Public attitudes towards prevention of depression

doi:10.1016/j.jad.2007.06.013

Journal of Affective Disorders

Volume 106, Issue 3, March 2008, Pages 257-263

https://doi.org/10.1016/j.jad.2007.06.013 Get rights and content

Abstract

Background

Various programs for depression prevention have been shown to be effective, but preventive efforts population wide are only beginning. We examine public attitudes towards prevention of depression and beliefs about helpful preventive measures.

Method

Fully structured telephone interview with a representative population sample including people of German nationality older than 14 years (n = 1016).

Results

75.4% of the sample agreed on the possibility to prevent depression. Of those, 403 (52.6%) stated that they would take part in prevention programs, and in this group 234 (58.1%) indicated readiness to pay out of their pocket for such programs. Out of a catalogue of 37 proposed actions, psychosocial and lifestyle related measures were preferred. Exploratory factor analysis revealed three factors – proactive lifestyle, relying on medicine, and relaxing – inherent in public beliefs about helpfulness of preventive measures. Higher education reduced willingness, high perceived personal risk of depression and previous contact to the disease increased willingness to take part in preventive programs.

Conclusion

The public entertains favourable attitudes and beliefs about prevention of depression that do not conflict with evidence-based programs. Our study thus encourages implementation of population based prevention programs.

Introduction

Depression is a very common mental disorder with a prevalence of 5–9% (Martin et al., 2006, Narrow et al., 2002). For 2020, unipolar depression is predicted to rank second after cardiovascular diseases in terms of burden of disease as measured by disability adjusted life years lost (Murray and Lopez, 1996). This heavy burden is increasingly recognised and challenges health and social systems in the western world. As a result, health politicians' interest in prevention of depression is growing (European Comission, 2005).

A substantial body of knowledge on prevention of depression exists, and numerous programs of universal, selective, and indicated prevention have been shown to be successful (Cuijpers et al., 2005, Jane-Llopis et al., 2003). Yet few of these ideas have been transferred to regular practice, and population wide efforts to reduce incidence of depression are only beginning (Hickie, 2004, Smith et al., 2004). One reason for this may be that healthy people's interest in prevention of depression is low. However, in contrast to medical conditions like cancer (Ulrich et al., 1998) and cardiovascular disease (Weiland et al., 1991), no published data is available on attitudes towards prevention of depression. In order to close this gap we conducted a representative population survey in Germany, aiming to explore the following questions: (1) Does the lay public consider prevention of depression to be possible? (2) Would people take part in prevention programs, and would they pay for it? (3) What particular actions are considered helpful? (4) How do these attitudes relate to socio-demographic characteristics, experience with depression and personal risk assessment?

Section snippets

Sample

In June 2005 a population-based survey was conducted by telephone, involving persons of German nationality aged 14 years and older, living in private households with conventional telephone connection. The sample was randomly drawn from all registered private telephone numbers and additionally generated numbers, allowing for ex-directory households as well. Numbers were assigned to regions and anonymized. 20,000 numbers were selected, representing 5% of all German households on the phone. Data

Results

Public attitude towards prevention of depression was overall positive. Of 1016 interviewees, 766 (75.4%) stated that it is possible to take action in order to prevent depression. Of those affirming the possibility to prevent depression, 403 (52.6%) stated that they would take part in prevention programs if they were offered by their health insurance. Of this group, 234 (58.1%) would even be willing to pay out of their pocket for taking part in a prevention program. 149 (64.9%) stated that they

Discussion

We found the public surprisingly open-minded about the possibility to prevent depression, which seems to represent a general attitude that was not associated with particular socio-demographic or illness-related characteristics of the respondents. Readiness to take part in programs was considerable among those with a generally positive attitude towards depression prevention. Since this first population-based survey on this issue was not linked to any particular prevention program, we do not know

Role of funding source

Internal funds only were used for this study.

Conflict of interest

No conflict declared.

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Cited by (28)

Psychometric properties of a measure to assess beliefs about modifiable behavior and emotional distress
2020, Mental Health and Prevention
Citation Excerpt :
Perceiving a behavior as better for physical health is related to actual behavior in some cases (i.e. physical activity, diet, smoking) but not others (i.e. drinking; Brotons et al., 2012). While studies have investigated lay beliefs about the prevention of mental health problems and risk factors for mental health problems (Jorm et al., 1997; Jorm, Morgan & Wright, 2010; Schomerus, Angermeyer, Matschinger & Riedel-Heller, 2008), less is known about the relationship between beliefs about modifiable behaviors and actual engagement in modifiable behaviors related to the development of mental health problems. The ability to assess beliefs about perceived benefits of modifiable behaviors would allow for the examination of the relationship between beliefs and actual behavior.
Assessing beliefs about the helpfulness of modifiable behaviors related to mental health could inform public health efforts to prevent emotional distress. This study examined the psychometric properties of a measure to assess beliefs about the helpfulness of modifiable behaviors involved in the development of anxiety and depression. The relationship between beliefs about modifiable behaviors and actual engagement in modifiable behaviors was also examined.
Item pool generation was based on a review of the literature. Experts (N = 10) and participants (N = 50) reviewed the items for content validity. An exploratory factor analysis was conducted on the resultant Beliefs about Behaviors and Emotional Distress Scale (BBEDS) for item reduction in a sample of MTurk participants (Study 1, N = 371). A confirmatory factor analysis was completed in a second MTurk sample (Study 2, N = 373). Construct validity was then examined in a sample of college students (Study 3, N = 215).
The questionnaire included 16 items across four domains: health behavior (0.77 ≤ α ≤ 0.84), social support (0.72 ≤ α ≤ 0.76), substance use (0.75 ≤ α ≤ 0.76), and avoidance (0.81 ≤ α ≤ 0.83). The BBEDS had adequate psychometric properties supporting its use to assess beliefs about the helpfulness of modifiable behaviors related to the development of emotional distress. BBEDS scores were associated with engaging in some but not all modifiable behaviors.
The BBEDS may be a useful instrument to assess beliefs about the helpfulness of modifiable behaviors implicated in the development of anxiety and depression.
Risk and protective factors for depression that adolescents can modify: A systematic review and meta-analysis of longitudinal studies
2014, Journal of Affective Disorders
Citation Excerpt :
There is some evidence from community mental health literacy surveys that adolescents respond positively to the idea of preventive action for mental health problems, which is commensurate with the generally favourable response that is reported in the literature to prevention interventions targeting adolescent mental health (e.g., Pössel et al., 2005). These surveys have found that adolescents endorse a range of preventive strategies that may be helpful for mental health problems, some of which are congruent with the evidence base and beliefs of professionals; however, there is also some misinformation evident in adolescents׳ beliefs that may be counterproductive (e.g., Jorm et al., 2010; Schomerus et al., 2008; Yap et al., 2012). These studies highlight the importance of a programme of education about effective strategies for prevention during adolescence.
Adolescence is a peak time for the onset of depression, but little is known about what adolescents can do to reduce their own level of risk. To fill this gap, a review was carried out to identify risk and protective factors for depression during adolescence that are modifiable by the young person.
Employing the PRISMA method, we conducted a systematic review and meta-analysis of longitudinal studies to identify risk and protective factors during the adolescent period (aged 12–18 years) that are potentially modifiable by the young person without professional intervention or assistance. Stouffer׳s method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations.
We identified 113 publications which met the inclusion criteria. Putative risk factors implicated in the development of depression for which there is a sound evidence base, and which are potentially modifiable during adolescence without professional intervention, are: substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; negative coping strategies; and weight. Modifiable protective factors with a sound evidence base are healthy diet and sleep.
Limitations include not systematically reviewing moderators and mediators, the lack of generalisability across cultures or to younger children or young adults, and the inability to conduct a meta-analysis on all included studies.
Findings from this review suggest that future health education campaigns or self-help prevention interventions targeting adolescent depression should aim to reduce substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; and negative coping strategies; and promote healthy weight; diet; and sleep patterns.
Young people's beliefs about preventive strategies for mental disorders: Findings from two Australian national surveys of youth
2012, Journal of Affective Disorders
Citation Excerpt :
In particular, in order to more effectively target messages to improve the public's knowledge and actions concerning the prevention of mental illness, a better understanding of predictors of the public's beliefs about prevention is required. To-date we are only aware of two studies that have examined public beliefs about prevention: a national survey of the German public aged 14 and over, specifically about depression (Schomerus et al., 2008); and a national survey of Australian youth aged 12 to 25 years and health professionals (Jorm et al., 2010), which examined beliefs about depression, psychosis, social phobia, and depression with alcohol abuse. Only the German survey examined predictors of the public's willingness to take part in preventive programs.
Political interest in prevention of mental illness has increased in recent years. However, relatively little is known about the public's beliefs about prevention, and the predictors of these beliefs. Since many disorders start in the first decades of life, a focus on young people is warranted.
Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youths aged 12–25 years in 2006. A similar survey was repeated in 2011 with 3021 youths aged 15–25. In both surveys, respondents were presented with a vignette portraying depression, psychosis, social phobia, or depression with alcohol abuse in a young person. The 2011 survey also included depression with suicidal thoughts and post-traumatic stress disorder. Respondents rated the helpfulness of seven potential prevention strategies, and reported on any experience of mental health problems and treatment in the past year, exposure to beyondblue and mental health information at school or work.
Most respondents believed that regular contact with friends and family and regular physical activity would be helpful. Respondents who had recently experienced mental health problems, younger respondents, females, and those not exposed to beyondblue or mental health information were more likely to hold beliefs that differed from those of health professionals or available evidence. No significant changes were observed between surveys.
Actual preventive actions and reasons behind respondents' beliefs were not assessed.
Future prevention efforts should target subgroups with beliefs that differ from professionals' and research evidence. Beyondblue and school and work settings may be promising avenues for these efforts.
Actions that young people can take to prevent depression, anxiety and psychosis: Beliefs of health professionals and young people
2010, Journal of Affective Disorders
Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance.
Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12–25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis.
Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety.
The surveys assessed beliefs, but not actual use of preventive strategies.
Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety.
Parents' beliefs about actions they can take to prevent depressive disorders in young people: Results from an Australian national survey
2012, Epidemiology and Psychiatric Sciences
Media Coverage of Alcohol-Use Disorders in German Newspapers and Magazines: A Topic-Specific Frame Analysis
2023, Health Communication

View all citing articles on Scopus

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Research reportPublic attitudes towards prevention of depression

Abstract

Background

Method

Results

Conclusion

Introduction

Section snippets

Sample

Results

Discussion

Role of funding source

Conflict of interest

J. Affect. Disord.

J. Affect. Disord.

Gen. Hosp. Psych.

Psychiatry Res.

Public beliefs about and attitudes toward people with mental illness: a review of population studies

Acta Psychiatr. Scand.

Lay beliefs about mental disorders: a comparison between the western and the eastern parts of Germany

Soc. Psychiatry Psychiatr. Epidemiol.

Public beliefs about schizophrenia and depression: similarities and differences

Soc. Psychiatry Psychiatr. Epidemiol.

Public attitudes toward psychiatric treatment

Soc. Psychiatry Psychiatr. Epidemiol.

Sociobehavioral determinants of compliance with health and medical care recommendations

Med. Care

Preventing the incidence of new cases of mental disorders: a meta-analytic review

J. Nerv. Ment. Dis.

Green Paper. Improving the Mental Health of the Population: Towards a Strategy on Mental Health for the European Union

Introduction

Can we reduce the burden of depression? The Australian experience with beyond blue: the national depression initiative

Australas. Psychiatry

Research report
Public attitudes towards prevention of depression