Identifying depression and schizophrenia using vignettes: a methodological note

The impact of patient weight on US mental health providers' diagnosis of bulimia nervosa

This study examined how patient weight influences mental health providers' diagnosis of bulimia nervosa (BN). US mental health providers (N = 200) from PsychologyToday.com and professional listservs participated in an online experiment, reading vignettes about patients with major depressive disorder (MDD) and BN with the compensatory behavior of excessive exercise. For the BN vignette, participants were randomized to read about a patient whose weight status was described as "healthy weight" or "obesity." Participants reported their diagnoses, confidence, treatment recommendations, and perceived symptom severity. Only 27% of participants accurately diagnosed BN, with 38% of participants instead diagnosing binge eating disorder. There were no significant differences between weight conditions in diagnostic accuracy, confidence, or treatment recommendations for the BN vignette (ps > .05). However, symptoms within the BN vignette were perceived as more severe in the "obesity" condition compared to the "healthy weight" condition (M = 5.08 ± 0.80 vs. M = 4.72 ± 0.99 on a 1-7 scale, p = .005). Within-subjects analyses revealed that participants were more accurate and confident in diagnosing MDD than BN (ps < .01). These findings suggest poor detection of BN among mental health providers when patients present with healthy or higher weights. Providers may benefit from improved training for detecting BN when excessive exercise is used as the primary compensatory behavior.

"When one has no REAL illness"-analysis of the knowledge component of mental health literacy in children and adolescents of parents with a mental illness

Introduction and objective

Mental Health Literacy (MHL) is important in promoting youth mental health. One key aspect of MHL is knowledge about mental disorders, which is particularly relevant for populations at risk for developing mental disorders, such as children of parents with a mental illness (COPMI), representing a mechanism within the transgenerational transmission. Currently, COPMI's level of disorder knowledge in general, and about the specific parental disorder has not been comprehensively researched. We, therefore, aimed to assess COPMI's disorder knowledge and clarify its association with COPMI's age and sex exploratively. To assess both general and disorder-specific knowledge, we took a novel approach that makes disorder knowledge comparable across samples and over time.

Methods

A mixed method analysis of N = 181 semi-structured MHL interviews with COPMI (aged 5 to 17 years) was carried out in the COMPARE-family study in Germany. We conducted a DSM-oriented deductive qualitative content analysis to assess COPMI's general and specific disorder knowledge. Chi-square tests served to identify age and sex differences.

Results

Children revealed limited knowledge of mental disorders in general, whereas adolescents displayed more knowledge that was also partly consistent with descriptions of classification systems like the DSM-5. The level of specific knowledge about the parent's disorder depended on the disorder group. More children displayed adequate knowledge of somatic and anxiety disorders compared to trauma and depressive disorders, and more adolescents displayed adequate knowledge of depressive and anxiety disorders. COPMI's age and sex were found to be significantly associated with disorder knowledge: adolescents exhibited higher levels of adequate general and specific disorder knowledge, and males exhibited higher levels of adequate general disorder knowledge.

Conclusion

Assessing COPMI's disorder knowledge and identifying associated age and sex differences yield valuable insights into the knowledge component of the MHL theory. Our findings can help to improve psychoeducational interventions for COPMI by orienting them to their prevailing levels of disorder knowledge. We recommend employing and extending the DSM-oriented deductive approach to assess knowledge within MHL. Analyses involving additional assessments within the COMPARE-family study are in preparation to identify potential knowledge gains over time, and associations to COPMI's own well-being and mental health symptoms.

Can Sri Lankan Australians Recognise Depression? The Influence of Acculturation, Age and Experiences with Depression on Recognition

Mental health literacy is an important determinant of mental health help-seeking and is associated with improved mental health. There is evidence that mental health literacy may be lower amongst some migrant communities in Australia. The present study conducted the first cross-sectional survey of mental health literacy in Sri Lankan Australians between April and October 2020. Participants (N = 404) were presented with a culturally-tailored vignette describing an individual with symptoms of major depressive disorder, with correct recognition determined by the coding of an open text response to the question 'what's wrong with Mr Silva?'. Binomial linear regression modelling was conducted to identify predictors of the correct recognition of depression. Approximately 74% of participants recognised the presented symptoms as depression, though multiple other labels were also used by the respondents. The results also suggested that younger age and having a prior diagnosis of depression were significant predictors of recognising depression in the vignette. In the first study of Sri Lankan migrants' mental health literacy in an Australian context, the rates of depression recognition were comparable to those found in the general Australian population. Further research is urgently required to replicate and extend the present findings and ultimately support the development of tailored interventions aimed at improving mental health literacy across the diverse Sri Lankan Australian community.

What Does the Public Know About Varying Depression Severity?-Results of a Population Survey

Objectives: In this study, we examine the public's knowledge about different levels of depression severity in Germany. Methods: Data stem from a national telephone survey in Germany. A total of 1,009 persons participated, response rate was 46.8%. A vignette was presented with signs of mild, moderate or severe depression. Participants were asked what they think the person has, which persons and services are helpful and how effective different treatment options are. Differences between the three vignettes were tested with 95% confidence intervals and χ ²-tests. Results: 55.3% of the respondents identified depression as the health problem in question. Participants who heard the vignette with moderate symptomatology recognized depression more often. Across groups, a general practitioner was named most frequently concerning helpful persons/services. Effectiveness of psychotherapy received high levels of approval, online therapy and books were less often rated as effective. There were only few significant differences between the three vignettes. Conclusions: This is the first study examining public depression literacy for different severity levels. Small differences between severity levels indicate a lack of knowledge, which may have adverse consequences for adherence to treatment, especially for mild depression.

Mental health literacy in Ghana: Implications for religiosity, education and stigmatization

Research on Mental Health Literacy (MHL) has been growing internationally. However, the beliefs and knowledge of Ghanaians about specific mental disorders have yet to be explored. This vignette study was conducted to explore the relationships between religiosity, education, stigmatization and MHL among Ghanaians using a sample of laypeople (N = 409). The adapted questionnaire presented two vignettes (depression and schizophrenia) about a hypothetical person. The results revealed that more participants were able to recognize depression (47.4%) than schizophrenia (15.9%). Religiosity was not significantly associated with recognition of mental disorders but was positively associated with both social and personal stigma for depression, and negatively associated with personal and perceived stigma for schizophrenia. Moreover, education was found to be positively associated with disorder recognition, and negatively with perceived stigma. Finally, perceived stigma was positively associated with disorder recognition, whereas personal stigma for schizophrenia related negatively to recognition of mental disorders. In conclusion, education but not religiosity predicted identification accuracy, but both predictors were associated with various forms of stigma. Findings from this study have implications for MHL and anti-stigma campaigns in Ghana and other developing countries in the region.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c)

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.

Mental Health Literacy and Dementia

This study aimed to investigate mental health literacy (MHL) with respect to dementia. Three forms of dementia were investigated. In all, 167 participants completed an online questionnaire which consisted of five vignettes that described the three dementia conditions, as well as depression and typical ageing. The vignette characters had no age specified, or they were described as 50-years-old or 70-years-old. Participants had to firstly decide if there was a disorder present and identify it by name, then answer questions relating to treatment and help-seeking. Results showed that participants could identify Alzheimer’s Disease significantly more so than they could vascular or frontotemporal dementia. All three dementias were significantly more recognised when the vignette was described as a 70-year-old. Frontotemporal dementia was significantly misdiagnosed as depression. Participant education and mental health experience did not influence the identification of dementia. Compared to some other well-known mental illnesses like schizophrenia, lay people are relatively good at recognising Alzheimer’s disease, but much less so at other forms of dementia. Implications and limitations of the study are discussed.

The Recognition of Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and Conduct Disorder in Adolescents and Adults—Assessing Differences in Mental Health Literacy

This was a Mental Health Literacy (MHL) study looking at three disorders, part of a systematic research programme on MHL using vignette methodology to examine lay people’s knowledge and recognition. The study compared the recognition of the disorders in children and adults. In all 485 participants, aged 18–69 years, read three vignettes describing a person with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Conduct Disorder (CD). Vignette characters were described as either a child (aged 8yrs) or adult (aged 28 yrs). Participants attempted to label the disorder and then rated perceived seriousness and likelihood of disorder. Results from a 2 (sex) × 3 (disorder) way analysis of variance showed that CD was significantly perceived as the most serious disorder. ADHD was significantly considered more likely to be a disorder in adults yet recognised more in children. Younger participants correctly recognised ADHD, yet gave lower seriousness ratings. ASD was considered more serious in children. Women and highly educated individuals perceived ASD more seriously and recognised it more. Parents incorrectly identified CD but considered all disorders more seriously than non-parents. Clinical behaviours are more likely to be perceived as a disorder if they occur in adults, rather than children.

Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study

BACKGROUND

Psychological treatments improve depressive symptoms in people living with HIV/AIDS (PLWHA). Adaptation of treatments should be based on explanatory models of depression and other elements within the given context.

AIM

This study aimed to examine explanatory models of depression and acceptable approaches for implementation of group IPT in Northwest Ethiopia.

METHODS

Qualitative data were collected from April to May 2019 from case managers, adherence supporters and service users using focus group discussion and analysed thematically.

RESULTS

PLWHA attributed depression to psychosocial problems, spiritual factors and biological factors. Depression had several impacts at individual and family level. Group-based interpersonal therapy (IPT) was acceptable if provided by trained peer counselors.

CONCLUSION

The current study findings informed how to conduct feasibility and acceptability trials of group IPT in the HIV population in Ethiopia.

Mental health literacy for autism spectrum disorder and depression

In this study, three hundred and sixty-eight participants answered a questionnaire consisting of three vignettes describing a person with depression, severe Autism Spectrum Disorder (ASD), and high-functioning Autism Spectrum Disorder/Asperger's Syndrome (AS). Each vignette was followed by thirteen questions concerning the participant's knowledge about diagnosis, treatment, and prognosis. Participants demonstrated good mental health literacy (MHL) for depression, but were poor at diagnosing ASD. Drug therapy was rated as the least effective treatment and 'talking to a family member of friend' was rated as the most effective for each disorder. The highest prognosis ratings were given to depression, and the lowest given to ASD. Participants demonstrated better MHL than expected, possibly due to the availability of information on the Internet and the increase in prevalence of mental illnesses such as depression and ASD among the general population.

Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey

Beliefs about and attitudes toward mental illness may be influenced by cultural- or country-specific contexts. Through a national survey, the current study investigated beliefs and attitudes toward people with schizophrenia and depression among the general public in Taiwan. A random-digit-dialing telephone-based cross-sectional survey was administered to Taiwanese adults aged 20-64 years (n = 1600). The data were analyzed through binary logistic regressions to test for differences between these disorders in causal beliefs, stereotypes, emotional reactions, desire for social distance, and help-seeking behavior. The results revealed that respondents were more concerned with biogenetic causal explanations for people with schizophrenia than for those with depression. Significantly more respondents perceived people with schizophrenia as more likely to be unpredictable and violent toward others. A similar trend was observed for the desire for social distance. For both disorders, respondents were significantly more likely to express compassion than to express anger toward the person described in the vignette. Respondents also expressed more desire for social distance from someone like the vignette who have received psychiatric treatment. These findings provide useful directions for the implementation of optimal psychoeducation among such communities. .

Mental Health Literacy: A Review of What It Is and Why It Matters

An increasing number of scholarly works have attempted to understand the reasons for poor rates of help-seeking for symptoms of mental health disorders all around the world. One particular body of work has focused on “mental health literacy” (MHL), defined as knowledge about mental health disorders that is associated with their recognition, management, and prevention. In this article, we report a nonsystematic review of studies on MHL, to give nonexpert academics, policymakers, and practitioners an understanding of the field. We find that studies consistently show that the general public have relatively poor recognition of the symptoms of mental health disorders and appear to emphasize self-help over traditional medical treatments. In addition, we find that there are age, gender, educational, urban−rural, and cross-cultural differences in MHL, which may differentially affect rates of help-seeking in different contexts. Implications and future directions for research are considered in conclusion.

Comparing physical and mental health literacy

BACKGROUND

This study attempted to ascertain whether people had better mental vs physical health literacy by comparing their knowledge of six conditions.

AIMS

The aim was to link two different literatures which have remained apart.

METHODS

In all, 186 young British participants (52% male) with an average age of 25 years completed an online questionnaire describing six vignettes characters. Three described mental health conditions (anorexia, bipolar disorder and schizophrenia) and three physical health conditions (asthma, diabetes and osteoarthritis). Participants were required to name the illness and rate how treatable and manageable they believed the condition is. They were also asked to rate how much the problem would affect an individual's daily life and suggest whether the individual should seek professional help.

RESULTS

The recognition of specific mental health conditions (anorexia, borderline personality disorder, schizophrenia) was marginally higher than the recognition of physical health conditions (arthritis, asthma, diabetes). Ratings about treatment and the effect of each illness showed considerable variation.

CONCLUSION

The results suggest that people are equally and relatively poorly informed about relatively common mental compared to physical illnesses.

Helping older adults to help themselves: the role of mental health literacy in family members

OBJECTIVES

Family members may play an important role in the health and well-being of older adults. However, little is known about the factors that influence the likelihood of family members supporting older relatives to seek help from mental health professionals for mental health concerns. Mental health literacy is associated with people's help-seeking intentions regarding their own mental health concerns, and some studies have suggested it may play a role in help-seeking on behalf of others. The purpose of this study was to investigate whether mental health literacy is associated with adults' likelihood of supporting an older relative to seek professional help for mental health concerns.

METHOD

Two hundred and sixty-three participants completed a measure of mental health literacy and responded to a hypothetical scenario by indicating their likelihood of supporting an older relative experiencing mental health problems to seek help from various sources.

RESULTS

Mental health literacy was positively associated with intentions to support older relative's help-seeking.

CONCLUSIONS

Interventions to increase the mental health literacy of the relatives of older adults may lead to additional support for older adults' help-seeking for mental health concerns.

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.

Empathy and Mental Health Literacy

Background:

There is growing literature on mental health literacy (MHL), but few studies have conducted research on anything more than demographic predictors of MHL. We believe that those who are more empathic would be more interested in and more knowledgeable about mental illnesses.

Objective:

This study was concerned to establish whether people who were more empathic would have higher MHL.

Methods:

The 129 volunteer, university panel, participants completed the Interpersonal Reactivity Index and were presented with 15 vignettes describing people with various mental disorders. Questions assessed participants' identification of the disorders and their perception of the life adjustment of each person.

Key Results:

The results showed that 3 of the 4 empathy subscales correlated with the MHL score. Results from correlation and regression analyses suggest that people who are more empathic, have studied psychology, and have had personal experience of mental illness demonstrate better MHL.

Conclusions:

As predicted, people with greater MHL had greater empathy, but this cross-sectional correlational study could not ascertain causal patterns. [Health Literacy Research and Practice. 2017;1(2):e31–e40.]

Plain Language Summary:

This study addressed whether people who are more empathic tend to be better informed about mental health issues because of their care for, interest in, and sympathy toward those with a range of mental illnesses. This was a questionnaire study and we did indeed find the relationship we thought may occur. However, we cannot be certain which caused which—do those who know more about mental illnesses and how common they are become more empathic or do those with greater empathy learn more about all aspects of mental illness?

Influence of age and gender on mental health literacy of anxiety disorders

This study explored the influence of age and gender on Mental Health Literacy (MHL) of various anxiety disorders. The aim was to determine whether the gender and age of participants and gender of the disorders character had a significant effect on their ability to recognise a range of anxiety disorders. A convenience sample of 162 individuals (aged 18-70yrs) completed one of two questionnaires, which differed only on the gender of the vignette's character. Participants had to label the "problems" of individual in six vignettes and state their opinion on how well adjusted the characters were in terms of happiness and work and personal relationships. 'Correct' labelling (using the official/technical term) of the different disorders varied from 3% to 29% of all participants. Gender differences of participants had a significant effect on literacy where females demonstrated higher MHL than males and the youngest group (18-29yrs) showed better MHL than older groups. There was a non-significant effect of vignette gender on recognition rates. The research points to the evidence that MHL remains relatively low for all anxiety disorders.

Knowledge of mental illnesses: Two studies using a new test

While the benefits of public knowledge of physical diseases are widely recognised, knowledge about mental disorders (mental health literacy, MHL) has received much less attention. This paper reports on two studies using the new Multiple-Choice Knowledge of Mental Illness Test (MC-KOMIT), a 33 item test of MHL (Compton et al., 2011). In Study 1, we examined cross-cultural associations between country of origin and their MHL in an online sample of 250 adults. In line with previous findings, we demonstrate that British and American participants outperform respondents from India. Furthermore, males showed significantly lower MHL, but - contrary to expectations - age did not have a significant impact. Study 2 was conducted to validate and extend findings of study 1 concerning the impact of demographics and individual difference factors on MHL. Results of the second study, using American participants are consistent with findings of study 1. In addition we show that while religious beliefs may reduce MHL, higher levels of education and self-confidence are associated with higher levels of MHL.

How to spot a narcissist: Mental health literacy with respect to Narcissistic Personality Disorder

Lay people were asked to read one Depression, one Schizophrenia, and three Narcissistic Personality Disorder (NPD) vignettes. After each, they were asked what they thought the problem was for the individuals concerned and to make various ratings. Half of each of the five vignettes were of male, and the other of female, characters. The results demonstrated that laypeople are less likely to suggest help for, and have more difficulty identifying NPD compared to Depression and Schizophrenia. There were differences in the likeliness to suggest help between all three NPD vignettes and differences in the identification of two NPD vignettes possible due to the length and details in different vignettes. The gender of the person in the vignette had no effect on identification. The participants NPI scores were not correlated with the Narcissism literacy suggesting no relationship between having, and spotting, the disorder. Implications and limitations of the research are considered.

Mental health literacy and borderline personality disorder (BPD): what do the public "make" of those with BPD?

INTRODUCTION

This study was part of a programmatic series into mental health literacy, specifically lay people's knowledge of causes, manifestations and cures of Borderline Personality Disorder (BPD). The aim was to determine to what extent non-experts understood BDP and to what extent they held erroneous beliefs about specific aspects of the causes and cures for the disorder

METHOD

A convenience sample of 102 participants completed a vignette-identification task that required them to answer open-ended questions about hypothetical people with four psychological problems, one of which was BPD and a 50-item questionnaire divided into three sections about BDP.

RESULTS

Analysis of the vignette identification task revealed very low rates of recognition for BPD, with participants significantly more likely to identify depression, schizophrenia or psychopathy. Participants' generally favoured psychological and sociological treatments, as well as rating early trauma and stress as possible causes of the symptoms of the person described in the BDP vignette. There were logical relationships between perceptions of cause and cure.

CONCLUSION

The results suggest that participants hold certain coherent beliefs (psychological, sociological, biological or theological) regarding aetiology and treatments of BPD. Further, the findings suggest the need for greater awareness and educational programmes to inform the general public accurately regarding BPD and to improve mental health literacy.

Trauma type affects recognition of Post-Traumatic Stress Disorder among online respondents in the UK and Ireland

BACKGROUND

Mental Health Literacy (MHL) predicts help-seeking for mental health difficulties. Public surveys show high recognition of Post-Traumatic Stress Disorder (PTSD) in relation to military contexts, but this has not been investigated with other sources of trauma.

METHODS

A self-selecting sample of 2960 participants from UK and Ireland completed an online survey. Participants viewed one of three vignettes that described either a male or female character experiencing identical PTSD symptoms, that differed only by trauma source (military combat, industrial accident, sexual assault). Participants were asked to state i) whether a mental health problem was being experienced, ii) what it was, and iii) what help should be sought.

RESULTS

Trauma type was a key predictor of classification as a mental health problem, correct identification of PTSD, and help-seeking suggestions. For participants shown the military scenario the odds of recognising PTSD were 5.2 times higher than for those shown the sexual assault vignette, and 2.2 times higher than for those shown the accident scenario. Age (younger), gender (female), education (university), and personal mental health experience were additional significant predictors of higher recognition of PTSD.

LIMITATIONS

Reasons for failing to recognise a mental health problem/PTSD were not explored. The online convenience sampling method may limit generalisability of results.

CONCLUSIONS

Recognition of PTSD is significantly affected by trauma source. The data confirmed the pervasive association with military combat and suggest under-recognition of PTSD from other traumas, particularly sexual assault. Awareness campaigns may aim to increase MHL of PTSD from diverse trauma sources.

Mental health literacy and obsessive--compulsive personality disorder

An opportunistic sample of 342 participants completed a vignette identification task that required them to name the possible psychological problem of an individual described in vignettes describing people with depression, schizophrenia, OCD and OCPD. Participants rated the degree to which they believed the individual experienced distress, they felt sympathetic towards the described individual, and the degree to which they believed the individual was well-adjusted in the community. There were very low recognition rates of OCPD, with participants more likely to identify depression, schizophrenia and OCD. Analysis of distress, sympathy and adjustment ratings also revealed significant differences between the disorders. The findings highlight the necessity of greater mental health awareness and the importance of psycho-education in order to increase successful treatment seeking of OCPD patients.