Illness representations of depression and perceptions of the helpfulness of social support: comparing depressed and never-depressed persons

Exploring the Barriers to Social Support Interactions: A Qualitative Study of Young Adult Cancer Patients and Young Adult Supporters

This study explores the reasons why young adults (ages 18-39) struggle to provide or avoid providing support to young adult cancer patients. The study also explores young adult cancer patients' perceptions of why they have not received support from individuals who did not provide support. A total of 722 reasons were collected through online surveys and analyzed: 438 were provided by young adults who knew a young adult with cancer (N = 131), and young adult cancer patients (N = 111) provided 284 reasons why they believe they did not receive support. Initially using a previous typology of 16 nonsupport reasons, an abductive thematic analysis yielded a total of 21 barriers to the provision of social support. These barriers were categorized across four higher-order categories: recipient-focused, supporter-focused, relationship-focused, and context-focused. Some reasons provided by young adult supporters were not provided by young adult patients and vice versa, suggesting the potential for discrepancies between why cancer patients believe they did not receive support and nonsupporters' actual reasons for not providing support. These various reasons why people struggled to provide support or avoided providing support can act as a list of barriers that future researchers and practitioners can address through the development of resources and interventions aimed at fostering adequate support provision throughout individuals' cancer experiences. Cancer patients can address the experience of nonsupport by individuals in their lives by being more direct in communicating their support desires and, when unsuccessful, using cognitive reappraisal strategies.

Support marshaling strategies among college students with anxiety and depression

Objective: The purpose of this study is to identify ways in which college students use support-seeking strategies to improve mental health-related goals. Participants: Participants included college students from a Mid-Atlantic university who identified as having experienced anxiety or depression in their lifetime. Method: Using a support marshaling framework and thematic analysis, this paper analyzed qualitative responses (n = 330) that detailed individuals' experiences with network members when trying to gain support or avoid barriers surrounding their mental health. Results: This analysis revealed new support marshaling strategies specific to a mental health context. Participants frequently employed indirect avoidance strategies (e.g., decreased interaction time; 12.66%) and direct approach strategies (e.g., soliciting mental health support; 43.33%). Conclusions: College students equally experience opposition and support when trying to achieve mental health-related goals. Future research might consider which network members express support and opposition, and how these newly identified strategies apply in support marshaling contexts outside mental health.

Lay beliefs about the causes and treatment of depression: Tests of measurement models and associations

BACKGROUND

There is reason to expect beliefs about depression's causes and treatment to influence use of psychotherapy, but the literature is marked by theoretical, methodological, and empirical inconsistencies. This study assessed the factorial validity of measures of beliefs about depression's causes and formal treatment versus self-management. It also tested the links of causal attributions to general treatment/self-management beliefs and endorsement of specific interventions.

METHODS

The revised Illness Perception Questionnaire (IPQ-R) adapted for depression was administered online to a non-patient, U.S. sample (N = 319).

RESULTS

Confirmatory factor analyses yielded three causal dimensions, Environmental Stressors, Biological Factors, and Personal Attributes, and two control dimensions, (Formal) Treatment and Personal. Both models fit irrespective of whether respondents believed they had ever experienced depression. A structural equation model (SEM) showed a positive relationship for Environmental and Biological attributions, and an inverse relationship for Personal attributions, in predicting general preferences for Formal Treatment. A second SEM, focusing on specific interventions, linked Environmental causation to endorsement of psychotherapy, dietary changes, and self-help, and Biological causation to endorsement of medication and exercise, with Personal causation inversely associated with endorsement of psychotherapy.

LIMITATIONS

A cross-sectional, correlational design precludes causal inferences. Potential sociocultural influences were not assessed.

CONCLUSIONS

Modifications to the IPQ-R suggested by this study improved its psychometric properties, validated its distinction between Treatment and Personal Control beliefs, and supported examination of both general and specific beliefs about ways to deal with depression. Relationships linking cause and treatment beliefs warrant further investigation as potential intervention targets to increase treatment utilization.

Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry

BACKGROUND

Depressive disorders are a serious public health concern. Left untreated, further clinical distress and impairment in important life domains may arise. Yet, the treatment gap remains large. Prior research has shown that individuals with depressive disorders prefer seeking help from informal sources such as family and friends ahead of formal sources. However, this preference has its disadvantages such as experiencing actual, perceived and internalized stigmatizing responses from them which may delay or deter help-seeking. This paper aimed to determine the role of perceived stigma among family and friends in an individual's help-seeking behavior.

METHODS

Data were collected using semi-structured interviews with patients with depressive disorders from a tertiary psychiatric hospital in Singapore to capture individuals' self-reported experience with depression and stigmatization among family and friends. Interviews were audio recorded and transcribed verbatim. Data of 33 young adults (mean age = 26 years, SD =4.6; 18 female, 15 male) were analyzed using thematic analysis.

RESULTS

In all, four broad themes were developed: (1) absence of support, (2) provision of unhelpful support, (3) preference for non-disclosure, and (4) opposition towards formal help-seeking. Lack of awareness of depression and perpetuation of stigma manifests as barriers towards help-seeking in the form of absence of support and provision of unhelpful support which subsequently leads to a preference for non-disclosure, as well as opposition by family and friends towards formal help-seeking.

CONCLUSIONS

Data from this study can contribute to the development of public health programs aimed at improving awareness and support from family and friends and facilitating earlier help-seeking among young people with depressive disorders.

The Experience of Depression Relapse among Adult Thai Patients with Depressive Disorder: A Qualitative Study

Background:

Depressive disorder is a disease with widespread incidence and has shown an annual increase, while depression relapse is also rising continually due to multiple causes. In Thailand, although many studies have been conducted to prevent depression incidence and relapse, there is little known about the meaning of depression relapse in adult Thai patients. An exploration of the direct experiences of adult Thai patients seems a suitable way to gather data for a care system development.

Objectives:

The objective of this study is to describe the perceptions of adult Thai patients concerning their experience of depression relapse and its management among adult patients with depressive disorder in the Thai context.

Methods:

This research is a qualitative study using the directed content analysis approach. In-depth interviews with 20 adult Thai patients with depressive disorders that had direct experience with depression relapse were the data collection method used in this study. The interviews allowed the participants to talk about their experiences with depression relapse and how to manage depressive symptoms; the interviews lasted approximately 60 minutes.

Results:

Two themes emerged from the study. First, the experience of depression relapse is the feeling of something pulling away from happiness. Second, managing depression relapse.

Conclusion:

Depression relapse among adult Thai patients with depressive disorder is an experience causing patients to feel that they are losing their happiness again. Care and management of depression relapse by each patient differ, despite being in the same social contexts. Therefore, depression relapse risk assessment is important in the care of each patient in order to design more effective care.

Understanding the Impact of the Psychological Cognitive Process on Student Learning Satisfaction: Combination of the Social Cognitive Career Theory and SOR Model

In higher education, student learning satisfaction is a significant predictor of learning that indicates the commitment students have to their learning and future academic achievement. The study combines the social cognitive career theory (SCCT) and the stimulus-organism-response (SOR) model to explore the psychological cognition and attitudes derived from students during their learning, discusses the pattern of student learning satisfaction enhancement from the aspect of process, and further understands the relationships among social support systems, interaction relationships, self-efficacy, generic skills, and learning satisfaction. In this study, 800 valid copies of questionnaires were collected from 12 universities through purposive sampling, and the structural model was analyzed by partial least squares structural equation modeling (PLS-SEM). The results showed that the relationships among all the constructs were positive and showed a significant effect; furthermore, the research results showed that self-efficacy and student generic skills had a significantly indirect effect in the model-specifically, a mediating effect. Finally, corresponding theoretical and practical implications were put forward based on the research results.

COVID-19 pandemic-related representations, self-efficacy, and psychological well-being in the general population during lockdown

The aim of this study was to examine the association among representations of the COVID-19 pandemic, self-efficacy to cope with the anti-pandemic measures (e.g., general lockdown), and psychological distress in the Greek general population. The study was conducted online, during the general lockdown in the country, and 358 individuals (239 females) participated (mean age = 36.89; SD = 12.15). A perception of personal control over the condition, negative emotions towards the pandemic, and self-efficacy to cope with the current anti-pandemic measures were related to psychological distress. Also, a significant interaction between representation clusters and self-efficacy to cope with potential future difficulties (i.e., after the anti-pandemic measures are ended), was found. Specifically, the association between this type of self-efficacy and psychological distress was significant only for the 'low-impact' representations cluster (i.e., a perception of the pandemic as less burdensome and more controllable). The findings indicate that the factors which, according to previous research and theory, are significantly related to psychological distress during a health threat, are important also in times of a pandemic. They also suggest a potential adaptation-promoting synergy between pandemic-related self-efficacy and a more positive representation of COVID-19, as far as psychological distress is conerned. Thus, these factors may serve as the basis for the development of pandemic-related health behavior promotion programs.

Illness Perceptions of Cystic Fibrosis: A Comparison of Young Adults with CF and Same-Aged Peers

In the last two decades, the life expectancy for individuals with Cystic Fibrosis (CF) has increased significantly. The limited research examining the psychosocial experiences of young adults with CF indicates that other young adults lack awareness and understanding of CF. Using the Illness Perception Questionnaire, perceptions of CF were examined in individuals with CF aged 16 to 25 and two groups of same-aged peers: those who did, or did not, know someone with CF. ANOVA with pairwise comparisons revealed that individuals with CF perceived significantly fewer physical symptoms of illness and fewer emotional and practical consequences of CF than both groups of peers. Individuals with CF also perceived significantly more personal control and greater understanding of CF than peers without experience of CF. Implications for enhancing opportunities for social engagement and for the provision of social support for young people with CF are identified.

Prevalence and influencing factors of depressive symptoms among women of reproductive age in the rural areas of Hubei, China

OBJECTIVES

Depression is one of the most common mental disorders and a major public health problem in the Chinese population, especially among women. The current study aims to understand prevalence of depression symptoms and provide detailed epidemiological factors associated with depression among reproductive women in rural areas which was paid less attention in previous surveys.

STUDY DESIGN

Cross-sectional study.

METHODS

Face-to-face household interviews were conducted on 1058 women (age: 15-49 years) in rural areas from July 2012 to August 2012. Questionnaires were used to investigate the influencing factors of depression among women. Pearson's χ(2), logistic regression analysis and structural equation modelling (SEM) were applied to analyze the related factors.

RESULTS

The prevalence of depression among women was 30.7% [95% confidence interval (CI): 27.9%-33.5%]. Compared with non-depressed individuals, those with depression were more likely to be short of social support [odd ratio (OR): 0.940, P < 0.001) and have no one to talk with (OR: 0.366, P < 0.001), to be dissatisfied with the house (OR: 2.673, P < 0.001) and economy (OR: 2.268, P < 0.01) of their family, and to have great pressure (OR: 2.099, P < 0.01), negative life events (OR: 1.485, P < 0.05) and physical diseases (OR: 1.364, P < 0.05). Pressure status, social support assessment, and socio-economic status were negatively related to depression (correlation coefficient: -0.57, -0.27 and 0.17).

CONCLUSIONS

The high prevalence of depression among reproductive women in rural areas is of particular concern. Factors associated with depression may assist health care administrations to identify and assess high-risk women and target strategies accordingly.

Social contacts and depression in middle and advanced adulthood: findings from a US national survey, 2005-2008

AIM

Empirical evidence has linked social contacts with mental stability. The aim is to assess how social contacts are associated with depression among the general population.

METHODS

We analysed the data of 5,681 adults aged 40 or older, who completed a depression screening as a part of the National Health and Nutrition Examination Survey, 2005-2008. Depression was ascertained using the Patient Health Questionnaire (PHQ), a nine-item screening instrument asking about the frequency of depression symptoms over the past two weeks. A PHQ score of 10 or higher was defined as depression.

RESULTS

The prevalence of depression was 5.54% (SE = 0.64) and 8.49% (SE = 0.71), respectively, among men and women. The association between social contacts and depression were more salient among men than women. The odds ratios (ORs) of depression were 2.43 (95% CI = 1.44-4.10), 2.42 (95% CI = 1.37-4.28), 1.00 (reference) and 1.94 (95% CI = 0.80-4.71), respectively, among men who never attended church, attended occasionally, weekly and more than weekly. The corresponding ORs were 1.79 (95% CI = 1.10-2.91), 1.72 (95% CI = 1.06-2.80), 1.00(reference) and 0.98 (95% CI = 0.52-1.84) for women. Compared with the respondents who had 10 or more friends, the ORs of depression were 4.01 (95% CI = 1.89-8.50) and 1.86 (95% CI = 0.92-3.79), respectively, for men and women who had no close friends.

CONCLUSIONS

The current study concluded that traditional social contacts remain strongly associated with depression in the digital era. Digital social networking is one of the biggest growing industries, creating a new platform to make social contacts. There is an urgent need to explore how to maximize the potential of digital social networking to strengthen social bonds while minimizing its negative effects.

Factors predicting the long-term illness course in a cohort of depressed inpatients

Depressed psychiatric inpatients show particularly high rates of recurrence and chronicity. To identify predictors of their long-term illness course is of high importance for tertiary prevention. We followed up 68 unipolarly depressed psychiatric inpatients 1, 6, 42, and 66 months after discharge. Outcomes included time spent in episodes, time to relapse/recurrence, and psychosocial functioning during the prospective 5.5-year interval. Predictors included demographic, clinical, cognitive vulnerability, and social support variables assessed at baseline. During the total observation period, 12 % of patients spent <50 % of time in remission, and 55 % of those remitted at post-discharge baseline suffered a relapse or recurrence. Mean psychosocial functioning was below normal functioning at all assessments. Depression levels after discharge and unsatisfactory relationships within the support network predicted all outcomes. Furthermore, early onset, longer episode duration prior to study entry, and state orientation predicted time spent in episodes. Further predictors of time to recurrence included number of previous hospitalizations and lack of psychotherapy after discharge. Long-term psychosocial functioning was additionally predicted by previous hospitalizations, duration of index episode, and state orientation. Our results demonstrate a highly recurrent and chronic illness course in depressed psychiatric inpatients. Identified predictors point to the need of treating depressive episodes to full remission. Psychological interventions should explicitly address patients' interpersonal needs and possible deficits.

Feeling labeled, judged, lectured, and rejected by family and friends over depression: cautionary results for primary care clinicians from a multi-centered, qualitative study

Background

Family and friends may help patients seek out and engage in depression care. However, patients’ social networks can also undermine depression treatment and recovery. In an effort to improve depression care in primary care settings, we sought to identify, categorize, and alert primary care clinicians to depression-related messages that patients hear from friends and family that patients perceive as unhelpful or detrimental.

Methods

We conducted 15 focus groups in 3 cities. Participants (n = 116) with a personal history or knowledge of depression responded to open-ended questions about depression, including self-perceived barriers to care-seeking. Focus group conversations were audio-recorded and analyzed using iterative qualitative analysis.

Results

Four themes emerged related to negatively-received depression messages delivered by family and friends. Specifically, participants perceived these messages as making them feel labeled, judged, lectured to, and rejected by family and friends when discussing depression. Some participants also expressed their interpretation of their families’ motivations for delivering the messages and described how hearing these messages affected depression care.

Conclusions

The richness of our results reflects the complexity of communication within depression sufferers’ social networks around this stigmatized issue. To leverage patients’ social support networks effectively in depression care, primary care clinicians should be aware of both the potentially beneficial and detrimental aspects of social support. Specifically, clinicians should consider using open-ended queries into patients’ experiences with discussing depression with family and friends as an initial step in the process. An open-ended approach may avoid future emotional trauma or stigmatization and assist patients in overcoming self-imposed barriers to depression discussion, symptom disclosure, treatment adherence and follow-up care.

Illness beliefs and treatment beliefs as predictors of short and middle term outcome in depression

The article investigates whether illness beliefs and beliefs about rehabilitation are predictors of short and middle term outcome in depression even when adjustments are made for variables, which are known to be predictors of the course of depression. Within the context of a non-controlled prospective study design, data were analyzed using forced entry hierarchical multiple regression analyses. The sample comprised N = 98 patients. Adjusting for a range of sociodemographic and medical predictors, illness beliefs and beliefs about rehabilitation predict outcome in depression. Illness beliefs and beliefs about rehabilitation are relevant starting points for designing patient-oriented interventions.

Seeking help for depression from family and friends: a qualitative analysis of perceived advantages and disadvantages

BACKGROUND

People with depression often seek help from family and friends and public health campaigns frequently encourage such help seeking behaviours. However, there has been little systematically collected empirical data concerning the effects of such informal help seeking. The current study sought to investigate the views of consumers about the advantages and disadvantages of seeking support from family and friends for depression.

METHODS

Participants were the subset of 417 respondents to a survey, sent to 7000 randomly selected members of an Australian electoral community, who indicated that they had sought help for depression from family or friends. One item on the survey asked participants to indicate the advantages or disadvantages of seeking help from family or friends. A coding system was developed based on a content analysis of the responses to the item. Each of the responses was then coded by two raters.

RESULTS

Respondents identified both advantages and disadvantages of seeking support from friends. The most commonly cited advantage was social support (n = 282) including emotional support (n = 154), informational support (n = 93), companionship support (n = 36) and instrumental support (n = 23). Other advantages related to family's or friend's background knowledge of the person and their circumstances (n = 72), the opportunity to offload the burden associated with depression (n = 62), the personal attributes of family and friends (n = 49), their accessibility (n = 36), and the opportunity to educate family and friends and increase their awareness about the respondent's depression (n = 30). The most commonly cited disadvantages were stigma (n = 53), inappropriate support (n = 45), the family member's lack of knowledge, training and expertise (n = 32) and the adverse impact of the help seeking on the family/friend (n = 20) and the relationship (n = 18).

CONCLUSIONS

Family and friends are well placed to provide support which consumers perceive to be positive and which can assist them in obtaining formal mental health treatment. However, the input of some family members may be unhelpful or toxic. There may be benefits in undertaking community education and destigmatisation programs which target carers.