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Depression is very disabling

La promotion de la santé mentale est encore assez peu connue des psychologues et insuffisamment portée par ceux-ci, notamment parce qu’elle s’appuie sur des concepts et des données issues de la Santé Publique. De plus, elle est portée par une approche dite « positive » de la santé — qui se distingue des modèles de déficits — dont le type d’intervention consiste à mobiliser le potentiel humain en amont afin d’éviter l’apparition d’un éventuel trouble psychiatrique.

L’enjeu actuel en matière de santé mentale implique ainsi un changement de paradigme chez les psychologues permettant de passer d’une action majoritairement curative à une action orientée vers les potentialités individuelles et collectives, les objectifs de ces deux champs étant complémentaires. Cet article présente une synthèse de déterminants de la santé mentale et de politiques publiques nationales et internationales ayant pour objet de favoriser la promotion de la santé.

L’article conclut sur la manière dont les psychologues pourraient devenir des acteurs essentiels de ce champ jusqu’à présent sous-investi par la profession.

Mental health promotion is still insufficiently known by psychologists and few of them work in this field, in part because it is based on public health concepts and data. Furthermore, its approach is focused on positive health – as opposed to deficit models – which proposes interventions consisting in developing human competencies and strengths as a means of preventing potential future mental illnesses.

The present stake, in the field of mental health, thus requires a paradigmatic change in psychologists which would enable to move from mainly curative interventions to actions oriented towards individual and collectives’ potentialities. This article presents a synthesis of mental health determinants as well as national and international public policies aiming at developing health promotion.

It concludes on how psychologist could become major actors in this field.

Of the millions of students enrolled in university, up to 50% will experience a mental disorder. Many of these students do not seek help, and for those who do, university-based services are often over-burdened. Anonymous, evidence-based, online interventions can improve students’ access to mental health support. The Uni Virtual Clinic (UVC) is a transdiagnostic online mental health program designed specifically for university students. This paper reports on a randomised controlled trial examining the effectiveness of the UVC in a sample of Australian university students.

University students with elevated psychological distress (K10>15; n = 200) were randomised to the UVC intervention or a waitlist control condition for a period of 6 weeks. Baseline, post-intervention, and 3-month follow-up surveys assessed depression, anxiety, self-efficacy, quality of life, adherence, and satisfaction with the UVC intervention.

Mixed models analysis demonstrated that use of the UVC was associated with small significant reductions in social anxiety and small improvements in academic self-efficacy. The program was not effective in reducing symptoms of depression, anxiety, or psychological distress compared to a control group. The majority of participants in the intervention condition who were retained at follow-up engaged with the program, and most of these participants reported satisfaction with the UVC.

The results suggest that multi-component online interventions such as the UVC have utility in a university environment. Future trials of the UVC should examine the impact of guidance and/or tailoring on treatment efficacy, and the potential role of the UVC in a stepped care model incorporating on-campus services.

Two core features of depression are elevations in negative valence system (NVS) functioning and reductions in positive valence system (PVS) functioning. Existing psychological treatments have focused on the NVS and neglected the PVS, which may contribute to sub-optimal outcomes. The present mixed methods multiple randomised baseline case series preliminarily evaluates Augmented Depression Therapy (ADepT), a novel depression treatment targeting PVS and NVS disturbance, that aims both to reduce depression and enhance wellbeing. Eleven clinically depressed participants were recruited. Intensive time series analyses showed that 7/11 participants improved on both wellbeing and depression. Reliable and clinically significant improvement was observed for 9/11 participants on at least one of these outcomes (and also across a range of other PVS and NVS outcomes). Group level analyses showed significant pre to post change on all outcomes. Benchmarking analyses indicated these effect sizes were at least comparable (and for some PVS outcomes superior) to existing treatments. Gains were largely sustained over one-year follow-up. Qualitative interviews indicated ADepT was feasible and acceptable. These findings provide preliminary support for ADepT as a novel depression treatment. Further evaluation, directly comparing ADepT to existing treatments using randomised controlled trial designs, is now required.

Currently, little is known about the prevalence of mental disorders in athletes. This study aims to investigate Australian elite athletes’ symptoms of general psychological distress and common mental disorders.

A cross-sectional survey design was employed to assess self-reported symptom prevalence.

A total of 224 elite athletes (118 female, 106 male) from national sporting organisations in Australia were administered a self-report internet-based survey comprising measures of demographic status and mental health symptoms.

Overall, 46.4% of athletes were experiencing symptoms of at least one of the mental health problems assessed. Percentages meeting criteria for mental disorders were similar to previous epidemiological studies of both international athlete and community samples: depression (27.2%), eating disorder (22.8%), general psychological distress (16.5%), social anxiety (14.7%), generalised anxiety disorder (7.1%), and panic disorder (4.5%). Injured athletes had higher levels of both symptoms of depression (t = 3.23, p = .001) and generalised anxiety disorder (t = 2.26, p = .025).

The level of symptoms of mental health problems reported by elite athletes appears similar to that observed in the community. However, caution must be exercised in interpreting the findings, as possible demographic differences between athletes and comparison population datasets may exist. Furthermore, self-selection of respondents in the present study may have reduced the representativeness of the sample and the validity of the comparisons. Athletes, particularly those currently injured, should be well-supported to seek help for mental disorders through access to mental health professionals.

Although depression can be treated effectively with Cognitive Behaviour Therapy (CBT), only a small percentage of Chinese Australians access evidence-based treatment due to practical and cultural barriers. The present study examined the efficacy and acceptability of an Internet delivered CBT (iCBT) program to treat Chinese Australians with depression.

The Chinese depression iCBT program (the Brighten Your Mood Program) is a culturally adapted version of the clinically efficacious Sadness iCBT Program. Fifty-five Chinese Australians with depression were randomly allocated to either an immediate treatment group or to a waitlist control group. Treatment consisted of an 8 week program with 6 CBT online educational lessons, homework assignments, additional resources presented in Chinese and English, and weekly telephone support with Mandarin/Cantonese-speaking support personnel. An intention-to-treat model was used for data analyses.

Seventeen of twenty-five (68%) treatment group participants completed all lessons within the timeframe. Compared to controls, treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory (CBDI) and Patient Health Questionnaire-9 item (CB-PHQ-9). The within- and between-group effect sizes (Cohen's d) were 1.41 and 0.93 on the CBDI, and 0.90 and 0.50 on the CB-PHQ-9, respectively. Participants rated the procedure as acceptable, and gains were sustained at three-month follow-up.

The study included several subclinical participants and some measures that have not been previously validated with Chinese Australians.

Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians.