Development and pilot testing of an online training program for better use of internet to learn about depression and anxiety (BUILDA).

BACKGROUND: Depression and anxiety are common issues among college students in the United States. Although college students routinely use the Internet for information regarding their mental health, they might lack the digital health literacy required to search, evaluate, and use Internet resources. MATERIALS AND METHODS: A web-based short training program with four modules aimed to improve mental health literacy and digital health literacy for Better Use of Internet to Learn about Depression and Anxiety (BUILDA). BUILDA was tested in a pilot study with 10 undergraduate students who completed the program and provided feedback via online surveys and exit interviews. Participants completed a pretest and a post-test, which included health literacy instruments and realistic case scenarios to assess student knowledge and ability to search and use Internet information on mental health topics. Descriptive analyses and paired t-tests were used. RESULTS: Increased knowledge about mental health topics was observed in pilot participants, with improvement in mean values of depression literacy (P =. 01) and anxiety literacy (P =. 019) from pretest to post-test. Better Internet search performance was also observed as the number of participants who scored >90% in case scenarios increased from two pretest to five post-test. Students used more valid and reliable Internet resources after training, citing more government health agency websites (20% in the pretest and 25% in the post-test) and scholarly resources (6% in the pretest and 30% in the post-test). The pilot participants reported the BUILDA program was useful and provided minor suggestions regarding program improvement. CONCLUSIONS: It was feasible to deliver a short training program via a simple website to help students develop mental health literacy and digital health skills.

Psychosocial risk factors associated with social anxiety, depressive and disordered eating symptoms during COVID-19.

The coronavirus (COVID-19) pandemic has disrupted society and negatively impacted mental health. Various psychosocial risk factors have been exacerbated during the pandemic, leading to the worsening of psychological distress. Specifically, a need for structure, loneliness, concerns about body image and social media use are risk factors previously implicated in poor mental health. The current study examines how these risk factors are associated with mental health outcomes (i.e., social anxiety, depressive and disordered eating symptoms) during the COVID-19 pandemic (January-March 2021). A total of 239 participants were recruited (average age = 24.74, 79% female, 68% White). The results revealed that a need for structure, loneliness and social media use were positively associated with social anxiety. In addition, loneliness, negative concerns about body image and social media use were significantly related to disordered eating and depressive symptoms. Lastly, when examined all together, the overall model for risk factors predicting mental health outcomes was significant: Wilks' Λ = 0.464, F(12, 608.814) = 17.081, p < 0.001. Loneliness and social media use were consistently associated with all psychological symptoms. These results emphasize the need for interventions for social anxiety, depressive and disordered eating symptoms that encourage structured daily activities, social connection, positive perception of oneself and mindful social media use.

University Students' Ability to Assess Misinformation About COVID-19.

In a university student survey on COVID-19 information assessment, 66% participants identified the falsehood of all misinformation statements and 66% provided web page URLs that are adequate in supporting statement accuracy assessment. The most cited web resources were government websites (43%) and media reports (30%). Those who identified misinformation falsehood were more likely to have higher GPA and liberal-leaning political views, and to implement evidence-based COVID prevention measures including mask-wearing and not self-medicating on (hydroxy-)chloroquine.

Effective use of online COVID-19 information and eHealth information literacy among US university students.

Objective: This study aimed to understand students' ability to search the Internet for COVID-19 information and apply it to evaluate the veracity of specific statements. Participants: Undergraduate students (N = 239) at a US university completed a Web-based questionnaire in September-October 2020. Methods: The questionnaire included self-reported measures of online health information literacy, COVID-19 knowledge, and anxiety along with exercises on searching and evaluating COVID information online. Results: Students reported moderate levels of information literacy (76%, 3.8 out of 5), but did not perform as well while searching the Internet for COVID-19 information (average accuracy: 65%, 10.5 out of 16 points). Students with higher Internet exercise scores reported higher GPA, higher household income, and liberal political views, and were more likely to follow public health measures [ie, social distancing, mask wearing, and not self-medicating with (hydroxy)chloroquine]. Conclusions: University students may overestimate their information literacy while struggling with searching the Internet for accurate COVID-19 information.

Minority status, depression and suicidality among counseling center clients.

Objective This study examined race/ethnicity, gender, sexual orientation, and financial stress and their association with depression and suicidality among university counseling center clients. Methods: The sample included 3,189 participants who received services at a university counseling center. Results: Asian American college students reported more depressive symptoms than European American and Hispanic students and were more likely to have a depression diagnosis than European American and African American students. Female and lesbian/gay/bisexual/questioning (LGBQ) individuals had higher depressive symptom scores, were more likely to have a depression diagnosis, and history of suicidal ideation and attempts than male and heterosexual individuals, respectively. Students with high financial stress reported higher depression scores and were more likely to have experienced past and current suicidality. More minority statuses were associated with higher risk for depression and suicidality. Conclusions: Counseling center clients who identified with one or more minority groups had higher risk for depression and suicidality.

Effective use of online depression information and associated literacies among US college students.

Mental health issues, such as depression, are rising among young people, who may benefit from online depression-related information. However, the competencies required to search for health information on the Internet and evaluate it before use may be poor among this population. This research aimed to investigate how college students use the Internet for solving problems in realistic case scenarios relevant to depression and to understand whether various literature-indicated literacies and factors may predict effective utilization of relevant online resources. We designed a web-based questionnaire survey including four depression-related case scenarios. A total of 218 undergraduate students who were enrolled in a Northeastern public US university were invited to participate in the survey in 2016, with 192 completed responses being included in this analysis (response rate = 88%; the participants' median age = 20; 79% female). Approximately half of the participants (47%) answered the depression-related questions in the case scenarios with 90% or higher accuracy. In a multiple linear regression model, prior depression knowledge and eHealth information literacy significantly predicted the effective use of online depression information. However, medical literacy and critical health literacy were not significant predictors. A few additional demographic and experience related factors were positively associated with the effective Internet use (e.g. female, non-Hispanic, psychology or health science major and prior experience with depression). These findings identify a need for college students to develop domain-specific knowledge and literacies in order to facilitate effective use of online information about depression.

Are "Superwomen" without social support at risk for postpartum depression and anxiety?

Postpartum depression and anxiety are common among women. Previous research has found perfectionism and the lack of social support to be associated with psychological distress. This study examined (1) social support as a protective factor against postpartum depressive and anxiety symptoms and perfectionism as a risk factor; (2) associations between different types of social support and postpartum depressive and anxiety symptoms; and (3) social support as a moderator between the relationship of perfectionism and postpartum depressive and anxiety symptoms. A total of 596 postpartum participants were included. Participants completed measures on postpartum depression, anxiety, social support, and perfectionism. Multivariate regressions revealed perfectionism was not significantly associated with depressive symptoms but predicted anxiety symptoms. Social support was a significant protective factor against depressive and anxiety symptoms. All support subscales were significantly associated with depressive and anxiety symptoms, with support from friends having the largest effect size (partial η2  = .061). High levels of support significantly moderated the relationship between perfectionism and depressive symptoms, ß = .003, 95% CI [.0006, .005], t (592) = 2.53, p = .012, and average and high levels of support significantly moderated the relationship between perfectionism and anxiety symptoms, ß = .0023, 95% CI [.0002, .004], t (592) = 2.13, p = .03. These results emphasize the importance of social support for postpartum women's mental health, especially for "Superwomen" with perfectionistic tendencies. Implications for healthcare and policies are discussed.

Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients.

INTRODUCTION: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. METHODS: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, -0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. CONCLUSIONS: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.

Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients / Confiabilidade e validade da versão persa do Patient Health Questionnaire-9 (PHQ-9) em pacientes psiquiátricos ambulatoriais iranianos

Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.

Resumo Introdução: O Patient Health Questionnaire-9 (PHQ-9) é uma ferramenta breve de triagem e diagnóstico para depressão. Tem sido usado em pesquisa e na prática clínica primária e em outros contextos clínicos e não clínicos. O PHQ-9 não teve sua validade examinada em contextos psiquiátricos e psicológicos no Irã. Métodos: Um estudo transversal foi conduzido para investigar a validação da versão persa do PHQ-9. Uma amostra de conveniência de 130 pacientes psiquiátricos ambulatoriais iranianos foi selecionada em clínicas psiquiátricas e psicológicas. Os pacientes completaram o PHQ-9, Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5) e a forma abreviada do Beck Depression Inventory-13 (BDI-13). Os dados foram analisados por estatística descritiva, α de Cronbach, coeficiente de correlação de Pearson, análise de componentes principais e análise fatorial exploratória e confirmatória. Resultados: O escore médio do PHQ-9 foi 12,83 (desvio padrão=6,25), indicando depressão moderadamente severa na amostra. O α de Cronbach para PHQ-9 foi 0,88, e a confiabilidade teste-reteste de uma semana 0,79. O PHQ-9 apresentou correlação de 0,64 com PHQ-15, −0,35 com WHO-5 e 0,70 com BDI-13, indicando boa validade do construto e dos critérios relacionados. Os resultados da análise fatorial dos itens do PHQ-9 identificaram, e a análise fatorial confirmatória confirmou, um único fator, chamado depressão geral. Conclusões: O PHQ-9 parece ter uma estrutura unidimensional, validade e confiabilidade adequadas, e pode ser útil em contextos epidemiológicos e de pesquisa. Com base na literatura prévia e neste estudo, o PHQ-9 pode ter aplicabilidade em outros contextos na população estudada, mas isso precisa ser confirmado.

Stigma, mental health, and counseling service use: A person-centered approach to mental health stigma profiles.

The current study examined reports of stigma toward mental health services, depressive symptoms, flourishing, and mental health service use among a sample of 8,285 college students across the United States who completed the Healthy Minds Study. The study aimed to: (a) identify profiles of public and personal stigma against mental health service utilization, and (b) examine the demographic predictors of stigma group membership and mental health service utilization. Latent profile analyses revealed 3 distinct groups based on public and self-stigma (i.e., "High Self, High Public Stigma," "Average Self, High Public Stigma," and "Low Self, Low Public Stigma"). Subsequent analyses examined demographic characteristics and mental health across the 3 groups. Results indicated significant differences in age, gender, race/ethnicity, mental health, and mental health service use across the 3 groups. Results further showed that students with high perceived need for mental health services, identifying as male or Asian, and belonging to the "High Self, High Public Stigma" group had lower likelihood of seeking mental health services in the past year. Implications for future research and clinical practice are discussed. (PsycINFO Database Record

Competencies for Effective Use of Online Depression Information Among College Students.

Mental health issues such as depression are rising among young people, who may benefit from online depression related information. However, the competencies required to search for and evaluate health information on the Internet were reported as poor among this population. We designed a web-based questionnaire survey including four case scenarios to understand how college students use online depression information, and what competencies or factors may facilitate effective use of the online resources.

Psychometric Properties of the Persian Version of the Short Beck Depression Inventory with Iranian Psychiatric Outpatients.

The short form of the Beck Depression Inventory (BDI-13) is useful for the screening and assessment of depression in clinical and research settings. The aim of the present study was to investigate the psychometric properties of the Persian (Farsi) version of BDI-13 in an Iranian clinical sample. The sample consisted of 52 Iranian psychiatric outpatients who received services at psychiatric and psychological clinics at the School of Behavioral Sciences & Mental Health-Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS) in Tehran, Iran. The study examined the reliability, construct validity, and factor structure of the instrument. The instrument indicated good reliability with Cronbach's alpha of .85 and strong construct validity based on moderate to strong positive correlations with other measures of mental health issues. Using a Principal Component Analysis and Varimax Rotation with Kaiser Normalization, three factors were identified and labeled Affective (F1), Somatic/Vegetative (F2), and Cognitive/Loss of Functioning (F3). The current factor structure suggests that depression is a multidimensional construct in an Iranian clinical sample. This study provides further evidence that the Persian version of the BDI-13 is a psychometrically sound instrument that can be used for clinical and research purposes in Iran.

A critical review of culturally sensitive treatments for depression: recommendations for intervention and research.

Recent meta-analyses and reviews have showed that culturally adapted mental health interventions are more effective for racial and ethnic minorities than traditional unadapted psychotherapy. Despite the advances in providing culturally sensitive mental health services, disparities among racial and ethnic minorities still exist. As a body of literature on culturally sensitive treatments accumulates, there is a need to examine what makes a treatment for specific presenting problems culturally sensitive. This article presents a critical review of existing culturally sensitive treatments for depression because it is one of the most common and debilitating mental disorders. In particular, we examined what treatment modalities were used, what types of adaptations were implemented, and what populations were targeted. The conceptual framework this review uses to categorize existing culturally sensitive treatments includes a top-down, a bottom-up, or an integrative approach. The review reveals that the majority of culturally sensitive treatments for depression employed an evidence-based bottom-up approach, which involved general and practical adaptations, such as translating materials or infusing specific cultural values. Most studies used cognitive-behavioral strategies and included Latinos and African Americans. Recommendations and future directions in interventions and research are discussed to decrease mental health care disparities among ethnic minorities.

Disentangling immigrant status in mental health: psychological protective and risk factors among Latino and Asian American immigrants.

This study aimed to disentangle the psychological mechanisms underlying immigrant status by testing a model of psychological protective and risk factors to predict the mental health prevalence rates among Latino and Asian American immigrants based on secondary analysis of the National Latino and Asian American Study. The first research question examined differences on the set of protective and risk factors between immigrants and their U.S.-born counterparts and found that immigrants reported higher levels of ethnic identity, family cohesion, native language proficiency, and limited English proficiency than their U.S.-born counterparts. The second research question examined the effect of the protective and risk factors on prevalence rates of depressive, anxiety, and substance-related disorders and found that social networking served as a protective factor. Discrimination, acculturative stress, and family conflict were risk factors on the mental health for both ethnic groups. Clinical implications and directions for future research are provided.

Barriers and facilitators of treatment for depression in a latino community: a focus group study.

We conducted focus groups with Latinos enrolled in a Medicaid health plan in order to ask about the barriers to and facilitators of depression treatment in general as well as barriers to participation in depression telephone care management. Telephone care management has been designed for and tested in primary care settings as a way of assisting physicians with caring for their depressed patients. It consists of regular brief contacts between the care manager and the patient; the care manager educates, tracks, and monitors patients with depression, coordinates care between the patient and primary care physician, and may provide short-term psychotherapy. We conducted qualitative analyses of four focus groups (n = 30 participants) composed of Latinos who endorsed having been depressed themselves or having had a close friend or family member with depression, stress, nervios, or worries. Within the area of barriers and facilitators of receiving care for depression, we identified the following themes: vulnerability, social connection and engagement, language, culture, insurance/money, stigma, disengagement, information, and family. Participants discussed attitudes toward: importance of seeking help for depression, specific types of treatments, healthcare providers, continuity and coordination of care, and phone calls. Improved understanding of barriers and facilitators of depression treatment in general and depression care management in particular for Latinos enrolled in Medicaid should lead to interventions better able to meet the needs of this particular group.

Depression among Asian Americans: Review and Recommendations.

This article presents a review of the prevalence and manifestation of depression among Asian Americans and discusses some of the existing issues in the assessment and diagnosis of depression among Asian Americans. The authors point out the diversity and increasing numbers of Asian Americans and the need to provide better mental health services for this population. While the prevalence of depression among Asian Americans is lower than that among other ethnic/racial groups, Asian Americans receive treatment for depression less often and its quality is less adequate. In addition, the previous belief that Asians somatize depression may become obsolete as more evidence appears to support that Westerners may "psychologize" depression. The cultural validity of the current DSM-IV conceptualization of depression is questioned. In the course of the review, the theme of complexity emerges: the heterogeneity of ethnic Asian American groups, the multidimensionality of depression, and the intersectionality of multiple factors among depressed Asian Americans.

Cross-cultural barriers to mental health services in the United States.

Getting treatment for a mental illness can be difficult for any American-and more than half of all adults in the country will experience a mental illness during their lives. But for members of ethnic and racial minority groups, the road to treatment is often blocked by cultural views of mental illness and therapy, lack of insurance and access to appropriate care, and a critical deficiency of studies pertaining to nonwhite populations. Significant, national changes to the mental health field must be made in order for proper care to be widely available and accepted.

Measuring homework completion in behavioral activation.

The aim of this study was to develop and validate an observer-based coding system for the characterization and completion of homework assignments during Behavioral Activation (BA). Existing measures of homework completion are generally unsophisticated, and there is no current measure of homework completion designed to capture the particularities of BA. The tested scale sought to capture the type of assignment, realm of functioning targeted, extent of completion, and assignment difficulty. Homework assignments were drawn from 12 (mean age = 48, 83% female) clients in two trials of a 10-session BA manual targeting treatment-resistant depression in primary care. The two coders demonstrated acceptable or better reliability on most codes, and unreliable codes were dropped from the proposed scale. In addition, correlations between homework completion and outcome were strong, providing some support for construct validity. Ultimately, this line of research aims to develop a user-friendly, reliable measure of BA homework completion that can be completed by a therapist during session.

Open trial of Vinyasa yoga for persistently depressed individuals: evidence of feasibility and acceptability.

The aim of this study was to assess the acceptability and feasibility of Vinyasa yoga as an adjunctive treatment for depressed patients who were not responding adequately to antidepressant medication. The authors also planned to ask participants for qualitative feedback on their experience of the class and to assess change over time in depression and in possible mediating variables. The authors recruited 11 participants in 1 month for an 8-week open trial of yoga classes. They found that 10 participants completed follow-up assessments, 9 of 10 were positive about their experience, and all provided feedback about what was and was not helpful about yoga, as well as barriers to class attendance. Over the 2-month period, participants exhibited significant decreases in depression symptoms and significant increases in an aspect of mindfulness and in behavior activation. This pilot study provided support for continuing to investigate Vinyasa yoga as an adjunct treatment for depression. The next step required is a rigorous randomized clinical trial.