Multifactorial explanatory model of depression in patients with rheumatoid arthritis: a structural equation approach.

OBJECTIVES: Depressive symptoms are common among patients with rheumatoid arthritis (RA). This study was aimed at developing a multifactorial explanatory model that evaluated the influence of personality traits, disease activity, perceived disease impact, and comorbidities. METHODS: This cross-sectional study used structural equation modelling estimation to analyse the associations between these dimensions, pursuing three hypotheses. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale, disease impact by the Rheumatoid Arthritis Impact of Disease score, personality by the Ten Item Personality Inventory and the disease activity through the Disease Activity Score 28 joints. The influence of comorbidities was investigated by multigroup analysis. RESULTS: The final model derived from data of 254 patients presented a good fit. Disease activity had an indirect relation with depressive symptoms mediated by disease impact (ß=0.17, p<0.001), but the direct relationship between disease activity and depressive symptoms was not significant (ß=0.09; p=0.07). "Positive" personality had a strong negative direct relation with depressive symptoms as well as an indirect relationship mediated by disease impact (total effect ß=-0.61, p<0.001). The final proposed model explained 58% of the variance of depressive symptoms. Multigroup analysis showed an invariant model when comparing patients with and without comorbidities (dχ2=9.03; df=12; p=0.70). CONCLUSIONS: Personality characteristics seem to have a major influence upon the impact of disease and the patient's adjustment to RA, including the vulnerability or resilience to depression. Individual personality traits deserve attention in tailored assessment and treatment of patients with RA, in order to optimise outcomes.

Mental health literacy about depression: a survey of portuguese youth.

BACKGROUND: Depression is a common disorder in adolescents and young adults, but help seeking is low. Mental health literacy about depression is a key concept to plan interventions for improving help seeking. This study aimed to evaluate youth mental literacy about depression in order to design school-based interventions. METHODS: During 2012, a survey was conducted with a stratified cluster sample of 4938 Portuguese young people between 14 and 24 years of age. Following the presentation of a vignette describing depression, a series of questions was asked concerning: recognition of the disorder; knowledge of professional help and treatments available; knowledge of effective self-help strategies; knowledge and skills to give first aid and support to others; and knowledge of how to prevent this disorder. RESULTS: In response to an open-ended question, around a quarter of the participants failed to recognize depression in the vignette. When asked about the potential helpfulness of various people, most of the participants considered mental health professionals, family and friends to be helpful. However, teachers, social workers and a helpline were less likely to be considered as helpful. With regard to medications, vitamins received more positive views than psychotropics. Some interventions were frequently rated as likely to be helpful, whereas for others there was a lack of knowledge about their effectiveness. A positive finding is that alcohol and tobacco consumption were seen as harmful. When asked about mental health first aid strategies, participants supported the value of listening to the person in the vignette and advising professional help, but some unhelpful strategies were commonly endorsed as well. CONCLUSION: Deficits were found in some aspects of depression literacy in Portuguese youth. Therefore intervention in this area is needed.