Perceived helpfulness of websites for mental health information

BACKGROUND: Despite the high risk of developing a mental disorder during adolescence, many young people fail to receive appropriate treatment from mental health professionals. Recent studies have found certain mental health information websites have improved mental health literacy and reduced symptoms of depression. However, studies exploring young people's perceptions of such resources still remain scarce. The current paper compared young people's preference for a website with self-help books and two face-to-face services-counselling and mental health services. The factors associated with believing in the perceived helpfulness of each intervention were also explored. METHOD: A national telephone survey was carried out with 3,746 people aged 12-25 years and 2005 co-resident parents. Perceived helpfulness of each intervention was assessed in relation to four vignettes (depression, social phobia, psychosis and depression with alcohol misuse). RESULTS: Approximately 71% of respondents rated websites and books as likely to be helpful, which was less than for counselling, but more than for mental health services. Predictors of rating a website as likely to be helpful were older age (18-25 years), belief in seeking help, less social distance from peers like the one in the vignette, and being presented with the vignettes depicting either social phobia or depression with alcohol misuse. Predictors of rating a book as helpful included belief in seeking help, awareness of the national depression initiative beyondblue, less social distance, being presented with the social phobia vignette, and the belief that the person in the vignette is 'weak not sick'. CONCLUSION: Most young people are open to the idea of accessing mental health information online, especially for disorders that are often perceived as behavioural problems. These young people also believe in help-seeking in general and are more willing to associate with peers who have mental health problems.     

Structure of beliefs about the helpfulness of interventions for depression and schizophrenia

Background The public tends to have different views from professionals about the treatment of mental disorders. It has been proposed that these differences do not simply reflect a lack of knowledge about treatments, but also the operation of pre-existing general belief systems about health interventions. The present study uses factor analysis to examine the structure of public beliefs about interventions for depression and schizophrenia, using case vignettes that vary in severity or stage of illness. Methods In a national survey of 3,998 Australian adults, respondents were presented with one of four vignettes: depression, depression with suicidal thoughts, early schizophrenia and chronic schizophrenia. Respondents were asked about the likely helpfulness or harmfulness of a wide range of interventions for the person in the vignette. Methods suitable for ordinal data were used to explore a range of factor analytic solutions. Once identified, the location of participants on each factor was estimated by calculating a mean score for items loading highly on that factor. These scale means were compared between subgroups of participants. Results Four factors were found. Three of these—Lifestyle, Psychological and Medical—corresponded to previously found factors. An additional factor named Information-seeking was defined by items that had not been included in earlier research. These items concerned obtaining information or advice from a variety of sources including the internet, books and health educators. Differences on the factors were a function of socio-demographic factors and ability to identify the condition portrayed in the vignette. However, the magnitude of these differences was small. Differences between factors were more pronounced, with mean ratings on the Medical factor falling between harmful and neutral, while mean ratings on other factors lay between neutral and helpful. Conclusion The public tends to favour psychological and lifestyle interventions over medical ones. These beliefs do not reflect specific knowledge about the effectiveness of particular treatments, but rather general commitments to broad classes of treatment that are applied irrespective of the type of mental disorder. Educational campaigns to improve public knowledge about treatments will need to take account of these pre-existing belief systems.     

The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations?

Objective: This study examined hypotheses that stigmatizing attitudes are increased by use of psychiatric labels, by conceptualization of symptoms as a medical illness and by belief in genetic causes. Method: A survey of 3998 Australian adults asked questions about one of four vignettes: early schizophrenia, chronic schizophrenia, depression and depression with suicidal thoughts. Attitudes were measured by a social distance scale and a question about likely dangerousness. Results: Social distance was unrelated to the hypothesized factors. For schizophrenia (but not depression), belief in dangerousness was predicted by medical illness conceptualizations and genetic causal attribution. However, more important factors were the behaviours in the vignette and the belief that they are because of weakness of character. Conclusion: Biomedical conceptualizations are not the major cause of stigma, rather it is the behaviour associated with mental illness and the belief that this is because of personal weakness.     

Diagnosis and treatment of mental disorders: a survey of Singapore mental health professionals

Background: A series of surveys of mental health literacy have been undertaken in Australia, involving members of the general public as well as general practitioners and mental health professionals, whereby respondents consider vignettes of depression and of schizophrenia, offer a diagnosis and rate a series of possible interventions for their judged helpfulness. A similar survey was undertaken in Singapore and is reported in this paper. Methods: The survey was undertaken at a large state psychiatric hospital with staff (psychiatrists, allied health professionals, psychiatrically and generally trained nursing staff) rating a vignette of mania, in addition to the vignettes derived in Australia for depression and schizophrenia, and with the Australian intervention options extended somewhat to respect Singapore facilities. Results: Responses of those in the four professional groups were compared. The psychiatrists were highly accurate in generating diagnoses, other staff somewhat less so for diagnosing depression (with a percentage instead choosing a diagnosis of stress) and mania (with a percentage instead diagnosing a schizophrenic condition). Reported helpfulness ratings identified those interventions judged consensually as likely to be helpful or harmful, as well as establishing some differences across the four professional groups. Conclusions: The consensus decisions of helpful treatments for depression and schizophrenia revealed very similar findings to judgements made by Australian professionals. The treated outcome of schizophrenia was judged as somewhat worse than that for mania and depression. While non-medical staff differed from psychiatrists in judging the comparative utility of some drug interventions and lifestyle issues, there was clear evidence of a relatively dominant `medical model' to recommended treatments, while traditional healing practices and services were rated as distinctly unhelpful. Accepted: 12 August 1999     

Associations between stigma and help-seeking intentions and beliefs: Findings from an Australian national survey of young people

To reduce stigma and improve help seeking by young people for mental illness, we need a better understanding of the associations between various dimensions of stigma and young people's help-seeking intentions and helpfulness beliefs for various sources of help and for different disorders. This study assessed stigmatizing attitudes and help-seeking intentions and helpfulness beliefs via a national telephone survey of 3021 youths aged 15–25. Five stigma scales were used: social distance, personally held weak-not-sick and dangerousness beliefs, and weak-not-sick and dangerousness beliefs perceived in others. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. Beliefs that mental illness is a sign of personal weakness and preference for social distance were associated with less intention to seek professional help and less endorsement of their helpfulness. In contrast, dangerousness/unpredictability beliefs were associated with more intention to seek professional help and more endorsement of their helpfulness. Findings highlight the importance of examining the associations between different dimensions of stigma with different sources of help, specifically for various mental disorders, to better inform future efforts to reduce stigma and increase help seeking in young people.     

Online mental health resources for teenagers: an evaluation of two websites developed for adolescents

Young people are less likely to seek help for mental health difficulties. Good quality mental health information from reliable sources may help overcome barriers to help seeking in young people and improve awareness of the common symptoms related to mental health problems. With an adolescent population in mind, websites for depression and for stress and anxiety were developed for young people and those caring for them by one of the authors. The current evaluation sought to assess the use of, and perceived satisfaction with, each of these mental health websites. Data from the website domains were considered in relation to unique visits, country of origin and source of referral. Qualitative website user feedback was gained from evaluation questionnaires. Findings showed that website visits for both resources have increased year-on-year and feedback from the evaluation revealed that the resource information was perceived to be trustworthy, reliable and informative. The feedback indicated that the resource was perceived to be accessible and informative for adolescents. Future developments to reduce the barriers for accessing mental health are discussed.     

Whom to ask for help in case of a mental disorder? Preferences of the lay public

Background: Although socio-cultural factors have been recognised as an important predictor in shaping help-seeking behaviour, few attempts have been made in this regard to specify the nature and impact of socio-cultural factors such as attitudes and belief systems prevalent in society. Methods: We investigated the lay public's attitudes toward help-seeking regarding psychiatric disorders, and their determinants, in a cross-sectional national survey in Germany (n=1564), using structured interviews with vignettes depicting a person either suffering from depression or from schizophrenia. Two distinct methodological approaches (rating vs ranking) were applied. Results: Public opinion considers mental health professionals helpful in treating schizophrenia but not in the treatment of depression. For depression, public opinion clearly favours the lay support system and believes in involving the family physician if the former resource is exhausted. Determinants of help-seeking recommendations were problem definition, perception of the cause of distress and anticipated prognosis, as well as resentment against mental health professionals. Conclusion: Our results suggest that attitudes and belief systems prevalent in society have a major impact on help-seeking behaviour, both through transmission to the person suffering from mental distress via his/her social network and through the person's own attitudes formed in the process of socialization. Implications are pointed out for the daily work of mental health care providers, health care planning and public discussion of mental health issues. Accepted: 16 November 1998     

Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia,depression and alcohol dependence

Separation is a central step in the process of stigmatizing persons with mental disorders. We examine whether belief in a continuum of symptoms from mental health to mental illness is associated with less stigmatizing attitudes. In a representative population survey in Germany (n=3642), using case-vignettes of persons suffering from schizophrenia, depression or alcohol dependence, we measured belief in a continuity of symptoms, emotional reactions and desire for social distance related to the person described in the vignette. While 42% of respondents agreed in symptom continuity for depression, this percentage was 26% for schizophrenia and 27% for alcohol dependence. Continuum beliefs were associated in general with more positive emotional reactions and less desire for social distance. This relationship was strongest for schizophrenia, followed by alcohol dependence. Continuum beliefs thus seem to be associated with less stigmatizing attitudes, particularly regarding schizophrenia and alcohol dependence. Educational information on the continuous nature of most psychopathological phenomena could usefully be integrated in anti-stigma messages.     

Lay beliefs about treatments for people with mental illness and their implications for antistigma strategies.

OBJECTIVE: First, to describe factors influencing the public's attitude toward treatment recommendations for people with mental illness; second, to identify coherent belief systems about the helpfulness of specific interventions; and third, to discuss how to ameliorate mental health literacy and antistigma strategies. METHOD: Participants of a representative telephone survey in the general population (n = 1737) were presented with a vignette depicting a person with either schizophrenia or depression. From a list of suggestions, they were asked to recommend treatments for this person. We used a factor analysis to group these proposals and used the factors as the dependent variables in a multiple regression analysis. RESULTS: Treatment suggestions are summarized in 4 groups, each characterizing a specific therapeutic approach: 1) psychopharmacological proposals (that is, psychotropic drugs), 2) therapeutic counselling (from a psychologist or psychiatrist or psychotherapy), 3) alternative suggestions (such as homeopathy), and 4) social advice (for example, from a social worker). Medical treatments were proposed by people who had a higher education, who had a positive attitude toward psychopharmacology, who correctly recognized the person depicted in the vignette as being ill, who were presented with the schizophrenia vignette, who kept social distance, and who had contact with mentally ill people. The variables could explain alternative and social treatment proposals only to a small extent. CONCLUSIONS: The public's beliefs about treatment for people with mental illness are organized into 4 coherent systems, 2 of which involve evidence-based treatments. Medical treatment proposals are influenced by adequate mental health literacy; however, they are also linked to more social distance toward people with mental illness. Additionally, efforts to better explain nonmedical treatment suggestions are needed. Implications for further antistigma strategies are discussed.     

Public beliefs about the helpfulness of interventions for depression: effects on actions taken when experiencing anxiety and depression symptoms

OBJECTIVE: Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms. METHOD: A postal survey of 3,109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions. RESULTS: There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions. CONCLUSIONS: Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched.     

Public belief systems about the helpfulness of interventions for depression: associations with history of depression and professional help-seeking

  Background: Previous research has found that there are major differences between public and professional beliefs about the helpfulness of interventions for depression. The public appear to be guided by general belief systems about the helpfulness of medical, psychological and lifestyle interventions rather than by specific knowledge about what interventions are effective for depression. The present paper examines the effect that experiencing depression and receiving treatment might have on these beliefs. Method: The study involved a postal survey of 3109 adults from a region of New South Wales, Australia. Respondents were presented with a vignette describing a person with depression. They were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions for the person described in the vignette. Respondents also completed the Goldberg Depression Scale and were asked whether they had ever had an episode of depression and whether they had seen a counsellor or a doctor for it at the time. Structural equation modelling was used to investigate the associations of history of depression and professional help-seeking with belief systems. Results: A three-factor model was found to fit the helpfulness ratings, with factors reflecting beliefs in medical, psychological and lifestyle interventions. People who had sought help for depression were less likely to believe in the helpfulness of lifestyle interventions and more likely to believe in medical interventions. As well as these general associations with belief systems, having sought help for depression had a number of specific associations with beliefs. Controlling for general belief systems, those who had sought help were more likely to rate antidepressants, holidays, massage and new recreational pursuits as helpful, and were less likely to rate ECT and family as helpful. Those who had a history of depression but had not sought help were more likely to rate counselling as helpful, and less likely to rate family as helpful. Those with current depressive symptoms were less likely to rate telephone counselling, family and friends as helpful. Conclusion: Having sought help for depression is associated with general belief systems about the helpfulness of lifestyle and medical interventions and also has some associations with specific beliefs that may reflect experiences with treatment (e.g. the helpfulness of antidepressants). Those currently depressed or with a history of depression are less likely to regard family as helpful, possibly due to poorer social support. Generally speaking, having sought help is associated with beliefs closer to those of professionals. Accepted: 31 January 2000     

Suicidal Behavior and Insight into Illness Among Patients with Schizophrenia Spectrum Disorders

The purpose of the present study was to explore the relationship between suicidal behavior and socio-demographic and clinical factors, including insight into illness, in patients with schizophrenia spectrum disorders. We evaluated 104 inpatients using the Self-Appraisal of Illness Questionnaire (SAIQ) for insight assessment, several Beck-related symptoms rating scales, and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. These patients were also evaluated for suicidal behavior and risk using the critical items of the Scale for Suicide Ideation (SSI) and lifetime suicide attempts. Patients with suicidal behavior generally had greater insight into illness than those who were non-suicidal. After controlling for depressive symptoms, the association of insight into illness with current suicidal ideation remained significant, whereas the association between insight and lifetime suicide attempts was no longer significant. As predicted, the regression analyses revealed that those with greater suicide risk had significantly higher levels of depressive symptoms and hopelessness and more lifetime suicide attempts. Moreover, greater insight into illness appeared to have a close, independent connection to suicidal behavior. Our findings suggest that depression, hopelessness, and greater insight into illness are major risk factors for suicide in patients with schizophrenia. It is plausible that depression mediates the relationship between greater insight into illness and suicidal behavior. Aggressive improvement of insight without the risk of deteriorating depressive symptoms may be warranted to reduce the risk of suicide.     

Views of people with schizophrenia regarding aspects of research: study size and funding sources

Serious mental illness research poses many ethical questions, including important considerations pertaining to how large a study is and its source of funding. Little is known about how people with schizophrenia understand these ethical considerations and whether these factors may influence their decisions to participate in research. Structured interviews were conducted with 60 people with schizophrenia. Participants were asked about levels of suffering and the importance of research for healthy people and for people with serious illnesses. Participants also rated helpfulness and harmfulness to society, and their likelihood of participating in studies involving 10 subjects, 1000 subjects, 1 research institution, or 10 research institutions and in studies funded by various organizations. Participants viewed all types of research positively and indicated willingness to volunteer. Likelihood of participating in research was correlated with perceived helpfulness to society and inversely correlated with perceived harmfulness. Research by pharmaceutical companies was seen as less helpful to society than research sponsored by federal or state government or by private foundations. Larger studies conducted at multiple sites were seen as more helpful to society than smaller studies or those at single sites. Larger studies conducted at single sites, however, were seen as more harmful. Respondents endorsed a positive view of medical research and expressed a willingness to participate in projects of all scales with diverse funding sources. The pattern of responses suggests the capacity for a nuanced understanding of ethically salient aspects of medical research by individuals with schizophrenia.     

Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey

This study examines the risk of depression, suicidal ideation, and lower self-esteem following an abortion versus a delivery, with and without adjusting for important correlates. Using the National Comorbidity Survey, we tested how first pregnancy outcome (abortion vs. delivery) related to subsequent major depression, suicidal ideation, and self-esteem. Models controlling for risk factors, such as background and economic factors, prepregnancy violence experience, and prepregnancy mental health, as well as a model with all risk factors, were examined. When no risk factors were entered in the model, women who had abortions were more likely to have subsequent depression, OR=1.53, 95% CI [1.05-2.22], and suicidal ideation, OR=2.02, 95% CI [1.40-2.92], but they were not more likely to have lower self-esteem, B=-.02. When all risk factors were entered, pregnancy outcome was not significantly related to later depression, OR=0.87, 95% CI [0.54-1.37], and suicidal ideation, OR=1.19, 95% CI [0.70-2.02]. Predictors of mental health following abortion and delivery included prepregnancy depression, suicidal ideation, and sexual violence. Policies and practices implemented in response to the claim that abortion hurts women are not supported by our findings. Efforts to support women's mental health should focus on known risk factors, such as gender-based violence and prior mental health problems, rather than abortion history.     

Lay recommendations on how to treat mental disorders

Background Beliefs about the helpfulness of interventions are influencing the individual help-seeking behavior in case of mental illnesses. It is important to identify these beliefs as professional helpers are asked to consider them in their treatment recommendations. Objective Assessing lay proposals for an appropriate treatment of mental illnesses. Methods We conducted a representative opinion survey in Switzerland. Eighteen treatment proposals were presented with respect to a vignette either depicting schizophrenia or depression. Respondents were asked to indicate the proposals considered to be helpful for treatment and those considered to be harmful, respectively. Results‘Psychologist,’‘general practitioner,’‘fresh air,’ and ‘psychiatrist’ were mostly proposed as being helpful. Among several psychiatric treatment approaches ‘psychotherapy’ was favored, while psychopharmacological treatment and electroconvulsive therapy were only proposed by less than one-fourth of the interviewees. Especially psychotropic drugs were considered to be harmful. Treatment by a psychiatrist was regarded as being more helpful for schizophrenic individuals than for depressive persons. For a person experiencing a life crisis, treatment by a psychiatrist and psychological treatment were viewed as being harmful, and non-medical interventions were preferred. However, for persons thought to be mentally ill, psychiatric and psychopharmacological treatments were recommended. Conclusion Mental health professionals are regarded as being helpful although their treatment methods are seen as being less helpful. A clear distinction is made between lay proposals for depression and schizophrenia. However, the perception of whether a condition is considered to be an illness or a life crisis has significantly more influence on lay treatment proposals than the cited diagnosis in the vignette. Accepted: 3 September 2001     

Do films about mentally disturbed characters promote ineffective coping in vulnerable youth?

Suicidal youth tend to doubt the effectiveness of professional mental health treatment. This study examined whether exposure to films about suicidal and mentally disturbed persons supports this lack of belief. Exposure to three popular films featuring suicides or the mentally ill was compared to films that featured a heroic suicide unrelated to mental illness as well as to films with violent and comedic content in a nationally representative survey of youth ages 14-22 (N=900). Exposure to films about mental disturbance among "vulnerable" respondents who had experienced recent depressive and suicidal symptoms (24% of sample) was compared to those without these symptoms. Increasing exposure to films with mentally disturbed characters was related to belief in the treatment inefficacy of mental disorders. The findings suggest that exposure to fictional depictions of characters failing to get help for mental disorders may have long-term effects on depressed and suicidal youth.     

Public Awareness About the Connection Between Depression and Physical Health: Specifically Heart Disease

The medical community continues to acknowledge a connection between depression and physical health, for example, cardiac disease. This study addresses public awareness about depression's effects on physical health, the relationship between cardiac disease and depression, and preferred sources of health information, in an effort to inform future health education programs. A survey, administered to 816 adults ages 40-69, focused on public awareness, perception of depression as an illness, its impact on other illnesses such as heart disease, and sources of health information. (1) Eighty-three percent (83%) of respondents felt depression was an illness; (2) a slightly higher percentage (85.8%) felt a mental disorder, like depression, could affect the course of a physical illness; (3) respondents' awareness of links between depression and cardiac disease ranged from 29.8% (awareness of depression as a risk factor for coronary artery disease) to 31.6% (awareness that depression can increase the risk of having a second heart attack); (4) print media were the most frequently cited sources of health information (22.7%); and (5) more highly educated respondents were more informed about depression than respondents with less education. Although a majority of respondents (1) recognized depression as an illness (2) thought it could complicate recovery from a physical illness, less than a third of them were aware of links between cardiac disease and depression. Demographic groups differed in their preferred sources of health information, especially across educational levels, demonstrating a need for targeted health educational outreach in efforts to reach a variety of populations.     

Recognition of mental illness and suicidality among individuals with serious mental illness

This preliminary study investigated the association of insight (defined as a patient's recognition of having a mental illness) with depression and suicidality among individuals with schizophrenia (N = 1009), bipolar I disorder (N = 297), and recurrent major depression (N = 162). Participants completed interviews at 2 time periods, 6-months apart. Individuals who were recognized having a mental illness reported significantly greater depression than those who denied having a mental illness. Recognition of mental illness was significantly related, both retrospective and prospectively, with suicidal ideation and attempts. No significant differences were found between the diagnostic groups in these relationships. Although there are many clinical benefits associated with insight, these findings suggest there may possibly be cause for concern in attempting to increase insight among individuals with a serious mental illness. However, current evidence suggests that certain forms of treatment may be beneficial in improving insight, while resulting in a decrease in negative affect, rather than an increase.     

Belief systems of the general public concerning the appropriate treatments for mental disorders

A study was conducted to assess the belief systems of the general public concerning the appropriate treatments for mental disorders and correlates of these belief systems. The study was based on the results of a household survey of the general public in Australia, using a national random sample of 2,031 adults aged 18–74 years. Respondents were given a vignette describing either a person with depression or one with schizophrenia, and were asked for their opinions about the helpfulness of various professional and non-professional treatments for the person described. A principal components analysis of the helpfulness ratings gave three factors: a Medical factor with high loadings on all drug treatments (exceptVitamins) and onPsychiatric ward andECT; a Psychological factor with high loadings onCounsellor, Social worker, Phone counselling, Psychiatrist, Psychologist, Psychotherapy andHypnosis; and a Lifestyle factor with high loadings onClose family, Close friends, Naturopath, Vitamins, Physical activity andGet out more. The same factors emerged from ratings of the two vignettes. Mean scores on scales constructed from the items with high loadings showed that the public tend to have a negative view of medical treatments and a positive view of psychological and lifestyle ones. However, medical treatments were rated more negatively for depression than for schizophrenia, psychological treatments were rated more positively for schizophrenia, and lifestyle treatments more positively for depression. Age, sex and education of respondents showed few associations with scores on the scales, although the better educated were more in favour of psychological treatments for both depression and schizophrenia and were less opposed to medical treatments for schizophrenia. Respondents who had suffered from the symptoms described in the schizophrenia vignette were more negative towards medical treatments. These findings about public belief systems could have implications for the provision of treatment: where there is a discrepancy in belief system between the patient and the clinician there may be poor adherence to treatment.