Increasing help-seeking among people with depression by self-distancing using mental time-travel.

BACKGROUND: Past research indicates that self-distancing through perspective-taking may increase help-seeking intentions among some people with depression. AIMS: The current pre-registered study tested the effect of self-distancing through mental time-travel on help-seeking attitudes, intentions, outcome expectations, and self-stigma. METHODS: Participants with elevated depressive symptomatology who had not yet sought help for current feelings of depression (n = 859) were randomly assigned to a self-distancing writing task, a self-immersive writing task, or a control condition. RESULTS: Help-seeking attitudes were significantly higher in the distancing condition than in the immersive or control conditions. Additionally, self-distancing through mental time-travel resulted in higher help-seeking intentions compared to the control condition but was not significantly different from the immersive condition. The immersive condition was not significantly different from the control for any outcomes. Interactions show that both self-distancing and the immersive task weakened the negative relationship between depression severity and help-seeking attitudes and intentions. CONCLUSION: Extending scholarship investigating self-distancing and help-seeking intentions, results show that self-distancing through mental time-travel can result in more favorable help-seeking attitudes compared to a control.

A Rebuttal-Based Social Norms-Tailored Cannabis Intervention for At-Risk Adolescents.

Many past cannabis prevention campaigns have proven largely ineffective due in part to the diversity of adolescents' cannabis-relevant beliefs. The current studies evaluated the impact of a sequential multiple message approach tailored to the usage norms of adolescents expressing negative attitudes toward a cannabis prevention appeal. A multiple-message strategy was implemented-initial unfavorable message evaluations were invalidated using attitudinal rebuttal feedback prior to presenting a third tailored communication. Participants were cannabis-abstinent middle and high school students (ages 11 to 16). Study 1 (N = 808) compared effects of gain- and loss-framed messages tailored to each student's normative usage perceptions. In Study 2 (N = 391), students were randomly assigned to receive a tailored or non-tailored message after receiving feedback meant to destabilize anti-message attitudes. For at-risk adolescents in Study 1 who perceived cannabis use as normative, a tailored gain-framed message resulted in the lowest usage intentions (p < .05). In Study 2, a conditional multiple-moderated mediation model showed that for high-risk teens with normative beliefs and pro-cannabis attitudes, exposure to a tailored gain-framed communication was associated with decreased cannabis attitude certainty, and lower usage intentions 2 months later (p < .05). Findings have implications for sequential messaging utilization in mass media campaigns and support the efficacy of tailored messages over a one-size-fits-all media approach. Further, results suggest that systematically weakening resistance to persuasive communications and tailoring messages consistent with individually perceived peer norms is an effective prevention strategy.

A Mixed Methods Approach to Creating Depression Public Service Announcements by Collaborating with People with Depressive Symptomatology.

Depression is a treatable condition; unfortunately, many do not seek help. Depression public service announcements (D-PSAs) are one means of increasing help-seeking behavior. However, as Beck's cognitive theory of depression indicates, it can be challenging to persuade people with depression. Although there have been successful D-PSAs, some have been ineffective or led to boomerang effects. With the goal of providing guidance for future messages, we use a mixed-methods approach to assess how people with heightened depressive symptomatology perceive motivations and barriers regarding help-seeking. Study 1 participants (N = 186), with and without depressive symptomatology, provided motivations and barriers to seeking help for depression. Study 1's qualitative analysis determined 112 motivations and 124 barriers to help-seeking. Study 2 participants (N= 214), all with heightened depressive symptomatology, rated the motivations and barriers from Study 1 on their attitude function, importance, awareness, and argument strength. This insight guided successful D-PSA creation in a follow-up study, reported elsewhere. The methodological approach utilized, and the specific motivations and barriers revealed, will ideally assist scholars and practitioners seeking to develop future D-PSAs.

Can Mental Health Anti-stigma Messages Have Untoward Effects on Some People with Depression?: An Exploratory Study.

Scholars have warned that mental health anti-stigma campaigns targeting the general public can possibly be detrimental to some who are stigmatized. Scholars also have noted that people with depression respond to some public service announcements (PSAs) differently than those without. Accordingly, the current study explored whether anti-stigma PSAs targeting the general public could cause problematic outcomes for people with depression. Participants with (n = 55) and without (n = 133) heightened depressive symptomatology viewed two mental health anti-stigma PSAs. Participants provided thoughts about the PSAs through a single, open-ended question. To allow for an assessment of convergence, participants rated overall favorability toward each PSA through a close-ended item. Results indicated that most qualitative responses were favorable; however, 23.6% of respondents with heightened depressive symptomatology, compared to 1.5% without, provided responses coded as indicating that at least one PSA caused unintended negative affect, χ2(1) = 25.96, [Formula: see text] p < .001. Evidence of untoward effects primarily came from the Friend PSA and the qualitative responses indicate how this occurred. Moreover, complementing the qualitative coding, the Friend PSA was rated less favorably by participants with heightened depressive symptomatology (M = 5.00, SD = 1.67), than those without (M = 5.64, SD = 1.44), F(1, 186) = 6.99, p = .009, ηp2 = .036. There were no significant differences in quantitative favorability ratings regarding the Labeling PSA. Indicating that further investigation is warranted, results suggest it is possible for an anti-stigma PSA targeting the general public to cause unintended negative affect among some people with depression.

Measuring Prosociality: The Development of a Prosocial Behavioral Intentions Scale.

Prosociality is a critical issue in behavioral research. In this investigation, we developed a measure of prosocial behavioral intentions. Qualitative responses from two surveys (n = 465) and items from existing measures were used to generate a list of prosocial behaviors in which people might intend to engage. We factor analyzed responses to these items (n = 319) and retained the most common and representative items. The new measure demonstrated adequate internal consistency (n = 247, 147; α = .81, .83); convergent validity with past prosocial behavior (r = .51, .43), moral identity (r = .50, .55), and materialism (r = -.30, -.20). The instrument also predicted prosocial behavior while controlling for a prior measure of prosocial intentions, Exp(B) = 1.99, Wald = 10.59, p = .001, thereby demonstrating incremental predictive validity. This 4-item scale could be used across contexts to advance the study of prosociality.

Increasing Help-Seeking Outcomes among People with Elevated Depressive Symptomatology with Public Service Announcements: An Examination of Functional Matching and Message Sidedness.

The current experimental study assessed the utility, and potential harm, of depression public service announcements (D-PSAs) that were matched, moderately matched, or mismatched based on attitude function (i.e., social-adjustive or object-appraisal) and either one-sided or refutational two-sided. US adults (N = 567) with mild to severe depressive symptomatology were randomly assigned to view control messages or one set of D-PSAs. Results indicate that functionally matched D-PSAs, regardless of message sidedness, caused more favorable help-seeking outcome expectations, attitudes, and intentions compared to the control messages. Exposure to the mismatched D-PSAs, particularly refutational, led to less-favorable help-seeking outcome expectations, attitudes, and intentions compared with the control condition. Help-seeking outcomes among those exposed to the moderately matched messages were not significantly different from those exposed to the control messages, with the exception of those exposed to the one-sided moderately matched messages. The one-sided moderately matched messages resulted in lower help-seeking intentions than the control messages. Overall, results indicate that if messages can be tailored to match the recipients' attitude functions, help-seeking outcomes among people with heightened depressive symptomatology can be increased. However, the results also indicate that some D-PSAs can have negative effects.

The Effect of Inconsistency Appeals on the Influence of Direct-to-Consumer Prescription Drug Advertisements: An Application of Goal Disruption Theory.

Scholars across multiple domains have identified the presence of inconsistency-arousing information in direct-to-consumer prescription drug advertisements and have suggested that these appeals, which highlight differences between people's actual and desired lives, may create psychological disequilibrium. However, experimental assessment of the distinct influence of inconsistency-arousing information in this domain is rare. Guided by goal disruption theory-a framework that outlines people's reactions to goal expectation violations-we created direct-to-consumer advertisements designed to make people's life inconsistencies salient. The influence of these ads on people's perceptions of, and intentions to use, prescription drugs was then assessed. Results from a structural equation modeling analysis supported the proposed model, indicating that compared to a control ad, an ad containing a goal expectation violation manipulation resulted in higher levels of psychological disequilibrium; in turn, psychological disequilibrium led to positive evaluations of the ad and the drug, positive outcome expectations of the drug, increased purposive harm endurance, and increased usage intentions. The current results suggest a psychological pathway that begins with a negative goal expectation violation and ends with increased usage intentions and a greater willingness to endure harm to make use possible.

State Psychological Reactance to Depression Public Service Announcements Among People With Varying Levels of Depressive Symptomatology.

Campaigns seeking to help people with depression can be effective, but they can also backfire. Psychological reactance is proposed as a partial explanation. Two experimental studies examined the effect of two depression messages (i.e., autonomy-supportive language, controlling language) for participants (n = 2027, n = 777) with varying levels of depressive symptomatology. For Study 1, two versions of a print public service announcement about seeking help for depression served as the experimental stimulus. Study 2 used an existing video public service announcement about seeking help for depression, but the text was altered to create the two conditions. In both studies, increased depressive symptomatology was associated with reduced help-seeking attitudes and intentions, as well as greater state reactance to a public service announcement about depression. Increased state reactance mediated the relationship between increased depressive symptomology and unfavorable help-seeking outcomes. Further, across the two studies, participants with high levels of depressive symptomatology who were exposed to the autonomy-supportive language ad reported either as much, or more, state reactance than participants with high levels of depressive symptomatology who were in the control condition. These results warn that language perceived as autonomy-supportive by people without depression might be perceived as controlling among people with depression.

The Potential (F)utility of a Passive Organ Donor Registration Opportunity: A Conceptual Replication.

CONTEXT: Approximately 22 people die each day in the United States as a result of the shortage of transplantable organs. This is particularly problematic among Spanish-dominant Hispanics. Increasing the number of registered organ donors can reduce this deficit. OBJECTIVE: The goal of the current set of studies was to conceptually replicate a prior study indicating the lack of utility of a lone, immediate and complete registration opportunity (ICRO). DESIGN AND SETTING: The study, a quasi-experimental design involving a total of 4 waves of data collection, was conducted in 2 different Mexican consulates in the United States. Guided by the IIFF Model (ie, an ICRO, information, focused engagement, and favorable activation), each wave compared a lone ICRO to a condition that likewise included an ICRO but also included the 3 additional intervention components recommended by the model (ie, information, focused engagement, and favorable activation). PARTICIPANTS: Visitors to the Mexican consulates in Tucson, Arizona, and Albuquerque, New Mexico, constituted the participant pool. MAIN OUTCOME MEASURE: New organ donor registrations represented the dependent variable. RESULTS: When all 4 components of the IIFF Model were present, approximately 4 registrations per day were recorded; the lone ICRO resulted in approximately 1 registration every 15 days. CONCLUSION: An ICRO, without the other components of the IIFF Model, is of minimal use in regard to garnering organ donor registrations. Future studies should use the IIFF Model to consider how the utility of ICROs can be maximized.

The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults.

Mental illness (MI) affects one in four people in their lifetime and a failure to seek help for MI can have grave consequences. To decrease stigma and increase help seeking, prior campaigns have promoted the biological origins of MI. Even though some research supports the efficacy of this approach, other research does not. We propose cultural differences as a partial explanation for these inconsistent results. The current study assessed ethnic differences in the relationship between perceived causes of MI, shame associated with MI and perceived family support for help seeking. White and South Asian American (SAA) undergraduate students completed an online survey (n = 177). Results indicated that SAAs were significantly more likely than whites to perceive character deficits as the cause of MI. Further, among those who had sought help for MI, ethnic differences emerged in perceptions of MI based on perceived cause. SAAs who believed that MI had biological origins perceived more shame and less family support for seeking help compared to SAAs who believed MI was due to character deficits. The converse was true for whites - those who believed that MI had biological origins perceived less shame and more family support for help seeking compared to whites who believed MI was due to character deficits. The results of the current study illuminate the role that culture plays in perceptions of MI. Further, these results have implications for interventions targeting South Asian populations and for mental health outreach in general.

Parent-child drug communication: pathway from parents' ad exposure to youth's marijuana use intention.

The authors combined the 2-step flow of communication model and the theory of planned behavior to create a framework to evaluate the effectiveness of a set of advertisements from the National Youth Anti-Drug Media Campaign promoting parent-child drug communication. The sample consisted of 1,349 pairs of parents and children who responded to the first and second annual rounds of the National Survey of Parents and Youth, and 1,276 pairs from Rounds 3 and 4. Parents' exposure to the campaign reported at Round 1 was indirectly associated with youth's lowered intentions to use marijuana at Round 2. Ad exposure was associated with positive changes in parental attitudes toward drug communication and perceived social approval of antidrug communications. These two beliefs, along with perceived behavioral control, predicted parents' intentions to discuss drugs with their children. Parental intentions to discuss drugs reported at Round 1 were associated with youth's report of actual drug communication with their parents at Round 2. Frequency and breadth of the topics in parent-child drug communication were associated with less positive attitudes toward marijuana use among youth who spoke with their parents. Together, the child's attitudes toward marijuana use and perceived ability to refuse marijuana use predicted youth's intentions to use marijuana. The proposed model fit well with the data and was replicated in a parallel analysis of the data from Rounds 3 and 4. Implications for future antidrug media campaign efforts are discussed.

Attitude ambivalence, friend norms, and adolescent drug use.

This study assessed the moderating effects of attitudinal ambivalence on adolescent marijuana use in the context of the theory of planned behavior (TPB). With data from the National Survey of Parents and Youth (N = 1,604), two hierarchical multiple regression models were developed to examine the association of ambivalent attitudes, intentions, and later marijuana use. The first model explored the moderating effect of ambivalence on intentions to use marijuana; the second tested the moderation of ambivalence on actual marijuana use 1 year later. Results across both analyses suggest that ambivalence moderated the association of friend norms and subsequent adolescent marijuana use: friend norms were better predictors of marijuana intentions (ß = 0.151, t = 2.29, p = 0.02) and subsequent use when adolescents were attitudinally ambivalent about marijuana use (ß = 0.071, t = 2.76, p = 0.006). These results suggest that preventive programs that affect the certainty with which adolescents holds pro- or antimarijuana attitudes may influence the likelihood of their resistance to, initiation, or continuance of marijuana use.

Differentiating Common Predictors and Outcomes of Marijuana Initiation: A Retrospective Longitudinal Analysis.

This quasi-experimental secondary analysis, funded by NIDA, employed data from a national sample of 1,968 US adolescents, collected from 1999 to 2003, self-classified as resolutely anti-marijuana on the first two yearly assessments (T1 and 2). At T3, respondents remained resolute non-users, or had moved to vulnerable non-use or use. Analysis of variance indicated that users at T3 were significantly heavier users of tobacco and alcohol, and reported significantly less intense parental monitoring, than those who did not initiate marijuana use. Furthermore, categorizing non-users as either resolute or vulnerable revealed behavioral patterns that otherwise would have been unidentified. Implications for prevention are discussed.

Barriers to living donation among low-resource Hispanics.

Hispanics are disproportionately affected by renal failure. Although living donation has been heralded as a potential means for alleviating the need for transplantable kidneys, a nuanced understanding of the obstacles faced by Hispanics is necessary. In our study, we conducted focus groups with 28 first-generation Spanish-dominant Hispanic renal patients. Although some of the barriers that emerged were akin to those reported in previous research (e.g., a lack of knowledge about the process), others were unique. Rarely chronicled barriers include the disqualification of family members because of medical issues, potential donors being unable to miss work, disqualification of family members who are undocumented, concern that potential donors cannot support their family if they donate, and declining social support because of illness. The interaction among this constellation of barriers makes living donation particularly difficult among this population. Investigations focused on the unique barriers faced by these low-resource individuals are warranted.

Weiner's Attribution-Emotion-Action Model: Uncovering the Mediating Role of Self-Blame and the Moderating Effect of the Helper's Responsibility for the Help Recipient's Behavior.

Seven preregistered experimental studies investigated a potential mediator (self-blame) and moderator (the perceived responsibility of the helper for the help recipient's behavior) of Weiner's attribution-emotion-action model. When participants considered a nonchild close other experiencing depression, higher perceived controllability was related to lower sympathy, which correlated with less willingness to provide support; however, among parents considering their child experiencing depression, perceived controllability was either positively associated with sympathy (study 1) or did not influence sympathy (study 2). Offering an explanation, studies 3a/3b indicated a significantly weaker relationship between controllability and responsibility attributions when the target of help was the participant's child. Study 4 investigated the underlying mechanism. Parents experienced self-blame when the cause was controllable, which lowered the association between controllability and responsibility attributions. Studies 5 and 6 revealed this pattern was not specific to the parent-child relationship but occurred whenever the potential helper felt responsible for the help recipient's behavior.

The paradox of the resident experiencing depression: Higher depression, less favorable help-seeking outcome expectations, and lower help-seeking intentions.

BACKGROUND: Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help. METHODS: The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier-and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States. RESULTS: There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies. CONCLUSIONS: The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking.

Effects of a one-hour intervention on condom implementation intentions among drug users in Southern California.

Approximately 36% of HIV cases are related to substance abuse. Substance abusers, including non-injection drug users, are at a high-risk for contracting HIV due to risky behaviors, including unprotected sex. Due to these behavioral and infection risks, feasible interventions that focus on condom use within this population are imperative. The current study involved the development of brief intervention designed to increase implementation intentions (situation-linked action plans) to use condoms in convicted non-violent drug offenders participating in drug diversion programs in Southern California. Participants (n = 143) were randomized at the individual level to either waitlist control or experimental conditions. The randomized waitlist control group received the HIV survey for the pre-test before the intervention, while the experimental group received a neutral, non-HIV-related, survey at pre-test. The experimental group received the HIV survey as the post-test after the intervention (waitlist control group received the neutral, non-HIV-related, survey). One-tailed Mann Whitney U tests were used to compare the waitlist control and experimental groups. The experimental group was more likely to report stronger implementation intentions to use condoms (p <0.001). These results indicate in the short term that a brief, easily disseminated HIV intervention can be effective for increasing implementation intentions to use condoms in an extremely high HIV-risk population.

The effect of depression on physician-patient communication among Hispanic end-stage renal disease patients.

End-stage renal disease is associated with increased level of depression. Depression is associated with a reduction in the ability of people to effectively communicate in interpersonal settings. The interaction between end-stage renal disease patients and their physicians has important implications for the course of the treatment of this disease; however, there is limited research examining the influence of depression on general patient-physician communication. This study examines the association between depression and physician-patient communication in a sample of Hispanic end-stage renal disease patients. Participating patients filled out the Beck Depression Inventory and self-reported their feelings about meeting with physicians. Patients then met with a physician, and a nurse practitioner observed the interaction. Results indicate that depression was negatively associated with patients' self-reported perceptions of their readiness for the appointment (r =-.20) and with self-reported communication efficacy (r =-.19). Moreover, the nurse practitioner rated patients with depression as being significantly less likely (a) to ask for clarification (r =-.40), (b) to be engaged in the conversation (r =-.46), and (c) to be forthcoming with the physician (r =-.37). Results of this study have significant implications for communication between physicians and end-stage renal disease patients and for the influence of depression on patient-physician communication.

Persuading people with depression to seek help: respect the boomerang.

People with depression are likely to process information with a negative bias when confronted with self-relevant information. Accordingly, we feared exposing depressed people to a public service announcement (PSA) addressing the stigma of depression would possibly boomerang and result in less intention to seek help and in increased self-stigma. College students (N = 271; Mage = 22.51, SD = 4.71; 63.1% female; 37.3% White, 31.9% Hispanic, 12.9% Asian, 6.8% multiethnic, 3.4% Black, 7.6% other) were randomly assigned to receive a print ad focused on depression or a nonrelevant comparison ad. A paper-and-pencil survey consisting of the Beck Depression Inventory-II, Self-Stigma of Seeking Help scale, help-seeking intentions, and demographics followed. Regression analysis indicated that viewing a depression ad caused people with greater depressive symptoms to experience greater levels of self-stigma than depressed people exposed to a nonrelevant comparison ad. Bootstrap mediation analysis showed that for individuals who viewed a depression PSA, self-stigma mediated the relationship between depressive symptoms and professional help-seeking intentions. While this current study offers no direct evidence in regard to the utility of current and past depression campaigns, results indicate a definite need for caution when developing materials targeting people with depression to seek help.

Vested in support: Applying vested interest theory to increase support for close others with depression.

Guided by vested interest theory, we assessed whether a lack of stake explains the discrepancy between people having positive attitudes toward their loved one's recovery from depression and the provision of support. We further investigated whether increasing the perceived personal consequences of providing support (i.e. stake) increased willingness to provide support. A stake-boosting message had no direct, but significant indirect effects on willingness to provide support when compared to a control and comparison condition. In summary, increasing stake in a loved one's recovery indirectly increases intentions to provide support.