Can Mental Health Anti-stigma Messages Have Untoward Effects on Some People with Depression?: An Exploratory Study

The role of mental well-being in the effects of persuasive health messages: A scoping review

Emerging evidence in health communication and psychology suggests that a) exposure to specific persuasive health messages can have unintended effects on the mental well-being of recipients and b) recipients' mental well-being before exposure can influence message processing. Available evidence regarding the relationship between mental well-being and exposure to specific health messages lacks consistency and is scattered across different fields. This scoping review of 24 publications summarizes what is known about mental health effects in health communication and provides a research agenda for future work. Among others, key findings suggest that particularly negative emotional appeals may have broad, negative effects on indicators of hedonic well-being. Further, humor and gain appeals may positively impact mental well-being, although positive message features are strongly understudied in this space. Lower mental well-being prior to message exposure may impact message processing, but not necessarily message effectiveness. We find that potential well-being effects of health communication have been largely ignored, especially outside the realm of mental health research. Yet, initial evidence does underline the importance of such inquiry. This review summarizes initial evidence of systematic, unintended effects of health messaging on mental well-being and highlights fruitful avenues for future work in this space.

The paradox of the resident experiencing depression: Higher depression, less favorable help-seeking outcome expectations, and lower help-seeking intentions

BACKGROUND

Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help.

METHODS

The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier-and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States.

RESULTS

There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies.

CONCLUSIONS

The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking.

Effort and effort discounting as predictors of seeking psychotherapy among individuals with depression

OBJECTIVES

Many individuals who experience depression do not seek psychotherapy, and past research has had limited success in predicting help-seeking in this population. Accounting for behavioral characteristics of depression that affect help-seeking decisions, such as effort discounting (devaluation of rewards as a function of effort), may address this gap.

METHODS

Individuals with moderate-severe depression symptoms who were not in psychotherapy (N = 253) reported their depression symptom severity and the amount of effort they anticipated seeking psychotherapy would require; they also completed a behavioral measure of effort discounting. At a 3-month follow-up, they reported whether they initiated psychotherapy during the follow-up period.

RESULTS

Depression symptom severity was associated with perceptions that seeking psychotherapy would be more effortful. In turn, perceptions that seeking psychotherapy would be more effortful prospectively predicted a lower likelihood of initiating psychotherapy. Effort discounting was unrelated to psychotherapy use.

CONCLUSIONS

These results suggest that differences in the anticipated effort required to seek psychotherapy can increase depressed individuals' risk of going untreated. Future research may test whether reducing the effort of seeking psychotherapy increases psychotherapy use among those with depression. For instance, streamlining insurance enrollment procedures, implementing patient decision aids, or offering telehealth treatment options may be beneficial.

A Reasoned Action Approach to Depression Help-Seeking Messaging for College Students: Implications of Cognitive Biases in Depression

In this study we integrated insights from research on cognitive biases in depression with the reasoned action approach to predicting and changing behavior (RAA) with the goal of identifying implications for help-seeking messaging for college students with varying levels of depression. Findings from a sample of 374 U.S. college students support the ability of RAA to explain help-seeking intentions for non-depressed, mildly depressed students, and moderate to severely depressed students. More severe depression was associated with less favorable attitudes, perceived norms, perceived capacity, and intention; changes in the relative strength of attitudes, perceived norms, and perceived capacity in explaining help-seeking intentions; stronger expectations of negative outcomes of help-seeking and weaker expectations of positive outcomes; and to some extent, stronger expectations of negative outcomes for oneself than for others. These findings underscore that depressed students construe help-seeking differently than non-depressed students, and that depressed and non-depressed students need different help-seeking messages.

Stigmatizing Attitudes Across Cybersuicides and Offline Suicides: Content Analysis of Sina Weibo

Background

The new reality of cybersuicide raises challenges to ideologies about the traditional form of suicide that does not involve the internet (offline suicide), which may lead to changes in audience’s attitudes. However, knowledge on whether stigmatizing attitudes differ between cybersuicides and offline suicides remains limited.

Objective

This study aims to consider livestreamed suicide as a typical representative of cybersuicide and use social media data (Sina Weibo) to investigate the differences in stigmatizing attitudes across cybersuicides and offline suicides in terms of attitude types and linguistic characteristics.

Methods

A total of 4393 cybersuicide-related and 2843 offline suicide-related Weibo posts were collected and analyzed. First, human coders were recruited and trained to perform a content analysis on the collected posts to determine whether each of them reflected stigma. Second, a text analysis tool was used to automatically extract a number of psycholinguistic features from each post. Subsequently, based on the selected features, a series of classification models were constructed for different purposes: differentiating the general stigma of cybersuicide from that of offline suicide and differentiating the negative stereotypes of cybersuicide from that of offline suicide.

Results

In terms of attitude types, cybersuicide was observed to carry more stigma than offline suicide (χ²₁=179.8; P<.001). Between cybersuicides and offline suicides, there were significant differences in the proportion of posts associated with five different negative stereotypes, including stupid and shallow (χ²₁=28.9; P<.001), false representation (χ²₁=144.4; P<.001), weak and pathetic (χ²₁=20.4; P<.001), glorified and normalized (χ²₁=177.6; P<.001), and immoral (χ²₁=11.8; P=.001). Similar results were also found for different genders and regions. In terms of linguistic characteristics, the F-measure values of the classification models ranged from 0.81 to 0.85.

Conclusions

The way people perceive cybersuicide differs from how they perceive offline suicide. The results of this study have implications for reducing the stigma against suicide.

Help-seeking intentions in the U.S. population during the COVID-19 pandemic: Examining the role of COVID-19 financial hardship, suicide risk, and stigma

The primary goal of this study was to increase understanding of help-seeking intentions in the U.S. population during the COVID-19 pandemic and to examine influencing factors such as COVID-19 financial hardship, suicide risk, and stigma in order to contribute to effective theory-based help-seeking and suicide prevention campaigns. In a representative sample of U.S. adults (N = 5,010), this research tested whether COVID-19 financial hardship was associated with higher levels of depression and suicidal ideation (supported), and whether the reasoned action framework could usefully predict help-seeking intentions in this context (supported). The reasoned action framework explained 36% of the variance in help-seeking intentions in the U.S. population and identified injunctive norm (social support) as primary determinant of intention. Neither suicidal ideation, COVID-19 financial hardship, or self-stigma of seeking help influenced determinants of help-seeking. Future research should test injunctive norm as causal predictor of help-seeking in the U.S. population to usefully inform effective help-seeking campaigns, particularly among those who have experienced COVID-19 financial hardship. Additionally, effective dissemination strategies for help-seeking campaigns should be tested and identified, such as broader targeted approaches as well as intentional mis-targeting techniques.