Brief report
Mental health literacy: an impediment to the optimum treatment of major depression in the community

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Abstract

Background: Mental health literacy refers to the knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This study examined the mental health literacy and experience of depression in a random and representative community population. Method: The experience of depression and mental health literacy of 3010 subjects from a random and representative population were determined on the basis of responses to the mood module of the PRIME-MD and questions about a vignette of a person with features of major depression. Results: Those with major depression had significantly more personal experience of depression than those with other depressions and those who were not depressed, but there were few significant differences between the groups in terms of mental health literacy. Of those with major depression, 40% considered anti-depressants helpful, but 40% also considered they were harmful. Conclusions: There is a considerable impediment to the recognition and management of major depression and a need for further community education programs.

Introduction

Depression is a major public health issue and it imposes a considerable economic and emotional burden upon the community (Murray and Lopez, 1997). At any one time the prevalence of major depression is around 5% and at least another 5% have other depressive conditions (Bebbington et al., 1981, Weissman et al., 1988, Oakley-Browne et al., 1989, Regier et al., 1993, Kessler et al., 1994).

However, depression is not well recognised and treated. For patients attending general practitioners with symptoms of depression, only half were correctly diagnosed (Paykel and Priest, 1992), and a number of other studies have found shortcomings in its detection and management (Priest, 1994, Lepine et al., 1997, Suominen et al., 1998, Isacsson et al., 1999, Oquendo et al., 1999).

Whilst it is correct to focus on diagnostic and treatment practices, another component in the optimum management of depression is what has been termed ‘mental health literacy’. This has been defined as “the knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (Jorm et al., 1997a). To illustrate the potential importance of this concept, only 39% of a community sample correctly labelled as depression a vignette of a classically depressed person and standard psychiatric treatments were considered more harmful than helpful (Jorm et al., 1997a).

In order to explore this issue further a vignette of depression and questions related to mental health literacy were administered to a random and representative population sample. Those with major depression were identified in order to determine whether mental health literacy was influenced by the presence of depression.

Section snippets

Method

Data were gathered using a Health Omnibus Survey (Wilson et al., 1992) conducted by experienced interviewers in 1998 of a random and representative sample of South Australians over the age of 15 years. Mental health literacy was assessed using the questionnaire devised by Jorm et al. (1997a), which includes a vignette (Appendix A) depicting either a male (John) or female (Mary) with classical features of depression. Respondents were asked what they thought was wrong with the person and whether

Results

From 4400 households, 3010 interviews were conducted, with a response rate of 70.2%. Two hundred and five (6.8%) had major depression (8.3% females, 5.4% males; 79 aged 15–34, 77 aged 35–54, 49 aged 55+); 319 (10.6%) had other depressive conditions and no depression was detected in 2486 (82.6%).

Respondents’ experience of depression is presented in Table 1. The results of open-ended questions about recognising a problem depicted in the vignette and how that person could best be helped are

Discussion

This is the first report of the delineation of mental health literacy in those with major depression in a random and representative population. Although those with major depression had a significantly greater experience of depression, including having had treatment for similar problems to those in the vignette five times more often than those who were not depressed, their mental health literacy was similar to those with other depressions or those who were not depressed. It is of concern that

Conclusions

Less than adequate physician diagnosis and management of depression have been noted in a number of studies (Paykel and Priest, 1992, Priest, 1994, Goldberg and Gater, 1996, Lepine et al., 1997, Ohayon et al., 1999). Furthermore, community attitudes appear to be an impediment to the seeking of treatment (Kuyken et al., 1992, Angermeyer and Matschinger, 1996). The present results extend the latter studies by clearly delineating issues of mental health literacy as being of relevance. Thus there is

Acknowledgements

This study was supported by grants from the University of Adelaide, Pfizer Pty. Ltd., Bristol-Myers Squibb Australia Pty. Ltd., and Wyeth Australia Pty. Ltd.

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