Werther or Papageno? Examining the effects of news reports of celebrity suicide versus non-celebrity peer suicide on intentions to seek help among vulnerable young adults.

INTRODUCTION: A large body of literature has examined the Werther effect following news reports of suicide, yet much less attention has been paid to the protective Papageno effect. This research explored the causal relationships between news reports of real celebrity suicides (e.g., pop-rock star Chester Bennington) and real non-celebrity "peer" suicides (e.g., college student Madison Holleran) and intentions to seek help. METHODS: Two survey experiments confirmed successful experimental manipulation (N = 280) and tested behavioral theory, clinical indicators, and intentions to seek help (N = 641) in samples of college students (18-25). RESULTS: Participants were motivated to seek help if they believed it could lead to positive outcomes, yet this was less likely among participants with depression. Exposure to news reports of non-celebrity suicides had a small positive effect on help-seeking intentions. Among participants with depression, news reports of celebrity suicides had a small positive effect on intentions. CONCLUSIONS: This research could not establish Werther effects for either of the news reports. Exposure to news reports of non-celebrity suicides had a small positive effect on intentions overall, but young adults with higher levels of depression were slightly more motivated to seek help after viewing news reports of celebrity suicides.

Inside the 'black box' of COVID-19 vaccination beliefs: Revealing the relative importance of public confidence and news consumption habits.

RATIONALE: President Biden's goal for 70% of U.S. adults to have received at least one vaccine by July 4, 2021 was not achieved. OBJECTIVE: The aim of this research was to assess the 'black box' of positive COVID-19 vaccination beliefs to determine the relative importance of each factor and thus inform well-targeted and tailored health promotion efforts. METHODS: A cross-sectional survey was conducted in a sample of U.S. adults (N = 1656), assessing the influence of demographic characteristics, cognitive effects, public confidence, and news source variety and evaluation on positive COVID-19 vaccination beliefs. RESULTS: Overall, the strongest predictor of positive beliefs was high confidence in public health officials and political institutions to handle the COVID-19 pandemic effectively, yet negative sentiments toward COVID-19 research and science and COVID-19 vaccine ambivalence reduced the likelihood that beliefs were positive. Cognitive effects and public confidence were identified as key predictors of positive COVID-19 vaccination beliefs over and above party identification. Importantly, high levels of confidence in science and government were mostly driven by positive evaluations of liberal news sources. High levels of COVID-19 science backlash were mostly driven by positive evaluations of conservative news sources. CONCLUSIONS: To motivate COVID-19 vaccination among hesitant or resistant groups in the population, health promotion efforts should seek to reinforce positive COVID-19 vaccination beliefs by increasing public confidence and by reducing COVID-19 science backlash, largely by choosing specific news media and social media platforms (e.g., Breitbart, Fox News, and Facebook) as channels for health promotion and health information dissemination.

Racial and ethnic differences in major depressive episode, severe role impairment, and mental health service utilization in U.S. adolescents.

BACKGROUND/OBJECTIVES: This study aimed to examine racial and ethnic variations in national trends, past-year prevalence, determinants of major depressive episode (MDE), MDE-related role impairment and mental health (MH) services utilization in U.S. adolescents. METHODS: Data was extracted from the National Survey on Drug Use and Health (NSDUH) from 2010 to 2018. A total of 137,671 nationally representative adolescents aged 12-17 were included in the study. Weighted temporal trends in the past-year prevalence of MDE, and MDE with severe role impairment were estimated both overall and by race and ethnicity. Weighted multivariate logistic regressions were conducted to assess racial/ethnic differences in determinants of MDE, MDE-related severe role impairment, and MH services utilization after adjusting for sociodemographic characteristics, family structure, substance use, activity participation, and problem-solving group engagement. RESULTS: The prevalence of MDE and MDE with severe role impairment among U.S. adolescents has steadily increased, while MDE-related health services utilization remained low from 2010 to 2018. Racial and ethnic minority adolescents were more likely to experience an MDE, but less likely to use MH services compared to their White counterparts. Participating in school, family, community, or faith-based activities was significantly associated with lower MDE incidence. Problem-solving group engagement was associated with MH services utilization (all p-values < 0.05). CONCLUSION: High prevalence of depression and low MH service utilization among U.S. adolescents remains a public health issue. Moreover, racial/ethnic disparities persist in MH and service utilization outcomes. Future research must investigate the burden and predictors of mental illness, and the factors influencing MH services utilization in diverse adolescent populations.

Suicidal Ideation During the COVID-19 Pandemic: Investigating Mental Health, COVID-19 Health Beliefs, and News Media Consumption in the United States Population in the Year 2020.

This study examines the role of general news media consumption during COVID-19 in aggravating mental health and suicide risk in the US population. In a sample of U.S. adults (N = 5,010), we investigated how mental health, COVID-19 health beliefs, and general news consumption influenced the odds of suicidal ideation using hierarchical logistic regression models. Both worsening mental health overall and specifically in regard to COVID-19 increased suicidal ideation. Perceived susceptibility to COVID-19 infection did not increase suicidal ideation, yet higher levels of COVID-19 self-efficacy reduced suicidal ideation. Overall news consumption did not affect suicidal ideation, but media-specific post-hoc analyses revealed that TV news watching decreased suicidal ideation as much as high levels of COVID-19 self-efficacy decreased suicidal ideation. Furthermore, online news consumption increased suicidal ideation as much as worsening mental health overall increased suicidal ideation. Further implications are discussed.

Help-seeking intentions in the U.S. population during the COVID-19 pandemic: Examining the role of COVID-19 financial hardship, suicide risk, and stigma.

The primary goal of this study was to increase understanding of help-seeking intentions in the U.S. population during the COVID-19 pandemic and to examine influencing factors such as COVID-19 financial hardship, suicide risk, and stigma in order to contribute to effective theory-based help-seeking and suicide prevention campaigns. In a representative sample of U.S. adults (N = 5,010), this research tested whether COVID-19 financial hardship was associated with higher levels of depression and suicidal ideation (supported), and whether the reasoned action framework could usefully predict help-seeking intentions in this context (supported). The reasoned action framework explained 36% of the variance in help-seeking intentions in the U.S. population and identified injunctive norm (social support) as primary determinant of intention. Neither suicidal ideation, COVID-19 financial hardship, or self-stigma of seeking help influenced determinants of help-seeking. Future research should test injunctive norm as causal predictor of help-seeking in the U.S. population to usefully inform effective help-seeking campaigns, particularly among those who have experienced COVID-19 financial hardship. Additionally, effective dissemination strategies for help-seeking campaigns should be tested and identified, such as broader targeted approaches as well as intentional mis-targeting techniques.

Rural and Urban Differences in COVID-19 Prevention Behaviors.

PURPOSE: To examine whether the adoption of COVID-19-related preventive health behaviors vary in rural versus urban communities of the United States while accounting for the influence of political ideology, demographic factors, and COVID-19 experiences. METHODS: We rely on a representative survey of 5009 American adults collected from May 28 to June 8, 2020. We analyze the influence of rural status, political ideology, demographic factors, and COVID-19 experiences on self-reported adoption of 8 COVID-19-related preventive health behaviors. FINDINGS: Rural residents are significantly less likely to have worn a mask in public, sanitized their home or workplace with disinfectant, avoided dining at restaurants or bars, or worked from home. These findings, with the exception of dining out, are robust to the inclusion of measures accounting for political ideology, demographic factors, and COVID-19 experiences. CONCLUSIONS: Rural residents are significantly less likely to participate in several COVID-19-related preventive health behaviors. This reality could exacerbate existing disparities in health access and outcomes for rural Americans. Health messaging targeted at improving COVID-19 preventive behavior adoption in rural America is warranted.

Bypassing the waitlist: examining barriers and facilitators of help-line utilization among college students with depression symptoms.

BACKGROUND: A large number of U.S. college students suffer from depression symptoms, yet existing resources cannot match the demand. AIMS: This study identified the psychological determinants of utilizing a help-line and examined potential barriers in order to inform effective help-line promotion. PARTICIPANTS: Four hundred and six undergraduate students (18-29 years) completed a survey at a large Southern United States university between January and May 2018. METHODS: The survey assessed depression symptoms (PHQ9), whether students were aware of the help-line they had access to, stigma beliefs about depression/suicide, stigma of seeking help (SSOSH), predictors of intention to utilize the help-line (RAT) and behavioral approach and avoidance motivation (BIS/BAS). RESULTS: Students showed mild symptoms of depression (M = 6.60, SD = 5.13) and knew about the help-line (74.8%), but expressed low intentions to use it (M = 1.5, SD = 0.97; 7-pt scale). Depression symptoms influenced the strength of association between determinants and intentions to use a help-line (ß = 0.25, p < 0.001). Participants with depression symptoms were also more likely to endorse adverse beliefs about depression/suicide (ß = 0.11, p = 0.025). CONCLUSION: Help-lines should be promoted by activating and reinforcing positive outcome expectations. Health campaigns should also address adverse beliefs in this population.

Which Beliefs Predict Intention to Get Vaccinated against COVID-19? A Mixed-Methods Reasoned Action Approach Applied to Health Communication.

This research examined the underlying beliefs and psychological determinants of COVID-19 vaccination intention in order to inform effective health promotion efforts. We utilized the reasoned action framework in a mixed-methods, two-study approach. Study 1, an open-ended belief elicitation survey (N = 197), explored the underlying beliefs associated with intention to get vaccinated against COVID-19 once a vaccine becomes available. In a quantitative survey with a representative sample of U.S. adults, study 2 (N = 1656) tested the psychological determinants of intention to get vaccinated. Results revealed (1) the most common attitudinal, normative, and control beliefs about COVID-19 vaccination; (2) instrumental attitude as the strongest determinant of COVID-19 vaccination intention; and (3) 'achieving peace of mind' as an effective target for health promotion efforts. Further implications and directions are discussed.

The Making of an Addiction: Examining Psychological Determinants of Prescription Stimulant Abuse among College Students.

Diagnoses of attention-deficit-disorders and stimulant prescriptions to treat these disorders (e.g., Adderall) are on the rise. The non-medical use of such stimulants (NUPS) as 'study drugs' has increased among college students, which aggravates the worsening prescription drug crisis in the U.S. This research examined the underlying psychological determinants of NUPS in order to inform effective health communication intervention efforts. It also tested potential individual-level characteristics that could influence such determinants in order to determine at-risk groups. This research utilized the reasoned action framework in a mixed-methods, two-study approach. Study 1 explored the underlying beliefs associated with intentions to engage in NUPS in an open-ended belief elicitation survey (N = 121), study 2 (N = 312) tested the psychological determinants of intentions and influencing individual-level characteristics in a quantitative survey. Results revealed (1) the top three unique attitudinal, normative, and control beliefs about NUPS; (2) instrumental attitude as strongest determinant of NUPS; (3) expectations of improved productivity, approval from friends and peers, access and financial means, peer pressure, and health risks as effective targets for effective health communication interventions; and (4) poor mental health, high levels of stress, and characteristics of perfectionism and sensation-seeking as aggravating risk factors among college students. Further implications and directions are discussed.

Should We Activate Risk Perceptions in the Context of Suicide Prevention? Examining Fear Appeals, Help-Seeking Determinants, and Help-Seeking Sources Among University Employees Who Suffer from Depression.

Health promotion strategies have largely focused on activating risk perceptions for health conditions in resistant at-risk populations in order to induce behavior change. Yet, doing so remains a questionable approach when promoting help-seeking behaviors among individuals who suffer from depression because clinical symptoms can negatively affect interpretations and responses to such efforts. This study sought to test the effects and effectiveness of risk-based health messaging utilizing fear appeals on help-seeking determinants, intentions, and sources. One hundred seventeen university employees affected by symptoms of depression were recruited to participate in a lab-based experimental setting. Participants were randomly assigned to one of three message conditions that differed in strength of fear appeal (low, moderate, high) when inducing suicide risk perceptions and promoting help-seeking. Consistent with previous research, participants indicated high stigma perceptions and low intentions to seek help. Risk-based messaging strategies such as fear appeals did not have an effect on help-seeking intentions in this sample. Intentions were largely determined by positive outcome expectations and social norms, whereas efficacy perceptions were positive and not a predictor of help-seeking intentions. Participants were most likely to seek help from intimate partners and friends and least likely to utilize a help-line. Health promotion messages should contain cues that activate, rather than change, the already positive outcome expectations of seeking help when targeting at-risk populations. Future research should explore possibilities for health promotion and education among support networks of those who suffer from depression and anxiety.

Depression's response to fear tactics: An integration of health promotion principles, eye-tracking technology and clinical tools.

OBJECTIVE: The main objective of this study was to utilize eye-tracking technology and self-report measures to test the effectiveness of varying strengths of fear appeals when educating about the seriousness of depression and motivate depressed individuals to engage in health-information-seeking. METHODS: We analyzed data from 117 university employees affected by a range of depression symptoms who were randomly assigned to a low-threat, moderate threat, and high-threat message condition in a lab-based experimental setting. Attention patterns were captured while participants viewed the health message. A particular emphasis was placed on understanding the role of valence and arousal in determining attention patterns. RESULTS: Attentional processes induced emotions (valence) and intensity (arousal) and differed by strength of fear appeal, but were not influenced by symptoms of depression in this study. Arousal mediated the effects of strong fear appeals on attitudes toward information-seeking, whereas negative emotions did not. CONCLUSION AND PRACTICE IMPLICATIONS: Until further research suggests otherwise, caution is warranted when utilizing fear appeals that are highly arousing for health education and promotion.

What's the Risk in Seeking Help for Depression? Assessing the Nature and Pleasantness of Outcome Perceptions Among Individuals With Depressive Symptomatology.

Despite a growing mental health crisis in the United States, empirical indicators of what could make a depression help-seeking message effective and why are currently not available. Even worse, some depression help-seeking messages can activate negative beliefs among depressed individuals that may make help-seeking even less likely than before. The current study is based on the premise that normative theoretical frameworks used for health promotion purposes might not work in populations affected by depression. Addressing a primary driver for health behavior change in gain-and-loss framing, the present research examines the nature of risk perceptions regarding help-seeking among those with depressive symptomatology who have not yet sought help ( N = 738) to inform more effective suicide prevention efforts. Previously, quantitative analyses revealed that the effectiveness of gain-and-loss framing, particularly on attitudes toward help-seeking, depends on the severity of depressive symptomatology. Whereas a persuasive gain-frame advantage was found for those with mild and severe depression symptoms, both framing strategies appeared to backfire and worsen attitudes among those with moderately severe depression symptoms. The present study enriches those results by conducting an in-depth analysis of risk perceptions regarding help-seeking to inform more effective depression help-seeking messages. Risk perceptions were primarily indicative of stigma and the related resistance to seeking help. Judgment and mistreatment were expected not only from the general public but also from the mental health professionals from whom help should be sought. Theoretical and practical implications are discussed.

Respecting the 'stages' of depression: Considering depression severity and readiness to seek help.

OBJECTIVE: Despite knowing the value of message customization, empirical results have failed to provide clear indicators of what make a depression help-seeking message effective. The present research examines stages of depression in response to a prominent communication strategy, gain versus loss framing, to inform possibilities for effective message customization. METHODS: Two experimental studies were conducted with a student (N = 126) and U.S. adult (N = 738) sample that tested the effects of gain versus loss framing at different stages of depression. RESULTS: A persuasive gain-frame advantage was found for those with mild and severe depression, whereas a boomerang effect was found for both gain and loss framing among those with moderately severe depression. With regards to intention to seek help, neither gain nor loss framing was found to influence intentions. Stages of depression was a strong predictor, with strongest intentions to seek help observed among those with either minor or severe symptoms of depression. CONCLUSION: Effective health messaging must be matched with unique characteristics and needs of individuals at each 'stage' of depression in order to produce favorable outcomes. PRACTICE IMPLICATIONS: 'Stages' of depression should be known and carefully assessed before the creation and launch of communication interventions.

Explaining Intentions to Seek Help for Depressive Symptoms in the Context of Responsibility Message Framing.

U.S. college students are disproportionally affected by depression but typically do not seek help. To advance understanding of the role of health messages in shaping college students' help-seeking intentions, we used a reasoned action approach to experimentally investigate help-seeking intentions for depressive symptoms. Due to negative interpretation biases among those who suffer from depression, scholars have previously warned against attempts to decrease feelings of responsibility for one's depression in health messages. We tested the determinants of help-seeking intentions as a function of exposure to depression help-seeking messages that differed in responsibility cues. Findings revealed that in our sample low responsibility health message framing did not affect determinants of help-seeking intentions. We identified instrumental attitude (ß = .53) and descriptive norms (ß = .24) as determinants of intentions to seek help (R2 = .42) across message conditions and across levels of depression. These findings indicate potentially important targets for messages that seek to increase help-seeking among depressed college students.

Matching Message Design and Depressed Cognition: An Exploration of Attention Patterns for Gain- and Loss-Framed Depression Help-Seeking Messages.

Although disproportionally affected by depression, most depressed college students do not seek the help they need. Research has recently uncovered the potential negative effects of depression help-seeking messages if depressed cognition is not considered in the health message design process. It is unclear if depression determines whether and how individuals pay attention to gain- and loss-framed depression help-seeking messages-a mechanism that has significant implications for the strategic planning of health communication interventions. In order to enable the effective matching of message design and audience features, this study investigated attention patterns for gain (n = 75)- and loss (n = 78)-framed depression help-seeking messages using eye-tracking technology and self-report measures. The results confirmed that depression is a characteristic of risk avoidance and negative cognition. Depressed participants tended to pay more attention to disease information that was placed in a loss-framed rather than a gain-framed depression help-seeking message. Using negative message framing strategies for health messages seeking to educate about depression symptoms might therefore be a useful persuasive strategy-particularly when disseminated to vulnerable populations affected by depression. Furthermore, the present study emphasizes the effective use of eye-tracking technology in communication research.

Selective transport of neurotransmitters and modulators by distinct volume-regulated LRRC8 anion channels.

In response to swelling, mammalian cells release chloride and organic osmolytes through volume-regulated anion channels (VRACs). VRACs are heteromers of LRRC8A and other LRRC8 isoforms (LRRC8B to LRRC8E), which are co-expressed in HEK293 and most other cells. The spectrum of VRAC substrates and its dependence on particular LRRC8 isoforms remains largely unknown. We show that, besides the osmolytes taurine and myo-inositol, LRRC8 channels transport the neurotransmitters glutamate, aspartate and γ-aminobutyric acid (GABA) and the co-activator D-serine. HEK293 cells engineered to express defined subsets of LRRC8 isoforms were used to elucidate the subunit-dependence of transport. Whereas LRRC8D was crucial for the translocation of overall neutral compounds like myo-inositol, taurine and GABA, and sustained the transport of positively charged lysine, flux of negatively charged aspartate was equally well supported by LRRC8E. Disruption of LRRC8B or LRRC8C failed to decrease the transport rates of all investigated substrates, but their inclusion into LRRC8 heteromers influenced the substrate preference of VRAC. This suggested that individual VRACs can contain three or more different LRRC8 subunits, a conclusion confirmed by sequential co-immunoprecipitations. Our work suggests a composition-dependent role of VRACs in extracellular signal transduction.

Awareness of and reactions to mammography controversy among immigrant women.

BACKGROUND: There is substantial expert disagreement about the use of mammography to screen for breast cancer, and this disagreement routinely plays out in the media. Evidence suggests that some women are aware of the controversy over mammography, but less is known about whether immigrant and other underserved women have heard about it and, if so, how they react to it. OBJECTIVE: To explore immigrant women's awareness of and reactions to mammography controversy. DESIGN: Community-engaged qualitative study: we conducted six focus groups with 53 women aged 35-55 from three immigrant communities (Somali, Latina and Hmong) in a major US metropolitan area. A grounded theory approach was used to identify themes; NVivo 10 was used to enhance analyses. RESULTS: Several themes emerged: (i) low awareness of mammography controversy across groups, despite self-reported attention to health information; (ii) high intentions to be screened, even after being told about the controversy; (iii) few reported discussions of mammography's risks and benefits with clinicians; (iv) substantial interest in learning more about mammography and breast cancer, but some low self-efficacy to obtain such information; and (v) questions about whether health recommendations matter and what qualifies as evidence. CONCLUSION: Given on-going expert disagreement about mammography screening, it is important for clinicians to help women understand mammography's risks and benefits so they can make an informed choice. This is particularly critical for immigrant and other underserved women, who may be less able to access, attend to, process, retain and act on health information (a phenomenon known as communication inequality).