Resistance, reactance, and misinterpretation: Highlighting the challenge of persuading people with depression to seek help

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

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

Change in attitudes after a suicide prevention media campaign in the Mid-Norway region

BACKGROUND

Suicide prevention media campaigns are one way of reaching people at increased suicide risk who would otherwise not seek help. This is the first study of a Norwegian campaign directed both at individuals at risk for suicide and at their social network.

METHODS

We evaluated a media campaign consisting of outdoor posters, feature articles, film clips, and online banners in print, digital, and social media spread across the Mid-Norway region in late autumn 2022. This campaign material consisted of information about how to seek help for suicide thoughts and mental health problems and how to help a friend in similar situations. Before and after this campaign, 1149 adult individuals living in Mid-Norway participated in a survey on attitudes to suicide, mental ill health, and help-seeking.

RESULTS

There were only marginal changes in attitudes and help-seeking literacy after the campaign. This result was sustained when controlling for age, sex, and campaign visibility. For males, there were a few changes in the negative direction, i.e. lack of willingness to seek help from family and friends, after the campaign.

CONCLUSION

We conclude that the campaign did not seem to have the desired effect and suggest ways of improving future regional Norwegian media campaigns.

The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial

BACKGROUND

Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers.

OBJECTIVE

This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people.

METHODS

This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability.

RESULTS

No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems.

CONCLUSIONS

Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Werther or Papageno? Examining the effects of news reports of celebrity suicide versus non-celebrity peer suicide on intentions to seek help among vulnerable young adults

INTRODUCTION

A large body of literature has examined the Werther effect following news reports of suicide, yet much less attention has been paid to the protective Papageno effect. This research explored the causal relationships between news reports of real celebrity suicides (e.g., pop-rock star Chester Bennington) and real non-celebrity "peer" suicides (e.g., college student Madison Holleran) and intentions to seek help.

METHODS

Two survey experiments confirmed successful experimental manipulation (N = 280) and tested behavioral theory, clinical indicators, and intentions to seek help (N = 641) in samples of college students (18-25).

RESULTS

Participants were motivated to seek help if they believed it could lead to positive outcomes, yet this was less likely among participants with depression. Exposure to news reports of non-celebrity suicides had a small positive effect on help-seeking intentions. Among participants with depression, news reports of celebrity suicides had a small positive effect on intentions.

CONCLUSIONS

This research could not establish Werther effects for either of the news reports. Exposure to news reports of non-celebrity suicides had a small positive effect on intentions overall, but young adults with higher levels of depression were slightly more motivated to seek help after viewing news reports of celebrity suicides.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictors and Outcomes of Help-Seeking Behaviors: A Longitudinal Investigation in Mental Illness

Millions of people around the world are affected by mental illness, yet a substantive portion of individuals with mental illness do not regularly seek help from medical professionals or utilize mental health services. Help-seeking involves an individual's communicative intention and behaviors to solicit advice and/or treatment and thus is essentially a communicative process. This manuscript reports a longitudinal study that examined predictors and outcomes of help-seeking in mental illness contexts. Three-wave data from 223 participants clinically diagnosed with one or more mental illness conditions were collected and analyzed. Results indicated that expected outcomes of help-seeking from counselors were significantly associated with participants' communication efficacy and target efficacy at Wave 1, which subsequently influenced motivation to seek help and actual help-seeking behaviors at Wave 2. Actual help-seeking behaviors predicted post-traumatic growth and cognitive reappraisal at Wave 3. Importantly, communication efficacy and target efficacy interacted in their effects on help-seeking motivation and behaviors. Theoretical implications for help-seeking communication processes and practical implications for mental health help-seeking are discussed.

Combatting negative bias: a mental contrasting and implementation intentions online intervention to increase help-seeking among individuals with elevated depressive symptomatology

Background

There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression.

Method

Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help.

Results

Study 1 (N = 74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N = 224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1.

Limitations

Participation was limited to US residents who self-reported data.

Discussion

These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement.

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

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

Effect of acute depression associated with COVID-19 infection on health-seeking behaviour: a psychiatrist's personal account and case report

BACKGROUND

Despite the abundant research on COVID-19-related mental health problems, little attention has been paid to acute depression occurring concurrently with the infection as a neuropsychiatric manifestation. This is important because depression is known to adversely affect help-seeking. Decreased help-seeking is likely to be aggravated by the isolation measures demanded as part of fighting the pandemic, given the disruption of social support networks.

AIMS

To study the effects of acute depression associated with COVID-19 infection on help-seeking behaviour.

METHOD

We present a case report and personal account of a patient psychiatrist who developed a first onset of acute depression as part of COVID-19 infection.

RESULTS

Despite being a mental health expert the patient lacked insight into his mood change and its negative effect on help-seeking behaviour, resulting in reliance on a family caregiver to raise the alarm.

CONCLUSIONS

For those experiencing this complex interaction between COVID-19 infection and the brain, social support will be needed to ensure timely presentation to the healthcare system. Greater attention to behavioural change as part of COVID-19 infection is needed to optimise treatment outcome.

The Influence of Pop Songs Referencing Anxiety, Depression, and Suicidal Ideation on College Students' Mental Health Empathy, Stigma, and Behavioral Intentions

U.S. college students' general mental health is rapidly declining, and scholars have observed significant increases in references to depression, suicide, and mental health metaphors in popular music. Given that college students are spending more time than ever before listening to popular music, this survey aimed to assess some of the potential implications. College students (N = 253) completed an online survey about their exposure to contemporary pop songs that reference mental health difficulties such as anxiety, depression, and suicidal ideation. Both college students' increased perceived personal connection (PPC) with the songs referencing mental health difficulties and parasocial relationships (PSR) with their performing artists were associated with increased mental health empathy. This increased mental health empathy mediated outcomes including reduced mental health stigma, increased support for public mental health resources, and increased willingness to support others struggling with their mental health. Neither PPC with the song nor PSR with the song's artist was associated with personal willingness to seek mental health help. However, post hoc analyses revealed that college students who reported stronger PPC to these songs also reported that they use music to "deal with their own mental health issues." This study's findings suggest that pop music artists who open up about mental health difficulties may have potential as novel message sources in communication campaigns designed to improve mental health outcomes among college students.

How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation

Background

Epidemiological studies show that even in highly developed countries many people with depression do not seek help for their mental health issues, despite promising prevention approaches encouraging people to seek help and reduce self-stigma. Therefore, an anti-stigma intervention study to support help-seeking behaviour will be developed on the basis of the newly explicated “Seeking Mental Health Care Model”.

Methods

A quasi-experimental online study will be carried out to assess the effect of different intervention variables relevant for the help-seeking process. The study is conceived as a fractional factorial design. Participants will be screened for depressive complaints (PHQ-9 sum score ≥ 8) and current psychiatric/psychotherapeutic treatment. After baseline assessment the participants will be randomly allocated into one of the 24 study groups receiving different combinations of the vignette-based intervention aiming to reduce stigma and support help-seeking. Next, relevant outcome measures will be administered a second time. In a 3- and 6-month follow-up help-seeking behaviour will be measured. Gamified elements and avatar-choice techniques will be used to heighten study immersion and adherence.

Discussion

On the basis of the project results, promising research and intervention perspectives can be developed. Results, firstly, allow for a more detailed empirical investigation and conceptualisation of the stages of mental health care utilisation, as well as an examination of theoretical approaches to stigmatisation. Secondly, our online study could provide insights for an evidence-based design and evaluation of online interventions for people with a mental illness.

Trial registration

German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12125-5.

Feeling pressured by health prevention campaigns as a motivational force: Examining the role of visual and verbal mode design features

This research examines the influence of address style (direct, no address) and narrative voice (first-person, third-person) on the feeling of being pressured by a public service announcement about work stress in two sequential studies. The results of a choice-based conjoint analysis show that persuasive messages designed with a first-person narrative voice and direct address tend to pressure recipients. Results of a between-subjects online experiment suggest that this feeling increases subjects' behavioral intentions to prevent stress when people interact parasocially with the displayed character. Both direct address and first-person narrative voice led directly to reduced behavioral intention to prevent stress.

Nostalgic Emotional Valence and Its Effects on Help-Seeking in Depression. An Application of the Theory of Planned Behavior

In times of distress, people show a tendency to remember the 'good old days,' a bittersweet emotion called Nostalgia. This study advances the role of nostalgic emotions to influence help-seeking intentions in depression. Depression is a critical public health concern, which can be mitigated by seeking professional psychological help. Several communication researchers have studied this area to improve help-seeking intentions through message design and evaluation. This study investigates the use of nostalgic valence: positive, negative, and coactive to influence help-seeking behavioral intentions. Using the theory of planned behavior (TPB) as a guiding framework, the study examined the effects of nostalgic valence on emotions, attitude, perceived behavioral control, and subjective norms to seek help. The study recruited 366 participants, experiencing mild to severe levels of depression, from Amazon Mechanical Turk. Participants were randomly assigned to one of the three video conditions: positive, negative, or coactive nostalgia. The study resulted in two distinct findings. First, we found that positive, negative, and coactive nostalgic messages lead to different levels of emotional responses. Specifically, the coactive nostalgic condition resulted in the least positive emotional response. Second, these different levels of emotional responses are correlated with perceived behavioral control, and descriptive norms that mediated the effects of nostalgia on help-seeking intentions. The main contribution of our study is to inform health communicators about the complexity of persuading people with depression to seek help via nostalgic emotional appeals. Theoretical implications of the study in context with emotion infusion are discussed, and practical implications for interventions to design depression-related help seeking campaigns are provided.

From writing tasks to a public service announcement: Experimentally assessing savoring as a means of increasing help-seeking for depression

RATIONALE

Prior studies that used positive emotion infusions (PEIs) to increase help-seeking for depression found initial support for the approach (Siegel & Thomson, 2016; Straszewski & Siegel, 2018, 2020). However, as people with depression experience negative biases that may be maximized when self-relevance is high (Clark et al., 1999), a potential way to maximize the effect of the PEI approach may be to reduce self-focus.

OBJECTIVE

We used two preregistered studies (US; 2/19/19 to 9/25/19) to identify the strongest version of a savoring writing task for the current context (Study 1) and test it in the form of a savoring-public service announcement (Study 2; S-PSA).

METHODS

Study 1 (N = 1308) compared five savoring writing tasks that varied in self-focus to a control writing task: vicarious, self-distanced, relational, combination, and personal savoring. Study 2 (N = 1238) compared a relational S-PSA to a comparison PSA and a basic control video on help-seeking attitudes, intentions, and behavior.

RESULTS

In Study 1, relational savoring was associated with greater help-seeking intentions than the combination savoring condition among all participants and greater help-seeking intentions than the control among participants who self-reported paying full attention during the study. In Study 2, the S-PSA did not perform better than the comparison PSA or basic control video on the outcome measures.

CONCLUSIONS

The present research highlights three important takeaways. 1) Researchers should continue to explore relational savoring as an approach to increase help-seeking for depression. 2) Similar to findings of prior depression help-seeking studies, crowdsourcing platforms may be useful for testing informational videos but less appropriate for testing videos that require deep levels of thinking for people experiencing heightened depressive symptomatology. 3) From a theoretical and methodological standpoint, these studies underscore the value of conceptual replications using multiple methods.

Personality Variables as Predictors of Health Services Consumption

Expenditure on healthcare and services can be a serious problem for public health. Personality variables should be included as indicators to be considered when studying the consumption of health resources and their planning. This study aims to identify the psychological and psychosocial variables that identify people who can be considered high consumers of health resources versus those who barely consume such resources. The sample was made up of a total of 1124 subjects; one half were men, and one half were women, all of legal age and residents in Spain. A battery of tests was created that included a questionnaire of sociodemographic variables and of healthcare consumption, as well as several psychological variables (Zimbardo Time Paradox Inventory, Multidimensional Locus of Control Scale, Psychological Reactance Scale, Coping Responses Inventory, self-efficacy scale applied to health, and the Symptom Checklist-90-R). The following variables of the model were significant predictors (p ≤ 0.05): a negative past, a fatalistic present, psychological cognitive reactance, behavioral coping, health self-efficacy, and the level of somatization. Data from the statistical analyses show how to create a psychological profile of people who are high consumers of healthcare resources that will allow for the creation of intervention programs in this regard.

Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study

Background

Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash.

Objective

This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals’ identities increases their compliance.

Methods

We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words.

Results

We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual’s identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points.

Conclusions

Using social media to deliver COVID-19 public health announcements customized to individuals’ identities is a promising measure to increase compliance with public health guidelines.

Trial Registration

ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899.

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTITIONER POINTS

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

Exploring perceived costs and benefits of first aid for youth with depression: a qualitative study of Japanese undergraduates

BACKGROUND

Early interventions for depression among youth are greatly needed. Although Youth Mental Health First Aid (YMHFA) program has been developed to teach the public how to help young people with mental disorders, including depression, it has assumed human altruism and overlooked the possibility that participants would experience conflict between the costs and benefits of helping behaviors. The present qualitative study, therefore, initially explored content of the costs and benefits perceived by youth in terms of helping their peers with depression.

METHODS

A total of 56 Japanese undergraduates (32 female, 24 male; M age  = 20.20, SD = 1.09) participated in the face-to-face survey. They were provided with basic knowledge about helping behaviors and were presented with a vignette describing an undergraduate with depression. Then, they left free descriptive comments on their views of the costs/benefits of helping/not helping the person in the vignette. As supplemental quantitative analyses, we statistically compared numbers of labels (n = 624), which were obtained from participants' comments, across two (costs/benefits) × two (helping/not helping) domains. Finally, we conducted a qualitative content analysis that combined inductive and deductive methods to categorize these labels.

RESULTS

The supplemental quantitative analyses (i.e., ANOVA and post hoc analyses) on the numbers of labels highlighted that the participants perceived suppressors (i.e., costs of helping, benefits of not helping) as well as motivators (i.e., costs of not helping) in making decision to help peers with depression. The qualitative content analysis mainly showed that: (i) the categories in each domain covered multiple facets of costs and benefits, including negative/positive effects on the participants themselves, the person in the vignette, and interpersonal relationships; and that (ii) the participants perceived the conflicts of costs and benefits regardless of whether they help their peers with depression.

CONCLUSIONS

These results provide evidence for how young people experience the conflicts between the costs and benefits of helping behaviors toward their peers with depression and reveal specific content of these costs and benefits. These findings could serve as a basis for extending YMHFA programs and designing educational content to promote public helping behaviors in realistic situations.

Bypassing the waitlist: examining barriers and facilitators of help-line utilization among college students with depression symptoms

BACKGROUND

A large number of U.S. college students suffer from depression symptoms, yet existing resources cannot match the demand.

AIMS

This study identified the psychological determinants of utilizing a help-line and examined potential barriers in order to inform effective help-line promotion.

PARTICIPANTS

Four hundred and six undergraduate students (18-29 years) completed a survey at a large Southern United States university between January and May 2018.

METHODS

The survey assessed depression symptoms (PHQ9), whether students were aware of the help-line they had access to, stigma beliefs about depression/suicide, stigma of seeking help (SSOSH), predictors of intention to utilize the help-line (RAT) and behavioral approach and avoidance motivation (BIS/BAS).

RESULTS

Students showed mild symptoms of depression (M = 6.60, SD = 5.13) and knew about the help-line (74.8%), but expressed low intentions to use it (M = 1.5, SD = 0.97; 7-pt scale). Depression symptoms influenced the strength of association between determinants and intentions to use a help-line (β = 0.25, p < 0.001). Participants with depression symptoms were also more likely to endorse adverse beliefs about depression/suicide (β = 0.11, p = 0.025).

CONCLUSION

Help-lines should be promoted by activating and reinforcing positive outcome expectations. Health campaigns should also address adverse beliefs in this population.

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

Scholars have warned that mental health anti-stigma campaigns targeting the general public can possibly be detrimental to some who are stigmatized. Scholars also have noted that people with depression respond to some public service announcements (PSAs) differently than those without. Accordingly, the current study explored whether anti-stigma PSAs targeting the general public could cause problematic outcomes for people with depression. Participants with (n = 55) and without (n = 133) heightened depressive symptomatology viewed two mental health anti-stigma PSAs. Participants provided thoughts about the PSAs through a single, open-ended question. To allow for an assessment of convergence, participants rated overall favorability toward each PSA through a close-ended item. Results indicated that most qualitative responses were favorable; however, 23.6% of respondents with heightened depressive symptomatology, compared to 1.5% without, provided responses coded as indicating that at least one PSA caused unintended negative affect, χ²(1) = 25.96, [Formula: see text] p < .001. Evidence of untoward effects primarily came from the Friend PSA and the qualitative responses indicate how this occurred. Moreover, complementing the qualitative coding, the Friend PSA was rated less favorably by participants with heightened depressive symptomatology (M = 5.00, SD = 1.67), than those without (M = 5.64, SD = 1.44), F(1, 186) = 6.99, p = .009, η_p² = .036. There were no significant differences in quantitative favorability ratings regarding the Labeling PSA. Indicating that further investigation is warranted, results suggest it is possible for an anti-stigma PSA targeting the general public to cause unintended negative affect among some people with depression.

A Mixed Methods Approach to Creating Depression Public Service Announcements by Collaborating with People with Depressive Symptomatology

Depression is a treatable condition; unfortunately, many do not seek help. Depression public service announcements (D-PSAs) are one means of increasing help-seeking behavior. However, as Beck's cognitive theory of depression indicates, it can be challenging to persuade people with depression. Although there have been successful D-PSAs, some have been ineffective or led to boomerang effects. With the goal of providing guidance for future messages, we use a mixed-methods approach to assess how people with heightened depressive symptomatology perceive motivations and barriers regarding help-seeking. Study 1 participants (N = 186), with and without depressive symptomatology, provided motivations and barriers to seeking help for depression. Study 1's qualitative analysis determined 112 motivations and 124 barriers to help-seeking. Study 2 participants (N= 214), all with heightened depressive symptomatology, rated the motivations and barriers from Study 1 on their attitude function, importance, awareness, and argument strength. This insight guided successful D-PSA creation in a follow-up study, reported elsewhere. The methodological approach utilized, and the specific motivations and barriers revealed, will ideally assist scholars and practitioners seeking to develop future D-PSAs.

Should We Activate Risk Perceptions in the Context of Suicide Prevention? Examining Fear Appeals, Help-Seeking Determinants, and Help-Seeking Sources Among University Employees Who Suffer from Depression

Health promotion strategies have largely focused on activating risk perceptions for health conditions in resistant at-risk populations in order to induce behavior change. Yet, doing so remains a questionable approach when promoting help-seeking behaviors among individuals who suffer from depression because clinical symptoms can negatively affect interpretations and responses to such efforts. This study sought to test the effects and effectiveness of risk-based health messaging utilizing fear appeals on help-seeking determinants, intentions, and sources. One hundred seventeen university employees affected by symptoms of depression were recruited to participate in a lab-based experimental setting. Participants were randomly assigned to one of three message conditions that differed in strength of fear appeal (low, moderate, high) when inducing suicide risk perceptions and promoting help-seeking. Consistent with previous research, participants indicated high stigma perceptions and low intentions to seek help. Risk-based messaging strategies such as fear appeals did not have an effect on help-seeking intentions in this sample. Intentions were largely determined by positive outcome expectations and social norms, whereas efficacy perceptions were positive and not a predictor of help-seeking intentions. Participants were most likely to seek help from intimate partners and friends and least likely to utilize a help-line. Health promotion messages should contain cues that activate, rather than change, the already positive outcome expectations of seeking help when targeting at-risk populations. Future research should explore possibilities for health promotion and education among support networks of those who suffer from depression and anxiety.