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Gender Differences in Depression Literacy and Stigma After a Randomized Controlled Evaluation of a Universal Depression Education Program.

ABSTRACT: PURPOSE:Depression is a debilitating illness with frequent onset during adolescence. Depression affects women more often than men; men are more likely to complete suicide and less likely to seek treatment. The Adolescent Depression Awareness Program (ADAP) is a school-based depression intervention that educates adolescents about depression symptoms and addresses accompanying stigma. The study aims examined gender differences in the ADAP's impact on depression literacy and stigma. METHODS:Data came from a randomized trial (2012-2015). Six thousand six hundred seventy-nine students from 54 schools in several states were matched into pairs and randomized to the intervention or wait-list control. Teachers delivered the ADAP as part of the health curriculum. Depression literacy and stigma outcomes were measured before intervention, 6 weeks later, and at 4 months. Multilevel models evaluated whether gender moderated the effect of ADAP on depression literacy and stigma. RESULTS:At 4 months, there was a main effect of the ADAP on depression literacy (odds ratio [OR] = 3.3, p = .001) with intervention students achieving depression literacy at higher rates than controls. Gender exhibited a main effect, with women showing greater rates of depression literacy than men (OR = 1.51, p = .001). There was no significant intervention × gender interaction. The ADAP did not exhibit a significant main effect on stigma. There was a main effect for gender, with women demonstrating less stigma than men (OR = .65, p = .001). There was no significant interaction between the intervention and gender on stigma. CONCLUSIONS:The ADAP demonstrates effectiveness for increasing rates of depression literacy among high school students. In this study, gender was not associated with ADAP's effectiveness.

SUBMITTER: Townsend L

PROVIDER: S-EPMC6571527 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Gender Differences in Depression Literacy and Stigma After a Randomized Controlled Evaluation of a Universal Depression Education Program.

Townsend Lisa L Musci Rashelle R Stuart Elizabeth E Heley Kathryn K Beaudry Mary Beth MB Schweizer Barbara B Ruble Anne A Swartz Karen K Wilcox Holly H

The Journal of adolescent health : official publication of the Society for Adolescent Medicine 20190104 4

<h4>Purpose</h4>Depression is a debilitating illness with frequent onset during adolescence. Depression affects women more often than men; men are more likely to complete suicide and less likely to seek treatment. The Adolescent Depression Awareness Program (ADAP) is a school-based depression intervention that educates adolescents about depression symptoms and addresses accompanying stigma. The study aims examined gender differences in the ADAP's impact on depression literacy and stigma.<h4>Meth ...[more]

PMID: 30612807

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Project description:BACKGROUND:The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. OBJECTIVE:Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. METHODS:Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. RESULTS:Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. CONCLUSIONS:If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. TRIAL REGISTRATION:Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/11255.

Project description:BackgroundDepressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world.ObjectiveThe aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial.MethodsA total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables.ResultsCompared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%).ConclusionsThe results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms.Trial registrationDutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033.International registered report identifier (irrid)RR2-10.2196/11255.

Project description:BackgroundMental health literacy consists of knowledge of a mental disorder and of the associated stigma. Barriers to depression treatment among Hispanic populations include persistent stigma which is primarily perpetuated by inadequate disease literacy and cultural factors. U.S.-born Hispanics are more likely to have depression compared to Hispanics born in Latin America and are less likely to follow a treatment plan compared to non-Hispanic whites. Hispanic women are more likely to access treatment through a primary care provider, making it an ideal setting for early mental health interventions.MethodsBaseline data from 319 female Hispanic patients enrolled in Project DESEO: Depression Screening and Education: Options to Reduce Barriers to Treatment, were examined. The study implemented universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9) and took place at one federally qualified health center (FQHC) over a 24-month period. The current analysis examined the relationship between four culturally adapted stigma measures and depression knowledge, and tested whether mental health literacy was comparable across education levels in a sample of Hispanic women diagnosed with depression.ResultsAlmost two-thirds of the sample had less than a high school education. Depression knowledge scores were significantly, weakly correlated with each the Stigma Concerns About Mental Health Care (ρ = - .165, p = .003), Latino Scale for Antidepressant Stigma (p = .124, p = .028), and Social Distance scores (p = .150, p = .007). Depression knowledge (F[2, 312] = 11.82, p < .001, partial η2 = .071), Social Distance scores (F[2, 312] = 3.34, p = .037, partial η2 = .021), and antidepressant medication stigma scores (F[2, 312] = 3.33, p = .037, partial η2 = .015) significantly varied by education category. Participants with at least some college education reported significantly greater depression knowledge and less stigma surrounding depression and medication than participants with lower education levels.ConclusionsPrimary care settings are often the gateway to identifying undiagnosed mental health disorders, particularly for Hispanic women with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education level as a predictor of mental health literacy. For Hispanic women, understanding the mental health literacy of patients in a healthcare setting may improve quality of care through early detection of symptoms, culturally effective education and subsequent engagement in treatment.Trial registrationThe study was registered with https://clinicaltrials.gov/: NCT02491034 July 2, 2015.

Project description:BackgroundAccredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy.MethodsWe conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem-solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables.ResultsWe analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p < 0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience.ConclusionsThe P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India.

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Gender Differences in Depression Literacy and Stigma After a Randomized Controlled Evaluation of a Universal Depression Education Program.

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Gender Differences in Depression Literacy and Stigma After a Randomized Controlled Evaluation of a Universal Depression Education Program.

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