Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma

The effectiveness of self-guided interventions in adults with depressive symptoms: a systematic review and meta-analysis

BACKGROUND

Despite promising scalability and accessibility, evidence on the efficacy of self-guided interventions for adult depression is inconclusive. This study investigated their effectiveness and acceptability, considering diverse delivery formats and support levels.

METHODS

We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library until 1st January 2024. Included were randomised controlled trials comparing self-guided interventions with a control condition for adult depression. Two independent researchers extracted data. Effect sizes were pooled using random-effects models, with post-intervention depressive severity compared with control conditions as the primary outcome. Study validity was evaluated using Cochrane Risk of Bias 2.0. This study was pre-registered with OSF (https://osf.io/rd43v).

FINDINGS

We identified 92 studies (111 interventions vs. control comparisons) with 16,706 participants (mean age: 18.78-74.41 years). Compared to controls, self-guided interventions were moderately effective at post-assessment (g = 0.53, 95% CI: 0.45-0.61; I2 = 79.17%) and six to twelve months post-randomisation follow-up (g = 0.32, 95% CI: 0.16-0.48; I2 = 79.19%). Trials with initial human screening (g = 0.59) and interventions delivered in computer programs (g = 1.04) had the significantly largest effect sizes. No differences in treatment effects were observed across support levels, therapy types, commercial availability, or the presence of online discussion forums. Self-guided interventions were less acceptable than control conditions (RR = 0.92, p < 0.001). Most studies showed a moderate to high risk of bias (n = 80).

INTERPRETATION

Existing trials on self-guided interventions are at high risk of bias, potentially overestimating treatment effects. Despite lower acceptability compared to controls, self-guided interventions are moderately effective in treating adult depression, regardless of support levels and online discussion features.

FUNDING

None.

Parental Depression and Self-Stigma Among Chinese Young People Living With Depression: A Qualitative Study

Self-stigma is detrimental to psychosocial well-being and the recovery journey among people living with depression. However, there has been limited research exploring the experience of stigma internalization when depression runs in families. This study aims to address this gap by (1) characterizing the manifestations of self-stigma among individuals living with depression whose parent(s) also have depression and (2) exploring the potential mechanisms underlying the impact of parental depression on self-stigma. Essential principles of the constructivist grounded theory approach were adopted to collect data through in-depth interviews with 27 participants aged 15-30, living in Mainland China. Many participants perceived depression running in their family as an endless disaster and an incurable illness. These beliefs further led to stigmatizing emotions (such as suppression, anger, and guilt) and behaviors (such as concealment and social withdrawal). Participants also highlighted ambivalent intergenerational relationships, tense family atmospheres, lower parental emotional involvement and support, and a lack of family flexibility due to parental depression. Furthermore, parental depression impacted participants' self-stigma by interfering with family relationships, family functioning, and parenting styles. It also shaped their perceptions of family, illness attribution, and public stigma. Additionally, parental depression had an impact on participants' social functioning, self-esteem, and personality, making them more susceptible to self-stigma. This study emphasizes the crucial role that the family plays in the internalization of stigma among individuals living with depression. It suggests that family dynamics, rather than family structure or economic backgrounds alone, shape this process.

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

BACKGROUND

Our knowledge of the broader impacts of antidepressant withdrawal, beyond physical side effects, is limited. Further research is needed to investigate the lived experiences of withdrawal, to aid clinicians on how to guide patients through the process.

AIM

To explore antidepressant users' experiences and views on the withdrawal process and how it affected their quality of life across multiple life domains.

DESIGN AND SETTING

We conducted in-depth qualitative interviews with 20 individuals from the community who had attempted to withdraw from Serotonin Reuptake Inhibitor antidepressants in the past year.

METHOD

Semi-structured interviews were conducted online. A topic guide was used to ensure consistency across interviews. The interviews were audio-recorded and transcribed verbatim and analysed using inductive reflexive thematic analysis.

RESULTS

Five themes were generated. The first highlighted the challenges of managing the release from emotional blunting and cognitive suppression following antidepressant discontinuation. The second related to the negative impact of withdrawal on close relationships and social interactions. The third showed that concurrent with negative physical symptoms, there was a positive impact on health (exercise was reported by some as a coping mechanism). The fourth theme focused on support from GPs and families, emphasising the importance of mental health literacy in others. The final theme underscored the importance of gradual and flexible tapering in enabling a manageable withdrawal experience, and the consideration of timing.

CONCLUSION

The lived experience of withdrawal significantly impacts individuals' well-being. Participants emphasised that withdrawal is not just about physical side effects but also affects their emotional, cognitive, and social functioning.

PATIENT AND PUBLIC INVOLVEMENT (PPI)

Eight people attended individual online meetings to share their experiences of antidepressant withdrawal to help inform the study design and recruitment strategy. Insights from these meetings informed the development of the topic guide. Questions about GP involvement, family relationships, and mood and thinking changes were included based on this PPI work. This ensured the inclusion of topics important to antidepressant users and facilitated the researcher's questioning during the interviews.

Serial multiple mediation of perceived professional healthcare support and social structural factors in the relationship between care-seeking behavior and perinatal mental health in Chinese mothers

BACKGROUND

In previous studies, it has been observed that mother's perinatal mental health (PMH) problems can be improved by engaging in appropriate health care-seeking behaviors. However, the exact mechanism that influences the relationship between these two factors is still not fully understood. This cross-sectional study aims to examine the serial multiple mediating effects of perceived professional healthcare support (PPHS) and social structural factors on the association between care-seeking behavior and PMH.

METHODS

The cross-sectional study evaluated 1705 Chinese mothers (pregnancy 12 to 41 weeks) through questionnaires from October 2021 to November 2022. These mothers were selected from three hospitals in Wuxi, with an annual delivery volume of at least 5000. We conducted a structural equation model (SEM) analysis to examine the multiple mediating effect of PPHS and social structural factors (social stigma or social trust) between care-seeking behavior and PMH. After analyzing the results of the SEM, we used bootstrapping to further test the mediating effect.

RESULTS

Among the 1705 Chinese mothers surveyed, 636 (37.3%) sought help from professionals. It was observed that more women tended to seek professional help during the early stages of pregnancy (12 to 28 weeks) compared to the later stages (28 to 41 weeks) (t = 1.47, p < 0.05). The results of the SEM analysis indicated that the mother's care-seeking behavior did not have a significant direct effect on PMH. However, it was identified as a crucial distal variable, with its significant effect being fully mediated by PPHS and social structural factors. The mediation effect of PPHS and social stigma on the pathway from care-seeking behavior to PMH was found to be 92.9% (direct effect = 0.002; indirect effect = 0.026). Additionally, the mediating effect of stigma contributed to 21.9% of the association between care-seeking behavior and PPHS (direct effect = 0.405; indirect effect = 0.114). Similarly, the mediation effect of PPHS and social trust on the pathway from care-seeking behavior to PMH was 73.3% (direct effect = 0.008; indirect effect = 0.022). Moreover, the mediating effect of social trust contributed to 22.0% of the association between care-seeking behavior and PPHS (direct effect = 0.407; indirect effect = 0.115). The proposed model showed a good fit with the collected data.

CONCLUSION

This study examines the serial multiple mediation effect, in which PPHS and social structural factors mediate the relationship between PMH and professional care-seeking behavior. We suggest three levels of intervention: implementing mental health in all policies, providing training for healthcare providers, and establishing healthcare channels with easily accessible information.

Prototypes of People With Depression

This article investigates the content and the consequences of the prototypes of people with depression in a multimethod fashion. Fourteen preregistered studies (total N = 5,023, with U.S. American, British, and French adult participants) show that laypeople consider people with depression as having specific psychological, social, and physical features (e.g., unattractive, overweight, unsuccessful, introverted). Target prototypicality influences how much laypeople believe others have depression, how much observers believe that depression-like symptoms cause someone to experience psychological pain, and how much professional mental health care is appropriate for others. This effect was not reduced by instructing people to focus on the symptoms and ignore the target features yet was weakly reduced by informing them of the effect. We discuss theoretical implications for the understanding of prototypes of people with depression and practical implications for alleviating the impact of prototypes.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain

Objectives

Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions.

Design

This study employed a cross-sectional questionnaire design.

Methods

Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed.

Results

Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits.

Conclusion

Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.

Discrimination, stigma and mental health: what's next?

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.

Rags and Riches: The Effects of Social Class Diversity on Team Viability

Social class inequality is growing at a record pace. What happens when individuals from different social classes work on the same team? We examined the direct and moderating influences of social class as an underexplored form of diversity on team viability in 132 student project teams. Guided by an overarching framework from the team diversity literature, we explored perspective taking and conflict resolution norms as moderators that may safeguard against the negative effects of social class diversity on team viability. As predicted, teams with a mix of higher and lower social class members who were less able to see their teammates’ points of view or develop open conflict resolution norms reported less desire to work together in the future. Given these promising results and the ongoing importance of social class inequality in organizations, future research should continue to examine social class in a team context.

What Do Patients Want in the Treatment of Major Depressive Disorder? Taiwan's TAILOR Survey

In Taiwan, the number of patients being treated for depression has been increasing over recent decades, but there remain some key unmet needs for these patients. One issue is the low rate of help-seeking, which may be at least partially attributable to the stigma of depression in Asian societies. Stigma also contributes to underdiagnosis, because stigmatised patients may emphasise somatic symptoms (e.g. lethargy/fatigue, sleep disorders or changes in appetite), fearing how they will be perceived if they discuss psychological symptoms with their physician. Underdiagnosis may also result from cross-cultural differences, because assessment scales and screening tools are usually developed in Western populations and may not have the same validity in Asian patients. Depression in Taiwan appears to be undertreated, with a high rate of suboptimal antidepressant dosages and inadequate duration of therapy. Patients may discontinue treatment earlier than recommended for a number of reasons related to their own beliefs about treatment, their relationship with their physicians, or the effects of the medication (adverse effects, slow onset of effect, or lack of effect on comorbid symptoms). Moreover, frequently there is discordance between how patients and physicians define treatment success in depression. Patients are more likely to achieve a benefit from treatment which remains persistent when physicians and patients are closely aligned on treatment goals. To better understand the experiences, preferences and attitudes of patients with depression in Taiwan, the Target Antidepressant Initiation choice to unLock positive patient Outcomes and Response (TAILOR) survey was conducted in 340 adult outpatients receiving treatment for major depressive disorder (MDD). The results of the TAILOR survey highlight the personal and perceived stigma of depression, current barriers to seeking help and maintaining treatment, and opportunities to improve shared decision-making, medication adherence and clinical outcomes for Taiwanese patients with MDD.

Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study

BACKGROUND

Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.

OBJECTIVE

This study aims to understand how stigma influences service seeking among youth with mental health challenges.

METHODS

Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.

RESULTS

Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services.

CONCLUSION

A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

Impact of alternative terminology for depression on help-seeking intention: A randomized online trial

OBJECTIVE

People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes.

METHODS

Participants (18-70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach").

PRIMARY OUTCOME

help-seeking intention (5-point scale, higher = greater intention); secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma.

RESULTS

A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD = 0.40, 95% CI: 0.14-0.66) and perceived severity was higher with the depression label compared to control (MD = 0.48, 95% CI: 0.22-0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD = 0.43, 95% CI: 0.25-0.60) and treatment control (MD = 0.69, 95% CI: 0.29-1.10) compared to the "mind coach" recommendation.

CONCLUSION

Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.

COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective

The association between coronavirus disease (COVID-19) vaccine acceptance and perceived stigma of having a mental illness is not clear. This study examined the association between COVID-19 vaccine acceptance and perceived stigma among patients with recurrent depressive disorder (depression hereafter) using network analysis. Participants were 1149 depressed patients (842 men, 307 women) who completed survey measures of perceived stigma and COVID-19 vaccine attitudes. T-tests, chi-square tests, and Kruskal-Wallis tests were used to compare differences in demographic and clinical characteristics between depressed patients who indented to accepted vaccines and those who were hesitant. Hierarchical multiple regression analyses assessed the unique association between COVID-19 vaccine acceptance and perceived stigma, independent of depression severity. Network analysis examined item-level relations between COVID-19 vaccine acceptance and perceived stigma after controlling for depressive symptoms. Altogether, 617 depressed patients (53.7%, 95 confidence intervals (CI) %: 50.82-56.58%) reported they would accept future COVID-19 vaccination. Hierarchical multiple regression analyses indicated higher perceived stigma scores predicted lower levels of COVID-19 vaccination acceptance (β = -0.125, P < 0.001), even after controlling for depression severity. In the network model of COVID-19 vaccination acceptance and perceived stigma nodes, "Feel others avoid me because of my illness", "Feel useless", and "Feel less competent than I did before" were the most influential symptoms. Furthermore, "COVID-19 vaccination acceptance" had the strongest connections with illness stigma items reflecting social rejection or social isolation concerns ("Employers/co-workers have discriminated", "Treated with less respect than usual", "Sense of being unequal in my relationships with others"). Given that a substantial proportion of depressed patients reported hesitancy with accepting COVID-19 vaccines and experiences of mental illness stigma related to social rejection and social isolation, providers working with this group should provide interventions to reduce stigma concerns toward addressing reluctance in receiving COVID-19 vaccines.

'It's more than sadness': The Discursive Construction of Depression on Australian Depression Websites

Depression has been the subject of increased awareness and concern in Australia, but there has been little research into how depression is constructed on mental health websites, which have become a major resource for mental health information among the general public. In this study, critical discursive psychology was employed to analyse the informational content of eight major Australian mental health websites concerning depression. Four interpretative repertoires were identified - a biomedical, a self-optimization, a normal-natural and a societal-structural repertoire. The biomedical and self-optimization repertoires were the most prevalent, constructing depression as an illness within an individual occurring as a result of a biological or psychological deficit. Whilst previous studies have identified the predominance of a biomedical repertoire of depression on official websites, this study highlights the growing prominence of a self-optimization repertoire alongside the biomedical. Whilst it appeared that the aim of the websites was to challenge stigma and encourage help-seeking, it is argued that this way of understanding depression may have counter-productive effects in that the problem is located within the individual rather than with society, and individuals may be positioned as responsible for managing their own mental health, under the guidance of experts. The implications of understanding depression in this way, and not in alternative ways, are discussed.

Stigma towards People with Mental Illness among Portuguese Nursing Students

Stigma is a substantial obstacle when caring for people with mental illness. Nursing students' negative attitudes towards people with mental illness may impact the quality of care delivered and consequentially patient outcomes. In this study, we assessed the stigmatising attitudes and beliefs of nursing students towards people with mental illness and examined its relationship with several psycho-socio-demographic variables. This was a quantitative, cross-sectional descriptive correlational study, which was developed with a non-probabilistic convenience sample of 110 nursing students. Stigmatising attitudes and beliefs were assessed using the Portuguese version of the Attribution Questionnaire AQ-27. Results show that the dimensions of stigma with higher scores were help, pity, coercion and avoidance. However, significant differences were only observed depending on the year of study (fourth-year students, who already had clinical placements in this area, are less likely to show stigma), the relationship (family is less prone to show coercion), the history of mental health treatment (students with a history of mental health treatment have more tendency to help) and whether they considered working in the mental health field (students who have considered working in this field are less prone to show anger, avoidance and think of patients as dangerous). Therefore, we conclude that education in a classroom setting alone is not enough to reduce stigma in nursing students, clinical placement in the area is required to achieve such results. It is thus essential to improve nursing curricula worldwide so that students are exposed to both psychiatric nursing theory and clinical practice in the first years of the nursing degree.

A Two-Person Neuroscience Approach for Social Anxiety: A Paradigm With Interbrain Synchrony and Neurofeedback

Social anxiety disorder has been widely recognised as one of the most commonly diagnosed mental disorders. Individuals with social anxiety disorder experience difficulties during social interactions that are essential in the regular functioning of daily routines; perpetually motivating research into the aetiology, maintenance and treatment methods. Traditionally, social and clinical neuroscience studies incorporated protocols testing one participant at a time. However, it has been recently suggested that such protocols are unable to directly assess social interaction performance, which can be revealed by testing multiple individuals simultaneously. The principle of two-person neuroscience highlights the interpersonal aspect of social interactions that observes behaviour and brain activity from both (or all) constituents of the interaction, rather than analysing on an individual level or an individual observation of a social situation. Therefore, two-person neuroscience could be a promising direction for assessment and intervention of the social anxiety disorder. In this paper, we propose a novel paradigm which integrates two-person neuroscience in a neurofeedback protocol. Neurofeedback and interbrain synchrony, a branch of two-person neuroscience, are discussed in their own capacities for their relationship with social anxiety disorder and relevance to the paradigm. The newly proposed paradigm sets out to assess the social interaction performance using interbrain synchrony between interacting individuals, and to employ a multi-user neurofeedback protocol for intervention of the social anxiety.

The Development of the Postpartum Depression Self-Management Mobile Application "Happy Mother"

Postpartum depression is the most common mood disorder that occurs after childbirth, rendering it a significant public health problem. Information and communication technologies hold tremendous promise for expanding the reach of quality mental healthcare and closing the treatment gap for depression. In particular, given that mobile applications are inexpensive and provide information systematically, they are suitable as a method of health management that does not require visiting a medical center. The purposes of this study were to document the process of developing a mobile application for the self-management of postpartum depression and to share usability test results. The mobile application "Happy Mother" was developed based on the first five of seven stages in the mobile application development lifecycle model. Components of cognitive behavioral therapy were adopted to guide content development for "Happy Mother." The usability of the completed mobile application was tested in the following three steps: it increased awareness of mood, promoted self-management, and implemented specific methods a mother can use in her daily life to improve mood, including modifications made based on the results of the usability test.

Associations of Sociodemographic Factors With Health-Related Social Networks Among Premigration Filipinos

Social networks provide health information that is useful to prevent illness, promote health, and facilitate treatment for health problems. One understudied facet is which people in social networks provide health information. The present article fills a critical gap in the empirical literature by identifying which social networks are reported based on a premigrant's sociodemographic status that operate as their source of health information. Data were analyzed from the Health of the Philippine Emigrants Study (HoPES) (n = 829) migrant sample. Findings indicated having high English proficiency and educational attainment reduces the likelihood of reporting no one in their network as a source of health information. Those who reported family/relatives are less likely to be younger, and those who reported friends are also less likely to be living-in with a partner. This article informs social work researchers and practitioners in implementing interventions among premigration immigrants to help increase and broaden their social networks.

Adherence to Established Treatment Guidelines Among Unguided Digital Interventions for Depression: Quality Evaluation of 28 Web-Based Programs and Mobile Apps

Background

Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed.

Objective

The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals.

Methods

A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression.

Results

Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46).

Conclusions

Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression.

Alexithymia and help-seeking attitudes in college-aged students

Aim

This epidemiological study focused on prevalence of the personality trait, alexithymia – the inability to recognize and describe one’s own emotions – among college-aged students.

Method

Levels of normative alexithymia (measured by the NMAS), clinical alexithymia (measured by the TAS), as well as attitudes towards help seeking behavior (measured by the ATSPPH) were assessed.

Results

A total of 547 participants were collected from over 48 colleges and universities, primarily in Western New York. Results indicated that 89.5% of college students displayed moderate to high levels of normative alexithymia and 48.7% displayed moderate to high levels of clinical alexithymia. Additionally, there were no significant differences between the scores of men and women on either alexithymia measure. Significant findings indicated that there was a positive relationship between clinical alexithymia scores and attitudes toward help-seeking.

Conclusion

These results call into question previous literature, which states that there is no correlation between alexithymia and help-seeking behavior (Berger et al., 2005, https://doi.org/10.1037/1524-9220.6.1.73). The results of this study suggest a shift in culture, as well as a need for more research regarding alexithymia.

How Healthcare Professionals in Cardiac Care Address Depressive Symptoms: Experiences of Patients With Cardiovascular Disease

Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

A systematic review of online depression screening tools for use in the South African context

Background

According to the World Health Organization, the alarming increase in rates of depression globally has become a serious concern. In 2010, the prevalence rate of depression in South Africa was 4.6%. Given the context of South Africa where the majority of the population have limited access to healthcare facilities and 59.3% of the population have access to the Internet, an online depression screening tool would have much to offer.

Objective

To determine whether online depression screening tools would be suitable for use in South Africa.

Methods

This study presents a systematic review of online depression screening tools to determine whether one would be suitable for use in South Africa. Articles were accessed from seven electronic databases from 1970 to 2018. All articles included in the review were critically appraised.

Results

A total of 17 articles met the inclusion criteria. From the results, there was only one screening tool available on an open access platform for use by the general population. The most common depression online screening tools were the Beck Depression Inventory-II (BDI-II), the Center for Epidemiology Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). It was also evident that there were negligible differences in the psychometric properties of online versus paper versions of the online screening tools. Furthermore, there were very few studies that considered the African or South African population and no online screening tools for major depressive disorder (MDD) developed in these contexts.

Conclusion

There appears to be a need for a depression screening tool to be adapted for online usage in South Africa. It is recommended that the online screening tool should be adapted from the three commonly used online depression screening tools: PHQ-9, CES-D and BDI-II.

Recruitment effort and costs from a multi-center randomized controlled trial for treating depression in type 2 diabetes

Background

Participant recruitment for clinical trials is a significant challenge for the scientific research community. Federal funding agencies have made continuation of funding of clinical trials contingent on meeting recruitment targets. It is incumbent on investigators to carefully set study recruitment timelines and resource needs to meet those goals as required under current funding mechanisms. This paper highlights the cost, labor, and barriers to recruitment for Program ACTVE II, a successful multisite randomized controlled trial of behavioral treatments for depression in adults with type 2 diabetes, conducted in rural and urban settings in three states.

Methods

Quantitative and qualitative data on recruitment were gathered from study staff throughout the study recruitment period and were used to calculate costs and effort. The study utilized two main approaches to recruitment: (1) relying on potential participants to see ads in the community and call a toll-free number; and (2) direct phone calls to potential participants by study staff.

Results

Contact was attempted with 18,925 people to obtain the enrolled sample of 140. The cost of recruitment activities during the 4.5-year recruitment period totaled $190,056, an average cost of $1358 per enrolled participant. Qualitative evaluations identified multiple barriers to recruitment.

Conclusions

Recruitment for Program ACTIVE II exemplifies the magnitude of resources needed to reach recruitment targets in the current era. Continuous evaluation, flexibility, and adaptation are required on the part of investigators, community partners, and funding agencies to successfully reach high-risk populations in rural and urban areas.

Trial registration

ClinicalTrials.gov, NCT03371940. Registered on 13 December 2017.

'Taking the wheels off': young people with cognitive impairment in out-of-home care

Children with cognitive impairment in out-of-home care (OOHC) are significantly over-represented in the criminal justice system. Little attention has been given to the connection between those with cognitive impairment who also have a care background and how these combined factors are linked to their criminal behaviour. A qualitative study utilising semi-structured interviews with 11 senior strategic officers and service providers to this cohort was conducted with the aim of investigating the views of these professionals and gaining insight into factors contributing to the criminalisation of children with cognitive impairment in OOHC. Five themes were identified using thematic analysis, suggesting that the primary areas of concern are: (a) increased vulnerability, (b) lack of belonging and security, (c) challenges with identification, (d) steering to the criminal justice system and (e) lack of support. These findings have important implications for both policy and practice, which are discussed in full.

A randomized controlled trial assessing the efficacy of a self-administered psycho-educational intervention for patients with cancer

OBJECTIVE

Bibliotherapy refers to psychological self-help interventions that utilize treatment books to improve psychological well-being. Research supports bibliotherapy as an efficacious intervention for a variety of mental health problems. Yet, few studies have investigated bibliotherapy in psychosocial oncology. The objective of this randomized controlled trial was to examine the efficacy of the NuCare intervention, delivered as a self-directed workbook, for enhancing empowerment, coping, and quality of life and reducing distress in patients with cancer.

METHODS

Eighty-nine adult patients with cancer were randomized to receive the workbook for 6 weeks or the control condition, usual care. Participants completed questionnaires at baseline, 6 weeks post-baseline, and 10 weeks post-baseline.

RESULTS

The increase of empowerment (main outcome) and quality of life and the decrease of distress in the NuCare group from pre-intervention to follow-up assessment differed significantly from the respective difference scores in the control group.

CONCLUSIONS

The self-administered NuCare workbook is a potentially cost-effective, minimal intervention addressing psychosocial needs of patients with cancer.

PRACTICE IMPLICATIONS

Evidence-based bibliotherapy can empower patients and has the promise of reducing the burden on the healthcare system while enhancing the immediacy of psychosocial support.

Stigmatization Behavior of Pre-Registration Nurses: Do the Self-Determined Psychological Needs Influence This?

Background/problem: Stigma and stigmatization are important concepts in the area of mental health and illness. Nursing and nurse education are continuously examining ways to understand and address the stigma toward people with a lived experience of mental illness. While the negative influence of stigma is understood, the variables that influence these behaviors are emerging. An area may provide insight into aspects that influence stigmatization of pre-registration nurses is motivation. Previous research has illustrated that individual motivation can significantly predict and influence work-related behaviors and actions across a range of work settings. Therefore, the purpose of this study was to examine the predictive influence that the motivational needs, as espoused by Self-Determination Theory, play in the stigmatization of pre-registration nurse toward people with a lived experience of mental illness. Approach: A total of 168 pre-registration nurses completed two surveys that measured support for their psychological needs and their stigmatization of people with a lived experience of mental illness. Outcomes/conclusions: Using a regression analysis, some psychological needs significantly influenced the stigmatization of pre-registration nurses. Results illustrate the potential importance of psychological needs in the training of the future nursing workforce.

Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study

Background

Modern psychiatry focuses on self-stigma, coping strategies, and quality of life (QoL). This study looked at relationships among severity of symptoms, self-stigma, demographics, coping strategies, and QoL in patients with neurotic spectrum disorders.

Methods

A total of 153 clinically stable participants who met criteria for generalized anxiety disorder, social phobia, panic disorder, agoraphobia, mixed anxiety-depressive disorder, adjustment disorders, somatoform disorders, or obsessive-compulsive disorder were included in a cross-sectional study. Psychiatrists examined patients during regular psychiatric checkups. Patients completed the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness Scale (ISMI), a sociodemographic questionnaire, the Stress Coping Style Questionnaire (Strategie Zvládání Stresu [SVF] 78), and the Clinical Global Impression (CGI) scale.

Results

The diagnostic subgroups differed significantly in age and use of negative coping strategies, but not in other measured clinical or psychological variables. The findings showed that neither sex nor partnership played a role in perceived QoL. All Q-LES-Q domains correlated negatively with all ISMI domains, except school/study. Unemployed and employed groups of patients differed in QoL. Each of the coping strategies, except the need for social support, was related to self-stigma. The findings showed that sex, partnership, education, and employment played no role in self-stigma. No differences between sexes in positive coping strategies, severity of disorder, self-stigma, or QoL were found. QoL correlated significantly with all coping strategies, except for guilt denial. Multiple regression showed the most important factors to be positive coping, employment, and overall self-stigma rating, explaining 32.9% of QoL. Mediation analysis showed self-stigma level and negative coping strategies to be the most influential. The most substantial factors associated with self-stigma, as indicated by regression analysis, were Q-LES-Q total, subjective CGI, and positive coping strategies, which clarified 44.5% of the ISMI.

Conclusion

The study confirmed associations among self-stigma, quality of life, disorder severity, and coping strategies of outpatients with neurotic spectrum disorders.

Depression and Unmet Needs for Assistance With Daily Activities Among Community-Dwelling Older Adults

Background and Objectives

This study aims to investigate the impact of depressive symptoms on adverse consequences of unmet needs for assistance with daily activities among community-dwelling older adults.

Research Design and Methods

Data came from round 1 to 5 of the National Health and Aging Trends Study. Study sample consisted of 3,400 Medicare beneficiaries needing assistance with activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility for any two consecutive years between 2011 and 2015. Study outcome was the number of self-reported adverse consequences of unmet needs for assistance with daily activities (e.g., went without eating, wet or soiled clothes). Mixed-effects negative binomial regression was used to estimate the association of lagged depressive symptoms and covariates in period t-1 and the number of adverse consequences of unmet needs in period t.

Results

The prevalence rates of adverse consequences of unmet needs were twice as high among older adults with elevated depressive symptoms as those without depression. After adjusting for covariates, prior wave depressive symptoms were associated with 1.24 times the rate of adverse consequences of unmet needs for assistance with ADL (Incidence Rate Ratio [IRR] = 1.24, 95% confidence interval [CI] = 1.09-1.41, p < .01) and IADL (IRR = 1.24, 95% CI = 1.06-1.44, p < .01), and 1.14 times the rate of adverse consequences of unmet needs for assistance with mobility (IRR = 1.14, 95% CI = 1.03-1.27, p < .05).

Discussion and Implications

Caring for older adults with mental health and long-term care needs calls for an integrated social and health services system.

Media reporting of suicide and adherence to media guidelines

BACKGROUND

International research consistently shows evidence for an association between sensationalised and detailed media reporting, and suicidal behaviour.

AIM

This study examined the quality of media reporting of suicide and adherence to media guidelines in Ireland.

METHODS

In accordance with the criteria outlined in the media guidelines for reporting suicide, 243 media articles were screened and analysed for quality of reporting of two high-profile cases of suicide and two cases of suicide that became high profile following a period of intense media coverage that occurred between September 2009 and December 2012.

RESULTS

A minority of articles breached the media guidelines in relation to sensationalised language (11.8%), placement of reports on the front page of the newspaper (9.5%), publishing of inappropriate photographs (4.2%) and mention of location of suicide (2.4%), while no articles disclosed the contents of a suicide note. However, in the majority of articles analysed, journalists did not refer to appropriate support services for people vulnerable to, and at risk of suicide (75.8%) or mention wider issues that are related to suicidal behaviour (53.8%). Overemphasis of community grief (48.3%) was also common. Nearly all articles (99.2%) breached at least one guideline and 58.9% of articles breached three or more guidelines.

CONCLUSION

Overall, adherence to media guidelines on reporting suicide in Ireland improved in certain key areas from September 2009 until December 2012. Nonetheless, important challenges remain. Increased monitoring by media monitoring agencies, regulators and government departments is required. Implementation should be conducted using a pro-active approach and form part of the curriculum of journalists and editors. The inclusion of guidelines for the reporting of suicidal behaviour in press codes of conduct for journalists warrants consideration.

A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care

Background

People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being strengthened and programs are being developed to address this burden, often building on HIV care strategies and infrastructure or through integrated care models. HIV remains a stigmatized condition and the role of HIV stigma in the provision of NCD care is not well understood.

Methods

We conducted a scoping literature review of both peer reviewed and grey literature to identify evidence of the role of HIV stigma in the NCD-care continuum (prevention, diagnosis, care seeking, retention in care, and adherence to treatment of NCDs). We searched PsychInfo and Pubmed and conducted additional searches of programmatic reports and conference abstracts. Included studies were published in English within the past decade and examined HIV-related stigma as it relates to NCD-care or to integrated NCD-and HIV-care programs.

Results

Sixteen articles met the inclusion criteria. Findings suggest: fear of disclosure, internalized shame and embarrassment, and negative past experiences with or negative perceptions of health care providers negatively influence engagement with NCD care; HIV stigma can adversely affect not only people living with HIV in need of NCD care, but all NCD patients; some NCDs are stigmatized in their own right or because of their association with HIV; integrating NCD and HIV care can both reduce stigma for people living with HIV and a present a barrier to access for NCD care.

Conclusion

Due to the dearth of available research and the variability in initial findings, further research on the role of HIV stigma in the NCD-care continuum for people living with HIV is necessary. Lessons from the field of HIV-stigma research can serve as a guide for these efforts.

Media Reporting on Suicide: Evaluating the Effects of Including Preventative Resources and Psychoeducational Information on Suicide Risk, Attitudes, Knowledge, and Help-Seeking Behaviors

We evaluated the effects of exposure to a suicide news article on a variety of outcome variables and whether adhering to one specific media guideline (i.e., including psychoeducational information and preventative resources) buffered any of the negative effects of exposure. Participants were randomly assigned to read one of three articles and then asked to complete a battery of self-report questionnaires. Overall, we found no effect of exposure to a suicide news article, regardless of the inclusion of resources and information, with a few minor exceptions. Although researchers have demonstrated the effectiveness of media guidelines in the aggregate at reducing imitative suicidal behavior, it remains unclear which guidelines in particular are responsible for this effect.

Stigma Towards Depression in Rural Ireland: A Qualitative Exploration

The configuration of one's social environment influences the course and experience of depression. Research suggests that experiencing depression is associated with stigmatisation and the concomitant experiencing of discrimination across many facets of social life. This is identified as a particularly important factor in rural communities. Contemporary work is absent in relation to understanding the stigma towards depression in Ireland, and its manifestation in rural Ireland specifically. Evidence is presented which suggests that depression is a significant source of stigmatisation in this setting, and that entrenched views centring upon disability and fear are prevalent.

A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness

OBJECTIVE

The cost of implementing professionally-led psychosocial interventions has limited their integration into routine care. To enhance the translation of effective psychosocial interventions in routine care, a self-administered format is sometimes used. The meta-analysis examined the efficacy of written self-administered, psychosocial interventions to improve outcomes among individuals with a physical illness.

METHODS

Studies comparing a written self-administered intervention to a control group were identified through electronic databases searching. Pooled effect sizes were calculated across follow-up time points using random-effects models. Studies were also categorised according to three levels of guidance (self-administered, minimal contact, or guided) to examine the effect of this variable on outcomes.

RESULTS

Forty manuscripts were retained for the descriptive review and 28 for the meta-analysis. Findings were significant for anxiety, depression, distress, and self-efficacy. Results were not significant for quality of life and related domains as well as coping. Purely self-administered interventions were efficacious for depression, distress, and self-efficacy; only guided interventions had an impact on anxiety.

CONCLUSIONS

Findings showed that written self-administered interventions show promise across a number of outcomes.

PRACTICE IMPLICATIONS

Self-administered interventions are a potentially efficacious and cost-effective approach to address some of the most common needs of patients with a physical illness.

Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial

BACKGROUND

The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment.

METHODS

This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses.

DISCUSSION

This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice.

TRIAL REGISTRATION

Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).

Self-guided interventions for managing psychological distress in people with cancer - A systematic review

OBJECTIVE

People with cancer can experience psychological distress but do not always desire, or engage with, professional support to assist with managing distress. Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need. The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer.

METHODS

A systematic search of Medline, PsychInfo and CINAHL identified 15 relevant papers, reporting on 14 studies.

RESULTS

Of the interventions, three studies comprised hard-copy workbooks, six studies used resource packs, four were online resources and one was a brief multimedia resource. One study was adequately powered and demonstrated a positive effect. Almost all interventions required some level of facilitation. Distressed participants may benefit more from interventions.

CONCLUSION

Self-guided interventions represent a potentially efficient way of delivering support for people affected by cancer, however evidence supporting them is lacking.

PRACTICE IMPLICATIONS

There is a need to generate evidence to understand the impact of self-guided interventions for: i) the ideal delivery point in the disease trajectory, ii) patient groups, iii) intervention content and iv) type and mode of delivery.

Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions

Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.

Finding brilliance using positive organizational scholarship in healthcare

PURPOSE

Positive organizational scholarship in healthcare (POSH) suggests that, to promote widespread improvement within health services, focusing on the good, the excellent, and the brilliant is as important as conventional approaches that focus on the negative, the problems, and the failures. POSH offers different opportunities to learn from and build resilient cultures of safety, innovation, and change. It is not separate from tried and tested approaches to health service improvement--but rather, it approaches this improvement differently. The paper aims to discuss these issues.

DESIGN/METHODOLOGY/APPROACH

POSH, appreciative inquiry (AI) and reflective practice were used to inform an exploratory investigation of what is good, excellent, or brilliant health service management.

FINDINGS

The researchers identified new characteristics of good healthcare and what it might take to have brilliant health service management, elucidated and refined POSH, and identified research opportunities that hold potential value for consumers, practitioners, and policymakers.

RESEARCH LIMITATIONS/IMPLICATIONS

The secondary data used in this study offered limited contextual information.

PRACTICAL IMPLICATIONS

This approach is a platform from which to: identify, investigate, and learn about brilliant health service management; and inform theory and practice.

SOCIAL IMPLICATIONS

POSH can help to reveal what consumers and practitioners value about health services and how they prefer to engage with these services.

ORIGINALITY/VALUE

Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.

Confirmatory Factor Analysis of a Questionnaire Measure of Managerial Stigma Towards Employee Depression

Managers' attitudes play a key role in how organizations respond to employees with depression. We examine the measurement properties of a questionnaire designed to assess managerial stigma towards employees with depression. Using data from a sample of 469 Australian managers representing a wide range of industries and work settings, we conducted a confirmatory factor analysis to assess three proposed subscales representing affective, cognitive and behavioural forms of stigma. Results were equivocal indicating acceptable fit for two-factor (affective and cognitive + behavioural), three-factor (affective, cognitive and behavioural) and higher order models. Failure to demonstrate the discriminant validity of the cognitive and behavioural dimensions, even though they are theoretically distinct, suggests that further work on the scale is warranted. These results provide an extension to the psychometric profile of this measure (exploratory factor analysis; Martin, ). Development of strategies to operationalize this construct will benefit occupational health research and practice, particularly in interventions that aim to reduce the stigma of mental health issues in the workplace or where managers' attitudes are a key mechanism in intervention efficacy. We encourage future research on this measure pertaining in particular to further enhancing all aspects of its construct validity. Copyright © 2015 John Wiley & Sons, Ltd.

Empirical exploration of brilliance in health care: perceptions of health professionals

Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area

BACKGROUND

The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder.

AIMS

This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions.

METHOD

A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions.

RESULTS

The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one's personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely.

CONCLUSION

Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications.

Frequent Use of Social Networking Sites Is Associated with Poor Psychological Functioning Among Children and Adolescents

Social networking sites (SNSs) have gained substantial popularity among youth in recent years. However, the relationship between the use of these Web-based platforms and mental health problems in children and adolescents is unclear. This study investigated the association between time spent on SNSs and unmet need for mental health support, poor self-rated mental health, and reports of psychological distress and suicidal ideation in a representative sample of middle and high school children in Ottawa, Canada. Data for this study were based on 753 students (55% female; Mage=14.1 years) in grades 7-12 derived from the 2013 Ontario Student Drug Use and Health Survey. Multinomial logistic regression was used to examine the associations between mental health variables and time spent using SNSs. Overall, 25.2% of students reported using SNSs for more than 2 hours every day, 54.3% reported using SNSs for 2 hours or less every day, and 20.5% reported infrequent or no use of SNSs. Students who reported unmet need for mental health support were more likely to report using SNSs for more than 2 hours every day than those with no identified unmet need for mental health support. Daily SNS use of more than 2 hours was also independently associated with poor self-rating of mental health and experiences of high levels of psychological distress and suicidal ideation. The findings suggest that students with poor mental health may be greater users of SNSs. These results indicate an opportunity to enhance the presence of health service providers on SNSs in order to provide support to youth.

Connection between self-stigma, adherence to treatment, and discontinuation of medication

INTRODUCTION

Self-stigma plays a role in many areas of the patient's life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups.

METHODS

This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past.

RESULTS

We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment.

CONCLUSION

The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist's recommendation. This connection was present in all diagnostic groups.

A "Mental-Health-at-the-Workplace" Educational Workshop Reduces Managers' Stigma Toward Depression

Stigma and discrimination are important factors hindering people with mental health conditions to stay employed or successfully make their careers. We surveyed 580 German managers before and after visiting a "mental-health-at-the-workplace" educational workshop using the Depression Stigma Scale. The workshop significantly reduced stigma toward depression. Managers at baseline already exhibited lower stigma toward depression compared with the general population. In addition, female gender and higher education predicted lower stigma, which is in line with findings from other studies. We conclude that an educational workshop giving practical guidance regarding "mental-health-at-the-workplace" reduces managers' stigma toward depression and improves knowledge regarding depression, its course, and its treatment.

[Attitudes towards anti-depressive therapy: acceptance vs. stigmatization]

OBJECTIVE

The current study investigates the attitude towards antidepressant treatment among general public.

METHODS

A total of 234 probands (139 women and 95 men) were asked to complete individually provided questionnaires examining socio-demographic data, psychoeducational levels, as well as personal beliefs concerning antidepressant treatment and levels of present stigmatisation. Three scales were used to quantify stigmatisation levels-"Revised Perceived Devaluation Discrimination Scale"/"Revised Internalized Stigma of Mental Illness Scale"/"Attitudes Toward Mental Health Treatment Scale", "Revised Perceived Devaluation Discrimination Scale".

RESULTS

65 people (27.8 %) reported to have had one or more episodes of depression during their lifetime; 169 people (72.2 %) indicated to have never had any episode of that type before. The words "sickness" and "anxiety" were the terms primarily associated with the word "depression". It was a common belief among interviewees that lonely individuals or those not receiving social support have a higher risk of becoming depressed. We further found that people experience higher levels of internalized stigma when talking about their antidepressant drug-therapy, than the level of perceived stigma would suggest. Opposed to those not indicating depression depressed people indicated that they considered the use of antidepressant medication helpful and a good option, if necessary. Stigma can still be found among those not indicating depression as well as among those with symptoms of depression. Based on the current study we conclude that work in the field of destigmatisation is of great importance.