Mental Health Literacy of Depression: Gender Differences and Attitudinal Antecedents in a Representative British Sample

Background

Poor mental health literacy and negative attitudes toward individuals with mental health disorders may impede optimal help-seeking for symptoms of mental ill-health. The present study examined the ability to recognize cases of depression as a function of respondent and target gender, as well as individual psychological differences in attitudes toward persons with depression.

Methods

In a representative British general population survey, the ability to correctly recognize vignettes of depression was assessed among 1,218 adults. Respondents also rated the vignettes along a number of attitudinal dimensions and completed measures of attitudes toward seeking psychological help, psychiatric skepticism, and anti-scientific attitudes.

Results

There were significant differences in the ability to correctly identify cases of depression as a function of respondent and target gender. Respondents were more likely to indicate that a male vignette did not suffer from a mental health disorder compared to a female vignette, and women were more likely than men to indicate that the male vignette suffered from a mental health disorder. Attitudes toward persons with depression were associated with attitudes toward seeking psychological help, psychiatric skepticism, and anti-scientific attitudes.

Conclusion

Initiatives that consider the impact of gender stereotypes as well as individual differences may enhance mental health literacy, which in turn is associated with improved help-seeking behaviors for symptoms of mental ill-health.     

Mental Health Help-Seeking Intentions and Preferences of Rural Chinese Adults

Purpose

We aimed to investigate mental health help-seeking intentions and preferences of rural Chinese adults and determine predictors of the intentions.

Methods

A total of 2052 representative rural residents aged 18–60 completed a cross-sectional survey by face-to-face interviews. The survey included seven questions asking about respondents’ help-seeking intentions and preferences, and a series of internationally validated instruments to assess self-perceived health status, depression, anxiety, alcohol abuse, mental health literacy, and attitudes towards mental illness.

Results

Nearly 80% of respondents were willing to seek psychological help if needed, and 72.4% preferred to get help from medical organizations, yet only 12% knew of any hospitals or clinics providing such help. A multivariate analysis of help-seeking intention revealed that being female, having lower education, higher social health, higher mental health knowledge, and physical causal attribution for depression were positive predictors of help-seeking intention.

Conclusion

A huge gap exists between the relatively higher intention for help-seeking and significantly lower knowledge of helpful resources. Predictors of help-seeking intention for mental problems in the current study are consistent with previous studies. Interventions to increase help-seeking for mental problems by Chinese rural adults may be best served by focusing on increasing public awareness of help sources, as well as improving residents’ mental health literacy and social health, with special focus on males and those more educated.     

Heritability of specific language impairment depends on diagnostic criteria

Heritability estimates for specific language impairment (SLI) have been inconsistent. Four twin studies reported heritability of 0.5 or more, but a recent report from the Twins Early Development Study found negligible genetic influence in 4-year-olds. We considered whether the method of ascertainment influenced results and found substantially higher heritability if SLI was defined in terms of referral to speech and language pathology services than if defined by language test scores. Further analysis showed that presence of speech difficulties played a major role in determining whether a child had contact with services. Childhood language disorders that are identified by population screening are likely to have a different phenotype and different etiology from clinically referred cases. Genetic studies are more likely to find high heritability if they focus on cases who have speech difficulties and who have been referred for intervention.     

Coverage of genetic technologies under national health reform.

This article examines the extent to which the technologies expected to emerge from genetic research are likely to be covered under Government-mandated health insurance programs such as those being proposed by advocates of national health reform. Genetic technologies are divided into three broad categories; genetic information services, including screening, testing, and counseling; experimental technologies; and gene therapy. This article concludes that coverage of these technologies under national health reform is uncertain. The basic benefits packages provided for in the major health reform plans are likely to provide partial coverage of experimental technologies; relatively broad coverage of information services; and varying coverage of gene therapies, on the basis of an evaluation of their costs, benefits, and the degree to which they raise objections on political and religious grounds. Genetic services that are not included in the basic benefits package will be available only to those who can purchase supplemental insurance or to those who can purchase the services with personal funds. The resulting multitiered system of access to genetic services raises serious questions of fairness.     

Surviving social assistance: 12-month prevalence of depression in sole-support parents receiving social assistance

BACKGROUND: Although it is generally recognized that poverty and depression can coexist among single parents receiving social assistance, there is insufficient research on this topic. The goals of this study therefore were to investigate the prevalence, correlates and health care expenditures associated with depression among sole-support parents receiving social assistance. METHODS: Sole-support parents who had applied for social assistance in 2 regions of southwestern Ontario were included in the study. Depression was diagnosed with the 1994 University of Michigan Composite International Diagnostic Interview short forms. RESULTS: The 12-month prevalence rate of depressive disorder among the parents interviewed was 45.4% (345/760). A total of 247 (32.5%) had major depressive disorder alone, 19 (2.5%) had dysthymia, and 79 (10.4%) had both major depressive disorder and dysthymia ("double depression"). Those with major depressive disorder, particularly double depression, had significantly higher rates of coexisting psychiatric disorder than those without depressive disorders. Parents with depression reported higher rates of developmental delay and behaviour problems in their children than parents without depression. Expenditures for health care services were higher for parents with depression and for their children than for parents without depressive disorder and their children. INTERPRETATION: Single parents receiving social assistance have high rates of depression. Such parents with depression also have higher rates of other psychiatric disorders and higher expenditures for health care services, and their children have higher rates of developmental delay and behaviour problems.     

Depressive illness and Navajo healing

What is the experience of Navajo patients in Navajo religious healing who, by the criteria and in the vernacular of contemporary psychiatry, would be diagnosed with the disorder called depression? We ask this question in the context of a double dialogue between psychiatry and anthropology and between these disciplines' academic constructs of illness and those of contemporary Navajos. The dialogue is conducted in the arena of patient narratives, providing a means for observing and explicating processes of therapeutic change in individuals, for illustrating variations in forms of Navajo religious healing sought out by patients demonstrating similar symptoms of distress, and for considering the heuristic utility of psychiatric diagnoses and nomenclature in the conceptualization of illness, recovery, and religious healing. From among the 37 percent of patients participating in the Navajo Healing Project who had a lifetime history of a major depressive illness, three are discussed herein, their selection based on two criteria: (1) all met formal psychiatric diagnostic criteria for a major depressive episode at the time of their healing ceremonies, and (2) together, their experiences illustrate the range of contemporary Navajo religious healing, including Traditional, Native American Church (NAC), and Christian forms. We suggest that, despite the explicit role of the sacred in religious healing interventions available to Navajo patients, differences between biomedical and religious healing systems may be of less significance than their shared existential engagement of problems such as those glossed as depression.     

Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care.

OBJECTIVE--To determine whether, in the treatment of major depression in primary care, a brief psychological treatment (problem solving) was (a) as effective as antidepressant drugs and more effective than placebo; (b) feasible in practice; and (c) acceptable to patients. DESIGN--Randomised controlled trial of problem solving treatment, amitriptyline plus standard clinical management, and drug placebo plus standard clinical management. Each treatment was delivered in six sessions over 12 weeks. SETTING--Primary care in Oxfordshire. SUBJECTS--91 patients in primary care who had major depression. MAIN OUTCOME MEASURES--Observer and self reported measures of severity of depression, self reported measure of social outcome, and observer measure of psychological symptoms at six and 12 weeks; self reported measure of patient satisfaction at 12 weeks. Numbers of patients recovered at six and 12 weeks. RESULTS--At six and 12 weeks the difference in score on the Hamilton rating scale for depression between problem solving and placebo treatments was significant (5.3 (95% confidence interval 1.6 to 9.0) and 4.7 (0.4 to 9.0) respectively), but the difference between problem solving and amitriptyline was not significant (1.8 (-1.8 to 5.5) and 0.9 (-3.3 to 5.2) respectively). At 12 weeks 60% (18/30) of patients given problem solving treatment had recovered on the Hamilton scale compared with 52% (16/31) given amitriptyline and 27% (8/30) given placebo. Patients were satisfied with problem solving treatment; all patients who completed treatment (28/30) rated the treatment as helpful or very helpful. The six sessions of problem solving treatment totalled a mean therapy time of 3 1/2 hours. CONCLUSIONS--As a treatment for major depression in primary care, problem solving treatment is effective, feasible, and acceptable to patients.     

Conceptualization of psychiatric illness and help-seeking behavior among Chinese

Problem conceptualizations of Chinese psychiatric patients were studied in relation to the patterns of help-seeking and ways of coping. Patients who conceptualized their initial problems in purely psychological terms were more likely to use self-directed psychological coping methods, delay initial professional consultation, and approach mental health professionals. Patients who used only somatic concepts were least likely to approach mental health professionals initially or any time during their previous consultation history, and tended to approach medical resources to cope with their problems. Patients who conceptualized their problems in mixed terms approached professional help early on and reached psychiatric resources soonest. These results provide a clearer perspective to understand the somatization tendency among Chinese patients.     

Infertility-related reproductive health knowledge and help-seeking behaviour in African countries

¹Correspondence address. E-mail: silke.dyer{at}uct.ac.za Data from African countries indicate that men and women attributeinfertility to traditional beliefs about health and diseaseas well as to biomedical causes, although appropriate knowledgeof the latter is frequently lacking. Infertility is a dreadedcondition and as a result help-seeking is often intense andpersistent. Most of the help-seeking is undertaken by womenand both traditional and modern biomedical health services areaccessed. There are, however, many barriers to effective andaffordable biomedical infertility care, many of which are relatedto poor resources and lack of infrastructure, and as a resultthe need for infertility treatment is often unmet. Advancesin the quality of care require greater commitment to the problemof infertility in African countries, the provision of healtheducation as an integral part of infertility management, theintegration of infertility services into reproductive healthcare programmes and defining the role of assisted reproductivetechnologies in low resource settings. At the same time theimportance of traditional health services in infertility managementshould be recognized.     

The Recognition of Mental Illness,Schizophrenia Identification,and Help-Seeking from Friends in Late Adolescence

Objective

The recognition of mental illness without anticipating stigma might encourage adolescents’ help-seeking behavior. We aimed to identify the relationship between mental illness identification and adolescents’ intention to seek help if faced with mental illness.

Method

We examined the relationships between help-seeking intentions and recognition of mental illness (RMI) without correctly identifying the disease name, as well as correct labelling of schizophrenia (LSC) using a vignette about a person with schizophrenia in a cross-sectional survey of 9,484 Japanese high-school students aged 15–18 years.

Results

When compared with adolescents who were unable to recognize the mental illness (UMI) in the vignette, those in the RMI group reported they were significantly more likely to seek help from friends (odds ratio [OR] = 1.29; 95% confidence interval [CI] = 1.17–1.41; P < 0.001) and expressed an increased likelihood to seek help from professionals (all P < .05). Those in the LSC group reported they were significantly less likely to exhibit help-seeking behavior (OR = 0.77, 95% CI = 0.65–0.92, P = 0.003) and expressed an increased likelihood of help-seeking from health professionals than the UMI group (all P < .05).

Conclusion

The ability to recognize mental illness without identifying the disease may increase help-seeking from friends, while the ability to identify the disease as schizophrenia might decrease late adolescents’ help-seeking. To promote help-seeking behavior among adolescents, improving their ability to recognize mental illness generally is recommended.     

Chronic illness and functional limitation in Ontario children: findings of the Ontario Child Health Study.

The Ontario Child Health Study (OCHS) was based on interviews of 1869 Ontario families who were selected by means of a stratified, multistaged sampling method from the 1981 census of Canada. Its primary purpose was to determine the prevalence and distribution of mental health problems in Ontario children aged 4 to 16 years and their families, but it also allowed an estimate of other significant medical conditions and provided an overview of these children''s use of health care, education and social services. Our results are based on questionnaire responses concerning 3294 children. Limitation of function without a chronic illness or medical condition was reported in 1.9%, the converse in 14.0%, and a chronic illness or medical condition with limitation of function in 3.7%. When the three groups are considered together, 19.6% of Ontario children had a chronic health problem. Children of lower socioeconomic status were much more likely to have chronic health problems. Overall, children with chronic health problems were more likely to use physician, special education, social and mental health services. These findings have implications for those who provide services for children, plan community programs or train professionals in caring for children.     

Die Diagnose im Nachgang: Eine Rehabilitierung der Anpassungsstörung*

Although a common diagnosis, adjustment disorder has received little scientific attention and instead the focus has been on major depression. It is likely that adjustment disorder and major depression have been conflated and the reasons for this are explored. Clearly delineating one from the other has crucial therapeutic and financial implications.     

Unrecognised depression in general practice.

Patients attending their general practitioner were screened and a group with unrecognised major depressive disorder identified. This group was interviewed and the findings compared with those in a group of patients recognised correctly as depressed by their general practitioners. Half of the patients with severe depression screened in their doctors'' waiting rooms went unrecognised, and they differed in few ways from those who were recognised. The differences found were that the patients with unrecognised depression were less obviously depressed and their illness had lasted longer. Physical illness was present in nearly 30% of patients in the unrecognised group, and the depression seemed related to it. Patients with unrecognised depression were more likely to have feelings other than those of normal sadness and more likely to respond with change of mood to intercurrent events. These data suggest that patients might benefit if general practitioners were better trained to recognise depression, although it is not known whether treatment would be effective.     

Ecosystem services classification: A systems ecology perspective of the cascade framework

Ecosystem services research faces several challenges stemming from the plurality of interpretations of classifications and terminologies. In this paper we identify two main challenges with current ecosystem services classification systems: i) the inconsistency across concepts, terminology and definitions, and; ii) the mix up of processes and end-state benefits, or flows and assets. Although different ecosystem service definitions and interpretations can be valuable for enriching the research landscape, it is necessary to address the existing ambiguity to improve comparability among ecosystem-service-based approaches. Using the cascade framework as a reference, and Systems Ecology as a theoretical underpinning, we aim to address the ambiguity across typologies. The cascade framework links ecological processes with elements of human well-being following a pattern similar to a production chain. Systems Ecology is a long-established discipline which provides insight into complex relationships between people and the environment. We present a refreshed conceptualization of ecosystem services which can support ecosystem service assessment techniques and measurement. We combine the notions of biomass, information and interaction from system ecology, with the ecosystem services conceptualization to improve definitions and clarify terminology. We argue that ecosystem services should be defined as the interactions (i.e. processes) of the ecosystem that produce a change in human well-being, while ecosystem components or goods, i.e. countable as biomass units, are only proxies in the assessment of such changes. Furthermore, Systems Ecology can support a re-interpretation of the ecosystem services conceptualization and related applied research, where more emphasis is needed on the underpinning complexity of the ecological system.     

Use of special education services by children with orofacial clefts

BACKGROUND: Our objective was to evaluate the use of special education services by children with orofacial clefts (OFCs). METHODS: We linked the birth certificates of children born from 1982–2001 in five counties of metropolitan Atlanta to a population‐based birth defects surveillance system to identify children with OFCs, and to the special education files for the school years 1992–2004 to identify children who used special education services. The special education data contained exceptionalities and services rendered for each school year. Prevalence ratios (PRs) and 95% CIs were calculated. The data were stratified by race/ethnicity, maternal education, type of OFC, and the presence of associated major malformations. In addition, we assessed the age at which special education began and the amount of time spent receiving services. RESULTS: Of the 777 children with OFCs, 201 (26%) were in special education at least 1 year compared with 8% of the children who had no major birth defects, yielding a PR of 3.2 (95% CI: 2.9–3.6). The most common exceptionality or service for children with an OFC was speech and language services. Compared with children with no birth defects, children with an OFC were four times more likely to be in this exceptionality (PR 3.8; 95% CI: 3.3–4.3). After excluding children in speech and language services, children with OFCs were still more likely to use special education services (PR 2.4; 95% CI: 1.7–3.2). CONCLUSIONS: Children with OFCs used special education services more often than children without birth defects. This information can help in planning for future population needs. Birth Defects Research (Part A), 2008. © 2008 Wiley‐Liss, Inc.     

Time intervals and patient-level factors in oral cancer diagnostic pathways: An application of the WHO framework in India

BackgroundOral cancer, a leading cancer-site in India, is often detected at advanced stages. We evaluated the time intervals from first symptom to help-seeking and diagnosis among oral cancer patients.MethodologyIn this cross-sectional study, we recruited 226 consecutive oral cancer patients (mean age ( ± SD) 51.9 years ( ± 10.9); 81.9% men; 70.3% advanced stage) registered for diagnosis and treatment, between 2019 and 2021 at a cancer care centre in South India. We used WHO framework and previously standardized tools to record time intervals (appraisal, help-seeking and diagnostic) and baseline characteristics. We utilized multivariable logistic regression models to test the associations between ‘prolonged (i.e., over 1 month) time intervals’) and patient-level factors to estimate odds ratios (ORs) with 95% confidence intervals (CIs).ResultsOver a half of patients presented with prolonged appraisal (60%) and help-seeking intervals (57%), and a third (34%) reported prolonged diagnostic interval. Patients with no formal education, no routine healthcare visits, no self-reported risk factors, and those who did not perceive initial symptoms to be serious were 2–4 times more likely to have prolonged appraisal and help-seeking than the rest. High travel costs and self-decision for visiting healthcare facility prolonged help-seeking. Diagnostic interval was prolonged only among women OR= 2.7 (95% CI: 1.2–6.1)) and in patients whose first doctor’s opinion was ‘nothing to worry’ OR (=7.3 (95% CI: 2.6–20.5)). ‘Correct knowledge of cancer’ shortened appraisal and help-seeking intervals and ‘incorrect knowledge and negative beliefs’ prolonged diagnostic interval.ConclusionOur findings highlight that interventions targeting sociocultural and economic determinants, symptom awareness, sensitizing persons at risk (especially women) and primary care providers might reduce overall time to diagnosis. Further, patients without any known risk factors for oral cancer might be at-risk for prolonged appraisal interval. These might help inform ‘pull’ strategies for cancer control in India and similar settings.     

Conceptualization And Manifestation Of Depression In An Asian Context: Formal Construction And Validation Of A Children’S Depression Scale In Singapore

Understanding that the conceptualization and manifestation of depression vary across cultures, in a preliminary study, Koh and colleagues (2002) identified a cultural model and a prototype measure of depression for Asian children. The present study sought to provide further examination of the initially identified conceptualization, manifestation, and measurement of depression in Asian children. Involving a community sample of 442 Singaporean Chinese children (6 to 12 years old), a culturally salient factor, Negative Social Self, was established to constitute part of depression, in addition to three universally recognized factors: Negative Affect and Cognitive Dysfunction, Loss of Interest, and Psychosomatic Manifestations. The Asian Children Depression Scale (ACDS) and Negative Social Self (NSS) were found to be positively related to hopelessness and negatively related to self-esteem, subjective well-being, and control-related beliefs, establishing support for convergent validity. Notably, NSS was found to account for significant incremental validity over that of the universally recognized factors in predicting most of the above-mentioned variables, supporting its added value as a factor of depression in Asian children. The results suggested that the ACDS and the culturally salient dimension reflect the phenomenological experiences and manifestations of depression in Asian children.