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Özaslan A, Yildirim M, Guney E, İlhan MN, Vostanis P. Mental health problems and help-seeking behaviours of Syrian refugee adolescents: mediating role of self-stigma. Psychol Med 2024; 54:732-741. [PMID: 37642171 DOI: 10.1017/s0033291723002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Although common mental health problems have been widely studied with self-stigma, few studies have focused on the mediating effect of self-stigma in the relationship between mental health problems and help-seeking behaviours of refugee adolescents. Therefore, the purpose of the present study was to examine whether self-stigma mitigates the adverse effects of stress, anxiety, and depression symptoms on the help-seeking behaviours of Syrian adolescents living in Turkey. METHODS The participants of this study included 488 Syrian refugee adolescents (boys, 63.73%; girls, 3627%) living in Turkey. Participants completed the Depression Anxiety Stress Scale and General Help-Seeking Scale and Self-Stigma of Seeking Psychology Help Scale. RESULTS The findings revealed that stress (β = 0.19, p < 0.01), anxiety (β = 0.12, p < 0.05), and depression (β = 0.17, p < 0.01) had significant and positive predictive effects on self-stigma, but not on help-seeking behaviours. Also, self-stigma (β = -0.12, p < 0.01) had a significant negative predictive effect on help-seeking behaviours. With regard to the indirect effects, the findings showed that self-stigma fully mediated the associations between stress - help-seeking [effect = -0.05, 95% confidence interval (CI) -0.11 to -0.01], anxiety - help-seeking (effect = -0.04, 95% CI -0.09 to -0.01)], and depression - help-seeking (effect = -0.05, 95% CI -0.12 to -0.01). CONCLUSIONS Our findings highlight the potential negative effects of self-stigma on the help-seeking behaviours of Syrian refugee adolescents, both directly and indirectly. These results can be used to develop and implement effective and efficient interventions to address the unmet mental health needs of refugee adolescents.
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Affiliation(s)
- Ahmet Özaslan
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Murat Yildirim
- Department of Psychology, Faculty of Science and Letters, Ağrı İbrahim Çeçen University, Agri, Turkey
| | - Esra Guney
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Mustafa Necmi İlhan
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
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Qiu L, Feng Y, Luo J, Zhang Y, Yang Q. Predictors of personal depression stigma in medical students in China: differences in male and female groups. MEDICAL EDUCATION ONLINE 2022; 27:2093427. [PMID: 35747998 PMCID: PMC9245981 DOI: 10.1080/10872981.2022.2093427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Depression is common worldwide, and stigmatizing attitudes toward depression have proved to be one of the major barriers to seeking professional help. The purpose of this study was to evaluate the level of personal depression stigma and identify its predictive factors among medical students in Hainan, China, as well as explore the gender difference. A total of 2,186 medical students were recruited using stratified random cluster sampling and interviewed by structured anonymous questionnaires. Personal stigma was measured by the standardized Depression Stigma Scale (DSS). Multivariate linear regression models were used to identify predictors of stigma, and the interactions between gender and each predictor were included to test its gender difference. The mean score on DSS Scale was 13.71 ± 5.35, with males significantly higher than females (14.85 vs 12.99, P < 0.0001). Compared to females, males were more likely to agree with 'I would not vote for a class cadre if I knew they had been depressed' and 'I would not make friends with him if I knew he had been depressed'. Multivariate linear regression analysis revealed that males' personal stigma was predicted by being only child (ß = 1.01, P = 0.0083), moderate-to-severe depression (ß = 1.12, P = 0.0302), and lower self-rated academic core competitiveness (Competitive: ß = 1.29, P = 0.0088, Not at all/Somewhat competitive: ß = 1.04, P = 0.0381), while females' personal stigma was only associated with moderate-to-severe depression (ß = 1.75, P < 0.0001). Significant interactions were found between gender and self-rated academic core competitiveness. Stigmatizing attitudes toward depression were prevalent among Chinese medical students, especially male students. Gender differences were found in the predictors of stigma. Effective measures must be taken to reduce the stigma of mental health among Chinese medical students.
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Affiliation(s)
- Lei Qiu
- International School of Public Health and One Health, Hainan Medical University, Hainan, P. R. China
| | - Yawen Feng
- School of Management, Hainan Medical University, Hainan, P. R. China
| | - Jiaxin Luo
- School of Management, Hainan Medical University, Hainan, P. R. China
| | - Yinuo Zhang
- International School of Public Health and One Health, Hainan Medical University, Hainan, P. R. China
| | - Qin Yang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, P. R. China
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Conceição V, Rothes I, Severo M, Griffiths K, Hegerl U, Gusmão R. Psychometric properties of the Depression Stigma Scale in the Portuguese population and its association with gender and depressive symptomatology. Health Qual Life Outcomes 2022; 20:42. [PMID: 35248057 PMCID: PMC8898398 DOI: 10.1186/s12955-022-01945-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Stigma is one of the most significant constraints on people living with depression. There is a lack of validated scales in Portugal to measure depression stigma; therefore, the Depression Stigma Scale (DSS) is essential to the depression stigma research in Portugal. Methods We developed the adaptation process with the ITC Guidelines for Translation and Adapting Tests taken into consideration. We collected the sample as part of the OSPI program—Optimizing suicide prevention programs and their implementation in Europe, specifically within the application in Portugal, and included 1693 participants. Floor-ceiling effects and response ranges were analyzed, and we calculated Cronbach alphas, and Confirmatory Analysis. Validity evidence was tested with two well-documented hypotheses, using data on gender and depression symptoms. Results The sample was well comparable with the general Portuguese population, indicating its representativeness. We identified a three-factor structure in each subscale (personal and perceived stigma): weak-not-sick, discrimination, and dangerous/unpredictable, with good model fit results. The Cronbach's alphas were satisfactory, and validity was confirmed. Conclusions This study established the validity and demonstrated good psychometric properties of the DSS in the Portuguese population. The validation of the DSS can be beneficial in exploring stigma predictors and evaluating the effectiveness of stigma reduction interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01945-7.
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Valdés JM, Díaz FJ, Christiansen PM, Lorca GA, Solorza FJ, Alvear M, Ramírez S, Nuñez D, Araya R, Gaete J. Mental Health and Related Factors Among Undergraduate Students During SARS-CoV-2 Pandemic: A Cross-Sectional Study. Front Psychiatry 2022; 13:833263. [PMID: 35711588 PMCID: PMC9193581 DOI: 10.3389/fpsyt.2022.833263] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/11/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Mental health problems among undergraduates are a significant public health concern. Most studies exploring mental health in this population during the pandemic have been conducted in high-income countries. Fewer studies come from Latin American countries. The aim of this study was to determine the prevalence of depression, anxiety, stress, insomnia, and suicide risk, and explore the association with several relevant variables in personal, family, university, and SARS-CoV-2 pandemic domains. METHODS A cross-sectional study was conducted in Chile in a medium-size private University. Outcome variables were explored with valid instruments: Depression, Anxiety, and Stress Scale (DASS-21), Insomnia Severity Index (ISI), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Independent variables from personal (e.g., sex, age, sexual orientation, history of mental health problems, substance use), family (e.g., parental educational background, family history of mental health problems, family functioning), university (e.g., course year, financial support, psychological sense of university belonging, history of failing subjects) and SARS-CoV-2 domains (e.g., history of personal and family contagion, fear of contracting SARS-CoV-2, frequency of physical activity, keeping routines and social contact). Multivariable logistic regression models were conducted for each outcome, after univariable and domain-specific multivariable models. The significant variable at each step was selected if the p-value was ≤ 0.05. RESULTS A total of 5,037 students answered the survey-the global response rate of 63.5%. Most of the students were females (70.4%) and freshmen students (25.2%). The prevalence of mental health problems was high: depression (37.1%), anxiety (37.9%), and stress (54.6%). Insomnia was reported in 32.5% of students, and suicide risk in 20.4% of students. The associated variables at personal domain were history of mental health problems, substance use, and sexual orientation; at family domain, family functioning and family history of mental health problems; at university domain, violence victimization and sense of belonging; and in SARS-CoV-2 domain, having a daily routine and fear to contracting SARS-CoV-2 by students themselves or others. CONCLUSIONS The prevalence of mental health problems is high among undergraduate students and some of the associated factors, such as victimization and a sense of belonging can be used in preventive interventions.
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Affiliation(s)
| | | | | | | | | | - Matías Alvear
- School of Medicine, Universidad de los Andes, Santiago, Chile
| | - Saray Ramírez
- Faculty of Education, Research Center for Students Mental Health (ISME), Universidad de los Andes, Santiago, Chile.,National Research and Development Agency (ANID), Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Daniel Nuñez
- National Research and Development Agency (ANID), Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Ricardo Araya
- National Research and Development Agency (ANID), Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Jorge Gaete
- Faculty of Education, Research Center for Students Mental Health (ISME), Universidad de los Andes, Santiago, Chile.,National Research and Development Agency (ANID), Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
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Martínez V, Espinosa-Duque D, Jiménez-Molina Á, Rojas G, Vöhringer PA, Fernández-Arcila M, Luttges C, Irarrázaval M, Bauer S, Moessner M. Feasibility and Acceptability of "Cuida tu Ánimo" (Take Care of Your Mood): An Internet-Based Program for Prevention and Early Intervention of Adolescent Depression in Chile and Colombia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189628. [PMID: 34574553 PMCID: PMC8472675 DOI: 10.3390/ijerph18189628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. “Cuida tu Ánimo” (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention.
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Affiliation(s)
- Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Correspondence: ; Tel.: +562-2978-6484
| | - Daniel Espinosa-Duque
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Facultad de Psicología, Universidad CES, Medellín 050010, Colombia
| | - Álvaro Jiménez-Molina
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Millennium Nucleus in Social Development (DESOC), Santiago 8380455, Chile
- Facultad de Psicología, Universidad Diego Portales, Santiago 8380455, Chile
| | - Graciela Rojas
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Millennium Nucleus in Social Development (DESOC), Santiago 8380455, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
| | - Paul A. Vöhringer
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA 02155, USA
| | | | - Carolina Luttges
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
| | - Matías Irarrázaval
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.B.); (M.M.)
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.B.); (M.M.)
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