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1.
Background
High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland.Methods
In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011.Results
43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression.Limitations
Community-level assessment with no control.Conclusions
Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking. 相似文献2.
Hee-Ju Kang Jae-Min Kim Ju-Yeon Lee Seon-Young Kim Kyung-Yeol Bae Sung-Wan Kim Il-Seon Shin Hye-Ran Kim Myung-Geun Shin Jin-Sang Yoon 《Journal of affective disorders》2013
Introduction
Suicide is a major health problem, and depression is a major psychiatric cause of suicide. Suicide is influenced by the multifactorial interaction of many risk factors. Therefore, epigenetic research may lead to understandings that are applicable to suicide. This study investigated whether epigenetic changes are associated with suicidal behavior and evaluated the treatment outcome of suicidal ideation in depressive patients.Methods
In 108 patients with major depression, the promoter methylation of the gene encoding brain-derived neurotrophic factor (BDNF) was measured. Sociodemographic and clinical characteristics including a history of previous depressive episodes, age at onset, duration of illnesses, family history of depression, and number of stressful life events as well as subjective perception of stress and assessment scales for depression (HAMD), anxiety (HAMA), function (SOFAS), disability (WHODAS-12), and quality of life (WHOQOL-BREF) were evaluated at baseline. Suicidal behavior was ascertained using a semistructured clinical interview with questions about severity and intent. Beck Scale for Suicide Ideation (BSS) was administered during 12 weeks of treatment with antidepressants.Results
A higher BDNF promoter methylation status was significantly associated with a previous suicidal attempt history, suicidal ideation during treatment, and suicidal ideation at last evaluation as well as with higher BSS scores and poor treatment outcomes for suicidal ideation.Limitations
Methylation status was investigated with limited area of the BDNF gene and sample size was relatively small.Conclusions
BDNF methylation status could be a proxy marker for previous suicidal attempts and a clinical biomarker for poor treatment outcomes of suicidal ideation in depression. 相似文献3.
Suicidal behaviors in elderly Koreans: One-month-point prevalence and factors related to suicidality
Jae Young Park Ji Won Han Hyeon Jeong Hyun-Ghang Jeong Tae Hui Kim In-Young Yoon Ki Woong Kim 《Journal of affective disorders》2013
Background
Suicide prevention in the elderly is a major public health priority worldwide and in Korea in particular. We investigated the one-month-point prevalence and factors related to suicidality for suicidal behaviors in elderly Koreans.Methods
A simple random sample (N=1588) was drawn from the residential roster of 14,051 Koreans aged 60 years or older who were residents of Osan in February 2010. All subjects were invited to participate in the survey through door-to-door home visits, and the response rate was 59.8%.Results
The age- and gender-standardized prevalence rates of lifetime suicide attempts, current suicidal ideation without a plan or attempt, and current suicidal ideation with a plan or attempt were estimated at 9.2%, 19.6%, and 2.24%. The prevalence of suicidal ideation without a plan or attempt was higher in women and less-educated individuals and increased with advancing age, whereas the prevalence of suicidal ideation with a plan or attempt was higher in more-educated individuals, was not differentiated by gender, increased until age 70, and then decreased thereafter. The factors related to suicidal ideation differed by the presence of a suicide plan or attempt.Conclusions
Depressive elders in their 70s who have recently developed suicidal ideation would be a prime target for suicide intervention programs.Limitations
The sample was regional, although the suicide rate in Osan was comparable to the average suicide rate in Korea. 相似文献4.
Background
Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.Methods
We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.Results
20.5% (95% CI: 18.4–22.7) reported suicidal ideation and 8.1% (95% CI: 6.8–9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.Limitations
The cross-sectional design and application of measures for different time periods did not allow for causal inferences.Conclusions
Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts. 相似文献5.
Lynn McIntyre Jeanne V.A. Williams Dina H. Lavorato Scott Patten 《Journal of affective disorders》2013
Background
Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.Methods
Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.Results
The prevalence of child hunger was 5.7% (95% CI 5.0–6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4–5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2–4.3).Limitations
A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.Conclusions
Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health. 相似文献6.
Tonelle E. Handley Frances J. Kay-Lambkin Amanda L. Baker Terry J. Lewin Brian J. Kelly Kerry J. Inder John R. Attia David J. Kavanagh 《Journal of affective disorders》2013
Background
Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity.Methods
Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up.Results
Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT.Limitations
Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions.Conclusions
CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide. 相似文献7.
Background
The Strain Theory of Suicide postulates that psychological strains usually precede suicide mental disorders including suicidal behavior. The four sources of strain are basically (1) differential value conflicts, (2) discrepancies between aspiration and reality, (3) relative deprivation, and (4) lack of coping skills. This paper focuses on the effect of perceived failed life aspiration on the individual's mental disorder and suicide risk.Method
Data for this study were from a large psychological autopsy study conducted in rural China, where 392 suicides and 416 community living controls were consecutively recruited. Two informants (a family member and a close friend) were interviewed for each suicide and each control. Major depression was assessed with HAM-D and the diagnosis of mental disorder was made with SCID.Results
It was found that individuals having experienced failed aspiration were significantly more likely than those having not experienced a failed aspiration to be diagnosed with at least one disorder measured by the SCID and major depression measured by HAM-D, and to be a suicide victim, which is true of both suicides and controls.Conclusion
This study supports the hypothesis that the discrepancies between an individual's aspiration and the reality is likely to lead to mental disorder including major depression and suicidal behavior. Lowering a patient's unrealistic aspiration can be part of the of psychological strains reduction strategies in cognitive therapies by clinicians' and mental health professionals. 相似文献8.
William R. Marchand James N. Lee Susanna Johnson Phillip Gale John Thatcher 《Journal of affective disorders》2013
Background
Objective methods of differentiating unipolar versus bipolar depression would enhance our ability to treat these disorders by providing more accurate diagnoses. One first step towards developing diagnostic methodology is determining whether brain function as assessed by functional MRI (fMRI) and functional connectivity analyses might differentiate the two disorders.Methods
Fourteen subjects with bipolar II depression and 26 subjects with recurrent unipolar depression were studied using fMRI and functional connectivity analyses.Results
The first key finding of this study was that functional connectivity of the right posterior cingulate cortex differentiates bipolar II and unipolar depression. Additionally, results suggest that functional connectivity of this region is associated with suicidal ideation and depression severity in unipolar but not bipolar II depression.Limitations
The primary limitation is the relatively small sample size, particularly for the correlational analyses.Conclusions
The functional connectivity of right posterior cingulate cortex may differential unipolar from bipolar II depression. Further, connectivity of this region may be associated with depression severity and suicide risk in unipolar but not bipolar depression. 相似文献9.
Background
Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women.Methods
Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15–85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used.Results
Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women.Limitations
Cross-sectional survey.Conclusion
The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior. 相似文献10.
Joanna Wilkowska-Chmielewska Waldemar SzelenbergerMarcin Wojnar 《Journal of affective disorders》2013
Background
We investigated effects of current age and age at onset on symptomatology of depression with reference to proposed revisions in DSM-5.Methods
The study entailed medical records of 326 inpatients diagnosed with major depressive disorder, including 520 depressive episodes, with 113 first episodes lifetime. Subjects were divided into three groups: young-adults, middle-aged adults and older adults.Results
In young-adults, active suicidal ideation, lifetime suicidal attempts, irritability, anhedonia and persistent depressive symptoms between the episodes were more frequent than in the other groups. Among older adults, depression was associated with insomnia, hypochondriasis, somatization, decreased appetite, weight loss, memory impairment and decreased activity. The older age was not associated with higher number of previous episodes of depression, bigger severity or duration of a single episode or a different degree of remission. Early-onset depression was associated with more suicidal attempts.Limitations
The study was retrospective and the sample may be treated only as representative for hospitalized depressed patients.Conclusions
Age and age at onset are important factors influencing the course and symptomatology of a depressive episode. Depressive episodes with anxiety and with suicide risk severity are important specifiers that vary with the age at onset and/or age of the patient and should be considered for inclusion in the DSM-5 revision. 相似文献11.
Background
Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.Objective
To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.Methods
A cross sectional study was conducted from March–December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.Results
The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2–138.8, p-value <0.01).Conclusion
Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt. 相似文献12.
Background
Suicidal ideation has been identified as both a common antecedent and a significant risk factor for suicide attempt and completed suicide. However, little is known about the incidence and persistence of suicidal ideation in the general population and the associated risk factors.Methods
A 12-month follow-up survey investigated 997 of the respondents who participated in the baseline territory-wide survey of adult population in Hong Kong. A set of baseline psychological factors was considered as predictors of first onset and persistence of suicidal ideation.Results
Twelve-month incidence (1.9%) and persistence (6.2%) rates were estimated. Respondents with anxiety and lack of reasons for living were more likely to report a development of suicidal thoughts in the follow-up assessment, while respondents with higher level of average life distress and lower level of hope were at increased risk of continuing to have suicidal thoughts. Depression was found to partially mediate the effect of average life distress on persistent suicidality.Limitations
Retention rate of the follow-up sample was about 50% only. Assessments of suicidal ideation were based on retrospective reports.Conclusions
Psychological factors differentially predict first onset and persistence of suicidal ideation. It is of clinical value that depression partially mediated the effect of life distress on persistence of suicidality. 相似文献13.
Lena M.C. Andersson Isabell Schierenbeck Johanita Strumpher Gunilla Krantz Kegan Topper Gunilla Backman Esmeralda Ricks Dalena Van Rooyen 《Journal of affective disorders》2013
Background
Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa.Methods
This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012.Results
The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints.Limitation
Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to.Conclusions
Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff. 相似文献14.
Background
Suicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military.Methods
This study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18–21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50).Results
Suicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters.Conclusions
Young soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach. 相似文献15.
Stéphane Richard-Devantoy Sébastien Guillaume Emilie Olié Philippe Courtet Fabrice Jollant 《Journal of affective disorders》2013
Background
Suicidal acts result from a complex interplay between vulnerability factors, such as reduced social and cognitive abilities, social stressors. To our knowledge nothing is known about the explicit recognition of others' facial emotions, a major component of social interactions, in patients at long-term risk for suicide.Methods
Thirty-five non-depressed patients with a history of a serious suicide attempt and mood disorders were compared with 31 patients with a history of mood disorders but no personal history of suicidal acts, and with 37 healthy controls with no personal history of mood disorders or suicide attempts. The explicit recognition of six facial emotions (anger, disgust, fear, sadness, happiness, and neutral) was assessed.Results
Suicide attempters made significantly more errors in the explicit recognition of disgust, relative to the other groups, with no differences between the control groups or for the other emotions examined. Semantic verbal fluency and verbal working memory performances were also reduced in suicide attempters relative to the other two groups but could not explain the facial recognition deficits.Limitations
Our results need replication with a larger sample size. Most patients were medicated.Conclusions
Explicit recognition of disgust appears to be specifically altered in relation to vulnerability to suicide but not to depression. Reduced ability to recognize some social emotions may impair the patient's capacity to adequately interact with his own social environment, potentially increasing the risk of interpersonal conflict, negative emotions and suicidal crisis. Improving cognitive and social skills may be a target for future individual suicide prevention. 相似文献16.
Magdalena Romanowicz Stephen S. O'Connor Kathryn M. Schak Cosima C. Swintak Timothy W. Lineberry 《Journal of affective disorders》2013
Background
Suicide is the third leading cause of death in the United States for youth 12–17 years or age. Acute psychiatric hospitalization represents a clear worst point clinically and acute suicide risk is the most common reason for psychiatric admission. We sought to determine factors associated with differences in individual suicide risk assessment for children and adolescents during acute psychiatric admission.Methods
Study participants were 1153 youth consecutively admitted to an inpatient psychiatry unit who completed a self-administered Suicide Status Form (SSF) within 24 h of admission. Additional information on suicide risk factors was obtained through medical chart abstraction.Results
Females reported significantly greater psychological pain, stress, hopelessness, and self-hate on the SSF and were significantly more likely to have made a suicide attempt just prior to the index hospital admission (OR=1.59, SE=0.29; CI=1.12–2.26), report a family history of suicide (OR=2.02, SE=0.33; CI=1.47–2.78), and had experienced a greater number of inpatient psychiatry admissions related to suicidal ideation (RR=1.33, SE=0.13; CI=1.10–1.61). High school aged youth and those with a primary diagnosis of depression displayed consistently elevated SSF scores and risk factors for suicide compared to comparison groups.Limitations
Diagnosis was determined through chart abstraction. Responses to access to firearm question had missing data for 46% of the total sample.Conclusions
Systematic administration of a suicide-specific measure at admission may help clinicians improve identification of suicide risk factors in youth in inpatient psychiatry settings. 相似文献17.
Background
This study involved a multi-level analysis of factors related to self-reported suicidality (both current and life-time) in adolescentsMethods
A sample of 2552 students aged 14–16 years answered questions relating to demographics, social and familial functioning, psychological well-being and suicidality.Results
Suicidality, defined as being at least some element of reported suicide ideation, Behaviourally, suicidality was also more likely if students smoked, drank alcohol without adult supervision or if they took illicit drugs was more likely in girls, and in those with poorer social, family and psychological functioning. Behaviourally, suicidality was also more likely if students smoked, drank alcohol or took illicit drugs. Multi-level modelling showed that negative affect, substance use and the presence of romantic relationships were most strongly associated with suicidality. Both current and life-time measures of suicidality showed similar results. Both models suggested that the presence of substance use in teenagers is a potentially useful indicator of elevated suicide risk and that many of the social problems commonly associated with suicidality are likely to be mediated by negative affective states.Limitations
The study had several limitations. First, it was cross-sectional so it was not possible to examine how variables measured at one time predicted subsequent suicidality. Second, the present analyses were based on a single measure of suicidality that did not differentiate between ideation and attempts. Thus, the analyses did not indicate the severity of the suicidality: whether it involved ideation or actual attempts.Conclusions
Adolescent girls and adolescents with poor social and family functioning and those who engage in substance use are at risk of suicidal ideation (a known precursor of suicide attempts). School counsellors and teachers need to be aware of the risks. 相似文献18.
Evelien Coppens Chantal Van Audenhove Gert Scheerder Ella Arensman Claire Coffey Susana Costa Nicole Koburger Katrin Gottlebe Ricardo Gusmão Rory O’Connor Vita Postuvan Marco Sarchiapone Merike Sisask András Székely Christina van der Feltz - Cornelis Ulrich Hegerl 《Journal of affective disorders》2013
Background
Stigmatizing attitudes toward depression and toward help-seeking are important barriers for people with mental health problems to obtain adequate professional help. This study aimed to examine: (1) population attitudes toward depression and toward seeking professional help in four European countries; (2) the relation between depression stigma and attitudes toward help-seeking; (3) the relation between both attitudes and socio-demographic characteristics; and (4) differences in attitudes across countries.Methods
A representative general population survey (n=4011) was conducted in Germany, Hungary, Ireland, and Portugal, assessing attitudes toward depression and toward help-seeking, and a number of socio-demographic variables.Results
Respondents showed a moderate degree of personal stigma toward depression and a strikingly higher degree of perceived stigma. Although a substantial majority showed openness to seek professional help, only half of the people perceived professional help as valuable. More negative attitudes were found in Hungary and were associated with male gender, older age, lower educational level and living alone. Also, personal stigma was related to less openness to and less perceived value of professional treatment.Limitations
The survey was cross-sectional, so no causal inferences could be drawn.Conclusions
Personal and perceived stigma toward depression deserves public health attention, since they impact upon the intention of people with depression to seek professional help. Public media campaigns should focus on the credibility of the mental health care sector, and target males, older people, and those with a lower educational level and living alone. The content of each campaign should be adapted to the cultural norms of the country for which it is intended. 相似文献19.
Ver?nica de Medeiros Alves Leilane Camila Ferreira de Lima Francisco Flaviane Maria Pereira Belo Valfrido Le?o de-Melo-Neto Vinicius Gomes Barros Antonio E Nardi 《Clinics (S?o Paulo, Brazil)》2016,71(3):135-139