Effects of psychoeducation for depression on help-seeking willingness: biological attribution versus destigmatization

Existing literature shows that the level of biological attribution and stigma of depression influences willingness to seek help. However, no study has used experimental methods to explore the question whether increasing biological attribution and decreasing blameworthy attitude towards depression will enhance willingness to seek help. In so doing, 299 college students were randomly assigned to biological, destigmatization, combined, and control groups. The measures included the Biological Attribution Scale, Psychological Blame Scale, and Help-Seeking Willingness Scale. The data were analyzed by a 2 x 2 ancova (with or without biological attribution education x with or without destigmatization education) on willingness to seek professional help which was assessed 2 weeks later, with adjusting for help-seeking willingness at baseline. Results showed that biological education had a significant main effect to elevate help-seeking willingness, but destigmatization education did not. In addition, no interaction effect existed between the two independent variables. The authors suggested that biological education makes people legitimize depression as a disease entity, so that it would be a practical approach to increase people's motivation to solve their emotional afflictions, especially in societies that emphasize emotional constraints. In contrast, although destigmatization information reduces people's negative appraisals to the depressed individuals, it does not go a step further to increase people's motivation to seek professional help. Further studies are needed to clarify the mechanisms of educational effects.     

A biopsychosocial model as a guide for psychoeducation and treatment of depression

Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the individual's resilience and leads to symptoms of depression. The pathogenesis of depression is symbolized by a negative downward loop, in which interactions among symptoms, vulnerability, and stressors drive the patient toward a depressive condition. Moreover, experiencing recurrent depression influences psychobiological vulnerability, the occurrence of stressors, and tremendously increases the risk of further relapse. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Moreover, it offers the patient and therapist a psychoeducational context in which the individual's vulnerability and depressive symptoms can be treated. Finally, applications of the depression model as a therapeutic approach to severe depression in the phases of remoralization, symptom reduction, and relapse prevention are presented.     

Service system finance: implications for children with depression and manic depression.

An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance.This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear.To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children.Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.     

Acute stress reduces reward responsiveness: implications for depression.

BACKGROUND: Stress, one of the strongest risk factors for depression, has been linked to "anhedonic" behavior and dysfunctional reward-related neural circuitry in preclinical models. METHODS: To test if acute stress reduces reward responsiveness (i.e., the ability to modulate behavior as a function of past reward), a signal-detection task coupled with a differential reinforcement schedule was utilized. Eighty female participants completed the task under both a stress condition, either threat-of-shock (n = 38) or negative performance feedback (n = 42), and a no-stress condition. RESULTS: Stress increased negative affect and anxiety. As hypothesized based on preclinical findings, stress, particularly the threat-of-shock condition, impaired reward responsiveness. Regression analyses indicate that self-report measures of anhedonia predicted stress-induced hedonic deficits even after controlling for anxiety symptoms. CONCLUSIONS: These findings indicate that acute stress reduces reward responsiveness, particularly in individuals with anhedonic symptoms. Stress-induced hedonic deficit is a promising candidate mechanism linking stressful experiences to depression.     

Researching the causes of depression: reasons for optimism

As part of its commitment to fostering research in all aspects of psychiatry, the Mental Health Foundation, a British charity, sponsors conferences in key areas. The 1995 research conference brought together leading academics and practitioners to discuss current ideas concerning the causes of depression. The papers selected for this supplement are based on presentations to the conference, appropriately expanded and updated. As such they cover most of the main ideas and issues in this developing topic. This paper seeks to place these in a broader context.     

Patient attitudes about treatments for intractable epilepsy

OBJECTIVE: The goals of this study were to understand patient attitudes about the treatment of medically intractable epilepsy and to document potential barriers limiting patient access to the surgical treatment of epilepsy, highlighting the attitudes of adolescents and minorities. METHODS: Focus groups of adults with intractable epilepsy (n=10), adolescents with intractable epilepsy (n=4), parents of adolescents with intractable epilepsy (n=4), and African-Americans with intractable epilepsy (n=6) were conducted at UCLA, Los Angeles, California. RESULTS: Patients with intractable epilepsy communicated frustration with their continued disability despite trials of new medications. Their perceptions of the risks of the surgical treatment of epilepsy were exaggerated. Patients felt that their health care providers did not provide adequate information about epilepsy and portrayed epilepsy surgery negatively. CONCLUSIONS: This study illuminated several factors that could change patient attitudes and help improve patient access to the surgical treatment of epilepsy, especially among minorities and adolescents.     

Impairment in major depression: implications for diagnosis

A significant change in the criteria for major depressive disorder in the DSM-IV over the earlier editions was the introduction of a criterion of "clinically significant distress and impairment" (criterion C). However, it is not clear that cases of depression which meet this criterion are distinct from cases that do not meet the criterion on characteristics beyond mere severity of illness. This report used data from the National Comorbidity Survey (NCS) to compare the psychiatric and sociodemographic characteristics of cases of DSM-III-R major depression with varying levels of self-rated impairment. The results of the analyses revealed no difference between respondents with different levels of impairment on gender, age of onset, parental history of depression and suicide, duration of illness, and symptom profiles. With regard to the social and psychiatric indicators of severity of illness, on the other hand, there was a gradient for worse outcome among more severely impaired respondents. It is concluded that the less impaired respondents with DSM-III-R major depression cannot be distinguished from the more impaired on illness characteristics that are not related to the severity of illness. Therefore, cases of DSM-III-R major depression with various levels of impairment most probably represent cases of the same illness that vary only in severity.     

Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia

OBJECTIVE: This study explored the effectiveness of a psychoeducational family intervention for schizophrenia on patients' personal and social functioning as well as on relatives' burden and perceived support. METHODS: Thirty-four mental health professionals from 17 public mental health centers in Italy selected 71 families of consumers with schizophrenia. Forty-two families were randomly assigned to a group that received the intervention for six months, and 29 families were assigned to a waiting list for six months. At baseline and six months later, validated tools were used to assess patients' clinical status, personal and social functioning, and social network as well as relatives' burden, social resources, and perception of professional support. RESULTS: In the intervention group the number of patients with poor or very poor global personal and social functioning decreased significantly, from 17 (47 percent) at baseline to nine (25 percent) at follow-up. A significant improvement was found for the intervention group in patients' social relationships, interests in obtaining a job, maintenance of social interests, and management of social conflicts. Twenty-seven patients (74 percent) reported that their social relationships had improved during the six-month period. For both the intervention and control groups, family burden significantly improved. Relatives' social contacts and perception of professional support significantly increased only in the intervention group. CONCLUSIONS: The results suggest that a psychoeducational family intervention may have a significant impact on functional outcomes of schizophrenia when provided to patients and caregivers in real-world settings.     

Family psychoeducation: an adjunctive intervention for children with bipolar disorder.

Childhood onset bipolar disorder is associated with significant morbidity and mortality, yet effective treatment strategies have remained underdeveloped and understudied. While some headway is being made vis-a-vis pharmacologic treatments, empirical efforts have not focused on adjunctive psychosocial interventions for childhood bipolar disorder. In this review, we discuss psychoeducation, delivered via workshops, multifamily psychoeducation groups, or individual-family psychoeducation, as an adjunct to the ongoing pharmacotherapy, psychotherapy, and school-based interventions for children with bipolar disorder. We review the theoretical rationale for psychoeducation, including expressed emotion and caregiver concordance; summarize findings in the adult literature; and then describe our development and testing of psychoeducational interventions for mood-impaired children. Data from three pilot studies are reviewed, and progress on two studies currently underway is presented. We conclude with current limitations of psychoeducation and recommendations for future study to develop psychoeducation as an empirically supported adjunctive intervention for children with bipolar disorder.     

Residual symptoms of depression: clinical and theoretical implications.

Residual symptoms of variable intensity often persist following pharmaco/or psychotherapeutic interventions for treatment of major depression (MD). In several studies, such persistent symptoms have been clearly shown to be associated with a higher risk of relapse, chronicity and functional impairment, but their true nature is still controversial. Several authors consider that these symptoms belong to the range of depression proper and thus indicate that the current episode has been inadequately treated, a hypothesis reinforced by their frequent similarity with the symptoms preceding the full-blown picture of MD. However, in the current state of research, their connection with certain personality traits or comorbid disorders--notably anxiety disorders--cannot be completely ruled out. This article reviews the main data from the literature concerning residual symptoms and their treatment, as well as the issues related to their psychopathological meaning. In practice, once the state of a patient has been stabilized in partial remission of the depressive syndrome, the clinician should revise the current therapeutic strategy and seek to find how to return as fully as possible to the previous euthymic state.     

Psychoneuroimmunology of depression: clinical implications

Psychoneuroimmunology is a field that investigates the interactions between the brain and the immune system. One important goal of this field of research is to translate basic research in order to understand how behavior affects health and resistance to disease in humans. This review evaluates the impact of depression on morbidity and mortality risk and asks whether neuroimmune mechanisms contribute to this association. Examples are drawn from three diseases: cardiovascular disease, infectious disease, and rheumatoid arthritis. Finally, the potential for biobehavioral interventions to impact psychological adaptation and the course of immune related disease is discussed.     

Research and laws regarding therapist-patient sexual involvement: implications for therapists

Therapist-patient sexual intimacy has emerged as a major issue. This article discusses the legal and ethical prohibitions, the accumulation of research regarding the prevalence and consequences of therapist-patient sex, and the implications for therapists, particularly those treating patients who have been sexually intimate with a previous therapist.     

A pilot study of adjunctive family psychoeducation in adolescent major depression: feasibility and treatment effect

OBJECTIVE: To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder. METHOD: Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used chi2 and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes. RESULTS: The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size > 0.5), and parents reported greater satisfaction with treatment. CONCLUSIONS: There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population.     

Nutrition and depression: implications for improving mental health among childbearing-aged women.

Adequate nutrition is needed for countless aspects of brain functioning. Poor diet quality, ubiquitous in the United States, may be a modifiable risk factor for depression. The objective was to review and synthesize the current knowledge of the role of nutrition in depression, and address implications for childbearing-aged women. Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than nondepressed persons. Dietary antioxidants have not been studied rigorously in relation to depression. Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman's risk of depression. Prospective research studies are needed to clarify the role of nutrition in the pathophysiology of depression among childbearing-aged women. Greater attention to nutritional factors in mental health is warranted given that nutrition interventions can be inexpensive, safe, easy to administer, and generally acceptable to patients.