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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Webb R, Uddin N, Constantinou G, Ford E, Easter A, Shakespeare J, Hann A, Roberts N, Alderdice F, Sinesi A, Coates R, Hogg S, Ayers S. Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare. BMJ Open 2023; 13:e066703. [PMID: 37474171 PMCID: PMC10360426 DOI: 10.1136/bmjopen-2022-066703] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care. OBJECTIVES To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy. DESIGN A meta-review of systematic reviews. REVIEW METHODS Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating. RESULTS A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators. CONCLUSION The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals. PROSPERO REGISTRATION NUMBER CRD42019142854.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Nazihah Uddin
- Centre for Maternal and Child Health Research, City University, London, UK
| | | | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
| | - Andrea Sinesi
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), University of Stirling, Stirling, UK
| | - Rose Coates
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Sally Hogg
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City University, London, UK
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The rise in acceptance of mental health professionals: help-seeking recommendations of the German public 1990-2020. Epidemiol Psychiatr Sci 2023; 32:e11. [PMID: 36786061 PMCID: PMC9971855 DOI: 10.1017/s204579602300001x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
AIMS We will first examine whether seeking help for depression and schizophrenia from mental health professionals is nowadays more accepted among the German public than it used to be 30 years ago. Next, we will explore whether changes in help-seeking preferences between 1990 and 2020 are specific to mental health professions or are part of changes in attitudes to professional help-seeking in general. Finally, we will study whether a temporal relationship does exist between the advent of awareness-raising and anti-stigma campaigns after the turn of the millennium and changes in the acceptance of mental health care. METHODS In 1990 (n = 2044), 2001 (n = 4005), 2011 (n = 1984) and 2020 (n = 2449) methodologically identical population-based surveys were conducted in Germany. After presentation of an unlabelled case vignette depicting someone with either schizophrenia or depression, we asked about help-seeking recommendations for the person described. RESULTS The German public's readiness to recommend seeking help from mental health professionals has markedly grown over the past 30 years. In contrast, in the eyes of the public, turning to a general practitioner has become only slightly more, consulting a priest even less advisable than it used to be three decades ago. Seeing a naturopath is seen with markedly less disapproval today compared to 1990, but explicit recommendation of this helping source has not increased correspondingly in. The most pronounced increase in the German public's propensity to recommend seeking help from mental health professionals occurred already in the 1990s, i.e. before efforts to heighten public awareness had started. CONCLUSIONS Today, the German public is more in favour of mental health professionals than it used to be three decades ago. This seems to be a specific trend, and not to reflecting an increasing propensity towards professional help-seeking in general. Our findings counter the narrative that mental health communication efforts and initiatives have created more favourable attitudes towards mental health care among the public, since the observed changes in attitudes have preceded any campaigns. Instead, we tend to interpret the rise of the popularity of mental health professionals as a reflection of general cultural changes that have taken place over the past decades in Germany, as in other western countries.
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Wong EC, Collins RL, McBain RK, Breslau J, Burnam MA, Cefalu MS, Roth E. Racial-Ethnic Differences in Mental Health Stigma and Changes Over the Course of a Statewide Campaign. Psychiatr Serv 2021; 72:514-520. [PMID: 33691488 PMCID: PMC8500546 DOI: 10.1176/appi.ps.201900630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors examined whether shifts in mental health-related stigma differed across racial-ethnic groups over the course of a California statewide antistigma campaign and whether racial-ethnic disparities were present at the beginning of the campaign and 1 year later. METHODS Participants had taken part in the 2013 and 2014 California Statewide Surveys (CASSs), a longitudinal, random-digit-dialing telephone survey of California adults ages ≥18 years (N=1,285). Surveys were administered in English, Spanish, Mandarin, Cantonese, Vietnamese, Khmer, and Hmong. RESULTS Compared with Whites, Latino and Asian respondents who preferred to take the survey in their native language had higher levels of mental health-related stigma on several domains of the 2013 CASS. Specifically, Latino and Asian respondents who completed the survey in their native language were more likely than White respondents to report social distance, prejudice, and perceptions of dangerousness toward people with mental illness. These racial-ethnic disparities persisted 1 year later on the 2014 CASS. Latino-Spanish respondents experienced significant decreases in social distance over the course of the campaign but not to a degree that eliminated disparities on the 2014 CASS. Of note, perceptions of dangerousness of people with mental illness significantly increased among Latino-Spanish respondents between the 2013 and 2014 CASSs. CONCLUSIONS Future research is needed to better understand which components of antistigma campaigns are effective across racial-ethnic minority groups and whether more targeted efforts are needed, especially in light of the persistent and growing racial-ethnic disparities in mental health care.
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Affiliation(s)
- Eunice C Wong
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Rebecca L Collins
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Joshua Breslau
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - M Audrey Burnam
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Matthew S Cefalu
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
| | - Elizabeth Roth
- RAND Corporation, Santa Monica, California (Wong, Collins, Burnam, Cefalu, Roth); Boston (McBain); and Pittsburgh (Breslau)
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Angermeyer MC, Carta MG, Ghachem R, Matschinger H, Millier A, Refai T, Schomerus G, Toumi M. Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany. Clin Pract Epidemiol Ment Health 2020; 16:70-81. [PMID: 33029184 PMCID: PMC7536730 DOI: 10.2174/1745017902016010070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
Background In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa. Objective To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences. Methods Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression. Results In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany. Conclusion Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.
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Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria.,Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.,Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany
| | | | - Tarek Refai
- Tarek Refaï, Creativ-Ceutical, Les Berges du Lac, Tunisia
| | - Georg Schomerus
- Department of Psychiatry, University of Greifswald, Greifswald, Germany
| | - Mondher Toumi
- Aurélie Millier, Creativ-Ceutical, Paris, France.,Department of Public Health, Aix-Marseille University, Marseille, France
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Raising Awareness on Contract Cheating –Lessons Learned from Running Campus-Wide Campaigns. JOURNAL OF ACADEMIC ETHICS 2020. [DOI: 10.1007/s10805-020-09365-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Khan ZR, Hemnani P, Raheja S, Joshy J. Raising Awareness on Contract Cheating –Lessons Learned from Running Campus-Wide Campaigns. JOURNAL OF ACADEMIC ETHICS 2020. [DOI: 10.1007/s10805-019-09353-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Do R, Park JR, Lee SY, Cho MJ, Kim JS, Shin MS. Adolescents' Attitudes and Intentions toward Help-Seeking and Computer-Based Treatment for Depression. Psychiatry Investig 2019; 16:728-736. [PMID: 31550876 PMCID: PMC6801318 DOI: 10.30773/pi.2019.07.17.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Many depressed adolescents do not seek professional help despite there being evidence-based treatments for depression, such as cognitive behavioral therapy or computer-based therapy. To increase professional help-seeking behavior in depressed adolescents, it is necessary to positively change help-seeking attitudes. This study aimed to explore the effect of sub-groups of help-seeking attitudes, gender, and depression level on adolescents' help-seeking intentions and their perceptions of computer-based psychotherapy. METHODS Participants were 246 adolescents aged 13-18 years recruited from six middle and high schools in South Korea. Measures were self-administered questionnaires, and included the Patient Health Questionnaire-9, the Attitudes Toward Seeking Professional Psychological Help Scale, the Intention to Seek Counseling Inventory, Preferences for Depression Treatment, and the Perceptions of Computerized Therapy Questionnaire. RESULTS Help-seeking intentions were positively related with female gender and the recognition of the need for help. A higher level of confidence in therapists was related to high preference for computer-based therapy and face-to-face therapy. Adolescents with more severe depression were more likely to prefer pharmacotherapy. The perceptions of computer-based therapy were more positive in male adolescents, and in adolescents with a higher level of confidence in therapists yet a lower level of interpersonal openness. CONCLUSION To promote adolescents' help-seeking behavior, improvement of the recognition of the need for help is required, especially among male adolescents. Computer-based therapy provides an alternative for male adolescents with high confidence in therapists yet low interpersonal openness. Consideration of the help-seeking attitudes and gender is needed when providing therapeutic intervention to depressed adolescents.
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Affiliation(s)
- Ryemi Do
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju-Ri Park
- Department of Child and Adolescent Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Song-Yi Lee
- Department of Child and Adolescent Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Ji Cho
- Department of Child and Adolescent Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee-Soo Kim
- Department of Child and Adolescent Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Sup Shin
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Akinsulore A, Esimai OA, Mapayi BM, Aloba OO. Public Awareness and Attitude Towards Depression: A Community Based Study Among an Adult Population in Ile-Ife South-Western Nigeria. Community Ment Health J 2018; 54:866-874. [PMID: 29368131 DOI: 10.1007/s10597-017-0222-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/27/2017] [Indexed: 12/01/2022]
Abstract
Depression has become a global health priority due to its associated burden. However, there is dearth of information regarding the public awareness and attitude towards depression in Nigeria. This study aimed to assess the level of public awareness and attitude towards depression in a semi-urban Nigerian community. A cross-sectional study conducted among 240 respondents with mean age of 34.7 years (± 1.2 years). A questionnaire assessed socio-demographic characteristics, level of awareness and attitude of people towards depression. While most respondents (72.5%) had heard about depression, it was less recognized as a major mental health problem. Also, most respondents (58.6%) had negative attitudes toward depression. There is low level of awareness of depression as a major health problem among community dwellers in South-western Nigeria and negative attitudes towards the illness also appear prevalent. Therefore, awareness should be improved through public health enlightenment programmes.
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Affiliation(s)
- Adesanmi Akinsulore
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
| | - Olapeju A Esimai
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Boladale M Mapayi
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olutayo O Aloba
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Chen H, Wang Z, Phillips MR. Assessing knowledge and attitudes about mental illness in Ningxia, China. Transcult Psychiatry 2018; 55:94-119. [PMID: 29264995 DOI: 10.1177/1363461517748847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the effectiveness of China's recent moves to increase community mental health literacy and decrease stigma, we developed the Mental Health Knowledge Questionnaire (MHKQ) and the Mental Health Attitude Questionnaire (MHAQ). Preliminary versions were assessed in pilot studies and revised versions were included in an interviewer-administered community survey of a representative sample of 2425 adult residents of Ningxia Province and a re-test survey in 188 individuals. Internal consistency, factor structure and test-retest reliability were assessed for three measures: (a) the 25-item MHKQ (alpha = .71, 6 factors accounting for 51% of variance identified in exploratory factor analysis of one-half of the sample, and intraclass correlation coefficient [ICC] for total score of .40); (b) the 14-item attitudinal subscale of MHAQ (alpha = .69, 3 factors accounting for 42% of variance, ICC = .47); and (c) the 7-item causal attribution subscale of MHAQ (alpha = .60, 3 factors accounting for 60% of variance, ICC = .26). Confirmatory factor analysis assessed fitness of modified models of the measures using chi-squared, comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA): (a) for the MHKQ, RMSEA = .037 (90% CFI = .033, .040), CFI = .86, TLI = .84, χ2 = 682.86 (df = 260); (b) for the attitudinal subscale of MHAQ, RMSEA = .045 (CI = .039, .052), CFI = .94, TLI = .92, χ2 = 226.67 ( df = 66); and (c) for the causal attribution subscale of MHAQ, RMSEA = .054 (.039, .069), CFI = .97, TLI = .94, χ2 = 49.13 ( df = 11). We conclude that the internal consistency and factor structure of the new measures are satisfactory, but further work is needed to improve the scales' stability and to assess the construct validity and responsiveness of the scales.
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Affiliation(s)
- Hanhui Chen
- Shanghai Jiao Tong University School of Medicine
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Henderson C, Robinson E, Evans-Lacko S, Thornicroft G. Relationships between anti-stigma programme awareness, disclosure comfort and intended help-seeking regarding a mental health problem. Br J Psychiatry 2017; 211:316-322. [PMID: 28935661 PMCID: PMC5663972 DOI: 10.1192/bjp.bp.116.195867] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/27/2017] [Accepted: 05/26/2017] [Indexed: 01/09/2023]
Abstract
BackgroundAnti-stigma programmes should aim to increase disclosure to those who can support someone with a mental health problem and appropriate professional help-seeking.AimsWe investigated associations among public awareness of England's Time to Change anti-stigma campaign and: (a) comfort envisaged in disclosing a mental health problem to family and friends; (b) comfort in disclosing to an employer; and (c) intended professional help-seeking from a general practitioner, i.e. a physician working in primary care.MethodUsing data from a survey of a nationally representative sample of adults, we created separate logistic regression models to test for campaign awareness and other variables as predictors of comfort in disclosure and intended help-seeking.ResultsWe found positive relationships between campaign awareness and comfort in disclosing to family and friends (odds ratio (OR) = 1.27, 95% CI 1.14-1.43) and to a current or prospective employer (OR=1.20, 95% CI 1.06-1.35); and likelihood of help-seeking (OR=1.18 95% CI 1.03-1.36).ConclusionsAwareness of an anti-stigma campaign was associated with greater comfort in disclosing a mental health problem and intended help-seeking.
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Affiliation(s)
- Claire Henderson
- Claire Henderson, MRCPsych, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; Emily Robinson, MSc, Biostatistics & Health Informatics Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; Sara Evans-Lacko, PhD, Graham Thornicroft, PhD, FRCPsych, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Kim YS, Lee HY, Lee MH, Simms T, Park BH. Mental health literacy in korean older adults: A cross-sectional survey. J Psychiatr Ment Health Nurs 2017; 24:523-533. [PMID: 28474412 DOI: 10.1111/jpm.12395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mental health literacy is a fairly new concept, first introduced in 1997. It refers to what people know and believe about mental health disorders. People's knowledge and beliefs help them to recognize, manage and prevent mental disorders. Generally, older adults have lower health literacy compared to young and middle-aged adults. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: This is the first study on the mental health literacy of Korean older adults. This study looks beyond peoples' ability to recognize mental health disorders and their opinions about them. It identifies factors that are associated with mental health literacy (level of education and social support, the number of people in one's social circles and how individuals rate their health). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Older adults might get more out of mental health literacy programmes in group or social settings. Programmes that use older adult peer educators/supporters, such as the "older people's champions" of the Healthy Passport programme in England, might make the programmes more effective. Mental health campaigns, such as Australia's beyondblue, might increase mental health literacy of older adults. ABSTRACT Introduction Korea is experiencing rapid population ageing, spurring an increased need for mental health services for the elderly. Approximately one-third of Korean older adults experience depressive symptoms, and Korea has the highest elder suicide rate among 34 developed nations. Mental health literacy is an important component of promoting mental health, yet studies on the concept have been conducted in few countries. Aim This study examines the level of mental health literacy among Korean older adults and identifies factors associated with their mental health literacy. Method A cross-sectional survey was conducted with 596 community-dwelling Korean adults aged 65 and older. Andersen's Behavioral Model of Health Services Use framed the study. Results Overall, participants displayed low levels of mental health literacy. They had difficulty recognizing their mental health issues and had limited knowledge about self-help strategies. Mental health literacy was positively associated with education, social support, social network and health status. Discussion and Implications This study highlights a need for efforts to increase mental health literacy among Korean older adults. Strategies that have the potential to empower this population to proactively attend to their mental health include community-based education and national mental health campaigns.
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Affiliation(s)
- Y S Kim
- Graduate School of East-West Medicine Science, Kyunghee University, Yongin-Si, Gyeonggi-Do, South Korea
| | - H Y Lee
- The School of Social Work, University of Minnesota, Minneapolis, MN, USA
| | - M H Lee
- The School of Social Work, University of Minnesota, Minneapolis, MN, USA
| | - T Simms
- The School of Social Work, University of Minnesota, Minneapolis, MN, USA
| | - B H Park
- Department of Social Welfare, Pusan National University, Busan, South Korea
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Zhuang XY, Wong DFK, Cheng CW, Pan SM. Mental health literacy, stigma and perception of causation of mental illness among Chinese people in Taiwan. Int J Soc Psychiatry 2017; 63:498-507. [PMID: 28805154 DOI: 10.1177/0020764017719303] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have been performed to explore mental health literacy and stigmatising attitudes towards mental illness and their relationships with causal beliefs about mental illness among Chinese people in Taiwan. AIMS Using a comparative approach, this study attempted to compare the mental health literacy and stigmatising attitudes of Taiwanese Chinese with those found among Australian and Japanese participants in other studies and to explore how mental health literacy and stigmatising attitudes relate to different perceptions of causes of mental illness. METHODS A convenience sample of 287 participants completed a battery of standardised questionnaires. RESULTS A much lower percentage of Taiwanese people than Australians could correctly identify depression and schizophrenia. The Taiwanese respondents rated psychiatrists and clinical psychologists as more helpful than social workers and general practitioners (GPs) and expressed more uncertainty about the usefulness of certain medications when compared to the Australian and Japanese samples. Interestingly, Taiwanese Chinese hold similarly high levels of stigma towards schizophrenia, but lower levels of stigma towards depression when compared to the Japanese respondents. Taiwanese respondents who have higher levels of mental health literacy about schizophrenia were less willing to interact with people with schizophrenia than those with lower levels of mental health literacy. CONCLUSION This study underlines the need for public education programmes to improve knowledge of various mental illnesses and to reduce stigmatising attitudes among Taiwanese Chinese. The aforementioned socially and culturally driven beliefs must be taken into consideration so that culturally relevant education programmes can be developed.
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Affiliation(s)
- Xiao Yu Zhuang
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Daniel Fu Keung Wong
- 1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Chi-Wei Cheng
- 2 Department of Social Work, Tunghai University, Taichung, Taiwan
| | - Shu-Man Pan
- 3 Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan
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15
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Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions. J Affect Disord 2017; 217:252-259. [PMID: 28437762 DOI: 10.1016/j.jad.2017.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/28/2017] [Accepted: 04/02/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. METHODS A representative general population survey (N=4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. RESULTS The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. CONCLUSION The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. LIMITATIONS The survey was cross-sectional and based on self-report, so no causal inferences could be drawn.
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Abstract
AIMS Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health. METHODS Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478). RESULTS Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks. CONCLUSIONS In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.
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Angermeyer MC, van der Auwera S, Carta MG, Schomerus G. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys. World Psychiatry 2017; 16:50-61. [PMID: 28127931 PMCID: PMC5269489 DOI: 10.1002/wps.20383] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.
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Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Sandra van der Auwera
- Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Mauro G Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany
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Haddad M, Waqas A, Qayyum W, Shams M, Malik S. The attitudes and beliefs of Pakistani medical practitioners about depression: a cross-sectional study in Lahore using the Revised Depression Attitude Questionnaire (R-DAQ). BMC Psychiatry 2016; 16:349. [PMID: 27756274 PMCID: PMC5070008 DOI: 10.1186/s12888-016-1069-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. METHODS A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. RESULTS Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. CONCLUSIONS Non-psychiatrist medical practitioners in Pakistan hold a range of views about the causes of depression, with supernatural explanations held by more than a third. Depression attitudes appear less positive than among UK and European clinicians, with the notions that depression is due to a lack of stamina and will-power and a natural part of growing old being especially commonly held; more positive attitudes appear to be associated with a rejection of supernatural explanatory models of depression.
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Affiliation(s)
- Mark Haddad
- Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK. .,East London NHS Foundation Trust, London, UK.
| | - Ahmed Waqas
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Wahhaj Qayyum
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Maryam Shams
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Saad Malik
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
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Makowski AC, Mnich EE, Ludwig J, Daubmann A, Bock T, Lambert M, Härter M, Dirmaier J, Tlach L, Liebherz S, von dem Knesebeck O. Changes in beliefs and attitudes toward people with depression and schizophrenia - results of a public campaign in Germany. Psychiatry Res 2016; 237:271-8. [PMID: 26805560 DOI: 10.1016/j.psychres.2016.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/04/2015] [Accepted: 01/13/2016] [Indexed: 01/22/2023]
Abstract
We examined the impact of a mental health awareness campaign on public attitudes. The campaign was embedded in the project psychenet - Hamburg Network for Mental Health. Beliefs and attitudes were examined before and after specific awareness measures in Hamburg (intervention region) and Munich (control region). Analyses were based on representative surveys (2011: N=2014; 2014: N=2006). Vignettes with symptoms suggestive of depression respectively schizophrenia were presented, followed by questions on social distance, beliefs and emotional reactions. Analyses of variance tested variations between regions over time and differences between those aware of the campaign and those not aware. In 2014, 7.3% (n=74) of the Hamburg respondents were aware of the psychenet campaign. Regarding the total sample, there were minor changes in attitudes. Differentiated according to campaign awareness among Hamburg respondents, those who were aware showed less desire for social distance toward a person with depression. Moreover, respondents aware of the campaign stated less often that a person with schizophrenia is in need of help. The campaign had small impact on attitudes. A substantial change in ingrained attitudes toward persons with mental health problems is difficult to achieve with interventions targeting the general public.
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Affiliation(s)
- Anna C Makowski
- Department of Medical Sociology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Eva E Mnich
- Department of Medical Sociology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Julia Ludwig
- Department of Medical Sociology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Thomas Bock
- Work Group Psychosis, Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Martin Lambert
- Work Group Psychosis, Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Martin Härter
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Jörg Dirmaier
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Lisa Tlach
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Sarah Liebherz
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Department of Medical Sociology; University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
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Hui A, Wong PWC, Fu KW. Evaluation of an Online Campaign for Promoting Help-Seeking Attitudes for Depression Using a Facebook Advertisement: An Online Randomized Controlled Experiment. JMIR Ment Health 2015; 2:e5. [PMID: 26543911 PMCID: PMC4607380 DOI: 10.2196/mental.3649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/30/2014] [Accepted: 02/17/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A depression-awareness campaign delivered through the Internet has been recommended as a public health approach that would enhance mental health literacy and encourage help-seeking attitudes. However, the outcomes of such a campaign remain understudied. OBJECTIVE The main aim of this study was to evaluate the effectiveness of an online depression awareness campaign, which was informed by the theory of planned behavior, to encourage help-seeking attitudes for depression and to enhance mental health literacy in Hong Kong. The second aim was to examine click-through behaviors by varying the affective facial expressions of people in the Facebook advertisements. METHODS Potential participants were recruited through Facebook advertisements, using either a happy or sad face illustration. Volunteer participants registered for the study by clicking on the advertisement and were invited to leave their personal email addresses to receive educational content about depression. The participants were randomly assigned into two groups (campaign or control), and over a four consecutive week period, received either the campaign material or official information developed by the Hospital Authority in Hong Kong. Pretests and posttests were conducted before and after the campaign to measure the differences in help-seeking attitudes and mental health literacy among the campaign and control groups. RESULTS Of the 199 participants that registered and completed the pretest, 116 (55 campaign and 62 control) completed the campaign and the posttest. At the posttest, we found no significant changes in help-seeking attitudes between the campaign and control groups, but the campaign group participants demonstrated a statistically significant improvement in mental health literacy (P=.031) and a higher willingness to access additional information (P<.001) than the control group. Moreover, the happy face Facebook advertisement attracted more click-throughs by users into the website than did the sad face advertisement (P=.03). CONCLUSIONS The present study provides evidence that an online campaign can enhance people's mental health literacy. It also demonstrates the practicality and effectiveness of an online depression awareness campaign using a Facebook-based recruitment strategy and distribution of educational materials through emails. It is important for future studies to take advantage of the popularity of online social media and conduct evaluative research on mental health promotion campaigns.
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Affiliation(s)
- Alison Hui
- Journalism and Media Studies Centre The University of Hong Kong Hong Kong China (Hong Kong)
| | - Paul Wai-Ching Wong
- Department of Social Work and Social Administration The University of Hong Kong Hong Kong China (Hong Kong)
| | - King-Wa Fu
- Journalism and Media Studies Centre The University of Hong Kong Hong Kong China (Hong Kong)
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A multifaceted intervention to improve mental health literacy in students of a multicampus university: a cluster randomised trial. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1655-66. [PMID: 24797396 DOI: 10.1007/s00127-014-0880-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 04/14/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of the current study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in students of a multicampus university in Melbourne, Australia. METHODS In this cluster randomized trial, nine university campuses were paired (some pairs included more than one campus), with one of each pair randomly assigned to either the intervention or control condition. The interventions were designed to be whole-of-campus and to run over 2 academic years with their effectiveness assessed through recruitment of a monitoring sample of students from each campus. Interventions included emails, posters, campus events, factsheets/booklets and mental health first aid training courses. Participants had a 20-min telephone interview at baseline and at the end of academic years 1 and 2. This assessed mental health literacy, help seeking, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. RESULTS There were no effects on psychological distress and alcohol use. Recall of intervention elements was greater in the intervention group at the end of year 2. Students in the intervention group were more likely to say they would go to a drug and alcohol centre for alcohol problems at the end of 6 months. CONCLUSION Although education and awareness may play a role in improving mental health literacy, it is likely that, to achieve changes in psychological distress, interventions would need to be more personalized and intensive.
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Ajdacic-Gross V. The Prevention of Mental Disorders has a Bright Future. Front Public Health 2014; 2:60. [PMID: 24926477 PMCID: PMC4044585 DOI: 10.3389/fpubh.2014.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/19/2014] [Indexed: 01/26/2023] Open
Abstract
This article takes four looks at the status of prevention in psychiatry. The first glance is critical, shaped by disappointment at the slow progress in the understanding of psychiatric diseases and the lack of promise in prevention. The second look is less humble. It characterizes and acknowledges the efforts made so far. The third and the fourth perspectives optimistically announce a new age in research and prevention. Breakthroughs, whose contours are already appearing on the horizon today, will transform the prevention of psychiatric diseases into a success story within the next 10–15 years.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich , Zurich , Switzerland
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Hui AKY, Wong PWC, Fu KW. Building a model for encouraging help-seeking for depression: a qualitative study in a Chinese society. BMC Psychol 2014. [DOI: 10.1186/2050-7283-2-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Clinical depression has been increasingly prevalent in international health statistics but people are often found to be reluctant to seek help when they encounter depression. However, there is no general theory to explain how personal, social and cultural factors affect an individual’s help-seeking intention, nor to guide the design of preventive programmes for such intention once needed.
Methods
Drawing on the theory of planned behavior, we deployed the illness narrative approach and interviewed 18 participants in Hong Kong.
Results
With the diverse results we gathered from the interviews, a behavioral model was built to conceptualize the interplays of various factors in shaping one’s help-seeking intention and behavior for depression. Participants appeared to have a limited view of treatment options and had diverse views of the symptoms of depression, both of which profoundly affected their motivation to seek help.
Conclusions
The role of family and friends and a holistic approach to mental health education were found to be particularly important for encouraging help-seeking behavior in future campaigns concerning depression.
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Public attitudes regarding individual and structural discrimination: two sides of the same coin? Soc Sci Med 2014; 103:60-66. [PMID: 24507911 DOI: 10.1016/j.socscimed.2013.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 10/31/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022]
Abstract
Public attitudes and beliefs are relevant to both individual and structural discrimination. They are a reflection of cultural conceptions of mental illness that form a reality that people must take into account when they enact behavior and policy makers must confront when making decisions. Understanding and keeping track of these attitudes is critical to understanding individual and structural discrimination. Theories of stigma posit that both forms of discrimination are distinct phenomena. Practically nothing is known about how attitudes regarding individual and structural discrimination relate. Our study addresses this gap by examining how attitudes toward allocating financial resources to the care of people with depression (structural discrimination) have developed over the last decade in Germany, compared to the public's desire for social distance from these people (individual discrimination). Previous studies have shown the public being more ready to accept cutbacks for the care for mentally ill persons than for medically ill persons. These preferences could have changed with regard to depression, since there is a growing awareness among the German public of an "epidemic of depression". The idea of a high prevalence of depression may have led to a heightened perception of personal susceptibility for this disorder, making the public become more reluctant to accept cutbacks for the care of people with depression. On the other hand, there is reason to assume that the growing awareness of high prevalence of depression among the general public has not affected individual discrimination of persons suffering from this disorder. The two assumptions were tested comparing data from population surveys conducted in Germany in 2001 and 2011. Within ten years, the proportion of respondents who opposed cutting money from depression treatment tripled from 6% to 21%. In contrast, the public's desire for social distance from persons with depression remained unchanged. Moreover, both trends proved to be independent from each other. Our findings suggest that attitudes relevant to structural and individual discrimination are not necessarily linked together and may lead to divergent results. This means that a comprehensive understanding of stigma must consider both forms of discriminating attitudes together. Studying both simultaneously may deepen our understanding of each and point to novel ways to produce change.
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J. Reavley N, V. McCann T, Cvetkovski S, F. Jorm A. A multifaceted intervention to improve mental health literacy in employees of a multi-campus university: a cluster randomised trial. JOURNAL OF PUBLIC MENTAL HEALTH 2014. [DOI: 10.1108/jpmh-03-2013-0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in staff of a multi-campus university in Australia.
Design/methodology/approach
– In this cluster randomised trial (ACTRN12610001027000), nine campuses were paired, with one of each pair randomly assigned to either intervention or control. Interventions (which were whole-of-campus) included e-mails, posters, campus events, factsheets/booklets and mental health first aid training courses. A monitoring sample of staff were recruited from each campus. Participants had a 20-minute computer-assisted telephone interview at baseline, and at the end of academic years 1 and 2. The interview assessed mental health literacy, help seeking for mental health problems, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. Six campuses were randomised to intervention and three to control and all campuses were included in the analysis.
Findings
– There were no effects on depression and anxiety levels and alcohol use. Recall of intervention elements was greater in the intervention group at the end of the two-year assessment period. Staff in the intervention group showed better recognition of depression, greater knowledge of the National Health and Medical Research Council guidelines for safe levels of drinking and a greater intention to seek help for alcohol misuse from a general practitioner.
Originality/value
– Future interventions should involve more focused interventions that include consideration of working conditions and their influence on mental health, as well as addressing mental illness among employees, regardless of cause.
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Wang J, Häusermann M, Weiss MG. Mental health literacy and the experience of depression in a community sample of gay men. J Affect Disord 2014; 155:200-7. [PMID: 24287169 DOI: 10.1016/j.jad.2013.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/02/2013] [Accepted: 11/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gay men are at higher risk of suffering from a variety of psychiatric disorders, yet the mental health literacy of this population has remained largely unknown. METHODS In 2007 and 2011, surveys were conducted among gay men in Geneva, Switzerland, recruited by probability-based time-space sampling. Based on a case vignette of a man with major depression, respondents were asked a series of questions about labelling, perceived risk, and help-seeking beliefs. Men meeting caseness for major depression were asked open questions about perceived causes and additional help-seeking/self-help. RESULTS Among the 762 respondents, 14.7% met diagnostic criteria for major depression (MDD) in the past 12 months. The vignette was labelled depression by 44.1% of the entire sample, and 61.9% of the men with MDD. Discrimination (33.2%), acceptance or rejection by others (21.4%), and loneliness (24.9%) were the most common reasons given for greater susceptibility among gay men, yet men with MDD reported problems with love/relationship (32.5%) and work (28.9%) as the most common perceived causes of recent depression, and problems with love/relationship (21.9%), accepting one's homosexuality (21.1%), and family (20.2%) at initial outset. The highest proportions of gay men rated non-medical options such as a close friend (91.6%), relaxation exercises or meditation (84.4%), and physical activity (83.5%) as being helpful for the depression vignette. LIMITATIONS No probes used for open questions, and findings generalizable only to gay men in the sampling scheme. CONCLUSIONS There are many commonalities in labelling, perceived causes, and help-seeking with general populations, but also numerous specificities in mental health literacy and experience among gay men.
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Affiliation(s)
- Jen Wang
- Institute for Social and Preventive Medicine, Hirschengraben 84, CH-8001 Zurich, Switzerland; Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4002 Basel, Switzerland.
| | | | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4002 Basel, Switzerland; University of Basel, Basel, Switzerland
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Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord 2013; 150:320-9. [PMID: 23706876 DOI: 10.1016/j.jad.2013.04.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/16/2013] [Accepted: 04/16/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stigmatizing attitudes toward depression and toward help-seeking are important barriers for people with mental health problems to obtain adequate professional help. This study aimed to examine: (1) population attitudes toward depression and toward seeking professional help in four European countries; (2) the relation between depression stigma and attitudes toward help-seeking; (3) the relation between both attitudes and socio-demographic characteristics; and (4) differences in attitudes across countries. METHODS A representative general population survey (n=4011) was conducted in Germany, Hungary, Ireland, and Portugal, assessing attitudes toward depression and toward help-seeking, and a number of socio-demographic variables. RESULTS Respondents showed a moderate degree of personal stigma toward depression and a strikingly higher degree of perceived stigma. Although a substantial majority showed openness to seek professional help, only half of the people perceived professional help as valuable. More negative attitudes were found in Hungary and were associated with male gender, older age, lower educational level and living alone. Also, personal stigma was related to less openness to and less perceived value of professional treatment. LIMITATIONS The survey was cross-sectional, so no causal inferences could be drawn. CONCLUSIONS Personal and perceived stigma toward depression deserves public health attention, since they impact upon the intention of people with depression to seek professional help. Public media campaigns should focus on the credibility of the mental health care sector, and target males, older people, and those with a lower educational level and living alone. The content of each campaign should be adapted to the cultural norms of the country for which it is intended.
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The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men. J Affect Disord 2013; 150:306-12. [PMID: 23683994 DOI: 10.1016/j.jad.2013.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. METHODS In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time-space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. RESULTS 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from -18% to -28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. LIMITATIONS Community-level assessment with no control. CONCLUSIONS Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.
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Casey LM, Joy A, Clough BA. The Impact of Information on Attitudes Toward E-Mental Health Services. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2013; 16:593-8. [DOI: 10.1089/cyber.2012.0515] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leanne M. Casey
- Behavioural Basis of Health, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Angela Joy
- Behavioural Basis of Health, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Bonnie A. Clough
- Behavioural Basis of Health, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Reavley NJ, Jorm AF. Stigmatising attitudes towards people with mental disorders: changes in Australia over 8 years. Psychiatry Res 2012; 197:302-6. [PMID: 22417929 DOI: 10.1016/j.psychres.2012.01.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 12/24/2022]
Abstract
The aim of the study was to investigate whether Australians' stigmatising attitudes towards people with mental disorders have changed over an 8-year period. In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. The survey interview used the same questions as those of the 2003/4 national mental health literacy survey, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Questions were asked about stigmatising attitudes, including personal and perceived stigma and social distance. Results showed decreases in social distance scores for all vignettes other than chronic schizophrenia and increases in beliefs about dangerousness and unpredictability. Campaigns to improve mental health literacy and reduce stigmatising attitudes may have had beneficial effects in reducing the desire for social distance from those with mental disorders. However, increase in beliefs about the dangerousness and unpredictability of those with these disorders is of concern and points to the need for public education to address these aspects of stigma.
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Highet N, Culjak G. Are mailouts an effective health promotion strategy? If so, for whom? INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2012.665340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Reavley NJ, Jorm AF. Recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey of mental health literacy and stigma. Aust N Z J Psychiatry 2011; 45:947-56. [PMID: 21995330 DOI: 10.3109/00048674.2011.621060] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to carry out a national survey in order to assess recognition and beliefs about treatment for affective disorders, anxiety disorders and schizophrenia/psychosis. METHOD In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia or post-traumatic stress disorder (PTSD). Questions were asked about what was wrong with the person, the likely helpfulness of a broad range of interventions and the likely outcomes for the person with and without appropriate treatment. RESULTS Rates of recognition of depression were relatively high, with almost 75% of respondents using the correct label. Rates of recognition for the schizophrenia vignettes and PTSD were similar, with around one third of respondents using the correct labels. Only 9.2% of respondents were able to correctly label social phobia. Respondents gave the highest helpfulness ratings to GPs, counsellors, antidepressants, antipsychotics (for schizophrenia) and lifestyle interventions such as physical activity, relaxation and getting out more. Respondents were generally optimistic about recovery following treatment, although relapse was seen as likely. CONCLUSIONS While Australians' beliefs about effective medications and interventions for mental disorders have moved closer to those of health professionals since surveys conducted in 1995 and 2003/4, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders. This is particularly the case for schizophrenia and anxiety disorders, which are less well recognized and, in the case of social phobia, generally perceived as having less need for professional help.
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Affiliation(s)
- Nicola J Reavley
- Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia.
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Kirchner JE, Farmer MS, Shue VM, Blevins D, Sullivan G. Partnering With Communities to Address the Mental Health Needs of Rural Veterans. J Rural Health 2011; 27:416-24. [DOI: 10.1111/j.1748-0361.2011.00362.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Meyer TD, Bernhard B, Born C, Fuhr K, Gerber S, Schaerer L, Langosch JM, Pfennig A, Sasse J, Scheiter S, Schöttle D, van Calker D, Wolkenstein L, Bauer M. The Hypomania Checklist-32 and the Mood Disorder Questionnaire as screening tools--going beyond samples of purely mood-disordered patients. J Affect Disord 2011; 128:291-8. [PMID: 20674032 DOI: 10.1016/j.jad.2010.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/03/2010] [Accepted: 07/04/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bipolar disorders are often not recognized. Several screening tools have been developed, e.g., the Hypomania Checklist-32 (HCL-32) and the Mood Disorder Questionnaire (MDQ) to improve this situation. Whereas the German HCL-32 has been used in non-clinical samples, neither the HCL-32 nor the MDQ has been validated in German samples of mood-disordered patients. Additionally, hardly any prior study has included patients with non-mood disorders or has considered potential effects of comorbid conditions. Therefore the goal of this study was to test the validity of both scales in a diverse patient sample while also taking into account psychiatric comorbidity. METHOD A multi-site study was conducted involving seven centers. Patients (n=488) completed the HCL-32 and MDQ and were independently interviewed with the Structured Clinical Interview for DSM (SCID). RESULTS Sensitivity for bipolar I was similar for HCL-32 and MDQ (.88 and .84) but slightly different for bipolar II (.90 and .83), specificity, however, was higher for MDQ. In general, a comorbid condition led to increased scores in both tools regardless of whether the primary diagnosis was bipolar or not. LIMITATIONS AND DISCUSSION: Although we included not just mood-disordered patients, detailed subgroup analyses for all diagnostic categories were not possible due to sample sizes. In summary, HCL-32 and MDQ seem fairly comparable in detecting bipolar disorders although their effectiveness depends on the goal of the screening, psychiatric comorbidity, and potentially the setting.
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Affiliation(s)
- Thomas D Meyer
- Institute of Neuroscience, Doctorate in Clinical Psychology, Newcastle University, Ridley Building, Newcastle upon Tyne NE17RU, UK.
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Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, Niklewski G, Althaus D. Sustainable effects on suicidality were found for the Nuremberg alliance against depression. Eur Arch Psychiatry Clin Neurosci 2010; 260:401-6. [PMID: 19921299 DOI: 10.1007/s00406-009-0088-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/28/2009] [Indexed: 11/25/2022]
Abstract
During an intense four-level community-based intervention program conducted in Nuremberg (490,000 inhabitants) in 2001 and 2002 [Nuremberg Alliance Against Depression (NAD)], the number of suicidal acts (main outcome completed + attempted suicides) had dropped significantly (-21.7%), a significant effect compared with the baseline year and the control region (Wuerzburg, about 290,000 inhabitants). To assess the sustainability of the intervention effects the number of suicidal acts was assessed in the follow-up year (2003), after the termination of the 2-year intervention. Also, in the follow-up year (2003), the reduction in suicidal acts compared with the baseline year in Nuremberg (2000 vs. 2003: -32.4%) was significantly larger than that in the control region (P = 0.0065). The reduction was even numerically larger than that of the intervention years (2001, 2002). Thus, 1 year after the end of the main intervention, preventive effects on suicidality of the NAD remain at least stable. The four-level intervention concept appears to be cost-effective and is presently implemented in many European regions.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
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