Bipolar disorder (BD) (i.e., BD-I or BD-II) is a serious mental illness (SMI) that can cause significant life challenges, but its impact and management may be mediated by psychosocial factors. This study's primary objectives were to investigate whether adults with BD differ from those without in terms of social support, negative social interactions (NSIs), and positive mental health (PMH). Secondly, examine whether gender differences exist in terms of these variables, as well as whether specific social support subscales and NSI predict PMH for those with BD.

Using data extracted from a national Canadian survey, 563 adults reporting a lifetime BD diagnosis were compared to a matched, non-BD sample using the Social Provisions Scale 10 Items (SPS-10), the NSI Scale, and the Mental Health Continuum - Short Form (MHC-SF) Scale. For the BD sample, males and females were compared based on study variables, and hierarchical regressions were subsequently performed to assess whether SPS-10 subscales and NSIs predicted PMH.

Respondents with BD reported significantly lower SPS-10 and PMH scores, and significantly higher NSI scores. Within the BD sample, females reported significantly higher SPS-10 and NSIs scores, and 'social integration' and 'reassurance of worth' positively predicted PMH, while NSI uniquely predicted lower PMH levels for both males and females.

The results implicate specific psychosocial factors and gender in the degree to which adults with BD might flourish, particularly in terms negative relationships. The implications of social erosion and the bi-directionality of social support are also considered.

The past few decades have seen the emergence both of new neuromodulation treatment protocols and novel applications of standard neuromodulation interventions in psychiatry. Yet little is known about different stakeholders' views about these interventions.

We administered an online survey with an embedded video vignette experiment to four national samples: the general public (N = 1022), caregivers for people with depression (N = 1026), patients living with depression (N = 1050), and board-certified psychiatrists (N = 505). We randomly assigned subjects to one of eight conditions in our full factorial design: four neuromodulation interventions [electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, or adaptive brain implants] by two depression severity levels [moderate or severe]. In this paper we present results from ANOVA and linear regression models explaining how views about these four neuromodulation interventions-as measured in five attitudinal scales (general affect, perceived influence on self, perceived benefit, perceived risk, and perceived invasiveness)-vary by (1) intervention, (2) depression severity, and/or (3) stakeholder group.

Our results provide evidence that psychiatrists views differ significantly in important ways from other stakeholder groups. Type of intervention also shaped participants' attitudes, including perceptions of invasiveness, effectiveness, and safety.

Given the differing affective valence among stakeholders and the differences found by modality and stakeholder groups across the different scales, future targeted educational initiatives could be developed to help address key misunderstandings and misinformed perceptions.

The patient's understanding of the illness may mediate beliefs towards its treatment. There is a paucity of studies examining the relationships between these variables in depression. This study was conducted to know the relationships between explanatory models and attitude to medication in depression.

494 patients with depression in remission were assessed with sociodemographic proforma, Drug Attitude Inventory, and Mental Distress Explanatory Model Questionnaire.

A favorable attitude toward medication was observed in 57.49% of participants. Mean scores on MDEMQ subscales Stress, Western Physiology, Non-Western Physiology, and Supernatural were 32.96, 21.87, 10.06, and 47.55, respectively. Statistically significant associations were found between attitude towards medication and the patient's marital status (more negative attitude with single status, χ2 = 11.72, df = 3, P = 0.008) and occupation (more negative attitude among unemployed patients, χ² = 4.17, df = 1, P = 0.041). The scores of explanatory models did not differ based on positive or negative drug attitude.

Though explanatory models are not linked to patient attitudes toward medication, patients who are single or unemployed have a negative attitude toward medications. Such negative attitude may impair compliance and worsen patient outcomes.

Objectives: In this study, we examine the public's knowledge about different levels of depression severity in Germany. Methods: Data stem from a national telephone survey in Germany. A total of 1,009 persons participated, response rate was 46.8%. A vignette was presented with signs of mild, moderate or severe depression. Participants were asked what they think the person has, which persons and services are helpful and how effective different treatment options are. Differences between the three vignettes were tested with 95% confidence intervals and χ ²-tests. Results: 55.3% of the respondents identified depression as the health problem in question. Participants who heard the vignette with moderate symptomatology recognized depression more often. Across groups, a general practitioner was named most frequently concerning helpful persons/services. Effectiveness of psychotherapy received high levels of approval, online therapy and books were less often rated as effective. There were only few significant differences between the three vignettes. Conclusions: This is the first study examining public depression literacy for different severity levels. Small differences between severity levels indicate a lack of knowledge, which may have adverse consequences for adherence to treatment, especially for mild depression.

Globally, mental disorders affect 25% of the society. This discursive paper aims to illustrate the mental health literacy levels in the public. Mental health literacy (MHL) is the understanding of mental health conditions, which helps in their prevention, recognition and treatment. Unfortunately, the public has minimal understanding of mental disorders, leading to poor recognition and delay in treatment. There is a need to conduct good quality research to assess the MHL levels among public and tailor interventions to enhance MHL among the public. This will ensure early detection of mental disorders, leading to early recovery and greater quality of life among the society. Nurses have a great role to play in leading these public educations, and enhancing a healthy and happy nation.

Objectives: Despite satisfactory effectiveness of treatment for somatic symptom disorders (SSD), treatment rates are low and treatment is usually initiated many years after first symptoms. In order to understand whether a lack of public mental health literacy might contribute to these poor treatment rates, we aimed to focus on two research questions: (1) What does the German public know and think about SSD? (2) Are knowledge and beliefs associated with socio-demographic factors and experiences with the disorder? Methods: Two vignettes with symptoms of a SSD were used in a national telephone survey in Germany (N = 1,004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked concerning knowledge and beliefs about causes, symptoms, and treatment using a standardized questionnaire. Results: 66% of the respondents agreed that a possible cause of the symptoms is a misinterpretation of body signals. About 1/3 recognized a mental health problem when confronted with the vignettes of cases with SSD. This rate was lower in case of a SSD with pain as the main symptom without a comorbid somatic disease (24.8%, 95%-CI: 21.1-28.6) compared to a case with fatigue as the main symptom and an earlier severe somatic disease (44.0%, 95%-CI: 39.6-48.3). Female respondents tended to have a more positive view on treatability and effectiveness of psychotherapy, while associations of knowledge and beliefs with education and age were inconsistent. Respondents who had contact with a person with SSD were more likely to think that psychotherapy is effective and that they know a lot about SSD compared to those who never had contact. Conclusions: While most of the German public seems to be well informed about causes of SSD as well as treatability and the effectiveness of psychotherapy, the majority has problems with interpreting symptoms and does not think they know a lot about symptoms like that. Increasing knowledge about SSD by education interventions may help to promote adequate help seeking.

One of the major challenges in treating major depressive disorder (MDD) is patients' non-adherence to medication. This study aimed to explore the barriers and facilitators of patients' adherence to antidepressants among outpatients with MDD.

Semi-structured and individual in-depth interviews were conducted among patients with MDD who were taking antidepressants, in the psychiatric clinic of a government-run hospital in Malaysia. Participants were purposively sampled from different genders and ethnicities. Interviews were conducted using a validated topic guide, and responses were audio-recorded, transcribed verbatim, checked, and analyzed using the grounded theory approach.

A total of 30 patients were interviewed. Forty different themes and sub-themes were identified which were conceptually divided into two distinct categories related to barriers and facilitators to adherence. The barriers were: patient-specific, medication-specific, healthcare provision and system, social-cultural, and logistics. The facilitators were: having insight, perceived health benefits, regular activities, patient-provider relationship, reminders, and social support networks.

Patient-specific barriers and medication side effects were the major challenges for adhering to treatment. Perceived health benefits and having insight on the need for treatment were the most frequently cited facilitators. Targeted interventions should be developed to address the key barriers, and promote measures to facilitate adherence in this group of patients.

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders.

Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses.

Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998).

The use of diagnostic tools might improve detection of anxiety disorders in "primary care."

Objectives. The current study investigated mental health literacy in an Australian sample to examine sex differences in the identification of and attitudes towards various aspects of mental illness. Method. An online questionnaire was completed by 373 participants (M = 34.87 years). Participants were randomly assigned either a male or female version of a vignette depicting an individual exhibiting the symptoms of one of three types of mental illness (depression, anxiety, or psychosis) and asked to answer questions relating to aspects of mental health literacy. Results. Males exhibited poorer mental health literacy skills compared to females. Males were less likely to correctly identify the type of mental illness, more likely to rate symptoms as less serious, to perceive the individual as having greater personal control over such symptoms, and less likely to endorse the need for treatment for anxiety or psychosis. Conclusion. Generally, the sample was relatively proficient at correctly identifying mental illness but overall males displayed poorer mental health literacy skills than females.

Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates.

The primary aim of this study was to determine the attitudes and beliefs of patients with depression toward depression and antidepressants. A secondary aim was to assess the influence of ethnicity on patients' attitudes and beliefs.

The study involved patients with chronic depression being followed up at an outpatient clinic at a government-run hospital in Malaysia. Patients' attitudes and beliefs were assessed using the Antidepressant Compliance Questionnaire.

A total of 104 patients of Malay, Chinese, and Indian ethnic groups met the selection criteria. Chinese patients had significantly negative attitudes and beliefs toward depression and antidepressants compared to Malays and Indians (b=-8.96, t 103=-3.22; P<0.05). Component analysis revealed that 59% of patients believed that antidepressants can cause a person to have less control over their thoughts and feelings, while 67% believed that antidepressants could alter one's personality; 60% believed it was okay to take fewer tablets on days when they felt better, while 66% believed that antidepressants helped solve their emotional problems and helped them worry less.

Patients had an overall positive view as to the benefits of antidepressants, but the majority had incorrect views as to the acceptable dosing of antidepressants and had concerns about the safety of the medication. Assessing patients' attitudes and beliefs, as well as the impact of their respective cultures, can be used in tailoring psychoeducation sessions accordingly.

There is not much known about the associations of beliefs about depression (depression literacy) with a history of depression and treatment experience.

Analyses were based on a telephone survey in two large German cities (Hamburg and Munich). Written vignettes with typical signs and symptoms suggestive of a depression were presented to 1293 respondents. Respondents were then asked about beliefs about causes, symptoms, prevalence, and treatment using a standardized questionnaire. For the analysis respondents were divided into three groups: (1) people who never had a depression, (2) people who had a depression but were not treated and (3) people with treatment experience.

Respondents with experience in treatment for depression were more likely to correctly recognize the disorder, to positively evaluate treatability and to favor external factors (adverse conditions in childhood and psychosocial stress) as potential causes of depression compared to those who never were afflicted. There were no significant differences between these two groups regarding beliefs about the effectiveness of treatment options. There were only few significant differences in depression literacy between respondents who have a history of depression but have not sought help and those who never were afflicted.

The three groups were constituted on the basis of respondents׳ self-reports, not medical diagnoses.

Our findings only partly support the general assumption that being afflicted and having sought help is associated with beliefs closer to those of professionals.

Over the last decade the use of psychotropic medications to treat common mental health problems has increased in Australia. This paper explores: 1) public attitudes towards the acceptability of using prescription drugs to treat depression and attention deficit hyperactivity disorder (ADHD), and 2) beliefs about over-diagnosis of depression and ADHD.

1293 members of the general public were surveyed about their attitudes towards drug treatment for depression and ADHD through the Queensland Social Survey (QSS), an omnibus state-wide survey of households in the state of Queensland. The survey was administered through a CATI (computer-assisted telephone interviewing) system. Logistic regression analyses were used to predict belief that drug treatment is acceptable, and that depression and ADHD are over-diagnosed.

Most participants (60.9%) said that it was acceptable to use prescription drugs to treat depression. In contrast, attitudes towards the use of prescription drugs to treat ADHD were much less positive with around the same proportion saying it was acceptable (42.1%) as unacceptable (38.2%). More than half of the sample agreed that too many people are diagnosed with depression when they don't really have it (57.7%), and 78.3% of participants agreed that too many children are diagnosed with ADHD when they don't really have it. Participants who said depression or ADHD were over-diagnosed were less likely to say that it is acceptable to treat these conditions with prescription drugs.

Despite increases in prescribing rates there is still considerable scope for increasing the public's acceptance of treating common mental illnesses with psychotropic drugs. Furthermore, the public's views on over-diagnosis of depression and ADHD appear to reflect ongoing controversy about the proper identification of these conditions, and these views negatively impact attitudes towards drug treatment. This may be a barrier to effective treatment of these conditions given that drug treatment is often recommended as a first line response.

This article examines the mental impairment (insanity) defense in the Australian state of Victoria and argues that the defense is successful only when offenders suffer from psychotic mental illnesses. This raises the question about how non-psychotic offenders are dealt with by the courts when they claim 'mental impairment' for serious acts of violence such as homicide, particularly when a relatively large number of perpetrators involved in homicide suffer from non-psychotic illnesses like depression. The analysis shows that depressive illnesses do not reach the threshold for mental impairment (legal insanity) such that they mitigate violent criminal behavior, although they can, arguably, diminish culpability. This article draws upon existing literature, qualitative analysis of two court cases and semi-structured interviews with four legal representatives to make its conclusions.

This paper examines public attitudes towards the acceptability of using prescription drugs to treat depression and attention deficit hyperactivity disorder (ADHD), and whether attitudes are influenced by familiarity with the use of pharmacological treatments for these disorders.

Participants were 1265 members of the general public aged 18-101 years (50% female) participating in the Queensland Social Survey (QSS), an omnibus state-wide survey of households in the state of Queensland. The survey was administered through a CATI (computer-assisted telephone interviewing) system.

Most members of the public thought that the drug treatment of depression was acceptable (55%) but attitudes were much less positive towards the use of drugs to treat ADHD (35.6% acceptable). Regression analyses showed that respondents who knew someone who had received pharmacological treatment for depression were more likely to find it acceptable. However, participants were divided about the acceptability of drug treatment for ADHD regardless of whether they knew someone who had received drug treatment for ADHD or not. Participants with a higher level of education were more likely to find drug treatment for depression and ADHD acceptable. Participants who did not know anyone who had received drug treatment were less likely to have a definite opinion on whether it was acceptable or unacceptable.

Attitudes towards the acceptability of the use of prescription drugs are more positive for depression than for ADHD. This may broadly reflect ongoing controversies in the public sphere about the potential over-diagnosis of ADHD or overmedication of children with ADHD. Members of the public who do not know anyone with depression or ADHD may need particular information from prescribers in the event that they (or their child) are diagnosed.

Negative views of psychiatric medications are a common in many countries and efforts have been made to improve these. Relatively little is known of the changes in beliefs about harmfulness of antidepressant medications.

A 2011 national survey of 2024 Australian adults assessed beliefs about the helpfulness or harmfulness of antidepressants for a person who is depressed or depressed/suicidal and the associations with sociodemographic characteristics, exposure to depression, recognition of depression, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes in attitudes since previous surveys (conducted in 1995 and 2003/2004) were also assessed.

Approximately 20% of Australian adults believe that antidepressants would be harmful for a person who is depressed or depressed/suicidal. This group was more likely to be male, born overseas, have less exposure to depression, show poorer depression recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antidepressants for depression decreased between 1995 and 2003/2004 and between 1995 and 2011, particularly in young people and in those with a lower level of education.

The study did not explore the reasons for belief in harmfulness.

Belief in the harmfulness of antidepressants for depression fell in the 16 years prior to 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antidepressants in the treatment of depression should focus on these groups.

Stigmatization is characterized by chronic social and physical avoidance of a person(s) by other people. Infectious disease may produce an apparently similar form of isolation-disease avoidance-but on symptom remission this often abates. We propose that many forms of stigmatization reflect the activation of this disease-avoidance system, which is prone to respond to visible signs and labels that connote disease, irrespective of their accuracy. A model of this system is presented, which includes an emotional component, whereby visible disease cues directly activate disgust and contamination, motivating avoidance, and a cognitive component, whereby disease labels bring to mind disease cues, indirectly activating disgust and contamination. The unique predictions of this model are then examined, notably that people who are stigmatized evoke disgust and are contaminating. That animals too show avoidance of diseased conspecifics, and that disease-related stigma targets are avoided in most cultures, also supports this evolutionary account. The more general implications of this approach are then examined, notably how it can be used to good (e.g. improving hygiene) or bad (e.g. racial vilification) ends, by yoking particular labels with cues that connote disease and disgust. This broadening of the model allows for stigmatization of groups with little apparent connection to disease.

Depression remains a significant public health issue globally; 121 million people are affected by depression health education campaigns. Regardless of the prevalence of depression and recent health education campaigns to reduce the burden of depression, many people are still stigmatized and sometimes excluded from the society in which they live. Using qualitative research, the aim of this study was to explore lay people's perceptions and attitudes of mental disorder and in particular depression. A purposive sample of 22 lay people were each asked to read a case scenario which was then followed up by the researcher using open-ended questions to explore their knowledge and attitudes and beliefs relating to depression. The data was analysed using Braun & Clarke's strategy of thematic analysis. The results revealed that many of the participants were familiar with the concept of depression, either through their own experiences of the disorder or through knowing people with depression. The participants also drew from psychosocial explanations of depression and located depression as part of the human condition. The paper suggests that lay people's concepts of depression offer rich complex and diverse perspectives that enhance professional views and may lead to a greater understanding of uptake and acceptance of care for depression.

To identify factors associated with non-compliance to antidepressant's (AD) treatment in Santiago, Chile.

A cross-sectional study was carried out in a household randomized and representative sample of 1000 individuals aged 15 years and older. Treatment adherence was studied in AD consumers using logistic regression to estimate factors associated with non-compliance in doses or time of treatment.

Antidepressant non-compliance was 52.8% and their main associated factor was income. Gender and educational level were also associated with AD non-compliance.

Antidepressant non-compliance was associated with income and sociodemographic characteristics in Chilean patients. Therefore, health strategies to improve AD compliance should consider inequities in access to medications and characteristics of the AD consumers.

There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder.

We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience.

After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder.

We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder.

Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder.

To develop and psychometrically assess an instrument to measure patients' attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression.

A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression.

Internal consistency reliability for the instrument was 0.79 (Cronbach's alpha) and there was 88% overall agreement between experts about the relevance of the instruments' items to test patients' attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy.

The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.

Improving patient adherence to antidepressant treatment is an important issue. Patients' attitudes toward symptoms, results, causes, disease course, and effective treatment of depression can influence their adherence to therapy. We aimed to assess the efficacy of an educational leaflet designed to improve patients' attitudes toward depression and antidepressant treatment. Participants were one hundred twenty-two outpatients of three psychiatric clinics in Japan who met the DSM-IV criteria for depression. Patients in the intervention group received an educational leaflet at the start of the study. Participants filled in The Antidepressant Compliance Questionnaire (ADCQ) and Beck Depression Inventory (BDI) before and after the intervention. Intervention group showed greater improvements on the total score of ADCQ, the score on the "positive beliefs regarding antidepressants" subscale. They maintained the scores on the "perceived doctor-patient relationship" subscale, where the control group lowered those scores. No significant difference in improvement in BDI scores was observed between groups. The intervention using an educational leaflet had a significant positive impact on patients' attitudes toward depression and antidepressant treatment. Our results indicate that the educational leaflet is an effective tool for enhancement of face-to-face education by medical professionals. Trial registration UMIN000002981, www.umin.ac.jp/ctr/index.htm.

Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown.

To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE).

A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework.

Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for ceiling values <or=$US3900 per treatment success.

These analyses suggest that initiating therapy with DRSP/EE may be a cost-effective option in the treatment of PMDD.

Previous studies have detected different variables influencing the attitude towards mentally ill individuals but they have never addressed mania. Furthermore, it is not known whether the same factors affect attitudes towards individuals experiencing major depressive or manic episodes.

Besides factors such as familiarity with mental illness, we were interested whether vulnerability to psychosis and mood disorders as well as social desirability can affect attitudes towards major depressive episodes and manic episodes.

Subjects were presented with a case vignette describing an individual experiencing either a major depressive episode or a manic episode (n = 188, age 16-34 years). Their attitudes towards that person were assessed. Furthermore, factors potentially influencing these attitudes have been assessed such as personal vulnerability factors (i.e. cyclothymia and magical ideation) and social desirability bias.

Familiarity with the phenomenon of mental illness turned out to influence the attitude towards affective episodes, whereas the influence of the other potential predictors such as their own experience of affective or schizotypal symptoms failed to appear to be of significance.

Whereas ;familiarity' turned out to be a factor positively influencing the attitude towards depression, it turned out to have a rather negative influence on the attitude towards mania. This result could have important implications for anti-stigma campaigns.

Older adults with mental health problems are especially unlikely to seek professional mental health services. It is not clear, however, whether their help-seeking attitudes and treatment beliefs contribute to this problem. The objectives of this study were to compare older adults' attitudes and beliefs to younger adults' and to examine the influence of age on these variables after controlling for other demographic variables, prior help-seeking, and mental disorders.

The authors analyzed cross-sectional data from Part 2 of the National Comorbidity Survey Replication. This dataset includes 5,692 community-dwelling adults, including 1,341 adults who were 55 years of age and older. Participants responded to three questions assessing attitudes toward seeking professional mental health services and one question examining beliefs about the percentage of people with serious mental health concerns who benefit from professional help. The authors used logistic regression to predict positive versus negative attitudes and beliefs from age, gender, education, and race/ethnicity, as well as prior help seeking and mood and/or anxiety disorder diagnosis.

Overall, more than 80% of participants exhibited positive help-seeking attitudes and more than 70% reported positive treatment beliefs. In contrast to the modest effect of age on beliefs, adults 55-74 years of age were approximately two to three times more likely to report positive help-seeking attitudes than younger adults.

Older adults' positive attitudes and treatment beliefs are unlikely barriers to their use of mental health services. This finding, which is consistent with recent positive views of aging, suggests that enabling resources and need factors are more likely explanations for older adults' low rates of mental health service use.

The aim of the research was to assess the consensus of clinicians about the appropriate treatments for depression and anxiety in youth, to discover any major differences between clinicians' beliefs and those of young people and their parents, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people.

Postal surveys were carried out on the beliefs of Australian general practitioners, psychiatrists, psychologists, and mental health nurses about what are helpful interventions for depression and social phobia in a 15-year old and in a 21-year old. The clinician data were compared to findings from an earlier national survey of Australian youth aged 12-25 years and their parents.

The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. Young people and their parents showed much lower endorsement than clinicians of antidepressants and cognitive-behavior therapy, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups.

The survey was adapted from one designed for the public and did not allow clinicians to express complex opinions.

Clinicians show substantial consensus about appropriate treatments. However, there are some major differences in beliefs between clinicians and young people, which may be a barrier to optimal help-seeking.

Depressive disorders are frequent. They are frequently unrecognised or sufferers use self help or self medication, e.g. with St. John's wort (SJW), instead of seeking professional help. The purpose of this study is to examine patients who buy SJW for the treatment of depression.

In pharmacies from all over Germany customers who bought SJW and the pharmacists were asked to fill in a questionnaire on the cause for buying SJW, their health status and the type of counselling they received.

588 individuals were included, 293 purchased SJW as an OTC preparation, 230 had a prescription (65 missing answers). The majority in both groups were women (78.8% in OTC group, 74.3% in prescription group. Self medication patients were significantly younger. Subjects with a prescription took SJW longer (26.99+/-26.84 vs. 15.25+/-20.84 months). Both groups did not differ in self rated symptoms of depression (severity of depression, anxiety, endurance).

No standardized interviews were used to establish the diagnosis of depression.

Patients who buy SJW for self medication report pronounced and persistent depressive symptoms. As this is a large group of patients they should get more attention in research. Pharmacists are the only professionals who come in contact with these patients and should therefore be considered as an important group of carers.

Despite the known effects of stigma on people suffering from affective disorders, no study so far has investigated and compared attitudes of the general public towards depression and mania. Furthermore, we were interested if it makes a difference if one asks a sample about its own attitudes or the assumed opinions of 'others'.

We used an experimental and randomized design.

People were faced either with a case vignette describing a man with current symptoms of depression or mania. Randomly people (N=387, age 16-34 years) were asked for their own attitudes or for the attitudes of the public in general.

Attitudes towards an individual with a current manic episode turned out to be significantly more negative than towards a person with current depression. Interestingly, the attitudes of the general public were reported to be more negative than the personal attitudes.

While depression is still associated with negative attitudes, this first study looking at manic symptoms as well finds that this seems to be even more so for manic episodes indicating bipolar disorder. It seems recommended to concentrate efforts to reduce stigmatization of the mentally ill more intensively on the bipolar spectrum of affective disorders. Furthermore, testable hypotheses have to be derived why individuals attribute less favourable attitudes to the general public when compared with their own attitudes. The question is if there is a general bias towards social desirability when people are asked for their opinion.

Various programs for depression prevention have been shown to be effective, but preventive efforts population wide are only beginning. We examine public attitudes towards prevention of depression and beliefs about helpful preventive measures.

Fully structured telephone interview with a representative population sample including people of German nationality older than 14 years (n=1016).

75.4% of the sample agreed on the possibility to prevent depression. Of those, 403 (52.6%) stated that they would take part in prevention programs, and in this group 234 (58.1%) indicated readiness to pay out of their pocket for such programs. Out of a catalogue of 37 proposed actions, psychosocial and lifestyle related measures were preferred. Exploratory factor analysis revealed three factors--proactive lifestyle, relying on medicine, and relaxing--inherent in public beliefs about helpfulness of preventive measures. Higher education reduced willingness, high perceived personal risk of depression and previous contact to the disease increased willingness to take part in preventive programs.

The public entertains favourable attitudes and beliefs about prevention of depression that do not conflict with evidence-based programs. Our study thus encourages implementation of population based prevention programs.

In Iceland, antidepressant sales figures rose from 8 Defined Daily Doses (DDD) per 1000 subjects in 1975 to 95 DDD/1000 in 2005. The aim of the study was to examine the views of adult Icelanders on antidepressant treatment and to identify the factors most influential in shaping their views, using cross-sectional national survey of views on antidepressant treatment in a randomly drawn sample of 2000 Icelanders aged 18-80 years old. Nine in 10 responders believed that regular exercise is an efficacious treatment for depression (92.6%) but supportive interviews came second (82.3%). Seven out of 10 believed that antidepressants are efficacious and the same proportion was willing to use antidepressants as a treatment for depression. The strongest predictor of this inclination was previous use of antidepressants (odds ratio, OR=6.9, 95% CI 3.4-13.8), followed by knowing someone well who had been treated with antidepressants (OR=2.3, 95% CI 1.6 to 3.3). Eight out of every 100 responders were taking antidepressants and further 8.3% had previously been on antidepressants for at least 6 weeks. Among past users of antidepressants, 77% felt that the benefits of therapy had outweighed the disadvantages. More knowledge on antidepressants was associated (chi-squared test=9.96, df=2, P=0.007) with willingness to use them. The majority of adult Icelanders are willing to use antidepressants for depression. The factors influencing their views most strongly are subjects' own experience and the experience of close friends or relatives as users.

To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care.

A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up.

At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%).

Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

The aim of this study was to examine, using Mental Health Literacy, acceptability and correlates of acceptability of three treatment interventions for bulimia nervosa; medication, psychological therapy and self-change/lifestyle therapies.

A self-report questionnaire to ascertain correlates of attitudes towards the three interventions was used. Respondents (n = 177) were females aged 18-53 years.

Psychological therapy was rated the most acceptable treatment to participants as well as the most acceptable to others, and to have most advantages and fewest disadvantages, followed by self-change/lifestyle therapies, and then medication. Social Pressures to be Thin was the most strongly endorsed cause of bulimia, followed by Low Self-Esteem, Eating Behaviour, Relationship and Family Environment, and lastly, Biology. Correlates with acceptability of different treatment approaches were identified.

Although no causal link can be assumed from this design, findings suggest that women appear to have a mixed understanding of the different mechanisms that each treatment intervention adopts to treat the causes and symptoms of bulimia, particularly self-change/lifestyle therapies. This may help to explain poor adherence to interventions.

To identify changes in depression, its management and associated excess costs, between 1998 and 2004 in South Australia.

A face-to-face Health Omnibus Survey was conducted in 2004 among 3015 randomly selected participants aged 15 years and over, who were a random and representative sample of the South Australian population, and this was compared with a survey conducted in 1998 that used the same methodology. The main outcome measures were prevalence of depression detected by the Mood Module of the Primary Care Evaluation of Mental Disorders (PRIME-MD); use of health services; health-related quality of life assessed by the Assessment of Quality of Life; estimates of excess costs and demographic data.

There was no significant change in the overall prevalence of depression, although there was a significant decrease in respondents with other depressions, and a non-significant increase in those with major depression. No significant differences in the mean number of PRIME-MD depression symptoms were reported. Greater use of predominantly non-medical treatment services and antidepressants were reported by both those with depression and those without depression. There was a marked increase in the associated excess costs of depression.

There has been no significant improvement in the prevalence of depression and its associated morbidity and financial burden in the South Australian community between 1998 and 2004, despite a number of professional and community education programmes. It is possible that without these efforts and the increased treatment reported on in this survey, there may have been an increase in the prevalence of depression and an even greater financial burden. However, it is also possible that community services for the provision of treatment for depression have not been able to implement research strategies that have been demonstrated to be effective.

Adherence with psychotropic medication is at least at poor as adherence with medication for physical health problems. There has been an assumption this was due to loss of insight resulting from psychiatric disorders themselves. Consequently, interventions have focussed on treating the underlying psychiatric disorder and generating psychological strategies to promote awareness. Recent surveys of patient preferences for information and involvement in health care decisions highlight that most individuals want to participate in the process of medical care. Patients often have strong pre-existing beliefs about different therapeutic options. This is supported by the self-determination theory which distinguishes between autonomous behaviour and behaviours that are influenced by external forces. When considering the patient perspective in medication adherence, it is useful to consider the self-medication hypothesis. This can equally be applied to prescribed and non-prescribed drugs. The self-medication hypothesis states that patients decide to start, adjust or stop prescribed medication according to perceived health needs. Such decisions are often conducted intentionally and rationally, given the information available to the patient and their understanding of their condition. In this narrative review, the evidence for and against intentionality in psychotropic adherence behaviour is examined. Studies of compliance and related predictors are examined in depression, schizophrenia and bipolar affective disorder. Results suggest that although concordance depends on patient, illness and clinician factors, patient choice is usually the final common pathway. Illness severity and insight is important in some cases but can act in concert with cognitive factors. Individuals appear to prefer to take medication "as required" (symptomatically) rather than prophylactically. Significant influences upon self-medication habits are prior health beliefs, medication attitudes, adverse effects and adequacy of communication from the health care professional. The self-medication hypothesis applied to prescribed psychotropic medication should assist rather than heed clinicians in improving adherence by taking a patient centred approach and where possible promoting patient autonomy.

Community surveys have found that some people believe that it is better to deal with depression alone rather than seek help. However, there has been little research into the characteristics of this group.

Data were drawn from three Australian surveys: (1) a national survey of 1001 adults aged 18+ years; (2) a school survey of 552 students aged 14-16 years from two regions; (3) a survey of 577 young people aged 12-17 years from the Melbourne region. In all three surveys, participants who believed it would be helpful to deal with depression alone were contrasted with those who believed it would be harmful in terms of sociodemographic characteristics, recognition of depression in a vignette, contact with people who experienced depression, beliefs about treatments, beliefs about using substances, beliefs about long-term outcomes, and beliefs about causes.

In both adolescents and adults, belief in dealing with depression alone was associated with male gender, less favourable views about mental health professionals, more favourable views about using substances to deal with depression, and a more positive expectation about the outcome if treatment is not sought. Adolescents believing in dealing with depression alone had more favourable views about some potential helpers, such as church workers and pharmacists. In adults, but not adolescents, there was an association with the belief that depression is caused by personal weakness.

The surveys did not directly ask about reasons for believing that dealing with depression alone would be helpful and did not assess actual help-seeking.

Factors encouraging dealing with depression alone are a belief that it is a self-limiting disorder, that substances are an effective way to deal with it and, in adults, that depression is due to personal weakness. Consistent with previous research, males are an important target group for encouraging seeking help to deal with depression.