An Evaluation ofbeyondblue, Australia's National Depression Initiative

Defining the Characteristics of an e-Health Tool for Suicide Primary Prevention in the General Population: The StopBlues Case in France

With over one million deaths per year in the world, suicide is a major public health problem that could be significantly reduced by effective prevention programs. E-health tools are of particular interest for primary prevention as they can address a broad population including people unaware of their own risk and provide information and help without the fear of stigma. Our main objective was to define the overall characteristics of an e-health tool for suicide primary prevention in the French general population by defining the characteristics of the IT features; the content of the information delivered; the best way to structure it; and how it should be relayed and by whom. The research was carried out through a literature review and a co-construction phase with stakeholders. Four types of strategies may guide the construction of e-health tools for suicide primary prevention: education and awareness, (self-)screening, accessing support, and mental health coping. They should be accessible on different devices to reach the most users, and language and content should be adapted to the target population and to the issue being addressed. Finally, the tool should be consistent with ethical and quality best practices. The e-health tool StopBlues was developed following those recommendations.

Designing and scaling up integrated youth mental health care

Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.

The effect of causal attributions for depression on help-seeking and treatment preferences

BACKGROUND

Depression is a leading cause of ill-health and disability globally and encouraging help-seeking and treatment engagement is a key priority of health authorities worldwide. Causal attributions for mental illness have numerous attitudinal and behavioural consequences; however, limited research has explored their implications for attitudes to treatment. This study experimentally investigates the impact of causal attributions for depression on attitudes to specific help-seeking and treatment options.

METHODS

In an online study, 196 participants read a vignette that emphasised either biological, social or biopsychosocial causes of a character's depression. Participants rated several help-seeking and treatment options on how helpful or harmful they would be for the individual described in the vignette and for themselves personally.

RESULTS

The causal attribution manipulation significantly affected treatment attitudes. Relative to social attributions, emphasising biological causes of depression significantly decreased the perceived helpfulness of lifestyle-based treatments, but did not affect attitudes to psychotherapeutic or medical treatment options. Participants rated most help-seeking and treatment options as less helpful for themselves compared to the vignette character. Participants with personal experience of depression had lower confidence in informal sources of help-seeking and greater confidence in medical treatment.

LIMITATIONS

Limitations include reliance on self-report measures and low reliability of certain sub-scales.

CONCLUSIONS

These findings suggest emphasising the biological underpinnings of depression could deter people from engaging with lifestyle-based treatment options. Promoting biopsychosocial theories of depression could increase awareness about the multifactorial causes of depression without negatively impacting the perceived efficacy of any help-seeking or intervention options.

Suicide Stigma and Suicide Literacy in a Clinical Sample

OBJECTIVE

The aims of this study were to (1) investigate levels and correlates of suicide stigma and suicide literacy in a sample of individuals attending a tertiary depression clinic in Australia (N = 287), with comparison to a community-based Australian sample (N = 1,410), and (2) validate measures of suicide stigma and literacy in a clinical sample.

METHOD

Australian adults (N = 287) aged 18-78 years referred by their general practitioners for assessment at a psychiatric clinic for patients with difficult-to-treat mood disorders were recruited to complete a survey, including measures of suicide literacy, suicide stigma, mental health symptoms, and demographics.

RESULTS

Compared to the Australian community sample, participants in the clinical sample reported lower suicide literacy, lower suicide stigma, greater glorification of suicide, and greater attribution of suicide to isolation. Suicide ideation was associated with greater glorification of suicide. Females had higher suicide literacy and lower suicide stigma than males. The psychometric properties of the suicide stigma measure appeared to be robust and consistent with previous evaluations.

CONCLUSION

Given the low levels of suicide literacy in this clinical sample, suicide prevention initiatives designed for community settings may also be important in clinical settings.

The first 30 months of the MindSpot Clinic: Evaluation of a national e-mental health service against project objectives

OBJECTIVE

The MindSpot Clinic provides online mental health services to Australian adults with anxiety and depression. This paper describes users of MindSpot between January 2013 and June 2015. Outcomes are considered against three key objectives: improving access to mental health services, improving public awareness of how to access services and providing evidence-based treatments.

METHOD

Website traffic data were examined to determine patterns of use. Demographic characteristics, past service utilisation and reasons for contacting MindSpot were analysed. Outcomes for patients enrolled in a MindSpot treatment course were also analysed. Primary outcomes were scores on the 9-Item Patient Health Questionnaire, Generalised Anxiety Disorder 7-Item, Yale-Brown Obsessive Compulsive Scale and Post-Traumatic Stress Disorder Checklist-Civilian Version, administered at assessment, post-treatment and 3-month follow-up.

RESULTS

The website was visited by almost 500,000 Australians, of which 33,990 adults started assessments, and 25,469 people completed assessment and were eligible for analysis. Mean age was 36.4 years (standard deviation = 13.3 years; range = 18-94 years), and 72% were female. The proportion living in rural or remote regions and who identified as Aboriginal and Torres Strait Islander closely matched national statistics. The majority (82%) reported that they were not currently in contact with mental health services. Most patients sought an assessment, information about treatment options, or referral to another service, and only 24% of those completing an assessment commenced a MindSpot treatment course. Of these, large clinical effects ( d: 0.7-2.4; average symptom reductions: 25.5% to 61.6%) were found from assessment to follow-up on all outcome measures. Deterioration ranged from 1.0% to 4.3%.

CONCLUSION

Based on the number of website visits, completed assessments and treatment outcomes, MindSpot achieved its three programme objectives. This model of service provision has considerable value as a complement to existing services, and is proving particularly important for improving access for people not using existing services.

The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia

AIMS

School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11-17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.

METHODS

We reviewed literature on the prevention of depression to identify all interventions targeting youth that would be suitable for implementation in Australia and had evidence of efficacy to support analysis. From this, we found evidence of effectiveness for the following intervention types: universal prevention involving group-based psychological interventions delivered to all participating school students; and indicated prevention involving group-based psychological interventions delivered to students with subthreshold depression. We constructed a Markov model to assess the cost-effectiveness of delivering universal and indicated interventions in the population relative to a 'no intervention' comparator over a 10-year time horizon. A disease model was used to simulate epidemiological transitions between three health states (i.e., healthy, diseased and dead). Intervention effect sizes were based on meta-analyses of randomised control trial data identified in the aforementioned review; while health benefits were measured as Disability-adjusted Life Years (DALYs) averted attributable to reductions in depression incidence. Net costs of delivering interventions were calculated using relevant Australian data. Uncertainty and sensitivity analyses were conducted to test model assumptions. Incremental cost-effectiveness ratios (ICERs) were measured in 2013 Australian dollars per DALY averted; with costs and benefits discounted at 3%.

RESULTS

Universal and indicated psychological interventions delivered through face-to-face modalities had ICERs below a threshold of $50 000 per DALY averted. That is, $7350 per DALY averted (95% uncertainty interval (UI): dominates - 23 070) for universal prevention, and $19 550 per DALY averted (95% UI: 3081-56 713) for indicated prevention. Baseline ICERs were generally robust to changes in model assumptions. We conducted a sensitivity analysis which found that internet-delivered prevention interventions were highly cost-effective when assuming intervention effect sizes of 100 and 50% relative to effect sizes observed for face-to-face delivered interventions. These results should, however, be interpreted with caution due to the paucity of data.

CONCLUSIONS

School-based psychological interventions appear to be cost-effective. However, realising efficiency gains in the population is ultimately dependent on ensuring successful system-level implementation.

Experiences of discrimination and positive treatment from health professionals: A national survey of adults with mental health problems

OBJECTIVE

To systematically investigate the scope and nature of discrimination and positive treatment experienced by adults with mental health problems when using health services in an Australian population-based survey.

METHODS

Australian adults (n = 1381) who reported a mental health problem or scored high on a screening questionnaire were interviewed about their experience of discrimination and positive treatment from healthcare professionals. Descriptions of experiences were content-analysed to identify key characteristics.

RESULTS

In all, 11.8% of respondents reported discrimination from a health professional in the past 12 months. The most common types of discrimination included being treated dismissively, being judged and not being listened to, particularly regarding personal history and treatment needs. In contrast, 40.4% reported being treated more positively by their health professional because of their mental health problem. Key types of positive treatment by health professionals were being supportive and understanding and being a good listener. Good quality care approaches were also appreciated, including making a referral, being engaged in the treatment process, regularly checking the status of the person's mental health and providing information.

CONCLUSION

A minority of respondents with mental health problems had experienced discrimination from their healthcare professional, potentially interfering with recovery. Anti-stigma education interventions for healthcare professionals should address how to increase knowledge and understanding of mental health problems, reduce negative attitudes and encourage supportive behaviours.

Over-diagnosed and over-treated: a survey of Australian public attitudes towards the acceptability of drug treatment for depression and ADHD

BACKGROUND

Over the last decade the use of psychotropic medications to treat common mental health problems has increased in Australia. This paper explores: 1) public attitudes towards the acceptability of using prescription drugs to treat depression and attention deficit hyperactivity disorder (ADHD), and 2) beliefs about over-diagnosis of depression and ADHD.

METHOD

1293 members of the general public were surveyed about their attitudes towards drug treatment for depression and ADHD through the Queensland Social Survey (QSS), an omnibus state-wide survey of households in the state of Queensland. The survey was administered through a CATI (computer-assisted telephone interviewing) system. Logistic regression analyses were used to predict belief that drug treatment is acceptable, and that depression and ADHD are over-diagnosed.

RESULTS

Most participants (60.9%) said that it was acceptable to use prescription drugs to treat depression. In contrast, attitudes towards the use of prescription drugs to treat ADHD were much less positive with around the same proportion saying it was acceptable (42.1%) as unacceptable (38.2%). More than half of the sample agreed that too many people are diagnosed with depression when they don't really have it (57.7%), and 78.3% of participants agreed that too many children are diagnosed with ADHD when they don't really have it. Participants who said depression or ADHD were over-diagnosed were less likely to say that it is acceptable to treat these conditions with prescription drugs.

CONCLUSIONS

Despite increases in prescribing rates there is still considerable scope for increasing the public's acceptance of treating common mental illnesses with psychotropic drugs. Furthermore, the public's views on over-diagnosis of depression and ADHD appear to reflect ongoing controversy about the proper identification of these conditions, and these views negatively impact attitudes towards drug treatment. This may be a barrier to effective treatment of these conditions given that drug treatment is often recommended as a first line response.

Youth mental health: we know where we are and we can now say where we need to go next

AIM

To provide an overview of the state of knowledge relevant to the development of youth-specific mental health initiatives.

METHODS

A selective review of data, particularly from Australian community and health service studies, that are relevant to the decisions faced by those who fund and organize health services internationally.

RESULTS

It is possible to reach consensus on key issues such as the current state of evidence, myths that need to be challenged, areas of genuine uncertainty, priorities for future reform, and five and ten year goals and targets.

CONCLUSIONS

There is considerable convergence of evidence from epidemiology, clinical and basic neuroscience, population health and health service evaluation that supports an urgent new investment in development and evaluation of youth mental health initiatives.

How to tackle a giant: creating a genuine evaluation of the Better Access Program

OBJECTIVE

This paper proposes a framework for a systematic evaluation of the Better Access Program, the largest single component of mental health reform announced under the Council of Australian Governments National Action Plan on Mental Health 2006-11.

METHOD

The article explores the genesis of the Program and considers extant data sets and information available with which to establish the impact of the Program on consumers and service providers.

RESULTS

There are useful data available in Australia from which to derive pre- and post-implementation analysis about the impact of the Better Access Program. There is doubt as to whether these data form part of the Federal Government's current approach to evaluation of the Program.

CONCLUSIONS

Anything less than a genuine and comprehensive evaluation will leave Australia unable to assess the real impact of the Better Access Program. The merit of further expenditure in the vital area of primary mental health care will be in doubt as a consequence.

Using e-health applications to deliver new mental health services

Traditional clinic-based service delivery systems remain inaccessible to many Australians with mental health problems. If we are to substantially reduce the burden of mental illness, we need to develop more accessible, empowering and sustainable models of mental health care. E-health technologies have specific efficiencies and advantages in the domains of health promotion, prevention, early intervention and prolonged treatment. It is timely to use the best features of these technologies to start to build a more responsive and efficient mental health care system.

The internet as a setting for mental health service utilisation by young people

OBJECTIVE

To explore patterns of internet use by young people in Australia and assess the usefulness of online resources for mental health problems, exploring functionality that may be relevant in the development of online mental health services.

DESIGN AND PARTICIPANTS

Cross-sectional survey of a nationally representative sample of young people (2000 randomly selected participants aged 12-25 years), via telephone interview, conducted in January-March 2008.

MAIN OUTCOME MEASURES

Patterns of internet use including type of use, social networking, sources of information about mental health, alcohol or other substance use problems and levels of satisfaction with the information, and type of information accessed via websites.

RESULTS

Young people reported using the internet to connect with other young people (76.9%; 1464/1905) and to seek information about a mental health problem, regardless of whether they had a problem themselves (38.8%; 735/1894). Twenty per cent of young people (398/1990) had personally experienced a mental health problem in the previous 5 years; when these people were asked about sources of information used for this problem, 30.8% (70/227) reported searching the internet. Patterns of internet use and types of resources used differed by age and sex.

CONCLUSION

Our findings suggest that technology is important in the everyday lives of young people, and online mental health services that encompass promotion and prevention activities should include a variety of resources that appeal to all ages and both sexes, such as "question and answer" forums and email.

Room for improvement: mixed portrayal of young people with mental illness on Australian television news

OBJECTIVE

The aim of the present study was to review television news depiction of mental illness in children and adolescents to test the hypothesis that positive portrayals of adults with mental illness also apply to young people.

METHODS

Content and frame analysis of first-person depictions and overall news angle was carried out to determine whether depictions were positive, neutral or negative.

RESULTS

The media portrayal of young people with mental illnesses was mixed. Overall, 10 items (29%) of news angles were positive, 13 items (37%) neutral and nine items (26%) negative. Positive themes were significantly less frequent for young people compared to adults (10 items, 29% compared to 151 items, 66%), and negative themes were more frequent (nine items, 26% vs 21 items, 9%). First-person depictions, however, were similar for young people and adults (24 items, 69% vs 150 items, 66%). An anti-medication sub-theme was notable.

CONCLUSIONS

Overall the portrayal of young people with mental illnesses on television news is not as positive as that for adults. Similar to adults, however, first-person depictions resulted in a more positive representation of young people. Fewer first-person depictions in combination with an anti-medication theme and historically less access to appropriate services for young people may have contributed to the less positive results for young people with mental illnesses.

Impact of a campaign on the public's attitudes towards depression

A public campaign was launched in 2000 as part of the four-level community-based intervention 'Nuremberg Alliance Against Depression' (NAD) in Nuremberg, Germany. Evaluation results will be presented. A baseline survey was done before the campaign in Nuremberg and Wuerzburg (control region), two surveys followed 10 and 22 months after the implementation. Multiple regression analyses were performed, with time, place and the interaction of time and location as independent and the corresponding items as dependent variables. For the general population, the campaign was successful in creating awareness for the NAD. For persons who reported experience with depression and persons aware of the NAD, analyses showed positive desirable effects: more awareness of depression and the NAD. In addition, among those aware, more positive attitudes towards medication treatment and antidepressants developed and also 'lack of self-discipline' declined as causal explanation as did the notion 'pull yourself together' as treatment option. The campaign induced relevant changes mainly in persons aware of the NAD and persons who reported to have had experience with depression. The fact that many of the changes in the general population declined in the second year of the campaign, when activities were done with lower intensity, illustrates the need for permanent depression awareness action.

Recognition and treatment of depression: a comparison of Australian and Chinese medical students

BACKGROUND

Depression is a major public health problem in both China and Australia. To improve services, we need to ensure health professionals have an appropriate understanding of depression and its treatments. This study compares the level of awareness of depression between Chinese and Australian medical students.

METHODS

The International Depression Literacy Survey assessing the public health impact, recognition and treatment of depression was completed by pre-psychiatric training medical students in China (n = 220) and Australia (n = 177).

RESULTS

Chinese students were far less likely to consider mental health conditions and depression as major public health problems (P < 0.001). Depression symptom recognition was similar with four of the top five symptoms of depression the same in both groups of students. Chinese students were more likely to consider some psychological symptoms such as "thinking life is not worth living", but less likely to consider somatic features such as "sleep disturbance" as typical for people with depression. Chinese students were more likely to claim that they would seek help from mental health professionals if experiencing depression whilst Australian students were more likely to seek help from a general or family doctor.

CONCLUSIONS

Chinese medical students recognise depression similarly to Australian students but do not consider it a major public health problem. These results challenge the stereotype that depression is characterised by somatic symptoms in China. Increasing awareness of the public health impact of depression should be incorporated into the medical curriculum in China.

More us than them: positive depictions of mental illness on Australian television news

OBJECTIVE

The aim of the present study was to review television news coverage of mental illness including self-depictions from people with mental illness, and views expressed by mental health experts and politicians in all 538 news and current affairs items related to mental illness broadcast on free-to-air Sydney television, May 2005-October 2007.

METHODS

Content and frame analysis was done of news actors (those with mental illnesses, experts and politicians) of whether depictions were positive 'one of us', or negative 'one of them'.

RESULTS

Only 6% of all items with a main focus on a specific health condition, focused on mental health. Individuals with mental illness were present in 264 (49%) of 538 items, with most (174, 66%) of these self-depictions categorized as either neutral or positive. Experts and politicians overwhelmingly represented and described people with mental illnesses in neutral or positive ways (95% and 84%, respectively). Overall news angle included 299 items (55%), which were categorized as positive 'recovery focused' items. Another 156 items (29%) were neutral, and 62 items (12%) were classified as negative. Twenty-one (4%) had unclear or mixed themes.

CONCLUSIONS

The present findings differ from previous descriptions of media depiction of mental illness, which have been largely negative. The present study provides support for the importance of involving those with histories of mental illness in news coverage.

Responding to experiences of young people with common mental health problems attending Australian general practice

The development of evidence-based ("collaborative care") mental health services in primary care for young people with anxiety, depression and alcohol or other substance misuse is a major challenge. Data from two clinical audits of selected Australian general practices (1998-1999 and 2000-2002) were analysed to explore actual experiences of care among people aged 16-25 years. Syndromal (1998-1999: 31.0% [n = 1849/5957]; 2000-2002: 37.8% [n = 148/392]) and subsyndromal (1998-1999: 27.4% [n = 1635/5957]; 2000-2002: 29.1% [114/392]) mental disorders are very common among young people presenting to general practitioners. However, a mental health diagnosis (1998-1999: 42.6% [n = 740/1736]; 2000-2002: 52.0% [n = 77/148]) or provision of formal treatment (1998-1999: 36.1% [n = 600/1661]; 2000-2002: 51.7% [n = 74/143]) occurs in only about half of the patients with syndromal conditions. While some active treatment was received by 19.4% (1998-1999 [n = 1018/5236]) and 35.9% (2000-2002 [n = 133/370]) of the young people, respectively, the most commonly reported interventions were non-pharmacological alone (1998-1999: 13.1% [n = 687/5236]; 2000-2002: 22.4% [n = 83/370]) or non-pharmacological and pharmacological combinations (1998-1999: 4.1% [n = 214/5236]; 2000-2002: 10.3% [n = 38/370]). Only rarely is pharmacological treatment alone provided (1998-1999: 2.2% [n = 117/5236]; 2000-2002: 3.2% [n = 12/370]). New systems of primary care for young people need to be based on proven collaborative care models and encourage presentations for care, increase detection rates, and promote access to information and effective e-health services. Improved access to specific psychological treatments should remain a priority.

Positive relationships between public awareness activity and recognition of the impacts of depression in Australia

OBJECTIVE

This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors.

METHOD

A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory).

RESULTS

Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiative was also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem.

CONCLUSION

The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.