Whom to Ask for Professional Help in Case of Major Depression? Help-Seeking Recommendations of the Sardinian Public

Public perception of psychiatry, psychology and mental health professionals: a 15-year analysis

Background

X (previously known as "Twitter") serves as a platform for open discussions on mental health, providing an avenue for scrutinizing public perspectives regarding psychiatry, psychology and their associated professionals.

Objective

To analyze the conversations happening on X about psychiatrists, psychologists, and their respective disciplines to understand how the public perception of these professionals and specialties has evolved over the last 15 years.

Methods

We collected and analyzed all tweets posted in English or Spanish between 2007 and 2023 referring to psychiatry, psychology, neurology, mental health, psychiatrist, psychologist, or neurologist using advance topic modelling and sentiment analysis.

Results

A total of 403,767 tweets were analyzed, 155,217 (38%) were in English and 248,550 (62%) in Spanish. Tweets about mental health and mental health professionals and disciplines showed a consistent volume between 2011 and 2016, followed by a gradual increase from 2016 through 2022. The proportion of tweets discussing mental health doubled from 2016 to 2022, increasing from 20% to 67% in Spanish and from 15% to 45% in English. Several differences were observed on the volume of tweets overtime depending on the language they were written. Users associated each term with varied topics, such as seeking for help and recommendation for therapy, self-help resources, medication and side effects, suicide prevention, mental health in times of crisis, among others. The number of tweets mentioning these topics increased by 5-10% from 2016 to 2022, indicating a growing interest among the population. Emotional analysis showed most of the topics were associated with fear and anger.

Conclusion

The increasing trend in discussions about mental health and the related professionals and disciplines over time may signify an elevated collective awareness of mental health. Gaining insights into the topics around these matters and user's corresponding emotions towards them presents an opportunity to combat the stigma surrounding mental health more effectively.

Help-Seeking Intentions for Depression from Mental Health Professionals Among Community-Dwelling Persons in Central China

Understanding the intention of community residents to seek help from mental health professionals (MHPs) is essential in targeting interventions that promote the prevention and treatment of depression. This study aimed to investigate the current status of Chinese community populations' depression help-seeking intentions from MHPs and explore factors influencing the intentions. Data were used from a survey conducted in a city in central China (n = 919 aged 38.68 ± 17.34, 72.1% female). Help-seeking intentions, help-seeking attitude, depression stigma, family function and depressive symptoms were measured. The total mean score on the intent to seek help from MHPs was 11.01 ± 7.78 and most of respondents were unwilling to seek professional help. Multiple linear regression showed that participants who were students, held a positive help-seeking attitude and had low personal stigma were more likely to have the intention to seek help from MHPs. It is necessary to utilize effective interventions to improve community residents' intention to seek professional help. These include promoting the importance of seeking professional assistance, optimizing the quality of mental health services and altering residents' prejudice to seeking professional help.

Why Was the Perception of Human Rights Respect and Care Satisfaction So High in Users of Italian Mental Health Services during the COVID-19 Pandemic?

The aim of this study was to compare users' and mental health workers' (MHW) perception of respect of human rights and job/care satisfaction in mental health services in Italy during the COVID-19 pandemic. A sample of users and MHW of Sardinia, Italy, fulfilled the "Well-Being at work and respect for human rights questionnaire" (WWRR). The study included 240 MHW and 200 users. Users showed a higher level of satisfaction of care than MHW of work, and a higher perception of the satisfaction of users and human rights respected for health workers. Both user and MHW responses were about 85% of the maximum score, except for satisfaction with resources. Responses were higher for users, but users and MHW both showed high levels of satisfaction. In previous surveys, MHW of Sardinia showed higher scores in all items of WWRR, except for satisfaction with resources, compared with workers from other health sectors of the same region, and with MHW from other countries. The low score for satisfaction with resources (in users and staff) is consistent with a progressive impoverishment of resources for mental health care in Italy. The study, although confirming the validity of the Italian model, fully oriented towards community, sets off an alarm bell on the risks resulting from the decrease in resources.

Burdens in mental health recovery: Causal beliefs and their relation to stigma and help seeking recommendations

BACKGROUND

Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focusses on actual help seeking behaviour, this study will focus on lay publics' referral behaviour.

AIMS

This study analyses the relation between causal beliefs and stigmatising attitudes and social distance on the one hand, and (in)formal help seeking recommendations on the other.

METHODS

Data from a survey carried out in 2019, assessing the attitudes of Public Health Insurance Provider (HIP) members towards mental health problems, was used. Part of the survey questions was based on a quantitative quasi-experimental design, using hypothetical written vignettes. The weighted data represent a sample of the adult Flemish population (22-94 years, N = 5675). Multiple linear regression analysis was used to examine the relation between causal beliefs and stigma, while binominal logistic regression analysis was used to investigate the relation between causal beliefs and help seeking recommendations.

RESULTS

The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral.

CONCLUSION

This study highlights the importance of causal beliefs in affecting public stigma and help seeking recommendations.

Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany

Background

In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa.

Objective

To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences.

Methods

Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression.

Results

In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany.

Conclusion

Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Survey of Chinese persons managing depressive symptoms: Help-seeking behaviours and their influencing factors

OBJECTIVES

To explore help-seeking behaviours of Chinese persons managing depressive symptoms and factors that influence these behaviours.

METHODS

A survey of residents living in communities in Wuhan, China was conducted using stratified random sampling. The Patient Health Questionnaire (PHQ-2), the Actual Help-Seeking Questionnaire (AHSQ) and a socio-demographic questionnaire were completed by participants. Descriptive statistics were analyzed. A multiple linear regression model was used to explore factors associated with help-seeking behaviours.

RESULTS

Of the 1785 respondents, 672 (37.6%) reported that they experienced depressive symptoms during the past year, and of these respondents, 517 (76.9%) indicated that they sought assistance. Among help-seeking sources utilized by participants, informal help was sought most frequently (72.9%), followed by hotline/Internet assistance (14.3%), mental health professionals (MHPs) (7.9%) and general physicians (GPs) (3.7%). The results of multilinear regression analysis showed that participants who were adults (aged 25-64 years), attended junior and high school (7-12 years education), and lived in urban areas were more likely to seek additional assistance for their depressive symptoms.

CONCLUSION

Mental health promotion and education efforts are needed to improve the public's mental health literacy and to promote appropriate utilization of informal sources of assistance in managing depressive symptoms such as a hotline or the Internet. Further interventions need to be considered to reinforce use of social supports and mental health professionals, especially in rural areas.

BEEP-Bodily and Emotional Perception of Pain. A Questionnaire to Measure Reaction to Pain in Chronic Pain Disorders

Background: The assessment of pain and its impact on quality of life is central to the evaluation of chronic pain syndromes. However, most available tools focus on the nociceptive experience of pain, and at best only consider the occurrence of anxious, depressive, or cognitive problems. Here is a new questionnaire aimed at measuring the multifaceted impact of pain in chronic pain syndromes, the Bodily and Emotional pErception of Pain (BEEP).

Methods: All consecutive patients who accessed a center for the treatment of pain were invited to take part in the study. The sample included 222 participants (51 with fibromyalgia, 84 with low back pain; 87 with other chronic pain syndromes). Women were 77% of the sample, the mean age was 61 ± 15. Participants completed the BEEP, the Patient Health Questionnaire-9 (PHQ-9), and the Mood Disorder Questionnaire (MDQ).

Results: Reliability was good for all questionnaires. The expected three dimensions of the BEEP were confirmed by confirmatory factor analysis, and a bifactor model with three orthogonal factors showed a good fit as well. Participants diagnosed with fibromyalgia showed higher scores on the BEEP than the participants who had been diagnosed with low back pain or other chronic pain syndromes. The prevalence of probable cases of major depression and bipolar disorder in the sample was higher than expected for non-clinical samples. Levels of depression, as measured by the PHQ-9, were associated with the three dimensions of the BEEP and with the intensity of pain.

Conclusions: The BEEP is a promising measure of the impact of pain in daily life and differentiates fibromyalgia from other chronic pain syndromes. The BEEP may be helpful to evaluate the patient's response to the treatment over time and may favor the identification of unmet needs in patients' personal, social, and daily functioning.

Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants

BACKGROUND

Depression is one of the most disabling and chronic mental illnesses. Despite its high burden, many people suffering from depression did not perceive that they had a treatable illness and consequently most of them did not seek professional help. The aim of this study was to assess the level of professional help-seeking behavior and associated factors among individuals with depression.

METHODS AND MATERIALS

The community-based cross-sectional study was conducted among residents of Dessie, Northeast Ethiopia. First, 1165 residents were screened for depression using patient health questionnaire and then 226 individuals who were screened positive for probable depression were interviewed with General Help-Seeking Questionnaire to assess the professional help-seeking behavior of participants with depression. Major associated variables were identified using logistic regression with 95% confidence interval (CI), and variables with a p value less than 0.05 were considered statistically significant.

RESULTS

Among the total participants with depressive symptoms, only 25.66% of them did seek professional help. Being female [adjusted odds ratio (AOR) = 2.769, 95% CI (1.280, 5.99)], current alcohol drinking [AOR = 2.74, 95% CI (1.265, 5.940)], co-morbid medical-surgical illness [AOR = 4.49, 95% CI (1.823, 11.071)], perceiving depression as illness [AOR = 2.44, 95% CI (1.264, 4.928)], having moderate depressive symptoms [AOR = 2.54, 95% CI (1.086, 5.928)] and moderately severe depressive symptoms [AOR = 7.67, 95% CI (2.699, 21.814)] were significantly associated with help seeking behavior of participants.

CONCLUSIONS

Level of professional help-seeking behavior is as low as previous studies in different countries. The severity of depressive symptoms, co-morbidity of medical-surgical illness, current drinking of alcohol, being female, and perceiving depression as illness were significantly associated with professional help-seeking behavior for depressive symptoms. Working on mental health literacy in the community is important to increase help-seeking behavior.

Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

BACKGROUND

Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.

OBJECTIVES

To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.

METHOD

Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).

RESULTS

The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.

CONCLUSION

Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

Depression in Sardinian immigrants in Argentina and residents in Sardinia at the time of the Argentinian default (2001) and the Great Recession in Italy (2015)

BACKGROUND

The aim of this study is to measure in two samples of Sardinian immigrants in Buenos Aires and representatives of the population in Sardinia the prevalence of depressive symptoms at the time of an economic crisis in Sardinia and to compare these results with those collected at the time of a similar crisis in Argentina more than 10 years before.

METHODS

Observational study. The associations of Sardinian immigrants in Buenos Aires provided the lists of families of Sardinian origin. A random sample of one fifth of registered families was selected. The sample of a study carried out in Sardinia was used as the control. The results were compared with those of the previous study performed in 2001-2002. The Patient Health Questionnaire (PHQ9) was used for the screening of depression.

RESULTS

The Sardinian immigrants show a lower rate of scoring positively on PHQ9 (i.e. less risk of being depressed) and reach statistical significance after standardization (8.7% vs. 13.1%, P = 0.046). Young women (≤40) are at higher risk. On the contrary, the risk of depression was higher in Sardinian immigrants in Argentina during the 2001-2002 crises.

CONCLUSION

The study indicates a risk for depressive episodes linked to the fallout of the economic crisis (in Argentina in 2001-2002, in Sardinia in 2015) and specifically more in females than in males. Due to the associated socio-demographic risk factors, these results could be interpreted as due to an increase in non-bipolar depression.

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.