Structure of beliefs about the helpfulness of interventions for depression and schizophrenia. Results from a national survey of the Australian public

DSM-IV-TR Axes-I and II mental disorders in a representative and referred sample of unemployed youths – Results from a psychiatric liaison service in a job centre

Objectives:

Increased levels of anxiety, depression and alcohol abuse are associated with unemployment. This study compares both DSM-IV-TR Axis-I and Axis-II mental disorders between a representative and a referred sample of unemployed youths aged 16.0 to 24.9.

Methods:

One hundred subjects were randomly recruited on the premises of the vocational services centre in the urban region of Essen, Germany (representative sample, RS). One hundred and sixty-five subjects constituting the ‘clinical sample’ (CS) were preselected and referred by case managers to the on-site psychiatric liaison service. Structured Clinical Interviews for DSM-IV (SCID-I and -II), measures of psychopathology and health service utilization were administered.

Results:

Ninety-eight percent and 43% of CS and RS subjects fulfilled DSM-IV criteria for mental disorders. Mood-, anxiety- and substance-related disorders were the most common Axis-I disorders in both samples. Personality disorders were diagnosed significantly more frequently in the CS. Despite the more severe psychopathology in subjects with mental disorders from the CS compared to the RS, no differences were found for recent mental health service utilisation.

Conclusion:

Because the sample of unemployed youths referred by case managers was significantly more disturbed in psychiatric terms, such a pre-selection is deemed useful in conjunction with a psychiatric liaison service on the premise of a job centre.

Exploring the dominant features of social media for depression detection

Recently, social media have been used by researchers to detect depressive symptoms in individuals using linguistic data from users’ posts. In this study, we propose a framework to identify social information as a significant predictor of depression. Using the proposed framework, we develop an application called the Socially Mediated Patient Portal (SMPP), which detects depression-related markers in Facebook users by applying a data-driven approach with machine learning classification techniques. We examined a data set of 4350 users who were evaluated for depression using the Center for Epidemiological Studies Depression (CES-D) scale. From this analysis, we identified a set of features that can distinguish between individuals with and without depression. Finally, we identified the dominant features that adequately assess individuals with and without depression on social media. The model trained on these features will be helpful to physicians in diagnosing mental diseases and psychiatrists in analysing patient behaviour.

Perceptions of attenuated psychosis in a diverse sample of undergraduates

AIM

Prior to the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, experts in the field of psychosis research considered including a psychosis high-risk syndrome-attenuated psychosis syndrome-as a formal diagnosis. Opponents argued that such a diagnosis may increase the risk of stigmatization of individuals whose symptoms often remit. Although previous research has examined provider perceptions of attenuated psychosis syndrome, little work has focused on lay perceptions.

METHODS

A total of 455 college students read three vignettes, each depicting a character with a different level of psychotic disorder (attenuated psychosis syndrome, schizophrenia or no psychosis). Following each vignette, participants responded to questions assessing: (1) identification of the character as mentally ill, (2) stigmatizing attitudes and (3) beliefs regarding the helpfulness of potential treatments.

RESULTS

Compared to a character with no psychosis, participants identified the attenuated psychosis syndrome character as more likely to be experiencing mental illness, but endorsed only slightly more stigmatizing attitudes. Participants tended to rate psychological types of treatment as more helpful than other types for an attenuated psychosis syndrome character.

CONCLUSIONS

Non-expert undergraduates appear to view attenuated psychosis symptoms as indicative of mental illness, though not as severe as schizophrenia symptoms. The minimal level of stigma endorsement indicates that college students may not be especially likely to spontaneously stigmatize peers with attenuated psychosis syndrome.

State of the art of population-based attitude research on mental health: a systematic review

AIMS

Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health.

METHODS

Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478).

RESULTS

Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks.

CONCLUSIONS

In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.

Measurement properties of mental health literacy tools measuring help-seeking: a systematic review

BACKGROUND

Mental health literacy is important to improve help-seeking behaviors. However, the quality of mental health help-seeking tools remains unknown.

AIMS

We conducted a systematic review to appraise the quality of such tools.

METHODS

We searched databases for English publications addressing psychometrics of help-seeking tools. We included help-seeking tools addressing mental health in general and tools on four mental disorders: anxiety, depression, attention deficit hyperactivity disorder (ADHD) and schizophrenia. We determined the methodological quality of studies as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of each measurement property as "strong", "moderate", "limited", "conflicting" or "unknown".

RESULTS

We found 12 help-seeking tools in 24 studies that assessed related psychometrics. The methodological quality of included studies ranged from "poor" to "excellent" with four studies on the content validity, structural validity or internal consistency demonstrating "excellent" quality. Three tools demonstrated overall strong evidence (content or structural validity); eight tools demonstrated moderate evidence (internal consistency, structural or construct validity); and eight tools demonstrated limited evidence (reliability, construct validity or internal consistency).

CONCLUSIONS

We recommend the application of tools with strong or moderate evidence for their psychometric properties. Future research may focus on the generalizability of the tools across diverse settings.

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

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.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

BACKGROUND

Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap.

METHODS

We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures.

RESULTS

We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

CONCLUSIONS

Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.

Quantifying and predicting depression literacy of undergraduates: a cross sectional study in Sri Lanka

BACKGROUND

The high rates of depression and low rates of related help-seeking among undergraduates are matters for concern. In response to the need to examine their knowledge about depression and its management, and the dearth of such research from non-western developing countries, this study examined the depression literacy of undergraduates in Sri Lanka.

METHODS

A questionnaire was administered among 4671 undergraduates to examine their depression literacy relating to problem-recognition, measured using a vignette of a depressed undergraduate, and their treatment beliefs measured by assessing their perceptions about the helpfulness of various options of help for the presented problem. Responses for the latter aspect were quantified using a scale comprising the options of help endorsed by Sri Lankan mental health professionals. Regression analysis models were used to identify the correlates of these aspects of depression literacy.

RESULTS

Females, medical undergraduates and those in higher years of study (compared to first-years) were more likely to recognise the problem as depression. The undergraduates obtained a mean percentage score of 76% on the constructed Depression Treatment Beliefs Scale. Scores on this scale were higher among females, medical undergraduates, those who got help for the problem after trying to deal with it alone and those who recognised the problem as depression, as well as those who used other mental health-related labels for this purpose. Scores were lower among undergraduates in years 2-4 (compared to first-years), those with family or friends with the problem and those with higher stigma on a Social Distance Scale. However, the effect sizes of these relationships were small.

CONCLUSIONS

As factors such as gender, discipline, year of study, exposure to depression and stigma are associated with differences in the depression literacy of these undergraduates, concerning their ability to recognise the problem and their related treatment beliefs, these must be considered when designing related educational initiatives. Recognising the problem as depression or the use of other mental health-related labels is associated with better treatment beliefs as per expert consensus, indicating that such labelling could have value for appropriate help-seeking.

Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention

BACKGROUND

Stigmatizing attitudes toward depression and toward help-seeking are important barriers for people with mental health problems to obtain adequate professional help. This study aimed to examine: (1) population attitudes toward depression and toward seeking professional help in four European countries; (2) the relation between depression stigma and attitudes toward help-seeking; (3) the relation between both attitudes and socio-demographic characteristics; and (4) differences in attitudes across countries.

METHODS

A representative general population survey (n=4011) was conducted in Germany, Hungary, Ireland, and Portugal, assessing attitudes toward depression and toward help-seeking, and a number of socio-demographic variables.

RESULTS

Respondents showed a moderate degree of personal stigma toward depression and a strikingly higher degree of perceived stigma. Although a substantial majority showed openness to seek professional help, only half of the people perceived professional help as valuable. More negative attitudes were found in Hungary and were associated with male gender, older age, lower educational level and living alone. Also, personal stigma was related to less openness to and less perceived value of professional treatment.

LIMITATIONS

The survey was cross-sectional, so no causal inferences could be drawn.

CONCLUSIONS

Personal and perceived stigma toward depression deserves public health attention, since they impact upon the intention of people with depression to seek professional help. Public media campaigns should focus on the credibility of the mental health care sector, and target males, older people, and those with a lower educational level and living alone. The content of each campaign should be adapted to the cultural norms of the country for which it is intended.

What made me feel better? Patients' own explanations for the improvement of their depression

BACKGROUND

Depression is common among primary care patients and the usual treatment often consists of antidepressant medication and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment, which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome.

AIMS

The purpose of this study was to investigate previously depressed patients' beliefs about the cause of their improvement.

METHODS

Depressed primary care patients (n = 184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus programme), whereas 67 were controls. The groups were comparable at baseline and 82% were on antidepressants.

RESULTS

In total, the patients mentioned 14 separate improving factors, which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus programme (53.0%), antidepressants (40.2%) and personal development (27.2%). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome.

CONCLUSIONS

The patients were generally positive to professional help such as antidepressants and the Contactus programme. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.

What to do about depression? Self-help recommendations of the public

BACKGROUND

While help-seeking and treatment preferences for depression have been assessed in a number of population studies, little is known about the public's self-help beliefs.

AIMS

To explore public beliefs about self-help actions to be taken in case of depression.

METHODS

In spring 2009, a population-based survey was conducted by telephone in the city of Vienna. A fully structured interview was carried out, which began with the presentation of a vignette describing a case of depression. Subsequently, respondents were asked to indicate to what extent they would recommend various self-help actions.

RESULTS

Among the self-help options proposed, confiding in a close friend or someone in the family were most frequently recommended. Apart from that, a variety of interpersonal actions (socializing with others, joining a self-help group), psychological methods (thinking positively), lifestyle changes (engaging in sport, listening to music, going on vacation, reading a good book) and dietary methods (eating healthy food) were endorsed by over half of respondents. While women were more ready to recommend self-help actions, the better educated were less enthusiastic about them.

CONCLUSIONS

As only some of the self-help measures endorsed by the public are evidence based, more research is needed before promulgating their use.

Lay diagnoses and views on causes, coping strategies, and treatment for schizophrenia

We aimed to clarify the relationship between lay diagnoses and perspectives on schizophrenia regarding causes, coping strategies, treatments, prognosis with and without the help of specialists. Our study sample was 500 adults in Japan. Participants read a vignette that depicted moderate to severe schizophrenic symptoms and yielded lay diagnoses. They also expressed their perspectives on the cause of the status in the vignette and coping strategies. We examined the relationship between lay diagnoses and the perspectives. Participants labeled the vignette as 'stress' held low expectations for the effectiveness of mental health professionals and psychiatric treatment. To enhance mental health literacy, it is important to help people distinguish a mental illness from mere stress. Lay diagnoses do not necessary have to be detailed, as long as people recognize a situation as an illness.

Constructing illness: how the public in eight Western nations respond to a clinical description of "schizophrenia"

According to classic and contemporary social theory, the community is crucial to how individuals respond to the onset of health problems. Cultural response to symptoms provides the foundation for lay diagnosis; offers a gauge for marking individual and societal health literacy; and reflects the cultural embeddedness of modern medical knowledge. Using data collected between 2004 and 2007 from the Stigma in Global Context - Mental Health Study (SGC-MHS) on the recognition of schizophrenia from vignettes describing individuals meeting DSM-IV criteria, we examine the nature and correlates of lay diagnosis. Focusing on Western societies in the SGC-MHS, we ask three questions regarding problem recognition in Bulgaria (N = 255), Cyprus (N = 253), Germany (N = 382), Hungary (N = 352), Iceland (N = 291), Spain (N = 327), Great Britain (N = 289), and the United States (N = 449): (1) What is the cross-national variation in recognition of schizophrenia as a mental illness? (2) Is lay diagnosis associated with individuals' socio-demographic characteristics and/or their evaluation of underlying causes? (3) Are lay diagnoses likely to shape the nature and direction of the illness career? We find lay diagnosis of "mental illness" to be high across these Western nations with some, though modest, difference across countries. Variation for the more specific diagnosis of "schizophrenia" is greater, though fairly consistent in country ordering. Lay diagnoses are shaped most consistently by attributions, inconsistently by socio-demographics, and generally associated with respondents' treatment recommendations and expected outcomes. In light of assumptions about public beliefs and knowledge that often underlie research, community efforts, clinical programs, and health policy, these findings suggest that a greater understanding of the complexities of lay diagnosis is warranted.

Community and health professionals' attitude toward depression: a pilot study in nine EAAD countries

BACKGROUND

Community facilitators (CFs), such as pharmacists, policemen, teachers and clergy, may be an important community resource for patients with depression in addition to (mental) health professionals. However, they are ill prepared for such a role and little is known about their attitudes toward depression, which may affect practice.

AIM

To investigate CFs' attitudes toward depression and compare them to those of (mental) health professionals and nurses.

METHOD

Attitudes were assessed in participants (n = 2,670) of training programmes about depression in nine countries of the European Alliance Against Depression (EAAD). The EAAD questionnaire included attitudes toward depression and its treatment, perceived causes, preferred treatment options, and knowledge of depression symptoms.

RESULTS

CFs and nurses had a more negative attitude toward patients with depression and toward antidepressants, and more limited knowledge of depression symptoms than (mental) health professionals. CFs more frequently supported non-standard treatment for depression. Nurse assistants clearly differed from registered nurses with their attitudes being among the least favourable and their knowledge the most limited of all groups.

CONCLUSIONS

CFs and nurses had less favourable attitudes and more limited knowledge regarding depression when compared to mental health professionals and doctors. This may negatively affect professional collaboration, challenge optimal treatment and stigmatize patients. CFs' and nurses' knowledge and attitudes may be similar to those of the general population and be related to a lack of training in mental health issues.

Late life depression and dementia: a mental health literacy survey of Australian general practitioners

BACKGROUND

Whilst previous surveys of mental health literacy of general practitioners (GPs) have shown high rates of recognition of common mental disorders, few studies have been carried out into GPs' understanding of presentations in late life. This study aims to determine GPs' recognition of mental disorders in older people, their intentions regarding investigation, specialist referral and treatment, and their beliefs about prognosis.

METHODS

Australian GPs who attended an educational seminar were administered questions based on clinical vignettes describing older people with depression, dementia and coronary heart disease.

RESULTS

There was a high rate of recognition of all disorders amongst the 436 respondents. GPs demonstrated a high level of consistency about screening questionnaires, investigations and specialist referral in the dementia vignette. In contrast, less than half of GPs endorsed using a screening questionnaire or neuroimaging, and considered referral to a variety of medical specialties in the depression vignette. For both the depression and dementia vignettes, self-help treatments like walking, dietary advice or alcohol reduction were endorsed more frequently than an antidepressant or cholinesterase inhibitor respectively. Dementia tended to be viewed as having a poor prognosis, and late-life depression a moderate prognosis.

CONCLUSIONS

Actual or intended rates of diagnostic recognition, specialist referral and benzodiazepine prescription found in this study may not translate into clinical practice for a number of reasons. Non-specific treatments without a clear evidence base were considered as often as those with a stronger evidence base. There is a need to improve the knowledge of GPs with regard to screening and investigating late life depression and managing dementia.

A cross-cultural comparison of British and Pakistani medical students' understanding of schizophrenia

This study aimed to compare British, British Pakistani and Native Pakistani (from Pakistan) medical students' beliefs about the manifestation, causes and cures of schizophrenia, prior to any psychiatric training. A total of 305 participants completed a questionnaire on general beliefs about people with schizophrenia, causal explanations concerning the aetiology of schizophrenia and the role of hospitals and society in treating people with schizophrenia. It was predicted that compared with the British and British Pakistanis, the Pakistanis would have more negative beliefs and attitudes, considering people with schizophrenia to be more dangerous and unpredictable; they were also expected to use more superstitious beliefs to explain the cause of schizophrenia and its symptoms; as well as believe more in seeking help from God and faith healers. There was strong evidence to suggest that Pakistanis possessed more negative beliefs and attitudes about people with schizophrenia, but there was no evidence to indicate that Pakistanis believed more in superstitious causal explanations. Pakistanis were more likely to consider seeking help from faith healers, but not God, compared with British Pakistanis and the British. Results confirm previous European-Asian difference in the understanding of the cause, manifestation and cure of schizophrenia. The impact of traditional and Western cultural influences on British Pakistanis is considered.

Training, attitudes and practice of district health workers in Kenya

BACKGROUND

The 1994 mental health policy in Kenya was rooted in the concepts of Primary Health Care articulated at Alma Ata, and required that mental health care be decentralized to all levels of the health care system, and delivered by all cadres of health staff rather than just mental health specialists. However, effective implementation of this policy was likely to be influenced by the degree to which the training, attitudes and practice of health staff was consistent with and supportive of the mental health policy.

OBJECTIVE

This article therefore reports a study conducted in 1997, which examined the training, attitudes and practice of district level health staff in relation to mental health care and compared them with the national mental health policy of 1994.

METHOD

A semi-structured questionnaire was sent to the medical superintendents of all district hospitals in Kenya, for distribution to respondents from each cadre of health staff. A total of 148 health workers from 28 districts out of 44 eligible districts (63%) responded.

RESULTS

District health workers did not think general health workers ought to manage most psychiatric patients, even if they were capable of doing so, preferring a system where these patients were managed by specialists and were not admitted into general wards. They also tended to equate mental illness with psychosis.

CONCLUSION

Despite their training in mental health care and their theoretical knowledge of the principles of Primary Health Care, the attitude and mental health care practice of most health workers were in keeping with a more medical model of health care, emphasising pharmacological treatment and expecting psychiatric patients to conform to the standard Sick Role. This orientation, being at variance with the orientation of the 1994 mental health policy, may have contributed to difficulties in implementation of the policy.

Public perceptions, explanatory models and service utilisation regarding mental illness and mental health care in Kenya

The degree to which the mental health services are utilized depends partly on the public's views about mental illness and the public's perceptions about the roles of the providers of the services. Therefore, effective implementation of Kenya's mental health policy during the 1990s was likely to be influenced in some degree by how far it was compatible with the public's concepts of mental illness. The aim of this study was thus to explore the conceptual model underlying the views of the Kenyan public about mental illness and relate it to the national mental health policy of 1994. A household survey was conducted using a Key Informant Interview schedule. Results showed that the public subscribed to a biopsychosocial view of mental illness and health care, which was indeed compatible with the mental health policy, which was rooted in the concepts of Primary Health Care, as articulated at Alma Ata. However, the public did not expect biopsychosocial care from the health services, but rather only the biological/pharmacological component, relying on other care providers for psychosocial management. This discrepancy could have impeded the implementation of the 1994 policy.

Public attitudes towards prevention of depression

BACKGROUND

Various programs for depression prevention have been shown to be effective, but preventive efforts population wide are only beginning. We examine public attitudes towards prevention of depression and beliefs about helpful preventive measures.

METHOD

Fully structured telephone interview with a representative population sample including people of German nationality older than 14 years (n=1016).

RESULTS

75.4% of the sample agreed on the possibility to prevent depression. Of those, 403 (52.6%) stated that they would take part in prevention programs, and in this group 234 (58.1%) indicated readiness to pay out of their pocket for such programs. Out of a catalogue of 37 proposed actions, psychosocial and lifestyle related measures were preferred. Exploratory factor analysis revealed three factors--proactive lifestyle, relying on medicine, and relaxing--inherent in public beliefs about helpfulness of preventive measures. Higher education reduced willingness, high perceived personal risk of depression and previous contact to the disease increased willingness to take part in preventive programs.

CONCLUSION

The public entertains favourable attitudes and beliefs about prevention of depression that do not conflict with evidence-based programs. Our study thus encourages implementation of population based prevention programs.

Mental health literacy and attitudes in a Swedish community sample - investigating the role of personal experience of mental health care

BACKGROUND

Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact.

METHOD

A postal screening questionnaire was sent to a random sample of the general population aged 20-64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).

RESULTS

Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic.

CONCLUSION

Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.

A method for functional network connectivity among spatially independent resting-state components in schizophrenia

Functional connectivity of the brain has been studied by analyzing correlation differences in time courses among seed voxels or regions with other voxels of the brain in healthy individuals as well as in patients with brain disorders. The spatial extent of strongly temporally coherent brain regions co-activated during rest has also been examined using independent component analysis (ICA). However, the weaker temporal relationships among ICA component time courses, which we operationally define as a measure of functional network connectivity (FNC), have not yet been studied. In this study, we propose an approach for evaluating FNC and apply it to functional magnetic resonance imaging (fMRI) data collected from persons with schizophrenia and healthy controls. We examined the connectivity and latency among ICA component time courses to test the hypothesis that patients with schizophrenia would show increased functional connectivity and increased lag among resting state networks compared to controls. Resting state fMRI data were collected and the inter-relationships among seven selected resting state networks (identified using group ICA) were evaluated by correlating each subject's ICA time courses with one another. Patients showed higher correlation than controls among most of the dominant resting state networks. Patients also had slightly more variability in functional connectivity than controls. We present a novel approach for quantifying functional connectivity among brain networks identified with spatial ICA. Significant differences between patient and control connectivity in different networks were revealed possibly reflecting deficiencies in cortical processing in patients.

The public's perception of the plausibility of dementia risk factors is not influenced by scientific evidence

BACKGROUND/AIM

The public know little about risk factors for dementia. The aim of this study was to explore belief structures underlying how plausible risk factors for dementia appear to the general public.

METHODS

Two thousand members of the Australian public were surveyed by telephone on their beliefs regarding dementia risk factors. Factor analysis was performed on 17 modifiable behaviours that were rated by participants as increasing, not changing or decreasing the risk of dementia.

RESULTS

Three factors were obtained - Health and Lifestyle, Activity, and Nutrition. Items loading on the Health and Lifestyle factor were management of cardiovascular risk factors, drinking more water, reducing stress, coffee and tea, and alcohol intake. Items loading on the Activity factor were mental, physical and social activity and getting out and about more. Items loading on the Nutrition factor were eating foods high in omega-3 fatty acids, antioxidants and estrogen, using non-aluminium cookware and taking vitamin and nutritional supplements. Factors were characterised by similarity of items, rather than level of scientific evidence of an association with dementia. Factor scale scores differed according to sociodemographic characteristics.

CONCLUSIONS

The public do not process dementia risk factor information based on level of scientific evidence.