. The following diagnostic tools were used: QOLIE-31-P, Wechsler Adult Intelligence Scale - Revised (WAIS-R (PL)), and Hamilton Rating Scale for Depression (HRSD).

RESULTS

Scores in QOLIE-31-P did not differ significantly between groups of men and women with drug-resistant epilepsy; however, a more detailed analysis revealed certain disparities. Multiple regression analyses indicated that some distinct factors were associated with quality of life in each sex. In the group of women, there were no significant predictors of their quality of life. Among the group of men, depression intensity was the only statistically significant QoL predictor, explaining 16% of the variance (adjusted R(2)=0.16, F(6, 24)=19.7, p<0.01). Moreover, patients with depression had lowered scores in the Emotional Well-Being and Energy/Fatigue subscales, regardless of the sex.

CONCLUSION

The study revealed that, despite similar scores in QOLIE-31-P, specific factors may differentially affect the quality of life of men and women with drug-resistant epilepsy in Poland. Nevertheless, replication of these results with a larger number of participants is needed for a more definitive conclusion.

American College Students' Views of Depression and Utilization of On-Campus Counseling Services

BACKGROUND

College students are becoming increasingly depressed; however, many do not attend university counseling to seek help.

OBJECTIVES

What is the relationship between young adults' mental health literacy, perceived stigma of depression and treatment, knowledge of treatment benefits and risks, beliefs about alternative therapies, and influence of his or her social network with usage of university counseling?

STUDY DESIGN

A survey was administered to N = 107 American undergraduate college students to ascertain the students' understanding of depression and their views of counseling services on campus.

RESULTS

Both likelihood of using alternative therapies and perceived discrimination of social network accounted for 18% of the variance for likelihood of participants seeking campus counseling.

CONCLUSIONS

When a young adult college student perceives stigma or discrimination of depression from family and friends, then they may be less likely to seek university counseling for depression as well as possible applications with alternative therapies as a favorable option.

Gender Differences in Borderline Personality Disorder Features in an Epidemiological Sample of Adults Age 55-64: Self Versus Informant Report

The literature on the prevalence of borderline personality disorder (BPD) across gender reveals multiple trends. A number of studies indicate that women have a higher prevalence. Others indicate no difference, and a few even reveal that men have a higher prevalence. Yet existing studies are plagued by sampling biases, use mainly self-reported information, and tend to report general prevalence of BPD categorically defined. The current investigation attempted to shed new light on this literature by analyzing BPD features dimensionally in a representative epidemiological sample of adults ages 55-64, using both self- and informant-reported perspectives. Data from the St. Louis Personality and Aging Network study revealed a significant interaction across gender and perspective, F(1, 1360) = 23.46, p < .01. Gender differences were found for self-report only, such that men reported greater BPD severity. Meanwhile, informant report indicated no gender difference. Trends underscore the importance of epidemiological sampling and multiple assessment perspectives when analyzing BPD.

Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men

Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts. Prior research has shown that men are less likely than women to express overt affect and/or report depression symptoms that may prompt primary care physicians' inquiry about depression. Previous studies have overlooked the idioms of distress common among older men. This study investigates: a) the range of idioms of distress that emerge in the narratives of depressed older men, and b) the use of these idioms among depressed WNM and Mexican-origin older men. The present report is based on qualitative data collected through the Men's Health and Aging Study (MeHAS), a mixed-method study of clinically depressed WNM and Mexican-origin older (65 and above) men recruited in primary care settings. Qualitative analysis of 77 interviews led to identification of idioms of distress and informed idiom categories. Study findings show that: a) both groups of men utilized a range of idioms of distress that met current DSM criteria for depression, b) both groups were also likely to utilize idioms that feel outside clinical depression criteria, and c) there were similarities as well as differences between WNM and Mexican-origin men. This study provides a larger vocabulary that clinicians might consider in recognizing depression and initiating depression care for older men from diverse ethnic backgrounds. This is important to improve depression care among older men in general and those of Mexican-origin in particular.

Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management

Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators.

Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables.

Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping).

Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity.

Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.

How do we improve men's mental health via primary care? An evaluation of the Atlas Men's Well-being Pilot Programme for stressed/distressed men

BACKGROUND

Over three-quarters of all suicides are men (England and Wales), this is despite higher levels of anxiety and depression being reported by women. This disparity may in part be explained by atypical presentations of distress in men, and gendered issues around help-seeking. Consequently, the Atlas Men's Well-being Programme was designed to engage stressed/distressed men who were patients at a London-based GP surgery. Atlas encouraged GPs to identify and refer men for counselling and/or acupuncture by raising their awareness of men's distress. The aim of this pilot study was to evaluate Atlas in terms of patients' characteristics, service utilisation, patient outcomes and cost implications.

METHODS

All patients using the Programme were asked to complete a questionnaire before and after their Atlas sessions. Outcome measures included the Hospital Anxiety and Depression scale, Perceived Stress Scale, Warwick-Edinburgh Mental Well-being Scale, a 11-point scale measuring physical health, and the Psychological Outcome Profiles (PSYCHLOPS), a patient-generated outcome measure. Additionally, for cost calculations, participants were asked about their employment, number of days off work due to illness, and their health and social care service use.

RESULTS

102 participants were recruited, 82 completed pre- and post-treatment questionnaires. Comparisons pre- and post-treatment revealed a statistically significant improvement in anxious mood (p <0.001), perceived stress (p < 0.001), positive well-being (p = <0.001), PSYCHLOPS (p = <0.001) and physical health (p = 0.001), though not depressed mood (p = 0.660). Additionally, reductions in costs related to lost employment and health and social care use, exceeded the cost of Atlas counselling and acupuncture sessions, with an average saving of nearly £700 per patient.

CONCLUSIONS

Atlas attendance was associated with improvements in patients' mental and physical health, and demonstrated likely cost savings. It is now important to understand patient and stakeholder perspectives. Further research could compare usual care with the Atlas approach, and investigate full cost-effectiveness.

Prenatal parental depression and preterm birth: a national cohort study

Objective

To investigate the effects of maternal and paternal depression on the risk for preterm birth.

Design

National cohort study.

Setting

Medical Birth Register of Sweden, 2007–2012.

Population

A total of 366 499 singleton births with linked information for parents’ filled drug prescriptions and hospital care.

Methods

Prenatal depression was defined as having filled a prescription for an antidepressant drug or having been in outpatient or inpatient hospital care with a diagnosis of depression from 12 months before conception until 24 weeks after conception. An indication of depression after 12 months with no depression was defined as ‘new depression’, whereas all other cases were defined as ‘recurrent depression’.

Main outcome measures

Odds ratios (ORs) for very preterm (22–31 weeks of gestation) and moderately preterm (32–36 weeks of gestation) births were estimated using multinomial logistic regression models.

Results

After adjustment for maternal depression and sociodemographic covariates, new paternal prenatal depression was associated with very preterm birth [adjusted OR (aOR) 1.38, 95% confidence interval (95% CI) 1.04–1.83], whereas recurrent paternal depression was not associated with an increased risk of preterm birth. Both new and recurrent maternal prenatal depression were associated with an increased risk of moderately preterm birth (aOR 1.34, 95% CI 1.22–1.46, and aOR 1.42, 95% CI 1.32–1.53, respectively).

Conclusions

New paternal and maternal prenatal depression are potential risk factors for preterm birth. Mental health problems in both parents should be addressed for the prevention of preterm birth.

Tweetable abstract

Depression in both mothers and fathers is associated with an increased risk of preterm birth.

Depression in both mothers and fathers is associated with an increased risk of preterm birth.

Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany

BACKGROUND

While standardized diagnostic interviews using established criteria are the gold standard for assessing depression, less time consuming measures of depression and depressive symptoms are commonly used in large population health surveys. We examine the prevalence and health-related correlates of three depression measures among adults aged 18-79 years in Germany.

METHODS

Using cross-sectional data from the national German Health Interview and Examination Survey for Adults (DEGS1) (n=7987) and its mental health module (DEGS1-MH) (n=4483), we analysed prevalence and socio-demographic and health-related correlates of (a) major depressive disorder (MDD) established by Composite International Diagnostic Interview (CIDI) using DSM-IV-TR criteria (CIDI-MDD) in the last 12 months, (b) self-reported physician or psychotherapist diagnosed depression in the last 12 months, and (c) current depressive symptoms in the last two weeks (PHQ-9, score ≥10).

RESULTS

Prevalence of 12-month CIDI-MDD was 4.2% in men and 9.9% in women. Prevalence of 12-month self-reported health professional-diagnosed depression was 3.8% and 8.1% and of current depressive symptoms 6.1% and 10.2% in men and women, respectively. Case-overlap between measures was only moderate (32-45%). In adjusted multivariable analyses, depression according to all three measures was associated with lower self-rated health, lower physical and social functioning, higher somatic comorbidity (except for women with 12-month CIDI-MDD), more sick leave and higher health service utilization.

LIMITATIONS

Persons with severe depression may be underrepresented. Associations between CIDI-MDD and correlates and overlap with other measures may be underestimated due to time lag between DEGS1 and DEGS1-MH.

CONCLUSIONS

Prevalence and identified cases varied between these three depression measures, but all measures were consistently associated with a wide range of adverse health outcomes.

Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda

PURPOSE

Mental disorders commonly affect young people but usually go unrecognized and untreated. This study aimed to investigate help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care among young adults with current depression and/or suicidality in a low-income setting.

METHODS

This cross-sectional study used two sub-populations: a sub-sample of those suffering from current depression and/or suicidality (n = 247) and another of those not suffering from these conditions and not suffering from any other mental condition investigated (n = 502). Help-seeking behaviours, barriers to care and self-efficacy for mental health care seeking were measured among those suffering from current depression and/or suicidality (n, %). Logistic regression was used to identify risk factors for experiencing barriers to care. Self-efficacy for seeking mental health care was compared between men and women in the two sub-populations.

RESULTS

Of the 247 men and women with current depression and/or suicidality, 36.0 % sought help at a health care unit and 64.0 % from trusted people in the community. Only six people received help from a mental health professional. The identified barriers were mainly related to accessibility and acceptability of health services. For the population suffering from current depression and/or suicidality, the self-efficacy scale for seeking mental health care suggested a low confidence in accessing mental health care but a high confidence in respondents' ability to successfully communicate with health care staff and to cope with consequences of seeking care.

CONCLUSION

The current study clearly highlights young adults' poor access to mental health care services. To reach universal health coverage, substantial resources need to be allocated to mental health, coupled with initiatives to improve mental health literacy in the general population.