Brief report
Does stigma predict a belief in dealing with depression alone?

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Abstract

Background

Community surveys indicate that many people with depressive disorders do not obtain professional help and that a preference for self-reliance is an important factor in this treatment gap. The current study sought to investigate whether stigmatising attitudes predict a belief in the helpfulness of dealing with depression without external assistance.

Methods

Data were collected as part of a national household survey of 2000 Australian adults aged 18 years and above. Participants were presented with either a vignette depicting depression (n = 1001) or a vignette depicting depression with suicidal ideation (n = 999) and asked if it would be helpful or harmful to deal alone with the problem. Logistic regression analyses were conducted to determine if belief in dealing with depression alone was predicted by personal stigma, perceived stigma or sociodemographic characteristics.

Results

Higher levels of personal stigma independently predicted a belief in the helpfulness of dealing alone with both depression and depression with suicidal ideation. By contrast, lower levels of perceived stigma were associated with a belief in the helpfulness of dealing alone with depression without suicidal ideation.

Conclusions

Personal stigma is associated with a belief in the helpfulness of self-reliance in coping with depression. Public health programs should consider the possibility that a belief in self-reliance is partly attributable to stigma. The findings also point to the potential importance of providing evidence-based self-help programs for those who believe in self-care.

Introduction

There is consistent evidence that many people with depressive disorders fail to seek professional help with an estimated median treatment gap for major depression of 56% (Kohn et al., 2004).

There are many potential barriers to mental health service use including structural (Caldwell et al., 2004, Rickwood et al., 2007) and demographic factors (Mackenzie et al., 2006, Oliver et al., 2005, Sheikh and Furnham, 2000), the stigma associated with mental illness (Barney et al., 2006, Cooper-Patrick et al., 1997, McNair et al., 2002) and poor mental health literacy (Thompson et al., 2004). In addition, a number of studies have reported that a preference for self-reliance and a belief that the condition will resolve on its own are among the leading barriers to formal help seeking for mental illness (Ortega and Alegria, 2002, Prins et al., 2010, Sareen et al., 2007, Wells et al., 1994).

Although typically treated as an independent concept, it is possible that this belief in self-reliance is, at least in part, a secondary consequence of stigmatising attitudes to mental illness. For example, a person who believes that depression is not a real condition and that it can be managed through will-power, might believe that it should be managed without external help. Consistent with this possibility, Jorm et al. (2006) reported that members of the public who believed it helpful to deal with depression alone were more likely than those who thought it harmful to endorse personal weakness as a cause of depression. This finding raises the possibility that a belief in dealing with depression alone is associated with greater levels of personal stigma. On the other hand, Jorm et al. reported that those believing in coping alone were less likely to believe that the person with depression would be subjected to discrimination, concluding that they were ‘less aware of discrimination against depressed people as an issue in society’ (p. 64).

Jorm et al. (2006) employed single items rather than validated measures of personal stigma (the respondents personal attitudes to depression) or perceived stigma (the respondent's beliefs about the attitudes of others). To our knowledge there have been no previous published reports of the association between a belief in dealing with depression alone and personal or perceived stigma measured using a validated scale or controlling for multiple demographic factors. Further, Jorm et al. investigated the beliefs of the public about coping with depression without suicidal ideation. Given that suicidal ideation is a risk factor for suicidal behaviour, it is of particular interest to examine public beliefs about coping alone with suicidal ideation.

The present study therefore sought to investigate whether personal or perceived stigma predicted the belief in dealing with depression alone or depression with suicidal ideation using validated measures of personal and perceived stigma and controlling for several demographic factors. We employed data from one of the cross-sectional surveys reported by Jorm et al.

Section snippets

Method

The survey methodology has been described previously elsewhere (Griffiths et al., 2006, Jorm et al., 2005, Jorm et al., 2006). It involved 3998 Australian participants aged 18 to 75 years recruited via a national face-to-face household survey. The current article is concerned with subset of 2000 participants (841 men and 1159 women) who answered questions about a male (John) or female (Mary) vignette depicting either a person with major depressive disorder (n = 1001) or a major depressive disorder

Statistical analysis

Participants were classified into those who believed that dealing with depression alone was likely to be helpful for the person in the vignette (DA group) and those who believed it was likely to be harmful, neither helpful nor harmful or who responded “depends” or “don't know” (non-DA group).

A series of chi-square and Student's t-tests were conducted to investigate the univariate associations between belief in dealing with depression alone and demographic status and personal and perceived

Results

Demographic and mean stigma scores for the DA and non-DA groups for each vignette type are shown in Table 1. The results of the univariate and logistic regression analyses are described below for each vignette type. Tests for linearity of the logit and multicollinearity for both sets of multivariate analyses indicated that these assumptions had not been violated.

Discussion

The key finding from this study was that personal stigma predicted a belief in the helpfulness of dealing with depression alone. This was the case whether or not the condition was accompanied by suicidal ideation. In addition, after controlling for other variables, those born overseas were more likely to endorse coping alone with depression without suicidal ideation, and men and older people were more likely to believe in coping alone with depression accompanied by suicidal ideation.

The

Conclusion

Stigma appears to play a small role in the belief in the helpfulness of dealing with depression alone. Further qualitative, cross-sectional and prospective intervention research is required to explore the effect of stigma and depression literacy on self-reliance and help seeking beliefs and treatment avoidance.

Role of funding source

Funding for this study was provided by the Australian Department of Health and Ageing, the NHMRC, and “beyondblue: the national depression initiative”. None of the funding partners had a role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

The survey was funded by the Australian Department of Health and Ageing, a National Health and Medical Research Council Program Grant, and “beyondblue: the national depression initiative”. KG is supported by NHMRC Fellowship No. 525413, HC by Fellowship No. 525411 and AJ by NHMRC Fellowship number was 40001. We thank Kelly Blewitt for her work on this survey and Andrew Mackinnon for statistical advice.

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