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

Development and validation of a geriatric depression knowledge scale for older adults with depression

Poor adherence to antidepressants increases the risk of suicide, while greater mental health awareness promotes seeking appropriate treatment, highlighting the urgent need to assess depression knowledge. This study aimed to develop and assess the psychometrics of a Geriatric Depression Knowledge Scale (GDKS) for older adults with depression. In phase 1, 18 items were generated through an intensive literature review and clinical experiences. Phase 2 involved assessing content and face validities of the GDKS. In phase 3, a cross-sectional study (206 older adults, 100 psychiatric professionals) determined construct validity, internal consistency, and test-retest reliability. GDKS demonstrated excellent content and face validity. Older participants scored significantly lower than psychiatric professionals, confirming excellent construct validity. Reliability was evident with a Kuder-Richardson formula 20 score of 0.72 and a 4-week test-retest reliability of 0.86 (p < 0.01). The GDKS provides a reliable tool for evaluating geriatric depression knowledge in psychiatric outpatient settings.

Depression literacy and misconceptions scale (DepSter): a new two-factorial tool for measuring beliefs about depression

BACKGROUND

Depression literacy has received extensive attention within mental health research. It has been studied by different social groups and professions in Western and non-Western cultures. The importance of this topic stems from the fact that depression literacy is strongly related to attitudes toward people who are diagnosed with depression, the tendency to stigmatize this mental disorder, and to the propensity to undertake help-seeking behaviors. Therefore, understanding and promoting depression literacy is crucial in contemporary mental health prevention and promotion. We propose a new two-factorial tool measuring beliefs about depression. This 14-item self-report measure captures how people vary across two dimensions of beliefs about depression-depression literacy and misconceptions about depression.

METHODS

In ten studies with a total sample of over 4,600 participants from three countries, we demonstrated the two-factorial structure of the Depression Literacy and Misconceptions Scale (DepSter) in Polish (Studies 1 and 2), American (Study 4), and British (Study 5) samples. We showed measurement equivalence for the Polish and English versions of the scale (Study 3). Furthermore, we tested the discriminant meaning of the two dimensions of beliefs about depression analyzing its association with health literacy, mental health literacy, and prejudice toward people with mental illness (Study 4), depression literacy and depression stigma (Study 5), empathetic concerns (Study 7), social dominance orientation (Study 8), and the Big Five personality traits (Study 9). We also investigated whether individuals with formal education in psychology and direct or indirect experience with depression demonstrate a higher level of depression literacy and a lower level of misconceptions about depression (Study 6). Our measure showed high stability for two dimensions of beliefs about depression (Study 10), in both its Polish and English versions, with the measurement conducted after three weeks and three months.

DISCUSSION

We conclude that the proposed approach to beliefs about depression capturing both depression literacy and misconceptions about depression measured with the DepSter scale can easily be applied in clinical and social settings, especially in studies concerning the perception of those diagnosed with depression.

Mental health literacy questionnaire-short version for adults (MHLq-SVa): validation study in China, India, Indonesia, Portugal, Thailand, and the United States

BACKGROUND

Mental Health Literacy (MHL) has become a focus of research in recent decades, as a prerequisite for early identification and intervention for mental health problems. Although several instruments have been developed for assessing MHL, there is a need for brief and psychometrically sound measures to capture important aspects of MHL in large and diverse adult samples. The present study aimed to: (1) provide a revised and shorter version of a previously validated questionnaire for assessing MHL; and (2) examine the psychometric properties of the MHLq-SVa in student samples from six different countries (China, India, Indonesia, Portugal, Thailand, and United States).

METHODS

The study involved 2180 senior school and undergraduate students, aged between 17 and 25 years old, from China, India, Indonesia, Portugal, Thailand, and the United States. Participants responded to the Mental Health Literacy Questionnaire for young adults (MHLq-ya), in their native language, following its translation and adaptation for each culture. The MHLq-ya comprises 29 items, organized into four dimensions: Knowledge of mental health problems; Erroneous beliefs/stereotypes; First-aid skills and help-seeking behavior; Self-help strategies. Confirmatory factor analyses and internal consistency analyses were performed on the combined data.

RESULTS

Data from the different countries supported a shorter version of the questionnaire (MHLq-SVa), composed of 16 items that fit with previously defined dimensions. Internal consistency and between-factor correlations further supported the adequacy of the instrument's psychometric properties.

CONCLUSION

The study provided preliminary support for the construct validity and reliability of the MHLq-SVa as a measure for assessing MHL in young adults from six different countries and languages. Future studies are needed to further validate the measure and undertake multicultural comparisons of MHL in diverse samples from around the globe.

Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE

BACKGROUND

Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders.

METHODS

We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data.

RESULTS

The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003).

CONCLUSIONS

The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.

Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory

OBJECTIVES

Understanding depression as biologically caused has been shown to impact both treatment preferences and prognostic pessimism. Attribution theory has been posited as an explanation for this relationship. Given that evidence-based psychotherapy is effective yet often not delivered to individuals with depression, the present study sought to determine factors that impact treatment credibility.

DESIGN

Non-treatment-seeking, depressed individuals (n = 229) were randomly assigned to read a psychoeducation article about depression that consisted of a biological causal explanation, psychosocial causal explanation, or a non-causal control.

METHODS

Attributional dimensions of locus, stability, and control were examined as mediating the relationship between causal explanation and treatment credibility and prognostic pessimism.

RESULTS

Individuals in the biological condition were more likely to find antidepressant medication a credible treatment for depression. The manipulation had no direct effect on preference for psychotherapy or prognostic pessimism. Attributional dimensions of locus, stability, and control did not mediate the relationship between causal explanation and treatment credibility. To the extent that the psychosocial article increased perceived instability of the depression cause, however, prognostic pessimism was reduced.

CONCLUSIONS

The present study has implications for framing education about depression in mental health literacy programs and public awareness campaigns.

PRACTITIONER POINTS

This study found that conceptualizing depression as biologically caused increased the credibility of medication but not psychotherapy Participants reading a biological explanation of depression demonstrated an increase on some aspects of stigma and prognostic pessimism Emphasizing the person-environment interaction rather than biological causes decreased the perceived stability of depression which was associated with a decrease in prognostic pessimism.

Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures

Although the last decade has seen a proliferation of research on mental illness stigma, lack of consistency and clarity in both the conceptualization and measurement of mental illness stigma has limited the accumulation of scientific knowledge about mental illness stigma and its consequences. In the present article, we bring together the different foci of mental illness stigma research with the Mental Illness Stigma Framework (MISF). The MISF provides a common framework and set of terminology for understanding mechanisms of mental illness stigma that are relevant to the study of both the stigmatized and the stigmatizer. We then apply this framework to systematically review and classify stigma measures used in the past decade according to their corresponding stigma mechanisms. We identified more than 400 measures of mental illness stigma, two thirds of which had not undergone any systematic psychometric evaluation. Stereotypes and discrimination received the most research attention, while mechanisms that focus on the perspective of individuals with mental illness (e.g., experienced, anticipated, or internalized stigma) have been the least studied. Finally, we use the MISF to discuss the strengths and weaknesses of mental illness stigma measurement, identify gaps in the literature, and provide recommendations for future research.

The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review

AIMS

Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools.

METHODS

We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown.

RESULTS

We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36).

CONCLUSIONS

We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.

Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure

Mental health literacy (MHL) is an important factor in mental health care. However, few measures are available that assess multiple components of MHL and that are applicable to lay community people. A valid, comprehensive measure is needed to adequately identify the level of MHL and need for mental health education. This study presents the development of a multicomponent MHL measure and its psychometric properties. Participants (n=211) were recruited from a local public housing authority in Texas. A series of an exploratory factor analysis, a confirmatory factor analysis, an independent sample t-test, and a correlation analysis were used to assess construct, known-groups, and concurrent validity. Internal consistency reliability was examined by Kuder-Richardson Formula 20. The result suggested a second-order factor model by three first-order factors: knowledge-oriented MHL; beliefs-oriented MHL; resource-oriented MHL. This measure was a valid tool to assess MHL among public housing staff. This measure can be useful in examining lay community members' levels of MHL.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

BACKGROUND

Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap.

METHODS

We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures.

RESULTS

We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

CONCLUSIONS

Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.

Beliefs about depression and its treatments: associated variables and the influence of beliefs on adherence to treatment

Beliefs and attitudes about treatment in patients with depression are significant factors related to treatment adherence. Despite their importance, few studies have evaluated the determining factors of these beliefs, and the positive or negative attitudes towards treatment. This review looks at areas such as, adherence to antidepressants and psychotherapy, influence of beliefs and attitudes on adherence to treatment, beliefs and attitudes about depression and its treatment, their assessment, variables associated with these beliefs, and limitations of available studies. Acknowledging the importance of patient beliefs about depression and treatment, and their assessment are essential to optimize the chances of success of therapy by identifying and addressing misconceptions, prejudices and negative attitudes, as well as the consideration of these aspects in order to improve treatment choice.

Clinicians' attitudes to depression in Europe: a pooled analysis of Depression Attitude Questionnaire findings

BACKGROUND

Depression in primary care is common but under-recognized and suboptimally managed. Health professionals' attitudes are likely to play an important part in their recognition and management of depression.

OBJECTIVES

To pool findings from studies using the Depression Attitude Questionnaire (DAQ) to provide greater detail of clinicians' attitudes and the measure's psychometric properties.

METHODS

Electronic databases and grey literature were searched for relevant studies. Data from eligible studies were requested and pooled analysis conducted.

RESULTS

Twenty studies were eligible and data were obtained from 12 of these involving GPs (n = 1543) and nurses (n = 984). Responses showed strong disagreement that depression is due to ageing or weakness. European GPs were more positive about depression treatments than UK GPs; nurses were more favourable about psychotherapy than GPs. UK GPs especially strongly opposed notions that depression is best managed by psychiatrists. Trends over time indicated increasing acknowledgement of psychological therapies and the nurse's role in depression management. Factor analysis indicated that many DAQ items fitted weakly within an overall model. The most parsimonious solution involved two factors: a positive view of depression and its treatment response and professional confidence in depression management.

CONCLUSIONS

Individual DAQ items appear to measure key aspects of clinicians' attitudes to depression, and item responses indicate important differences between professions and geographical settings as well as changes over time. There are problems with the DAQ as a scale: its internal consistency is weak, and several items appear specific to particular professions or service structures, indicating that this questionnaire should be revised.

Evaluating the psychometric properties of the attitudes towards depression and its treatments scale in an Australian sample

BACKGROUND

Individuals' attitudes towards depression and its treatments may influence their likelihood of seeking professional help and adherence to treatment when depressed. Objective measures, such as the Attitudes Towards Depression and its Treatments scale (ATDT), have been developed to assess such attitudes. The aims of this research were to test the reliability and validity of ATDT on an Australian sample who were not depressed during the study or who had previously been depressed, to explore the attitudes of the Australian public towards depression, and to compare these attitudes to those of a Canadian sample of people with depression.

METHODS

A sample of 63 males and 140 females (mean age = 32.2 years, SD = 12.9 years) from Melbourne, Australia took part in this study. Fourteen of the males and 52 of the female participants (mean age = 35.4 years, SD = 13.2 years) stated that they had been previously diagnosed with depression.

RESULTS

THE ATTITUDES OF THE AUSTRALIAN SAMPLE AND THE SUBSET OF THAT SAMPLE WHO HAD PREVIOUSLY EXPERIENCED DEPRESSION DIFFERED FROM THOSE OF THE CANADIAN OUTPATIENT SAMPLE: they were less ashamed of depression, more likely to take antidepressants and consider psychotherapy, and more likely to seek help from professionals or significant others in their lives. However, those in the Australian sample were more likely to report that antidepressants made them lose control, and they were less willing to consider electric shock as a treatment option for their depression. The internal reliability as measured by Cronbach's alpha was lower in the current study (0.63 and 0.57 for both the general public and the depressed Australian sample) than in the Canadian study. Confirmatory factor analysis failed to replicate the factor structure reported previously.

LIMITATIONS

The Australian sample of this study may be underrepresentative due to the sampling methods used, and the high proportion of females should not be overlooked.

CONCLUSION

Researchers should be vigilant when utilizing measures constructed in different countries. In comparison to the Canadians, the selected Australian sample had more positive attitudes towards depression and its available treatments. The ATDT scale was not a reliable and valid measure in this sample.

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.

Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study

BACKGROUND

There is little information on the degree to which self-stigma is experienced by individuals with a diagnosis of bipolar disorder or depression across Europe. This study describes the levels of self-stigma, stigma resistance, empowerment and perceived discrimination reported in these groups.

METHODS

Data were collected from 1182 people with bipolar disorder or depression using a mail survey with members of national mental health non-governmental organisations.

RESULTS

Over one fifth of the participants (21.7%) reported moderate or high levels of self-stigma, 59.7% moderate or high stigma resistance, 63% moderate or high empowerment, and 71.6% moderate or high perceived discrimination. In a reduced multivariate model 27% of the variance in self-stigma scores, among people with a diagnosis of bipolar disorder or depression, was accounted for by levels of empowerment, perceived discrimination, number of areas of social contact, education and employment.

LIMITATIONS

Findings are limited by the use of an unweighted sample of members of mental health charity organisations which may be unrepresentative of the reference population.

CONCLUSIONS

These findings suggest that self-stigma occurs among approximately 1 in 5 people with bipolar disorder or depression in Europe. The tailoring of interventions to counteract (or fight against) the elements of self-stigma which are most problematic for the group, be they alienation, stereotype endorsement, social withdrawal or discrimination experience, may confer benefit to people with such disorders.

Knowledge of and attitudes towards depression and adherence to treatment: the Antidepressant Adherence Scale (AAS)

BACKGROUND

Non-adherence to treatment can result from forgetting, carelessness, stopping the drug when feeling worse, or stopping the drug when feeling better.

OBJECTIVE

To develop and psychometrically assess a brief instrument that can be easily used in clinical practice to measure adherence to antidepressants.

METHOD

We developed the Antidepressants Adherence Scale (AAS); a self report rating scale including four items to assess the degree to which forgetting, carelessness, and stopping due to feeling worse or feeling better interfere with adherence in the last 4 weeks. Our proposed four-item adherence instrument was developed based on previous research and theory.

PARTICIPANTS

Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to patients who were prescribed antidepressants (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, and a Likert self report questionnaire to assess attitudes towards depression and its treatment.

RESULTS

There was 90% agreement among experts that the items were highly relevant providing strong evidence for content validity. Also, there was empirical evidence for validity. There were significant correlations (p<0.05) between knowledge and attitude subscales and adherence items. The internal consistency reliability (Cronbach's alpha) was 0.66 for the instrument.

CONCLUSION AND SIGNIFICANCE

Knowledge of and attitudes to depression and its treatment may have significant impact on the adherence to antidepressants. The AAS can be used in clinical settings (2-3 min to administer) to evaluate patients' adherence to antidepressants.