Psychometric Properties of the Dutch Depression Stigma Scale (DSS) and Associations with Personal and Perceived Stigma in a Depressed and Community Sample.

BACKGROUND: Research on depression stigma is needed to gain more insight into the underlying construct and to reduce the level of stigma in the community. However, few validated measurements of depression stigma are available in the Netherlands. Therefore, this study first sought to examine the psychometric properties of the Dutch translation of the Depression Stigma Scale (DSS). Second, we examined which demographic (gender, age, education, partner status) and other variables (anxiety and knowledge of depression) are associated with personal and perceived stigma within these samples. METHODS: The study population consisted of an adult convenience sample (n = 253) (study 1) and a community adult sample with elevated depressive symptoms (n = 264) (study 2). Factor structure, internal consistency, and validity were assessed. The associations between stigma, demographic variables and anxiety level were examined with regression analyses. RESULTS: Confirmatory factor analysis supported the validity and internal consistency of the DSS personal stigma scale. Internal consistency was sufficient (Cronbach's alpha = .70 (study 1) and .77 (study 2)). The results regarding the perceived stigma scale revealed no clear factor structure. Regression analyses showed that personal stigma was higher in younger people, those with no experience with depression, and those with lower education. CONCLUSIONS: This study established the validity and internal consistency of the DSS personal scale in the Netherlands, in a community sample and in people with elevated depressive symptoms. However, additional research is needed to examine the factor structure of the DSS perceived scale and its use in other samples.

Repetition rate after non-fatal self-poisoning in Sri-Lanka: a one year prospective longitudinal study

Introduction: Attempted or non-fatal self-poisoning is an important public health problem in Sri Lanka. Current evidence from Sri Lanka suggests that this phenomenon is more common among young people, and females, and is associated with a recent interpersonal conflict. International studies indicate that recent non-fatal selfharm is associated with an increased risk of repetition and completed suicide. Prospective follow-up data regarding rates of repetition of self-harm in Sri Lanka is limited. Objectives: The aim of this study was to describe the rate of repetition, and rate of suicidal ideation, at one-year follow up among those who have survived an act of selfpoisoning. Methods: Participants who presented to the toxicology unit, Teaching Hospital Peradeniya over a 14-month period, for medical management of non-fatal self-poisoning, were contacted by telephone one-year following the initial presentation. Results: A total of 949 persons were included in the study, of which 35.3% (n=335) were contactable at one-year follow-up. The rate of repetition of self-harm after one year was 2.5% and 2.7% of participants had suicidal ideation at one-year follow-up. Conclusions: The rate of repetition of self-harm in Sri Lanka is lower than the rate reported in the West (15%).

Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression.

BACKGROUND: By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals. METHOD: An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions (Interpersonal Psychotherapy [IPT; n=620] and Cognitive Behavioral Therapy [CBT; n=610]) to an active control intervention (MoodGYM; n=613) over a period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-demographic characteristics [age, gender, marital status, education level], clinical characteristics [depression/anxiety symptoms, disability, quality of life, medication use], skills [mastery and dysfunctional attitudes] and treatment preference) were assessed using internet-delivered self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated Measures (MMRM). RESULTS: Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs. LIMITATIONS: Although the sample of participants was large, power to detect moderator effects was still lacking. CONCLUSIONS: Different e-mental health programs may be more beneficial for specific age groups. The findings raise important possibilities for increasing depression treatment effectiveness and improving clinical practice guidelines for depression treatment of different age groups.

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.

Online randomized controlled trial of brief and full cognitive behaviour therapy for depression.

BACKGROUND: Effective internet-based programs for depression usually incorporate a component that provides telephone or email contact. Open access websites, without such contact, show high rates of attrition and poorer outcomes. The present study was designed as an exploratory investigation of the parameters that influence the effectiveness and retention of users on open access websites. We investigated whether brief cognitive behaviour therapy (CBT) was as effective as an extended version, whether add-on components of behaviour therapy or stress management contributed to positive outcomes, and whether longer programs were associated with greater attrition. METHOD: An online randomized controlled trial (RCT) was conducted between 13 January 2005 and 26 May 2005 (19 weeks). A total of 2794 registrants (1846 women and 948 men; median age category 35-44 years) with elevated scores on the Goldberg Depression Scale of 5.96 (S.D.=2.09) elected online to be randomized to one of six versions of a CBT website. The versions were compiled consisting of various components of brief CBT, extended CBT, behaviour strategies, stress management and problem solving. RESULTS: A total of 20.4% of participants completed the assigned intervention. The interaction of measurement occasion and treatment version was significant [F(13,131)=2.20, p=0.01]. A single module of brief introductory CBT was not effective in reducing depression symptoms. However, extended CBT with or without the addition of behaviour strategies resulted in the reduction of depression. CONCLUSIONS: Brief CBT-based interventions are not as effective as extended interventions. However, longer programs are associated with higher rates of dropout.

Actions taken to cope with depression at different levels of severity: a community survey.

BACKGROUND: Many people with symptoms of psychological distress do not seek professional help. Little is known about the actions taken by these people to reduce their symptoms. The present study aimed to assess, in a community sample, actions taken to cope with depression at different levels of psychological distress. METHOD: A postal survey was carried out with 6618 adults living in Canberra and south-east New South Wales, Australia. Measures covered psychological distress and a checklist of actions taken to cope with depression in the previous 6 months. RESULTS: Actions taken to cope with depression could be classified as: intensification of everyday strategies, initiation of new self-help (including complementary therapies, non-prescription medication and dietary changes) and seeking professional help. Use of everyday strategies peaked with mild psychological distress, new self-help showed a peak in moderate distress, while professional help-seeking peaked in severe distress. CONCLUSION: Self-help strategies are very commonly used, particularly in mild-moderate psychological distress. More evidence is needed to evaluate their effectiveness, so that optimal self-help can be encouraged.

Providing information about the effectiveness of treatment options to depressed people in the community: a randomized controlled trial of effects on mental health literacy, help-seeking and symptoms.

BACKGROUND: Many people who are depressed do not receive any professional help and their beliefs about the helpfulness of treatment do not always correspond with those of health professionals. To facilitate choices about treatment, the present study examined the effects of providing depressed people in the community with evidence on whether various treatment options work. METHOD: A randomized controlled trial was carried out with 1094 persons selected at random from the community who screened positive for depressive symptoms and agreed to participate. Participants were mailed either an evidence-based consumer guide to treatments for depression or, as a control, a general brochure on depression. Outcomes were the rated usefulness of the information provided, changes in attitudes to depression treatments, actions taken to reduce depression, and changes in depressive symptoms, anxiety symptoms and disability. RESULTS: Participants rated the evidence-based consumer guide as more useful than the control brochure. Attitudes to some treatments changed. Improvements in symptoms and disability did not differ significantly between interventions. CONCLUSION: Providing people who are depressed with evidence on which treatments work produces some changes in attitudes and behaviour. However, this intervention may need to be enhanced if it is to produce symptom change.

Sterol composition of mycelia of the plant pathogenic ascomycete Leptosphaeria maculans.

Analysis of sterols in mycelia of the ascomycete, Leptosphaeria maculans by gas chromatography-mass spectrometry revealed that ergosterol comprised 95% of the total sterols, with eight other sterols comprising the remaining 5%. Six of these latter sterols were putative precursors of ergosterol and their presence suggested a pathway for ergosterol biosynthesis in this fungus. Ergosterol biosynthesis in fungi is inhibited by the triazole antifungal agent flutriafol. When L. maculans was grown in the presence of flutriafol, ergosterol content decreased while two 14 alpha-methylated sterols, 24-methylene dihydrolanosterol and obtusifoliol, accumulated.

Quality of web based information on treatment of depression: cross sectional survey.

OBJECTIVES: To evaluate quality of web based information on treatment of depression, to identify potential indicators of content quality, and to establish if accountability criteria are indicators of quality. DESIGN: Cross sectional survey. DATA SOURCES: 21 frequently accessed websites about depression. MAIN OUTCOME MEASURES: (i) Site characteristics; (ii) quality of content-concordance with evidence based depression guidelines (guideline score), appropriateness of other relevant site information (issues score), and subjective rating of site quality (global score); and (iii) accountability-conformity with core accountability standards (Silberg score) and quality of evidence cited in support of conclusions (level of evidence score). RESULTS: Although the sites contained useful information, their overall quality was poor: the mean guideline, issues, and global scores were only 4.7 (range 0-13) out of 43, 9.8 (6-14) out of 17, and 3 (0.5-7. 5) out of 10 respectively. Sites typically did not cite scientific evidence in support of their conclusions. The guideline score correlated with the two other quality of content measures, but none of the content measures correlated with the Silberg accountability score. Content quality was superior for sites owned by organisations and sites with an editorial board. CONCLUSIONS: There is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality. Ownership by an organisation and the involvement of a professional editorial board may be useful indicators. The study methodology may be useful for exploring these issues in other health related subjects.

Sites for depression on the web: a comparison of consumer, professional and commercial sites.

OBJECTIVE: To provide information on the range of treatments for depression provided by commercial, professional and consumer web sites. METHODS: An audit of the 21 most popular depression sites on the world wide web undertaken from March 1999 to July 1999, in Canberra, ACT. Treatment types and categories of treatment were compared among commercial, professional and consumer web sites. RESULTS: A total of 53 treatments or treatment types were mentioned. The number of treatments mentioned per site ranged from 2 to 38. Antidepressant medication and psychotherapy were noted by almost all sites. Consumer sites mentioned psychological therapies less frequently but did not mention dietary supplements or complementary treatments more frequently. CONCLUSIONS AND IMPLICATIONS: Consumer web sites provide a point of comparison to those from commercial or professional sources. They provide a voice to inform psychiatrists and GPs about preferred treatments and side effects and to alert researchers to areas that need formal investigation.

Clozapine in community practice: a 3-year follow-up study in the Australian Capital Territory.

OBJECTIVE: This paper aims to present the first data on the long-term use of clozapine in an entire cohort of patients encountered in a community, the Australian Capital Territory. It examines the clinical and financial outcomes 3 years after the prescription of clozapine to a cohort of 37 patients. METHOD: Experience during the 2 years before clozapine was prescribed was compared with experience in the following 3 years on the basis of a retrospective review of official records. Data included hospital and hostel bed use and an estimate of treatment costs. In addition, changes in living circumstances and employment status were assessed and treating psychiatrists reported the presence of side effects and their impressions of clinical change since clozapine was prescribed. RESULTS: Compared with the preclozapine period, there were significant reductions postclozapine in hospital admissions (year 3) and hospital bed-days (year 2) by the total cohort and in hospital bed-days and hospital expenditure for those patients (n = 25) who remained on clozapine (years 2 and 3). There was no significant increase or decrease postclozapine in the estimated combined cost of treatment attributable to bed use (hospital or hostel), clozapine tablets, blood monitoring, and the employment of a Clozapine Coordinator. Clinically, all patients who stayed on clozapine were reported to be moderately or markedly improved. Five of nine patients who were not taking clozapine at study's end were unimproved or deteriorated. CONCLUSIONS: The findings of significant clinical improvement without evidence of increased cost lend support for the selective use of clozapine in community practice.

Cube copying after cerebral damage.

The capacity of patients with cerebral lesions to copy a picture of a cube, as opposed to a nonrepresentational figure of similar structural complexity, was examined. Patients with copying disability showed greater impairment for the cube than the noncube whereas patients without copying impairment and controls performed equally on the two figures. It was concluded that the copying-deficit patients had particular difficulty in drawing 3-dimensional figures and that the copying deficit was not simply one of formulating the sequence of steps necessary to produce a complex as opposed to a simple abstract form. The results suggest that copying-disability patients may experience particular difficulty in encoding the pictorial structure of a model which depicts a three-dimensional object. The occurrence of errors of intellectual realism in cube copying (which also occur in children's drawings) was noted and it was suggested that the patients were experiencing difficulty in perceptually isolating the picture structure from the picture content.