Improving Australians' depression literacy

Effectiveness of school-based preventive programs in suicidal thoughts and behaviors: A meta-analysis

BACKGROUND

Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective.

METHODS

We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted.

RESULTS

Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes.

LIMITATIONS

Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution.

CONCLUSIONS

School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.

Public Awareness and Attitude Towards Depression: A Community Based Study Among an Adult Population in Ile-Ife South-Western Nigeria

Depression has become a global health priority due to its associated burden. However, there is dearth of information regarding the public awareness and attitude towards depression in Nigeria. This study aimed to assess the level of public awareness and attitude towards depression in a semi-urban Nigerian community. A cross-sectional study conducted among 240 respondents with mean age of 34.7 years (± 1.2 years). A questionnaire assessed socio-demographic characteristics, level of awareness and attitude of people towards depression. While most respondents (72.5%) had heard about depression, it was less recognized as a major mental health problem. Also, most respondents (58.6%) had negative attitudes toward depression. There is low level of awareness of depression as a major health problem among community dwellers in South-western Nigeria and negative attitudes towards the illness also appear prevalent. Therefore, awareness should be improved through public health enlightenment programmes.

Depression screening and education: an examination of mental health literacy and stigma in a sample of Hispanic women

Background

Mental health literacy consists of knowledge of a mental disorder and of the associated stigma. Barriers to depression treatment among Hispanic populations include persistent stigma which is primarily perpetuated by inadequate disease literacy and cultural factors. U.S.-born Hispanics are more likely to have depression compared to Hispanics born in Latin America and are less likely to follow a treatment plan compared to non-Hispanic whites. Hispanic women are more likely to access treatment through a primary care provider, making it an ideal setting for early mental health interventions.

Methods

Baseline data from 319 female Hispanic patients enrolled in Project DESEO: Depression Screening and Education: Options to Reduce Barriers to Treatment, were examined. The study implemented universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9) and took place at one federally qualified health center (FQHC) over a 24-month period. The current analysis examined the relationship between four culturally adapted stigma measures and depression knowledge, and tested whether mental health literacy was comparable across education levels in a sample of Hispanic women diagnosed with depression.

Results

Almost two-thirds of the sample had less than a high school education. Depression knowledge scores were significantly, weakly correlated with each the Stigma Concerns About Mental Health Care (ρ = − .165, p = .003), Latino Scale for Antidepressant Stigma (p = .124, p = .028), and Social Distance scores (p = .150, p = .007). Depression knowledge (F[2, 312] = 11.82, p < .001, partial η² = .071), Social Distance scores (F[2, 312] = 3.34, p = .037, partial η² = .021), and antidepressant medication stigma scores (F[2, 312] = 3.33, p = .037, partial η² = .015) significantly varied by education category. Participants with at least some college education reported significantly greater depression knowledge and less stigma surrounding depression and medication than participants with lower education levels.

Conclusions

Primary care settings are often the gateway to identifying undiagnosed mental health disorders, particularly for Hispanic women with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education level as a predictor of mental health literacy. For Hispanic women, understanding the mental health literacy of patients in a healthcare setting may improve quality of care through early detection of symptoms, culturally effective education and subsequent engagement in treatment.

Trial registration

The study was registered with https://clinicaltrials.gov/: NCT02491034 July 2, 2015.

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial

BACKGROUND

Since 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously.

METHODS

We will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes.

DISCUSSION

If the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale.

TRIAL REGISTRATION

The study is registered in the Dutch Trial Register ( NTR6622 ).

Recruiting participants for interventions to prevent the onset of depressive disorders: possible ways to increase participation rates

Background

Although indicated prevention of depression is available for about 80% of the Dutch population at little or no cost, only a small proportion of those with subthreshold depression make use of these services.

Methods

A narrative review is conducted of the Dutch preventive services in mental health care, also addressing the problem of low participation rates. We describe possible causes of these low participation rates, which may be related to the participants themselves, the service system, and the communication to the public, and we put forward possible solutions to this problem.

Results

There are three main groups of reasons why the participation rates are low: reasons within the participants (e.g., not considering themselves as being at risk; thinking the interventions are not effective; or being unwilling to participate because of the stigma associated with depression); reasons within the health care system; and reasons associated with the communication about the preventive services. Possible solutions to increasing the participation rate include organizing mass media campaigns, developing internet-based preventive interventions, adapting preventive interventions to the needs of specific subpopulations, positioning the services in primary care, integrating the interventions in community-wide interventions, and systematically screening high-risk groups for potential participants.

Discussion

Prevention could play an important role in public mental health in reducing the enormous burden of depression. However, before this can be realized more research is needed to explore why participation rates are low and how these rates can be improved.

Age differences in mental health literacy

Background

The community's knowledge and beliefs about mental health problems, their risk factors, treatments and sources of help may vary as a function of age.

Methods

Data were taken from an epidemiological survey conducted during 2003–2004 with a national clustered sample of Australian adults aged 18 years and over. Following the presentation of a vignette describing depression (n = 1001) or schizophrenia (n = 997), respondents were asked a series of questions relating to their knowledge and recognition of the disorder, beliefs about the helpfulness of treating professionals and medical, psychological and lifestyle treatments, and likely causes.

Results

Participant age was coded into five categories and cross-tabulated with mental health literacy variables. Comparisons between age groups revealed that although older adults (70+ years) were poorer than younger age groups at correctly recognising depression and schizophrenia, young adults (18–24 years) were more likely to misidentify schizophrenia as depression. Differences were also observed between younger and older age groups in terms of beliefs about the helpfulness of certain treating professionals and medical and lifestyle treatments for depression and schizophrenia, and older respondents were more likely to believe that schizophrenia could be caused by character weakness.

Conclusion

Differences in mental health literacy across the adult lifespan suggest that more specific, age appropriate messages about mental health are required for younger and older age groups. The tendency for young adults to 'over-identify' depression signals the need for awareness campaigns to focus on differentiation between mental disorders.

Depression literacy in Alberta: findings from a general population sample

OBJECTIVE

To assess the public's knowledge about depression, attitudes toward treatments for depression, perceived causal factors for depression, and reported prognoses of depression, overall and by sex.

METHODS

We conducted a cross-sectional telephone survey in Alberta between February and June 2006. We used a random phone number selection procedure to identify a sample of adults in the community (n = 3047). Participants were presented with a vignette describing an individual with depression and then asked questions to assess recognition of depression, attitudes toward mental health treatments, possible causal factors for depression, and prognosis of depression.

RESULTS

The response rate was 75.2 %. Among the final participants, 75.6% could correctly recognize depression described in a case vignette. General practitioners or family doctors were considered as being the best help for depression. Of the participants, 35% were in complete agreement with health professionals about appropriate interventions for depression, 28% believed in dealing with depression alone, and 43% thought that "weakness of character" was a likely cause of depression. Men had poorer mental health literacy than women and were more likely to endorse the use of alcohol to cope.

CONCLUSIONS

Mental health promotion and education efforts are needed to improve the general public's mental health literacy and to clarify misunderstanding about depression. Men need to be a particular target of these efforts.

The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments

OBJECTIVE

To evaluate whether a campaign to increase public knowledge about depression (beyondblue: the national depression initiative) has influenced the Australian public's ability to recognize depression and their beliefs about treatments.

METHOD

Data from national surveys of mental health literacy in 1995 and 2003-04 were analysed to see if states and territories which funded beyondblue (the high exposure states) had greater change than those that did not (the low exposure states). In both surveys, participants were asked what was wrong with a person in a depression case vignette and to give opinions about the likely helpfulness for this person of a range of treatments. In the 2003-04 survey participants were also asked questions to assess awareness of beyondblue.

RESULTS

Awareness of beyondblue in the states that provided funding was found to be around twice the level of those that did not. Using the low-exposure states as a control, the high-exposure states had greater change in beliefs about some treatments, particularly counselling and medication, and about the benefits of help-seeking in general. Recognition of depression improved greatly at a national level, but slightly more so in the high-exposure states.

CONCLUSIONS

The data are consistent with beyondblue having had a positive effect on some beliefs about depression treatment.

Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample

BACKGROUND

The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression.

METHODS

Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month. Data gathered included age at onset, age at help-seeking, primary reason for the delay, prompt to seek help and first professional contacted.

RESULTS

The most frequently endorsed reasons for the delay related to lack of knowledge about mental illness or available treatment. Increasing illness severity or disability was the primary prompt to seek help for the majority of respondents. Reason for the delay showed some relationship with length of the delay, but prompt to seek help did not. A general medical practitioner (GP) was the first professional contacted in 71 % of cases.

CONCLUSIONS

Lack of public 'mental health literacy' contributes to slow problem recognition. Increasing illness severity eventually facilitates problem recognition and prompts help-seeking. Structural barriers to initial help-seeking are relatively unimportant within the Australian health care system. General practitioners play an important role as gate-keepers to appropriate mental health care.

Barriers to the effective management of depression in general practice

OBJECTIVE

The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

METHOD

Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

RESULTS

General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p=0.00), as did female GPs (p=0.00). Male GPs (p=0.00) and those in rural settings (p=0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p=0.00). Urban-based GPs (p=0.04) and those with prior mental health training (p=0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p=0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p=0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p=0.01), although the results were not entirely consistent.

CONCLUSIONS

Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Knowledge and attitudes about suicide in 25-year-olds

OBJECTIVE

To examine knowledge and attitudes about suicide in a New Zealand sample of young people aged 25 years.

METHOD

The sample was a birth cohort of 1265 young people born in New Zealand in 1977 who have been followed in a longitudinal study for 25 years. At age 25, participants were asked a series of questions designed to assess their knowledge and attitudes about suicide.

RESULTS

Young people had poor knowledge about youth suicide. They overestimated the number of youth suicide deaths, with a quarter believing that the number of deaths was at least 10x higher than the actual number. They overestimated the fraction of all suicides accounted for by youth suicides with two-thirds believing that 50% or more of all suicides occurred among young people. The most common source of information about suicide was the media. Young people tended to hold mixed attitudes toward suicide, having both liberal and conservative views. Those with lifetime histories of suicidal ideation or suicide attempt and those with family histories of suicide or suicide attempt tended to hold more liberal attitudes. Attitudes toward suicide were unrelated to gender and to knowledge about suicide.

CONCLUSIONS

Young people over-estimate the prevalence of youth suicide and the fraction of suicides accounted for by youth deaths, and hold both conservative and liberal attitudes toward suicide. Their primary source of information about suicide is the media. These findings raise concerns about the potential for media coverage of youth suicide issues to normalize suicide as a common, and thereby acceptable, response among young people, and suggest the need for careful dissemination of accurate information about suicide by knowledgeable, respected and reputable sources.

Preventing depression: a challenge for the Australian community

Prevention is feasible by providing quality interventions at key moments.