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DEPRESSION: EXPERIENCES, PERCEPTIONS, AND ATTITUDES BY KRISZTINA SCHLESSEL A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Dr. Heidi Harley Sarasota, Florida Fall, 2008
Table of Contents Acknowledgments ----------------------------------------------------------------------------i Abstract --------------------------------------------------------------------------------------ii Introduction to Depression and the current study ---------------------------------------1 Sleep Abnormalities -----------------------------------------------------------------3 Perfectionism and Silencing the Self -------------------------------------------4 Cognitive Functioning ---------------------------------------------------------------7 Suicide -----------------------------------------------------------------------------11 Perceptions of Depression, Help-See king Behavior, and the Roles of Gender and Race --------------------------------------------------------14 Perceptions of and Familiarity With Depression -------------------------------18 Attitudes Toward Depression, Race, and Lay Beliefs ------------------------21 Attitudes Toward and Familiarity With Depression ----------------------------23 The Current Study -----------------------------------------------------------------25 Method ---------------------------------------------------------------------------------------28 Participants--------------------------------------------------------------------------28 Material -----------------------------------------------------------------------------28 Procedures --------------------------------------------------------------------------31 Results --------------------------------------------------------------------------------------32 Discussion -----------------------------------------------------------------------------------35 Appendix A: Figures and Regre ssion Matrix -------------------------------------------40 Appendix B: The Survey -----------------------------------------------------------------46 References ----------------------------------------------------------------------------------67
i Acknowledgments I would like to thank my thesis sponsor and academic advisor, Dr. Harley, for all of her help and advice. I also want to thank Dr. Bauer and Dr. Cooper for their help with the statistical analyses, and Dr. Barton for he r time. I am also thankful to my boyfriend, John Emanuello, who encouraged me every step of the way. Last but not least, this thesis would not have been possible if it were not for my family, who gave me the opportunity to study in the United States.
ii DEPRESSION: EXPERIENCES, PERCEPTIONS, AND ATTITUDES Krisztina Schlessel New College of Florida, 2008 ABSTRACT The current study investigated the relati onship between people s experiences with depression and their perceptions of and att itudes toward depression. There were four levels of experience: current depression, past depression, knowing a depressed individual, and no experience with depression. The fina l sample consisted of 75 participants. Regression analyses revealed that, overall, experiences were not re lated to perceptions and attitudes; similarly, perceptions and att itudes were not correlated. However, there were several significant findings: (1) Participants were able to recognize their symptoms of depression and were willing to acknow ledge them; (2) Current experience with depression predicted a significantly bette r understanding of depression; (3) Better understanding of depression was associated with an increased willingness to label a depressed individual as mentally ill; (4) Male participants were less likely to desire social distance from a depressed indi vidual; and (5) Participants who were seeking counseling for depression at the time of the study desi red less social distance from a depressed person and were less likely to think that a depressed individual would do something dangerous. Thus, at least at some level, e xperience with depre ssion plays a role in peoples perceptions of and attitudes toward depression. ______________________________ Dr. Heidi Harley
1 Depression: Experiences, perceptions, and attitudes Depression is a sensitive topic to many, but because its prevalence is very high and its consequences are also alarming, it is im portant that people talk about it. Indeed, 58% of the US adult population experiences ma jor depression in any given year, which is equivalent to about 15 million people. While de pression is prevalent in people of all ages, races, ethnicities, and both se xes, these factors may affect how the symptoms manifest themselves and how they are perceived (National Alliance on Mental Health). The first step toward awareness is familiarity with the general characteristics of depression. Major depression, also known as clinical or unipolar depression, is a persistent illness that involves two or more major depressive episodes. A major depressive episode lasts for at least two week s and is characterized by symptoms such as sad and irritable mood; lack of pleasure from and interest in previously enjoyable activities; changes in appeti te, sleep, and energy; difficulty concentrating, thinking, and remembering; feelings of worthlessness or excessive guilt; and recurring thoughts of death and suicide (DSM-IV-TR). Such sympto ms can and do significantly interfere with ones everyday functioning and seeking professi onal help is crucial. In fact, if left untreated, symptoms may appear more freque ntly and become more severe (National Alliance on Mental Health). Clinical depression is not a sign of pe rsonal weakness; rather, it is a medical condition that can be caused by biological, environmental, a nd psychological factors. The good news is that clinical depr ession can be successfully treat ed in 80-90% of the cases. There are a number of methods that are used to treat depression; th e three main methods
2 are medication, psychotherapy, and electroconvul sive therapy. Sadly, though, only about one-third of depressed individua ls seek treatment (National Alliance on Mental Illness). Clearly, it is important for people who suffe r from depression to seek help in order to reduce the risk of suicide and to improve the quality of their lives. In fact, getting professional help is likely to make a world of difference. The right medication can treat the symptoms to a great extent and, th rough psychotherapy, depre ssed individuals and their loved ones can learn about the illness and the techniques that can be used to cope with the symptoms when present. However, there is a large problem that hinders, or even prevents improvement. It is reluctance to s eek help due to the perceptions that people have regarding depression (Anglin, Link, & Phelan, 2006; Kenderick, Anderson, & Moore, 2007; Kuehn, 2006). Subsequently, the pur pose of the current paper is threefold: (1) to gain insight into the reasons why depr essed individuals need to seek help, (2) to understand what may contribute to peoples reluctance to seek help, and (3) to investigate whether experience with depression plays a role in people percepti ons of and attitudes toward depression. Thus, this paper includes two main parts. First, some of the most relevant literature on depression is discus sed. After careful consideration of the literature, it will become even more apparent that a major obstacle to overcoming depression lies in peoples perceptions. This gives rise to the s econd part of the paper, which describes a research study that looked at the relationship among people s perceptions of depression, their attitudes toward depressed people, a nd their own experiences with depression. Finally, the findings are discussed and th e recommendations are made about the directions future research could take.
3 Sleep Abnormalities As mentioned earlier, changes in slee p patterns commonly accompany clinical depression. While some people who are affected by the illness sleep excessively, others find it extremely hard to fall asleep. Accord ing to Ohayon (2007), insomnia is reported by as many as 60% of the people who suffer fr om depression, and more frequently by women than men. In fact, insomnia is often the reason why people seek professional help, and it is not only frequently recognized as a residual symptom, but also as an early indicator of relapse. Based on these findings Ohayon concluded that it is clear that insomnia and depression are correlated. This as sociation has led researchers to investigate whether depression precedes or is preceded by insomnia; in most cases insomnia occurs first. In their literature review on insomnia, Br unello et al. (2000) wr ote that, according to epidemiological studies, 19-46% of th e population report sleeping difficulties. The insomnia is often accompanied by problems with concentration and memory, difficulties in carrying out everyday tasks, health problem s, accidents, and psychiatric illnesses. In fact, according to a national study, 51% of people who reported insomnia met the diagnostic criteria for a mental disorder. Wome n are at a greater risk for insomnia than men, and the risk increases with age. Persistent sleep disturbances are strongly associated with depression, a relapse into depression, and an increased risk of suicide. There are a number of sleep abnormality features that ar e present in cases of depression: difficulty falling asleep, difficulty maintaining sleep, di fficulty falling back asleep, reduced sleep efficiency, reduced sleep time, increased light sleep, decreased deep sleep, short latency to first REM sleep, longer firs t REM sleep, increased total RE M sleep, higher density of rapid eye movement during REM sleep, and greatly altered patterns of nocturnal
4 hormone secretion. The occurrence of these pr oblems may give some insight into the treatment options and their efficiency. Fi nally, Brunello et al. noted that most antidepressants repress REM sleep and RE M sleep deprivation may be related to decreased symptom severity. Ohayon (2007) reported the same features of sleep abnormalities as Brunello et al. and also noted that there are a number of pharmacological and non-pharmacological treatments available for depression. Oddly, among the non-pharmacological treatments for depression, the most efficient one seems to be sleep deprivation. Indeed, improvement in depressive symptoms is seen after only one night of sleep deprivation in 50-60% of the cases, which makes it the fastest acting treatment. Both total and partial sleep deprivation seem to be equally effective. However, in order to experience la sting effects, sleep deprivation is necessary up to three times a week, and the positive effects are reduced by naps and micro sleep and disappear after one night of recovery sleep. Perfectionism and Silencing the Self Besides insomnia, depression is also corre lated with perfectionism and silencing the self (Flett, Besser, Hewitt, & Davis, 2007). People engage in silencing of the self when they do not express their feelings in order to maintain relationships and obtain approval from others. In one study, 202 th ird-year undergraduate students (102 women, 100 men) completed the Multidimensional Perfectionism Scale (MPS), the Silencing The Self Scale (STSS), and the Center For Epidemiological Studies Depression (CES-D) The MPS is a 45-item measure that assesses self-oriented perfectionism (exceeding high personal standards), other-oriented perfectionism (demanding perfectionism from others), and socially prescrib ed perfectionism (pressure to be perfect imposed on the
5 self). The STSS is a 31-item scale that has four factors: silencing the self (e.g., I dont speak my feelings in an intimate re lationship when I know they will cause disagreement), externalizing self-perceptions (e.g., I te nd to judge myself by how I think other people see me), care as self-s acrifice (e.g., Caring means putting the other persons needs in front of my own), a nd divided self (e.g., Often I look happy enough on the outside, but inwardly I feel anxious and rebellious). Finally, the 20-item CES-D assesses symptoms of depression. The only significant gender difference was on the externalized self-perception s ubscale of the STSS, with men scoring higher than women. Significant positive correlations were found be tween the self-oriented perfectionism subscale of the MPS and the self-silencing subscale of the STSS. Further significant positive associations were discovered between socially prescribed perfectionism and the total STSS score, as well as between socia lly prescribed perfectionism and each of the four STSS subscales. Moreover, scores on th e depression measure we re significantly and positively correlated with socially prescribed perfectionism, with overall silencing of the self, and with each of the STSS subscales. The analysis also revealed that the combination of socially prescribed perfectio nism, high scores on the externalized selfperception subscale, and high overall silenc ing of the self predicted more intense depression. Therefore, it appears that self-ori ented and socially prescribed perfectionism, silencing the self, and de pression are interrelated. Similarly to Ohayon (2007) and Flett, et al. (2007), ArpinCribbie and Cribbie (2007) looked at fatigue, depression, and pe rfectionism, but they included automatic negative thoughts as an additi onal variable. They found significant positive correlations between fatigue and each of the other three variables, as well as significant correlations
6 among those three variables. Three hundred and seven undergraduate students (187 women, 120 men) participated in the study, most of whom were first-year students. Participants completed five measures: the Automatic Thoughts Questionnaire (ATQ) the Dysfunctional Att itude Scale (DAS) the Multidimensional Perfectionism Scale (MPS) the Profile of Fatigue-Related Symptom Scale (PFRS) and the Center for Epidemiologic Studies-Depressed Mood Scale (CES-D) The 30-item ATQ assesses four components of negative automatic thoughts: pe rsonal maladjustment and desire for change, negative self-concepts and negative expectations, lo w self-esteem, and helplessness/giving-up. The DAS, a 40-item questionnaire, measures cognitive distortions by assessing social approval and perfectionism, and the 45-item MPS assesses self-oriented perfectionism, other-oriented perfectionism, and socially prescribed pe rfectionism. The PFRS is a 54item scale that measures four major factor s of fatigue: emotional distress, cognitive difficulty, fatigue, and somatic symptoms. The fifth measure, the CES-D, is a 20-item questionnaire that assesses depressive symptomatology. No significant age effects were found for any of the variables. However, the following gender differences were found: Compared to men, women sc ored significantly higher on the fatigue and emotional distress subscales of the PFRS, whereas men scored significantly higher than women on the perfectionism subscale of the DAS. Signi ficant correlations also existed among depression, perfectionism, and automatic negati ve thoughts, and fatigue was significantly related to each of these variables. Specif ically, higher scores on depression were significantly correlated with higher scores on each of the four aspects of PFRS. Significant positive correlations were also found between automatic negative thoughts and each aspect of the PFRS. Finally, perf ectionism was significantly related to the
7 emotional distress and cognitive difficulty subscales of the PFRS, but not to the fatigue and somatic symptoms subscales. In sum, depression, perfectionism, and automatic negative thoughts were significantly interrelated. All four factors of fatigue were significantly correlated with depression and with negative automatic thoughts, and two of the factors were significantly related to perfectionism. Cognitive Functioning Depression is also correlate d with irrationality (Macav ei, 2005). Fifty-one people participated in a study. The control group was comprised of 19 participants (6 women, 13 men) who were not diagnosed with any mental disorder. The clinically depressed group consisted of 17 participants (12 women, 5 men) who were diagnosed with major depressive disorder but had no suicidal ideations. Finally, 15 participants (12 women, 3 men) were in the dysphoric group that consis ted of people with elevated depressive symptoms, but who did not meet the di agnostic criteria for major depression. The Structured Clinical Interview for DSM-IV was used to determine diagnoses, the Attitudes and Beliefs Scale to measure irrational beliefs, and the Beck Depression Inventory to evaluate depressive symptoms. For irrational beliefs, significant differences were found between the major depression group and th e control group, as well as between the dysphoric group and the control group. Furt her significant differences were found between the major depression group and the dysphoric group. Irrational beliefs characterized both depressive groups, but more so for the clinical major depression group that the dysphoric, or subclinical, group. Similarly to Macavei (2005), who studie d the relationship between depression and irrational thinking, Reppermund et al. (2007) investigated cognitive functioning in
8 depressed individuals. The pa rticipants were 75 people ( 37 women, 38 men) who were admitted to an inpatient unit in Germany. In or der to be included in the study, participants had to have had a single de pressive episode, recurrent de pression, or double depression (major depressive episode with dysthymia). Th ere was also a set of criteria that excluded those patients whose main diagnosis was a neurological or physical illness, e.g., those who were abusing substances at the time, etc. Of the 75 patients, 59 were on antidepressants at the initial assessment. The Hamilton Rating Scale for Depression (HAMD) was used to assess the course and severity of depression and the patients response to pharmacological treatment. The test indicated that the depression level of the participants was between moderate and seve re. The following neurological areas were assessed at admission and then at discharge: information processing speed, verbal shortterm memory using the digit span forward te st, verbal working me mory with the digit span backward test, divided attention, and selective visual attention. No significant differences were found between participants who were receiving medication at the time of the study and those who were not. Repperm und et al. found that the most profound impairments were found in divided attention and verbal working memory, which did not improve from the time of admission to di scharge. On the other hand, significant improvements were shown in selective attenti on, verbal short-term memory, and speed of information processing. Most importantly, de spite the decrease in the severity of depressive symptoms from the time of admissi on to discharge, and regardless of some of these improvements, many participants exhib ited impairments in all cognitive areas even at the time of discharge.
9 In a more recent study, Reppermund (2008) confirmed his previous finding that cognitive impairments remain even afte r the remission of depressive symptoms. Participants were 53 depresse d individuals (28 female, 25 male, mean age of 43.5) at an inpatient clinic in Germany. Participants eith er had their first episode of major depression or a recurrent episode at the time of assessm ent, and 50 of them were on antidepressant medication. Their symptoms ranged from m oderate to severe as indicated by the Hamilton Rating Scale For Depression. An additional 13 individuals without a history of Axis I disorders were selected to serve as the control group; thei r demographics were matched to those of the experimental group. Participants completed 25 cognitive tests at the initial assessment, and then again at discharge. The major areas that were assessed were information processing/attention (alertne ss, speed of information processing, selective visual attention, and divided attention), memory (verbal working memory and verbal short-term memory), and executive functioning (cognitive flexibility, working memory, and visual problem solving). The average length of hospitalization was 9.3 weeks, at the end of which time 43 particip ants were considered as remitted. Although significant improvements were found on 10 of the 25 cognitive tests, impairments were present at admission as well as at discharg e on every area tested. There were not any significant differences between participants who remitted and participants who did not. Twenty of the remitted participants were asse ssed again 6 months after discharge, and 13 of them remained remitted while 7 relapsed. The only difference between the latter two groups was that those who relapsed did much more poorly on the aler tness test at followup. Thus, it can be concluded once again that cognitive impairments do not diminish with
10 depressive symptomology and that cogn itive impairments are not contingent upon symptom severity. Cognitive impairments are also present in ca ses of bipolar disorder and, as is the case with major depression, the impairments tend to persist regardless of mood (Argen, & Backlund, 2007). Bipolar disorder is worth me ntioning because it is another depressive disorder that, in itself, is experienced by 3% of the US adult populat ion in any given year (National Alliance on Mental Il lness). Whereas women are twice as likely to experience major depression than men, men and women ar e equally likely to experience bipolar disorder. Bipolar disorder has two main s ubtypes: bipolar I and bipolar II. Bipolar I disorder is characterized by manic and hypo manic episodes, and is usually accompanied by depressed mood. Bipolar II disorder, on th e other hand, is always distinguished by depressed mood and hypomanic episodes, however, no manic episodes may occur. A manic episode entails elevated, expansive, or irritable mood, and a hypomanic episode is a less severe manic episode. Argen and Backlund (2007) reported that th e risk of having a depressive episode during a persons lifetime is 20-25% for wo men and 15-20% for men. They also noted that among a sample of 127,800 people, 3.7% were diagnosed with either bipolar I or bipolar II disorder. Those who suffer from bipol ar II disorder often receive the incorrect diagnosis of major depression, and almost 40% of the people who suffer from bipolar disorder are insufficiently treate d, or not treated at all. In the absence of treatment, the depressive episodes are likely to worsen. Bipolar disorder is often accompanied by Axis I and II disorders, such as anxiety disorders or substance use. The outcome of depression tends to be worse in bipolar cases than in unipolar cases. For example, cognitive
11 impairments are common, especially among people with bipolar II, and they are likely to persist even during elevated mood. Individuals who suffer from bipolar II disorder have a poorer quality of life than individuals with bipolar I disord er, and they also have the highest suicide rate of all peopl e with affective illnesses. Suicide Raja and Azzoni (2004) found that particip ants with bipolar disorder, as opposed to unipolar or other disorders, were more likely to be at risk for lethal suicidal attempts. They studied suicide attempts among 2395 people (1067 men, 1328 women) who were admitted to an intensive psychiatric care unit. Participants completed a long set of questionnaires that inquired about demogra phic information, psychiatric disorders, suicidal attempts, and family history. Among these participants, 80 had attempted suicide (28 men, 52 women). Twenty-two of these people were diagnosed with unipolar depression, 31 with bipolar depression, and 27 with other disorders. The most commonly reported suicide methods were poisoning, cu tting, hanging or strangulation, jumping, drowning, and electrocution. Furt hermore, 39 of the 80 partic ipants reported that their attempts were impulsive and 38 had disclosed their suicidal ideation to someone prior to the suicide attempt. In addition, during the interview 68.8% of the participants expressed relief to be alive, 61.3% reported they were surprised they were still alive, and 7.5% expressed joy to be alive. As for fee lings concerning the suicide attempts, 57.5% expressed guilt, 51.3% reported feelings of shame, and 50% were remorseful. Further analyses revealed that men were significantly more likely than women to be in the high lethal risk group, as were people with bipolar disorder. The suicidal attempts of men and women differed in three main aspects: women attempted suicide at an older age, men
12 were more likely to use more violent methods, and men were more likely to report joy during the interview. Depression affects people of all ages, races, and ethnicities, but suicidality (suicidal ideations and attempts) varies acr oss nations. Bernal et al. (2007) used the European Study on the Epidemiology of Mental Disorders survey to study suicidality in Spain, Belgium, France, Germany, Italy, and the Netherlands. There were a total of 21,425 respondents who were selected randomly and were interviewed in person in their homes. Statistical analyses included only the responses of those who had experienced a mental disorder during their lifetime, plus 25% of a random subsample of the respondents who had never suffered from a mental diso rder. The disorders under study were major depressive episodes, dysthymia, panic di sorder, agoraphobia, post-traumatic stress disorder, generalized anxiety disorder, sp ecific phobia, social phobia, and alcohol dependence. A total of 8796 respondents (48% male, 52% female) were included in the final analyses. The study revealed that the prevalence of suicidal ideation was 7.8%, and the prevalence of suicidal attempts was 1.3% in the current sample. This indicates that most people who had thought about committing suicide never actually carried it out. Suicidality during ones lifetime was more common in women, younger people, people living in urban areas, and divorced or widow ed persons. The lowest rate of suicidal ideations was found in Italy and Spain, and th e highest rate in Germany and France. The highest suicidal attempts rate was in Belgiu m and France. Mental illnesses were strongly associated with suicidality, and those sufferi ng from a major depressive episode were at the greatest risk. In fact, 28% of participants who suffe red from a major depressive episode reported a previous suicide attempt. The authors interpreted this latter finding to
13 imply that by preventing major depression, th e occurrence of suicid e attempts could be cut by almost one-third. Another study showed that the interaction between depressive symptoms and violent daydreaming predicts suicidality (Selby, Anestis, & Joiner, 2007). Participants were 83 undergraduate students who completed the Anger Rumination Scale (ARS), which consists of four subscales and a ssesses the tendency to think about anger provoking situations, to recall a nger, and to think about the causes and consequences of anger episodes. The participants depre ssive symptoms were assessed using the Beck Depression Inventory (BDI), and their suicidal ideations were measured by the Beck Scale for Suicidal Ideation (BSS). The four subscales of the ARS were significantly intercorrelated. The Thoughts of Revenge subscale, which emphasized violent daydreaming, predicted BSS scores, as did th e interaction between BDI and Thoughts of Revenge. None of the other two-way inter actions were significant. The researchers interpreted these results to indicate that the interaction between depressive symptoms and violent daydreaming predicts suicidality. They also noted that such daydreaming might serve as a way to increase positive affect by fa ntasizing about final re lease from pain and suffering. However, violent daydreaming may increase the likelihood of committing suicide. Fortunately, suicide prevention programs seem to help reduce suicide rates. One example of this is presented by Szanto, Kalmar, Hendin, Rihmer, and Mann (2007), who found that a five-year depression management training program for general practitioners (GPs) resulted in a decrease in suicide rates. The study was conducted in Hungary, the country with the highest suicide rate averaged over the past 100 years. The participants
14 were 28 of the 30 general practitioners of the region, each of whom treated about 2,100 local adults. The GPs nurses, 4 psychiatrists, and 1 psychologist also participated. The training was formatted as a dialectic lecture that included question and answer sessions and suicide case discussions. In addition, three times a year, for five years, the GPs were invited to a 1-hour lecture on suicide preven tion. Also, the GPs were encouraged to use the Beck Depression Inventory to aid in diagnosis, and th ey were provided with free telephone consultation services with the local psychiatrist who could authorize cheaper antidepressants for patients. During the five -year pre-intervention period, average suicide rates were similar in the intervention region and a cont rol region. During this same period, the average suicide rate was higher in the rural intervention region than in the town intervention region. After the interv ention period, the suicide rate in women decreased by 34% in the intervention re gion, while it increased by 90% in the local control region. The decrease in suicide rates was even greater in men and in rural areas in the intervention region. Appare ntly, the 5-year depression management training program for GPs resulted in a significant decrease in suicide rates among their patients. Perceptions of Depression, Help-Seeking Be havior, and the Roles of Gender and Race In a review, Kuehn (2006) noted that de pression is underdiagnosed in men, which is partly due to the fact that many men cons ider depression as a sign of weakness that is unmanly and a sign of craziness. Men who do not recognize depression as an illness tend to be reluctant to seek help. In addition to this perc eived stigma, men, especially older men, tend to exhibit symptoms less cons istent with the DSM-IV. For example, men are more likely to report irrita bility, stress, somatic complain ts, or cognitive dysfunctions
15 as opposed to sadness or depressed mood. These findings are of special concern because even though women are twice as likely to su ffer from depression, men are four times as likely to commit suicide. Kuehn concluded that because depression is treatable, campaigns, the media, and health care pr ofessionals should increase awareness of depression among men and decrease the stigma that is associated with it. Physicians could achieve some of this by recognizing the need to be more sensitive to the symptoms, avoid the use of labels, and involve family members in the treatment phase. Help-seeking behavior is also hamper ed among African American men. Even though African American men experience th e same symptoms of depression that Caucasian men do, they do not associate thes e symptoms with depression (Kenderick, Anderson, & Moore, 2007). The participan ts were 28 African American young men between the ages of 18 and 25, who were recruited from the same community. The majority of the participants was enrolled in college at the time of the study and came from well-to-do families. Information was collected via observation and informal group and individual interviews. The main finding was that participants used the word stress to describe depression, and they reported that they felt that the s ource of the stress was rooted in their identity as African Americ an men. All participan ts described feeling anger, agitation, hurt, decreased energy, redu ced motivation, as well as the other major symptoms of depression. These feelings were the result of constant aversive experiences with non-African Americans, especially the police, who apparently not only perceived them and treated them differently, but who also actively targeted them. Thus, African American young men viewed stress/depression as part of everyday life, something they were often unable to fight because of its cons tant occurrence. As a result, many turned to
16 substance abuse in order to temporarily relieve themselves of stress. Moreover, participants admitted that they were not alwa ys honest with their therapists about their symptoms. This, they said, was partly due to the common perception of depression as a weakness and also due to their own beliefs that the therapist was using them for research and was not genuinely interested in their problems. Findings such as these are important because they have the potential to help therapists make the correct diagnosis of depression and thus choose the proper treatm ent. This is especially vital given the increasing occurrence of suicide am ong young African American men. Similarly, Edwards, Tinning, Brown, Boardman, and Winman (2007) found that help-seeking behavior in de pressed people is contingent upon peoples perceptions of the illness. People have very different view s of anxiety and depression, and peoples perceptions of depression a nd anxiety and the likelihood of these people seek ing help are correlated. The researchers approached 160 pe ople over the age of 18 in public libraries in London. Participants completed demographi cs and treatment-seeking questionnaires, the Hospital Anxiety and Depression Scale (HADS) and a modified version of the Brief Illness Perception Questionnaire (BIPQ). Of these, 113 participan ts had experienced an emotional problem (54 women, 59 men) and only their results were included in the final analysis. Of the 113 participants, 55 had s ought treatment and 58 had not. Participants perceptions of depression and anxiety were measured using vignette methodology. Participants viewed two vignettes taken from the Short Explanatory Model Interview One of the vignettes depicted a character who suffered from anxiety, while the other depicted a person who suffered from de pression. Upon viewing the vignettes, the modified version of the BIPQ was used to measure peoples perceptions of the illness and
17 its cause. This was done through the assessm ent of participants perceptions of the difficulties that the depicted characte rs experienced on the following dimensions: consequences of difficulties (seriousness), timeline (duration), personal control, treatment control (possible effectiveness of trea tment), identity (how many symptoms are experienced), comprehension, and upset (emotional effect). In addition, a multiple-choice question investigated the perceived cause of depression. When participants who had sought help were compared to participants who had not, no significant sociodemographic differences were found, nor were there signif icant differences in their scores on the HADS. Compared to participants who had not sought help, participants who had sought help scored higher on the cons equences, upset, identity, a nd comprehension dimensions of the BIPQ, indicating that they had a be tter understanding of the problem and the consequences of not dealing with it. As for gender differences, women scored significantly higher on the cons equences and timeline dimensions than men; that is, women were more aware of the problem. No significant differences were found in the perceived causes of depression between treatment-seeking and non-treatment-seeking participants. However, compared to non-tr eatment-seeking participants, treatmentseeking participants were significantly more likely to report medical illness as the cause of anxiety. Finally, the scores for the timelin e, personal control, and treatment control dimensions were significantly higher for de pression than for anxiety, suggesting that participants viewed anxiety as an illness, although not a se rious one, that can be helped by treatment. On the other hand, they viewed depression as a seri ous chronic problem that is more likely to be under personal control a nd less likely to be helped by treatment.
18 Perceptions of and Familiarity With Depression Apparently then, peoples perception about depression plays an important role in their help-seeking behavior, and it has been suggested that peoples experiences with depression might play a role in their pe rceptions. However, Wernicke, Pearlman, Thorndike, and Haaga (2006) did not find a si gnificant correlation between experience with and perception of depression. The part icipants were 127 individuals (63 men, 64 women) who were 18 years-old or older, were not depressed or suicidal at the time of the study, and had no major depressive episode or tr eatment within the 2 months prior to the study. Of the 127 participants, 63 were classifi ed as recovered-depressed and 64 as neverdepressed. Participants completed the 21-item Beck Depression Inventory (BDI) portions of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV (SCID) the 10-item Depression Proneness Inventory (DPI) and the Revised Self-Appraisal Questionnaire (R-SAQ). The BDI measured current depr essive symptom severity, the SCID assessed lifetim e major depression and current major depression, the DPI measured vulnerability to depression due to stre ss, and the R-SAQ assessed participants perceptions of other peoples experien ces with depression. The R-SAQ had seven subscales: need for balance (e.g., When people are depressed, they have to work hard not to let themselves get worn down), lack of energy (e.g., When people are depressed, they have a hard time getting anything done), imposition of limits (e.g., When people are depressed, they let the po ssibility of getting depressed limit the things they try to do), management of burden (e. g., When people are depressed, they worry that their being down depresses other people), relationship concerns (e. g., When people are depressed, they worry about whether someone could stand to be around them all the
19 time), found strength in depression (e. g., When people are depressed, they feel stronger in some ways than they did before) and sense of stigma (e. g., People dont seem to listen to a persons opinion about things since that pe rson had depression). Recovered-depressed and never-depressed part icipants did not differ significantly on any of the R-SAQ subscales, and the DPI scores al so were not significantly correlated with any of the R-SAQ subscales. Finally, African Am erican participants reported lower levels of proneness to depression than participan ts of other races. The authors suggested two possible explanations for the lack of signi ficant differences in the perceptions of depression among never-depressed and recovere d-depressed individu als. On one hand, it may be that people, regardless of their pers onal experience with depr ession, have a hard time imagining what depression is like for other people. Conversely, it may be the case that never-depressed individuals are able to perceive the characteristics of depression similarly to those who were once depressed. Conversely, Coyne and Calarco (1995) are among those who reported a significant correlation between familiarity w ith depression and perceptions of it. The sample consisted of 37 female participants, 20 of whom never experienced depression and 17 of whom recently recovered from depression. Of the 17 women, 7 had just recovered from their first depres sive episode and 10 had just recovered from a recurrence. Participants completed the original Self-Appraisal Questionnaire (SAQ) that assessed perceptions of their own depr ession using nine scales. The only significant difference between the two recovered-de pressed groups was that women with recurrent depression scored higher on the sense of being a burden to others scale, suggesting that they were more concerned about being a burden to ot hers. Compared to recovered-depressed
20 women, never-depressed women scored significantly lower on each of the subscales, except for the found strength in depression scale. This indica tes that recovereddepressed participants were more likely to feel that they had less energy and were a burden on others; their outlook on life was mo re limited and guarded; they were more afraid of their ability to maintain relationships; and they were more likely to believe that depression is associated with stigma, that a r ecurrent depressive epis ode is inevitable, and that symptoms of depressi on need to be hidden. Kirk, Brody, Solomon, and Haaga (1999) also investigated the role of experience on perceptions; specifically, they looked at the relationship between experience with depression and perceived causes of it. The pa rticipants were 50 adults who were not depressed at the time of the study, as determined by the Beck Depression Inventory the Beck Scale for Suicide Ideation, and the Structured Clinical Interview for DSM-IV After completing the Inventory to Diagnose Depression-Lifetime, 25 of the participants were diagnosed as recovered depressed. All participants completed the Helpfulness of Antidepressive Activi ties Questionnaire that asked them to rate how helpful each of 15 activities would be to somebody who was feeling depressed. Participants filled out a scale that described different causal theories and treatment methods. Participants were also asked about their academic and professional ex periences with depression. Compared to the 25 never-depressed individuals, the 25 recovered-depressed participants were experiencing a significantly higher level of depression at the time of the study, as measured by the BDI. There were no sex di fferences and no recovered/never depressed differences regarding perceptions of causal theories and therapies. On the other hand, compared to the never-depressed group, r ecovered-depressed pa rticipants were
21 significantly less likely to find se lf-help activities (such as goi ng for a walk or talking to a friend) useful and significantly more likely to find professional an tidepressive activities (reading about depression cure a nd taking antidepre ssants) useful. Attitudes Toward Depression, Race, and Lay Beliefs A difference in the perceptions of depression by African Americans and Caucasians is that even though African Americ ans are more likely to believe that people suffering from schizophrenia or major depres sion may do something violent, they are less likely to believe that these individuals s hould be blamed or punished (Anglin, Link, & Phelan, 2006). Researchers used a random sampling telephone survey method to recruit participants. The sample consisted of 1,241 participants (118 Af rican Americans, 913 Caucasians) who were 18 years of age or olde r and resided in the US. Participants were randomly assigned to a vignette that de scribed a character who suffered from schizophrenia, major depression, or one of a number of physical illnesses. The characters gender, socioeconomic status, and cause of illness were randomly varied and his/her race and ethnicity were matched to thos e of the participant. The analyses focused on the 81 African Americans and 590 Caucasians who were assigned to the schizophrenia or major depression vignettes. Participants beliefs about violence, blame, and punishment were measured with the followi ng questions, respectively: In your opinion, how likely is it that _____ w ould do something violent toward other people -Very likely, somewhat likely, not very likely, or not likely at all?, If ______ did something violent as the result of the problems I described, do you think it would definitely be his fault, probably be his fault, probably not be hi s fault, or definitely not be his fault?, If
22 ______ did something violent because of his prob lem, he should be dealt with the police and courts just like any ot her person would be (strongl y agree, somewhat agree, somewhat disagree, strongly disagree). While both African American and Caucasian participants believed that the person with schizophrenia was more dangerous than the person with major depression, African American s were more likely than Caucasians to believe that persons suffering from mental illness would be dangerous. Nevertheless, Caucasians were significantly more likely to believe that these persons should be blamed for violent behavior. This latter belief was also shared by participants who were younger, more conservative, and Protestant. Participan ts were also signifi cantly more likely to assign blame to a person who suffered from major depression as opposed to schizophrenia. Finally, Caucasians and participants who were younger, more conservative, and who had higher incomes were significantly more likely to believe that individuals who suffer from mental illness should be punished. Participants of both groups were less likely to believe that i ndividuals with schizo phrenia, compared to depression, should be punished. Even lawyers and highly educated comm unity members overestimate the violent tendencies of people who suffer from depr ession and schizophrenia (Minister, & Knowles, 2006). Participants were 46 lawy ers (24 men, 22 women) and 44 community members (19 men, 25 women) in Australia. Bo th groups of partic ipants were highly educated and had similar personal experiences with mentally ill people. All participants were mailed a questionnaire about general demographics and th ree vignettes that described (1) a man suffering from depression, (2) a man suffering from schizophrenia, and (3) a troubled man. One third of the que stionnaires contained these three vignettes
23 in the absence of a comorbid condition, a second third contai ned the same vignettes with the addition of a drinking problem, and th e rest of the vignettes included a heroin addiction problem. Participants also rated the likelihood that the vi gnettes depicted cases of mental illness and the seriousness of the pr oblem. There were signif icant differences in the perceptions of the problem among the three mental c onditions (depression, schizophrenia, troubled), as well as in the perceptions of the seriousness of these conditions. In particular, partic ipants viewed the schizophrenia vignette as the most likely case of mental illness and the most serious one, and the troubled vignette as the least likely case of mental illness and the least serious one. Overall, both lawyers and community members supported the need for lega l coercion for treatment, especially when there was potential risk of harm to the self or others. However, compared to community members, lawyers were significantly less likely to support co erced treatment for depressed individuals. Participan ts also believed that the sc hizophrenia vignette character would be the most likely to be violent, followed by the depressed character, and exaggerated the risk of violent behavior for all three conditions. Finally, neither comorbid substance abuse condition cause d a significant change in participants perceptions of violence. Attitudes Toward and Familiarity With Depression Given that labeling someone as mentally il l is associated with viewing that person as dangerous, it is not surprising that people desire social distance from mentally ill individuals (Phelan & Basow, 2007). Phelan and Basow investigated the stigmatization of mental illness, which, they pointed out, is a major reason why people do not seek help.
24 The participants were 168 undergraduate stude nts (96 female, 72 male) between the ages of 17 and 22. Participants were presented w ith three vignettes and the gender of the characters was manipulated. One of the vignette characters suffered from major depression, another from al cohol problems, and a third from common stress. The researchers assessed social tolerance, perceived dangerousness, willingness to label the character as mentally ill, familiarity with mental illness, adherence to traditional gender roles, empathy, and social dominance orientation (SDO). Stigmatization was measured by its three components: labeling, perceived dangerousness, and social distance. There were significant intercorrela tions among the three stigma components: Labeling was associated with negative ster eotyping, which in turn led to increased discrimination. Increased empathy was associated with decreased SDO and decreased hypergender ideology. Interestingly, empathy was also positively associated with labeling and social tolerance, whereas SDO was negatively correlat ed with social tolerance. Also, compared to males, female participants scored lo wer on SDO and hypergender ideology and higher on empathy and familiarity with depression. As for the gender of the vignette character, male characters were viewed as more dangerous and were less tolerated. Finally, familiarity with mental illness only margina lly predicted perceptions of dangerousness, which the researchers found surprising give n that it was in disagreement with many previous findings that showed a clear negative correlation between familiarity and negative stereotyping. Contrary to Phelan and Basow, Co rrigan, Green, Lundin, Kubiak, and Penn (2001) concluded that familiarity with mental illness is in fact co rrelated with peoples attitudes toward mental illness. The partic ipants were 208 community college students
25 (172 female, 36 male) who completed the Level of Contact Report, which has 12 different levels of experience, ranging from Never observed person with mental illness to Has a serious mental illness. Particip ants also filled out the 21-item Attribution Questionnaire that includes three questions for each of se ven constructs: personal responsibility and dangerousness (attitudes); anger, concern, and fear (emotional reactions); and help and avoidance (behavioral responses). The final measure was the Social Distance Scale a 7item scale that asks participants how willing they would be to do something that involves someone with a serious mental illness. Less than 10 percent of the sample reported no experience with depression and over 90% were exposed to mental illness via the media. Analyses showed that participants who had more experience with mental illness were less likely to believe that a mentally ill person w ould be dangerous and less likely to desire social distance. There was not a significant relationship between familiarity and fear, but fear was associated with beliefs about danger ousness and with increase d social distance. The Current Study From the literature on depressi on, it is apparent that it is important for people who suffer from depression to seek help (Berna l et al., 2007; Nationa l Alliance on Mental Health; Raja & Azzoni, 2004; Szanto et al., 200 7). However, in order to do that, one must recognize that help is neede d. Perceptions of and attitudes toward depression are major factors that influence help-seeking behavior (Edwards et al., 2007; Kendrick et al., 2007; Kuehn, 2006), and some researchers have found that they are correlated with peoples experiences with depression. For example, Corrigan et al. (2001) found a significant correlation between peoples attitudes toward mental illness and their experiences with
26 mental illness, whereas Phelan and Basow (2007) found only a marginally significant relationship between experiences with depression and perceived dangerousness of depressed individuals. Moreover, Wernicke et al. (2006) did not find a significant correlation between experience with depres sion and perceptions of others experience with depression among never-depressed and recovered-depressed individuals. Conversely, Coyne and Calarco (1995) f ound that compared to never depressed individuals, recovered-depre ssed participants had a better understanding of what their experience with depression is/w ould be like. Their sample, however, consisted of women participants only, and they only compared individuals who were never depressed, who had just recovered from their first depressive episode, and w ho had just recovered from a recurrent episode. The current study took this inquiry a st ep further and attempted to look at perceptions of what others experience with depression is like and attitudes toward depression as its dependent variables, and e xperience with depression as its independent variable. However, unlike in previous studies, there were four levels of e xperience in the current study: currently experiencing depr ession, having experienced depression in the past, knowing somebody who suffers/suffered from depression, and absolutely no experience with depression (never havi ng experienced depre ssion and not knowing anybody with depression). This study was also unique because none of the others compared perceptions and attitudes for the sa me sample. The research questions were the following:
27 1. Does experience with depression a ffect perceptions of depression? 2. Does experience with depression a ffect attitudes toward depression? 3. Is there a relationship between perceptio ns of and attitudes toward depression? 4. Are there any demographic differences rega rding peoples experiences with depression and their perceptions of and attitudes toward depression? Despite the mixed literature on the topic, it was expected that experience with depression would affect perceptions of depression (Coyne & Calarco, 1995) and that experience with depression would also affect attitudes toward depressi on (Corrigan et al., 2001). Specifically, more experience was predic ted to be associated with increased understanding of depression and more positiv e attitudes toward a depressed vignette character. A positive correlation was also antic ipated between perceptions and attitudes. Finally, it was expected that men would be less likely to report experience with depression, would have a poorer understanding of the nature of depression, and would be more likely to have negative attitudes to ward a depressed person, especially if the depressed individual was male. To answer these questions, particip ants were asked to complete the Revised SelfAppraisal Questionnaire (R-SAQ) as administered by Wernicke, Pearlman, Thorndike, and Haaga (2006); the vignette survey admi nistered by Phelan and Basow (2006); the Beck Depression Inventory (BDI); and a revised version of the Zung Self-Rating Depression Scale The R-SAQ measured how people perceived depression in others, the BDI assessed current depressive symptoms the Zung was revised to measure past depressive symptoms, and the vignette survey was used to assess participants attitudes toward depression. In addition, pa rticipants in the current study were asked what factors
28 they believed were responsible for depressi on; what their experiences with depression were; and what their gender, ethnicity, age, and educational attainment were. Method Participants The responses of 121 individuals (44 male, 72 female, 5 unspecified) were collected. However, participants who omitte d one or more answers on the perception, experiences, or attitudes scales were automati cally excluded from the final analyses. The final sample included 75 participants (26 ma les, 46 females, 3 unspecified) whose ages ranged between 18 and 44 (M = 23.11, SD = 6.196). The sample was not diverse. There were 57 Caucasian participants and 39 were currently in college (see Figures 1 and 2 in Appendix A for information about the ethnic composition and educati onal attainment of participants). A few participants were mi ssing information about something other than perceptions, experiences, or attitudes, but th eir data were used in the analyses. All participants were recruited online and completed the study on an online forum called SurveyMonkey (http://www.surveymonkey.com/). Material See Appendix B for a complete list of survey questions. Perceptions. The Revised Self-Appraisal Questionnaire (R-SAQ) was used, as revised by Wernicke, Pearlman, Thorndike, an d Haaga (2006), to assess participants perceptions of other peoples experiences with depression. The R-SAQ consists of 34 statements and participants were asked to in dicate, on a 5-point Likert scale from 1 to 5,
29 the degree to which they agreed or disagreed with each statement. The statements correspond to seven subscales, which are need for balance, lack of energy, imposition of limits, management of burden, relationship concerns, found strength in depression, and sense of stigma. For the purposes of the cu rrent study, the subscales were ignored and only total scores were considered, wh ich ranged between 34 and 170. Wernicke, Pearlman, and Thorndike reported that while th e internal consistency of the R-SAQ is not as high as that of the original SAQ, it is st ill fairly high. The coefficient alphas of the RSAQ subscales range between = .54 and = .83. Attitudes. In order to measure participants attitudes toward depression, the vignette method that Phelan and Basow (2007) used was utilized in the current study. Participants were presente d with a character that su ffered from major depression. Attitudes were assessed by asking ten social tolerance questions: six social distancing questions, three questions regarding perceived danger ousness, and one question concerning willingness to label the character as mentally ill. Moreover, unlike in the study of Phelan and Basow where the sex of th e character was randomly alternated, in the current study all participants were introduced to a character named Casey. This name was chosen in order to make the sex of the char acter ambiguous. Participan ts answered the ten questions using a 5-point Likert scale from 1 to 5; thus yiel ding a distancing score that ranged between 6 and 30, a dangerousness score between 3 and 15, and a willingness to label score between 1 and 5. While higher distancing scores indicated more positive attitudes, higher dangerousness scores mean t more negative atti tudes. Afterwards, participants were asked to i ndicate the sex of the charac ter. Although Phelan and Basow failed to discuss the reliability and validity of the scales they used, Link, Yang, Phelan,
30 and Collins (2004) reported that social distan cing scales tend to have high internal consistency, ranging between .75 and over .90. Experiences. To find out whether or not participants were currently experiencing depression, they were asked to fill out the well-known 21-item Beck Depression Inventory (BDI-II). The BDI uses a 3-point Like rt scale that ranges from 0 to 3, and yields a total score between 0 and 63 The BD I is highly reliable and valid. Beck, Steer, and Brown (1996) reported internal consistenc y of a coefficient alpha of .92 for an outpatient sample ( N = 500) and a coefficient alpha of .93 for a college sample ( N = 120). A test-retest stability study with an outpatient sample (N = 26) resulted in a test-retest correlation of .93. Furthermore, the BDI wa s based on the DSM-IV criteria for major depression; therefore, has high content validity. The factorial validity was determined to be .95 with an outpatient sample ( N = 500). Having personally experienced depression in the past was measured with a revised version of the Zung Self-Rating Depression Scale. The ZUNG uses a 4-point Likert that ranges between 1 and 4, thus yielding a total score between 20 and 80. The original questionnaire is worded in the present tense and asks how often in the past few days the participant experienced what each of 20 statements describes. However, for the purposes of this study all the questions were c onverted into the past tense. Participants were asked if there was a peri od in their life, lasting at le ast two weeks, when they felt very sad. The two-week period was chosen b ecause it conforms to the BDI and the DSMIV criteria for major depressi on. If the answer was yes, par ticipants proceeded to the 20 statements. One study found that the internal consistency of the Zung was .90 and that of
31 the BDI was .94 for the same psychiatric sample (Schaefer et al., 1985). In the same study Schaefer et al. also reported that in most cases the Zung showed the highest validities when compared to the BDI and the Minnesota Multiphasic Personality Inventory Depression scale (MMPI). The researchers conc luded that the Zung is a better measure of depressive symptoms than the MMP I and slightly better than the BDI. (Note: A sample comprised entirely of male particip ants and the older ve rsion of the BDI and the DSM-III criteria were used.) Finally, participants were directly asked about their experiences with depression. They were asked if they were currently depressed, depressed in the past, or knew anybody who suffered from depression (and what their relationship to that person was). In addition, participants were asked whether or not they, or the people they knew, took any prescription medication for depre ssion or sought counseling for it. Causes of depression. Participants were then asked what factor or factors they believed were responsible for depression. Th e choices were genetic, environmental, mental/personal weakness, chemical imbalan ce, or other. If they thought some other factor was the cause, they were asked to specify it. Demographic information. In the final section, information was collected about the participants sex, age, ethnic ity, and educational attainment. Procedures A survey was posted on SurveyMonkey and was open to anybody over the age of 18. Participants were recruited via e-mail to the New College Forum, as well as via Facebook. Participants were first presented with a consent form, wh ich informed them
32 that the purpose of the study was to look at their views about de pression. Participants were reminded about the sensitivity of the t opic and were encouraged not to take the survey if they thought they could become distressed as a result; in case that response did occur, they were provided with two suicid e hotline numbers. Upon consent, participants proceeded to the study, which began with the R-SAQ, followed by the attitudes measure, experiences measures, and the demographic s ection. At the end, participants were given the hotline numbers again and were thanked for their participation. In addition, they were provided with some basic information about depression and links to further readings. Results Participants experiences with depression Evaluation of the ZUNG, the BDI, and the number of depressed individuals participants knew revealed th at of the 75 participants, only 2 reported absolutely no experience with depression, 71 participants kne w at least one depres sed individual, 54 participants had been depresse d in the past, and 30 particip ants were depressed at the time of the study. See Figure 3 in Appendix A fo r a visual representation of these data. Figure 4 depicts a more detailed breakdown of the various levels of experience that participants had: Only 2 pa rticipants had absolutely no experience with depression, and only 16 participants had never experienced depression themselv es, but knew somebody who had. Another 2 participants only experienced depression in the past and did not know anyone who had experienced it, and 25 par ticipants experienced depression only in the past and knew somebody who had also expe rienced it. Furthermore, there was not a single participant who was only currently depressed and did not know anybody who had
33 experienced depression, but ther e were 3 participants who we re only currently depressed and knew somebody who had experienced de pression. Finally, there were not any participants who were curre ntly depressed, depressed in the past, and did not know anybody who had been depressed; however, 27 pa rticipants were depr essed currently, in the past, and knew at least one individual who had experienced depression. Thus, with the exception of 4 participan ts, everybody knew at least one depressed individual (see Appendix A, Figure 5 for a representation of the number of depressed individuals participants knew). As for the severity of depression, the ma jority of participants were currently experiencing only normal to minimal depressi on, as measured by the BDI (see Appendix A, Figure 6). Conversely, according to the ZUNG, most participants had experienced severe depression (Appendix A, Figure 7). Finally, the most commonly reported cause of depression was environmental factors ( n = 70) and the least fre quently reported one was spirituality ( n = 2) (see Appendix A, Figure 8). Because of the lack of a diverse sample ethnicity was not included as a variable and neither were medication usage and absolutely no experience with depression. See the table in Appendix A for a Pearson correlation ma trix that includes all the variables under study. Does experience with depression affect perceptions of depression? A multivariate linear regression analysis re vealed that, overall, the three levels of experience (current experience, past e xperience, know somebody) did not predict perceptions about the nature of depression, F [1, 74] = 1.84, p = .148. [Note: Given that
34 only two participants reported no experi ence with depression, no analyses were conducted with that level of experience.] Th e BDI was, however, significantly correlated with the R-SAQ, r (74) = .267, p = .021. The more depressed pa rticipants were at the time of the study, the greater understanding th ey demonstrated about the nature of depression. Self-reports of current and past depression and familiarity with depressed individual(s) were not significantly related to participants perceptions. Does experience with depression af fect attitudes toward depression? A canonical analysis was performed to analyze the relationship between attitudes (distancing, dangerousness, and labeling) a nd experiences (current depression, past depression, knowing somebody with depression ). The result was not significant, R = .040, p = .889. However, compared to participan ts who were not seeking counseling at the time of the study, participants who were being counseled desired significantly less distance from the depressed character in the vignette, r (74) = -.257, p = .026, and they were less likely to believe that the depressed character was dangerous, r (74) = .250, p = .031. Is there a relationship between percepti ons of and attitudes toward depression? Another multivariate linear regression analysis was carried out in order to investigate whether attitudes w ould be predictive of perceptions. The overall result of this test also was not sta tistically significant, F [1, 74] = 2.40, p = .075. Nevertheless, Labeling and the R-SAQ were significantly correlated, r (74) = .230, p = .047, suggesting
35 that people who had a better understanding of depression were more likely to label the vignette character as mentally ill. Are there any demographic differences regardi ng peoples experiences with depression and their perceptions of and attitudes toward depression? Gender and Distancing were correlated, r (71) = -.277, p = .019. Specifically, compared to women, men were less likely to desire social distance from the depressed character. No other gender differences were found, not even regarding the perceived gender of the character. Age and education were significantly correlated only with each other, r (69) = .336, p = .005, but with no other variable. On the other hand, several correlations were found among participants experiences with depression. A Pearson correlation showed that the BDI and the ZUNG were correlated, r (74) = .378, p = .001. Thus, participants who were depressed at the time of the study we re likely to have been depressed in the past. Further analyses were done with particip ants self-reports of depression, which were measured toward the end of the study by simp ly asking participants if they thought they were currently experiencing depression a nd if they thought they had experienced depression in the past. Participants who left the questions blank or were unsure were eliminated from these analyses. Self-reports of current and past depression were significantly correlated with the BDI and ZUNG scores. Finally, current counselingseeking was significantly related to counseling-seeking in the past, r (74) = .329, p = .004, and to self-reported current depression, r (60) = .286, p = .026. It was not, however, significantly correlated w ith any other variable, not even the BDI, r (74) = -.190, p =
36 .102. On the contrary, counseling-seeking in the past was only significantly correlated with past depression as indicated by the ZUNG, r (74) = -.459, p = .00; that is, participants who were depressed in the past were more likely to have sought counseling. Discussion The current study investigated the relati onship between people s experiences with depression and their perceptions of and att itudes toward depression. Participants were recruited via e-mail and Facebook, and were aske d to fill out an online survey that was posted on SurveyMonkey. Originally there were four levels of experience: current depression, past depression, knowing a depres sed individual, and having no experience with depression. Current depres sion was measured with the Beck Depression Inventory (BDI) past depression with the ZUNG and knowing somebody with a single question. In addition, current and past depression were al so assessed by a direct single-item question. However, only 2 of the final 75 participants had no experience with de pression; thus, that level of experience was excluded from the analyses. Perceptions were assessed with the Revised-Self Appraisal Questionnaire (R-SAQ), and attitudes with a vignette method. The attitude measure consisted of three sub-scales that assessed participants' desire for social distance from a depressed individual, their perceived dangerousness of the depressed individual, and their willi ngness to label the depressed person as mentally ill Given that it is unlikely that somebody in our society would have absolutely no experience with depression, it might be that t hose two participants who had no current or past depression and did not know anybody who had depression were uninformed about the illness and failed to r ecognize it or acknowledge it. Such failure to recognize
37 depression might be expected with a mo re diverse and less educated sample. Furthermore, there was a significant corre lation between current (BDI) and past depression (ZUNG), as well as between peopl es self reports of current and past depression and their BDI and ZUNG scores. This indicates that par ticipants were aware of the symptoms of depression and were w illing to admit it. Again, this may be so because the participants were educated, or th ey might have been attracted to the study because of the topic. The majority of participants reported environmental factors as the cause of depression, which is consistent with the findings of others (Link et al., 1999). However, given that the participants were well educat ed, it is surprising how many times depression was attributed to mental weakness ( N = 23). Contrary to what was expect ed, a regression analysis rev ealed that the three levels of experience (current depression, past de pression, knows somebody w ith depression) did not predict perceptions of de pression (R-SAQ). Higher level of current depression (BDI) was, however, significantly correlated with an increased understandi ng of the nature of depression (R-SAQ), which suggests that at least levels of se verity of current depression predict perceptions of depression. This might be the case because participants who had experienced depression in the pa st were not able to fully re call what the experience was like, whereas those who were currently e xperiencing the symptoms did not have to remind themselves. Current and past depression and knowing somebody with depression appeared to have no affect on peoples attitudes toward depression, and neither was the perceived gender of the vignette characte r related to any of the vari ables. This latter finding is
38 inconsistent with the finding of Phelan and Basow (2007), who showed that the male vignette character was thought to be more dangerous than the female character, and that more distance was desired from the male vignette character than from the female one. Also, unlike in Phelans study, desire for social distance and perceived dangerousness were not interrelated in the current study. On the other hand, participants who were seeking counseling at the time of the study desired significantly less distance from the depressed character and were significantly le ss likely to believe that the depressed character was dangerous. It makes sense that somebody who felt the need to seek counseling would have a more positive attitude toward another individual with a similar experience. In fact, what is strange is that people who we re currently depressed did not demonstrate the same attitude as those w ho were currently seeking counseling. Increased willingness to label the vi gnette character as mentally ill was significantly associated with an increased understanding of de pression. This finding is not surprising because almost all of the participants were educated and were likely to know that depression is in fact considered a mental illness, as evidenced by its listing in the Diagnostic and Statistical Ma nual of Mental Disorders. As mentioned earlier, it was not feasible to conduct any analyses regarding ethnicity, and age was not correl ated with any of the variable s. On the other hand, the sex of the participant was correlated with Di stancing, whereby male participants desired considerably less distance from the depre ssed character, perhaps because men are less likely to feel scared or endangered in potentially threatening situations. It is very possible that some of the findings, such as the an alyses with the three levels of experience, were not significan t due to the participant pool. It would be
39 interesting to see the results with a more di verse sample that would allow for analyses with ethnicity and education, at least the form er of which would be expected to have an effect on perceptions and experience reporti ng (Kenderick, et al., 2007), as well as on attitudes (Anglin, et al., 2006). Moreover, there are a few drawbacks to the survey. For one, the survey was composed of many questions and sections, po tentially making it too long for participants. Related to this issue is that it would have been a good id ea to start off the survey with the demographic section. This would have allowed for a close scrutiny of the characteristics of those who started the survey but failed to finish it. Particularly, the attitude section seemed to be the point at which participan ts were the most likely to quit the survey. Although the vignette method is widely used, it appears that partic ipants might have gotten frustrated with the m easure, possibly because they did not feel comfortable judging somebody based only on a few sentences. In addition, one mistake was made in this section: instead of using a 6-point s cale like Phelan and Basow (2007) did, a 5-point scale was used in the current study. Despite these shortcomings, the current study is of importance because it demonstrates that people who were depressed at the time of the study did, in fact, have a better understanding of depression than those who were not currently depressed. Furthermore, compared to participants who we re not seeking counseli ng at the time of the study, those who were in counseling desired less distance from a depressed person and were less likely to believe that a depressed person was da ngerous. This indicates that experience with depression does play a role in forming peoples perceptions of and attitudes toward depression; however, it is the presence of current symptoms, not
40 depression history, that seems to matter. Futu re research should in clude a more diverse sample in order to allow for analyses with ethnicity and educati on, while retaining the various levels of experience. A diverse samp le might allow for an alyses with the no experience with depression condition, which wa s of interest in the current study, but was not feasible to include due to the low number of individuals who fe ll into that category. Studies targeting different age groups and cu ltures and how peoples perceptions of and attitudes toward depression develop and persist over time are also needed.
41 Appendix A: Figures an d Regression Matrix Figure 1 : Ethnic Composition of Participants Ethnic Composition of Participants57 9 2 30 10 20 30 40 50 60 CaucasianHispanicAfrican AmericanBiracialRaceFrequency Figure 2 : Educational Attainment of Participants Educational Attainment of Participants 22 15 39 8 2 4 1 0 5 10 15 20 25 30 35 40 45 High schoolAA/ASSome college Currently in college BA/BSSome graduate school MA/MSMD/JD/PhD Education levelFrequency
42 Figure 3: Participants Experiences with Depression Participants' Experiences with Depression2 71 54 30 0 10 20 30 40 50 60 70 80 No experienceKnow somebodyPast depressionCurrent depression ExperiencesFrequency Figure 4 : Detailed Breakdown of Participan ts Experiences with Depression Participants' Experiences With Depression2 16 2 25 0 3 0 27 0 5 10 15 20 25 30 NoDepNobodyNoDepSomebody PastDepNobodyPastDepSomebodyCurrDepNobodyCurrDepSomebodyCurrPastNobodyCurrPastSomebody ExperienceFre q uenc y
43 Figure 5 : Number of Depressed Indivi duals Participants Know Number of Depressed Individuals Participants Know4 37 17 15 11 0 5 10 15 20 25 30 35 40 012345 Number knownFrequency Figure 6 : Severity of Current Depres sion (BDI) Among Participants Severit y of Current Depression ( BDI ) Amon g Participants 45 15 10 5 0 5 10 15 20 25 30 35 40 45 50 Minimal Mild Moderate Severe Severity of depressionFrequency
44 igure 7 : Severity of Past Depressi on (ZUNG) Among Participants F Severity of Past Depression (ZUNG) Among Participants19 2 5 15 34 0 5 10 15 20 25 30 35 40 Not depressedNormal Minimal/MildModerate/MarkedSevere/Extreme Severity of depressionFrequency Figure 8 : Perceived Cause of Depression Perceived Cause of Depression 70 62 57 23 222 0 10 20 30 40 50 60 70 80 EnvironmentalChemicalGeneticMental weakness PersonalitySpiritualOther CauseFrequency
45 Regression Matrix RSAQ Distancing Dangerous Labeling ASex BDI ZUNG RSAQ Pearson 1.000 .152 .086 .230*-.159 .267*.095 Sig. (2-tailed) .194 .463 .047 .181 .021 .417 N 75 75 75 75 72 75 75 Distancing Pearson .152 1.000 -.221 -.037 -.144 .179 .088 Sig. (2-tailed) .194 .057 .755 .227 .124 .451 N 75 75 75 75 72 75 75 Dangerous Pearson .086 -.221 1.000 .030 .140 -.104 -.066 Sig. (2-tailed) .463 .057 .798 .242 .375 .575 N 75 75 75 75 7 2 75 75 Labeling Pearson .230*-.037 .030 1.000 -.018 .017 -.015 Sig. (2-tailed) .047 .755 .798 .878 .885 .898 N 75 75 75 75 72 75 75 ASex Pearson -.159 -.144 .140 -.018 1.000 -.040 -.121 Sig. (2-tailed) .181 .227 .242 .878 .737 .310 N7 2 7 2 7 2 7 2 7 2 7 2 7 2 BDI Pearson .267*.179 -.104 .017 -.040 1.000 .378**Sig. (2-tailed) .021 .124 .375 .885 .737 .001 N 75 75 75 75 72 75 75 ZUNG Pearson .095 .088 -.066 -.015 -.121 .378**1.000 Sig. (2-tailed) .417 .451 .575 .898 .310 .001 N 75 75 75 75 72 75 75 NKnown Pearson .054 .042 -.021 .141 -.160 .099 .159 Sig. (2-tailed) .645 .722 .855 .227 .179 .398 .172 N 75 75 75 75 72 75 75 Sex Pearson -.099 -.277*-.050 .073 .075 .064 .028 Sig. (2-tailed) .409 .019 .678 .545 .535 .592 .817 N 72 72 72 72 70 72 72 Age Pearson .091 -.037 .220 -.136 -.051 .057 .189 Sig. (2-tailed) .451 .761 .065 .257 .682 .636 .115 N 71 71 71 71 68 71 71 Education Pearson -.143 -.067 .010 .069 -.022 -.080 .082 Sig. (2-tailed) .229 .576 .933 .559 .857 .503 .491 N 73 73 73 73 70 73 73 CDep Pearson -.121 -.238 .035 .015 .100 -.607**-.343**Sig. (2-tailed) .354 .065 .788 .909 .454 .000 .007 N 61 61 61 61 58 61 61 PDep Pearson -.044 -.127 .128 .131 .034 -.373**-.559**Sig. (2-tailed) .723 .310 .307 .293 .794 .002 .000 N 66 66 66 66 63 66 66 CurrentCounseling Pearson -.027 -.257*.250*-.196 -.007 -.190 -.160 Sig. (2-tailed) .815 .026 .031 .092 .951 .102 .170 N 75 75 75 75 72 75 75 EverCounseling Pearson -.059 -.025 .219 -.150 -.029 -.165 -.459**Sig. (2-tailed) .613 .833 .059 .199 .812 .157 .000 N 75 75 75 75 72 75 75 *. Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed)
2 1 3 46 Regression Matrix NKnown Sex Age Education CDep PDep CurrCounsel EverCounsel RSAQ Pearson .054 -.099 .091 -.143 -.121 -.044 -.027 -.059 Sig. (2-tailed) .645 .409 .451 .229 .354 .723 .815 .613 N 75 72 71 73 61 66 75 75 Distancing Pearson .042 -.277*-.037 -.067 -.238 -.127 -.257*-.025 Sig. (2-tailed) .722 .019 .761 .576 .065 .310 .026 .833 N 75 72 71 73 61 66 75 75 Dangerous Pearson -.021 -.050 .220 .010 .035 .128 .250*.219 Sig. (2-tailed) .855 .678 .065 .933 .788 .307 .031 .059 N 75 7 7 7 61 66 75 75 Labeling Pearson .141 .073 -.136 .069 .015 .131 -.196 -.150 Sig. (2-tailed) .227 .545 .257 .559 .909 .293 .092 .199 N 75 72 71 73 61 66 75 75 ASex Pearson -.160 .075 -.051 -.022 .100 .034 -.007 -.029 Sig. (2-tailed) .179 .535 .682 .857 .454 .794 .951 .812 N 72 70 68 705863 72 72 BDI Pearson .099 .064 .057 -.080 -.607**-.373**-.190-.165 Sig. (2-tailed) .398 .592 .636 .503 .000 .002 .102 .157 N 75 72 71 73 61 66 75 75 ZUNG Pearson .159 .028 .189 .082 -.343**-.559**-.160 -.459**Sig. (2-tailed) .172 .817 .115 .491 .007 .000 .170 .000 N 75 72 71 73 61 66 75 75 NKnown Pearson 1.000 .087 -.099 -.022 -.137 -.227 -.133 -.156 Sig. (2-tailed) .468 .413 .852 .291 .067 .256 .182 N 75 72 71 73 61 66 75 75 Sex Pearson .087 1.000 -.082 -.078 .160 -.005 -.109 -.164 Sig. (2-tailed) .468 .498 .518 .225 .967 .361 .169 N 72 72 70 71 59 64 72 72 Age Pearson -.099 -.082 1.000 .336**.057 -.192 .096 .031 Sig. (2-tailed) .413 .498 .005 .665 .129 .424 .795 N 71 70 71 70 59 64 71 71 Education Pearson -.022 -.078 .336**1.000 .056 .100 -.019 .131 Sig. (2-tailed) .852 .518 .005 .672 .433 .872 .268 N 73 71 70 73 60 64 73 73 CDep Pearson -.137 .160 .057 .056 1.000 .328*.286*.166 Sig. (2-tailed) .291 .225 .665 .672 .015 .026 .201 N 61 59 59 60 61 54 61 61 PDep Pearson -.227 -.005 -.192 .100 .328*1.000 .175 .585**Sig. (2-tailed) .067 .967 .129 .433 .015 .160 .000 N 66 64 64 64 54 66 66 66 CurrCounsel Pearson -.133 -.109 .096 -.019 .286*.175 1.000 .329**Sig. (2-tailed) .256 .361 .424 .872 .026 .160 .004 N 75 72 71 73 61 66 75 75 EverCounsel Pearson -.156 -.164 .031 .131 .166 .585**.329**1.000 Sig. (2-tailed) .182 .169 .795 .268 .201 .000 .004 N 75 72 71 73 61 66 75 75.000 *. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed).
47 Appendix B: The Survey Consent Form New College of Florida Informed Consent For persons 18 years of age or older who take part in a research study The following information is being presented to help you decide wh ether or not you want to take part in research study. Please r ead this carefully. If you do not understand something, ask the person in charge of the study. Title of research study: What is depression? Person in charge of stud y: Krisztina Schlessel The purpose of this research study is to learn about peoples views on depression. Description You are invited to participate in a research study on depressio n. The study is part of the researchers thesis project, and it hopes to add to the literature on depression. Specifically, the study is intended to measur e peoples views about depression. You will be asked to answer a series of questions. Your participation will take approximately 1520 minutes. Benefits of Being a Part of this Research Study By taking part in this research study, you will increase your overall knowledge of depression. Upon submission of the survey, you will have the option of reading some facts surrounding depression and will be provided with links for more information. Risks of Being a Part of this Research Study Depression may be a sensitive topic for you. Even though the questions are not designed to go into detail about your experience with depression, it is possible that you may become distressed. If you think that this res ponse is likely to happe n, do not proceed with the survey. In the event that you take the survey and become distressed, please call the National Hopeline Network at 1-800-784-2433 or the National Suicide Prevention Lifeline at 1-800-273-8255. Payment for Participation You will not be paid for your participation in this study. Confidentiality of Your Records Your privacy is important. However, the re sults of this study may be published. Your individual privacy will be maintained in all published and written data resulting from the study. Only authorized research personnel, em ployees of the Department of Health and Human Services, and the NCF Institutional Review Board may inspect the data from this research project. The data obtained from you will be combined with data from others in
48 the publication. The published results will not include your name or any other information that could personally identify you in any way. Volunteering to Be Part of this Research Study If you have read this form and have decided to participate in this project, please understand your participation is voluntary a nd you have the right to withdraw your consent or discontinue particip ation at any time without pena lty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. Questions and Contacts If you have any questions about this research study, contact Krisztin a Schlessel via e-mail at Krisztina.Schlessel@ncf.edu. If you have questions about your rights as a person who is taking part in a research study, you may contact the Human Prot ections Administrator of New College of Florida at (941) 487-4649 or by email at firstname.lastname@example.org. Consent to Take Part in This Research Study By proceeding with the study, you agree that: You have fully read this informed consent form describing this research project. You have had the opportunity to question the person in charge of this research and have received satisfactory answers. You understand that you are be ing asked to participate in research. You understand the risks and benefits, and you freely give your consent to participate in the research project outlined in this form, under th e conditions indicated in it.
49 Questionnaires Please read the following statements and indicate the degree to which you agree or disagree with them. 1. When people are depressed, they feel like they are in a daze much of the time. 1 2 3 4 5 Strongly disagree Strongly agree 2. When people are depressed, they ha ve a hard time getting anything done. 1 2 3 4 5 Strongly disagree Strongly agree 3. When people are depressed, they feel totally drained of energy. 1 2 3 4 5 Strongly disagree Strongly agree 4. When people are depressed, they don't ha ve the patience for everyday tasks. 1 2 3 4 5 Strongly disagree Strongly agree 5. When people are depressed, ge tting small things done come s to feel more important than they really are. 1 2 3 4 5 Strongly disagree Strongly agree 6. When people are depressed, they find themse lves thinking -They better not plan things too far in advance because they could get depressed. 1 2 3 4 5 Strongly disagree Strongly agree 7. When people are depressed, they worry about having a job or responsibility that they couldn't do if they became depressed. 1 2 3 4 5 Strongly disagree Strongly agree
50 8. When people are depressed, they let the possibility of getting depressed limit the things they try to do. 1 2 3 4 5 Strongly disagree Strongly agree 9. When people are depressed, they feel fr ightened about getting depressed again. 1 2 3 4 5 Strongly disagree Strongly agree 10. When people are depressed, having a "bad day" leaves them wo rrying if they are getting depressed. 1 2 3 4 5 Strongly disagree Strongly agree 11. When people are depressed, they worry that they'll always be at risk for depression. 1 2 3 4 5 Strongly disagree Strongly agree 12. When people are depressed, there are time s that they worry about others being concerned about how down they feel. 1 2 3 4 5 Strongly disagree Strongly agree 13. When people are depressed, they worry that their being down de presses other people. 1 2 3 4 5 Strongly disagree Strongly agree 14. When people are depressed, they are afraid of other people feeling that they have to take care of them. 1 2 3 4 5 Strongly disagree Strongly agree 15. When people are depressed, th ey are afraid of other peop le feeling that they are "dragging them down." 1 2 3 4 5 Strongly disagree Strongly agree
51 16. When people are depressed, they are afra id of their moods turning people off. 1 2 3 4 5 Strongly disagree Strongly agree 17. When people are depressed, they find that th ey have a lighter at titude about things than they used to. 1 2 3 4 5 Strongly disagree Strongly agree 18. When people are depressed, when things go wrong they take them less seriously than they used to. 1 2 3 4 5 Strongly disagree Strongly agree 19. When people are depressed, they find they are more accepting of others than they used to be. 1 2 3 4 5 Strongly disagree Strongly agree 20. When people are depressed, th ey feel stronger in some ways than they did before. 1 2 3 4 5 Strongly disagree Strongly agree 21. When people are depressed, they have to wo rk hard not to let themselves get worn down. 1 2 3 4 5 Strongly disagree Strongly agree 22. When people are depressed, th ey believe that they can tr igger a serious depression if they let themselves get worn down. 1 2 3 4 5 Strongly disagree Strongly agree 23. When people are depressed, they have a sense of being a fragile person. 1 2 3 4 5 Strongly disagree Strongly agree
52 24. When people are depressed, if they are not careful, they'll get th emselves depressed. 1 2 3 4 5 Strongly disagree Strongly agree 25. When people are depressed, if they don't wo rk at it, they'll become discouraged and hopeless. 1 2 3 4 5 Strongly disagree Strongly agree 26. When people are depressed, if others are around them long enough, they will get driven off by their mood swings. 1 2 3 4 5 Strongly disagree Strongly agree 27. When people are depressed, they worry about others being able to "hang in there" with them over the long-term. 1 2 3 4 5 Strongly disagree Strongly agree 28. When people are depressed, th ey are afraid of being in relationships because not handling them well could make them depressed. 1 2 3 4 5 Strongly disagree Strongly agree 29. When people are depressed, they worry a bout whether someone could stand to be around them all the time. 1 2 3 4 5 Strongly disagree Strongly agree 30. When people are depressed, th ey are afraid that if othe rs really get to know them, they will see them as fragile and vulnerable. 1 2 3 4 5 Strongly disagree Strongly agree 31. When people are depressed, they feel that having a long-term relationship is more of an obligation than they could handle. 1 2 3 4 5 Strongly disagree Strongly agree
53 32. It doesn't seem like other people really und erstand what it feels like to be depressed. 1 2 3 4 5 Strongly disagree Strongly agree 33. People are afraid of being seen as mentally ill. 1 2 3 4 5 Strongly disagree Strongly agree 34. People don't seem to listen to a persons opinion about things since that person had depression. 1 2 3 4 5 Strongly disagree Strongly agree
54 Please read the following paragraph and answer the questions below. Casey has a college education. For the past year, Casey has been feeling really down. Casey wakes up in the morning with a flat, he avy feeling that stic ks all day long. Casey isnt enjoying things as usual. In fact, nothing gives pleasure. Even when good things happen, they dont seem to make Casey ha ppy. Casey pushes on through the days, but it is really hard. Casey finds it hard to c oncentrate on anything. And even though Casey feels tired, when night comes, Casey cant go to sleep. Casey feels pretty worthless, and very discouraged. Casey's family has noticed that Casey hasnt been the same for about the last year and that Casey has pulled away from them. Casey just doesnt feel like talking. 1. How willing would you be to move next door to Casey? 1 2 3 4 5 Very unwilling Very willing 2. How willing would you be to make friends with Casey? 1 2 3 4 5 Very unwilling Very willing 3. How willing would you be to spend an evening socializing with Casey? 1 2 3 4 5 Very unwilling Very willing 4. How willing would you be to start wo rking closely with Casey on a job? 1 2 3 4 5 Very unwilling Very willing 5. How willing would you be to have a group home for people like Casey opened up in your neighborhood? 1 2 3 4 5 Very unwilling Very willing 6. How willing would you be to have Casey marry into your family? 1 2 3 4 5 Very unwilling Very willing
55 7. How likely is it that Casey would do something violent toward other people? 1 2 3 4 5 Very unlikely Very likely 8. How likely is it that Casey would inflict self-injury? 1 2 3 4 5 Very unlikely Very likely 9. How dangerous do you think Casey is? 1 2 3 4 5 Not at all Extremely dangerous dangerous 10. How likely is it that Casey is experiencing a mental illness? 1 2 3 4 5 Very unlikely Very likely
56 1. You just answered few questions about a character named Casey. In your opinion, what is the sex of this character? Male Female
57 Please read carefully the following 21 groups of statements and pick out the one statement in each group that best describes th e way that you have been feeling during the past two weeks, including today. If several st atements in the group seem to apply equally well, choose the highest number for that group. 1. Sadness 0 I do not feel sad 1 I feel sad much of the time 2 I am sad all the time 3 I am so sad or unhappy that I cant stand it 2. Pessimism 0 I am not discouraged about my future 1 I feel more discouraged about my future that I used to be 2 I do not expect things to work out for me 3 I feel my future is hopeless and will only get worse 3. Past failures 0 I do not feel like a failure 1 I have failed more than I should have 2 As I look back, I see a lot of failures 3 I feel I am a total failure as a person 4. Loss of pleasure 0 I get as much pleasure as I ever did from the things I enjoy 1 I dont enjoy things as much as I used to 2 I get very little pleasure from the things I used to enjoy 3 I cant get any pleasure from the things I used to enjoy 5. Guilty feelings 0 I dont feel particularly guilty 1 I feel guilty over many things I ha ve done or should have done 2 I feel quite guilty most of the time 3 I feel guilty all of the time 6. Punishment feelings 0 I dont feel I am being punished 1 I feel I may be punished 2 I expect to be punished 3 I feel I am being punished 7. Self-dislike 0 I feel the same about myself as ever 1 I have lost conf idence in myself 2 I am disappointed in myself 3 I dislike myself
58 8. Self-criticism 0 I dont criticize or blame myself more than usual 1 I am more critical of my self than I used to be 2 I criticize myself for all of my faults 3 I blame myself for everything bad that happens 9. Suicidal thoughts or wishes 0 I dont have any thoughts of killing myself 1 I have thoughts of killing myself but I would not carry them out 2 I would like to kill myself 3 I would kill myself if I had the chance 10. Crying 0 I dont cry anymore than I used to 1 I cry more than I used to 2 I cry over every little thing 3 I feel like crying, but I cant 11. Agitation 0 I am no more restless or wound up than usual 1 I feel more restless or wound up than usual 2 I am so restless or agitated that its hard to stay still 3 I am so restless or agitated that I have to keep moving or doing something 12. Loss of interest 0 I have not lost interest in other people or activities 1 I am less interested in other people or things than before 2 I have lost most of my intere st in other people or things 3 Its hard to get interested in anything 13. Indecisiveness 0 I make decisions about as well as ever 1 I find it more difficult to make decisions than usual 2 I have much greater difficulty in making decisions than I used to 3 I have trouble making any decisions 14. Worthlessness 0 I do not feel I am worthless 1 I dont consider myself as worthwhi le and useful as I used to be 2 I feel more worthless as compared to other people 3 I feel utterly worthless
59 15. Loss of energy 0 I have as much energy as ever 1 I have less energy than I used to have 2 I dont have enough energy to do very much 3 I dont have enough energy to do anything 16. Changes in sleeping pattern 0 I have not experienced any ch ange in my sleeping pattern 1a I sleep somewhat more than usual 1b I sleep somewhat less than usual 2a I sleep a lot more than usual 2b I sleep a lot less than usual 3a I sleep most of the day 3b I wake up 1-2 hours early and cant get back to sleep 17. Irritability 0 I am no more irritable than usual 1 I am more irritable than usual 2 I am much more irritable than usual 3 I am irritable all the time 18. Changes in appetite I have not experienced any change in my appetite 1a My appetite is somewhat less that usual 1b My appetite is somewh at greater than usual 2a My appetite is much less than usual 2b My appetite is much greater than usual 3a I have no appetite at all 3b I crave food all the time 19. Concentration difficulty 0 I can concentrate as well as ever 1 I cant concentrate as well as usual 2 Its hard to keep my mind on anything for very long 3 I find I cant concentrate on anything 20. Tiredness or fatigue 0 I am no more tired or fatigued than usual 1 I get more tired or fatigued more easily than usual 2 I am too tired or fatigued to do a lot of the things I used to do 3 I am too tired or fatigued to do most of the things I used to do
60 21. Loss of interest in sex 0 I have not noticed any recent change in my interest in sex 1 I am less interested in sex than I used to be 2 I am much less interested in sex now 3 I have lost intere st in sex completely
61 Was there a period in your life, lasting at least two weeks, when you felt very sad? If no, please skip this page and click Next If yes, please read each statement and d ecide how much of the time the statement describes how you felt during that period. 1. I felt down-hearted and blue 1 2 3 4 A little of the time Some of the time Good part of th e time Most of the time 2. Morning was when I felt the best 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 3. I had crying spells or felt like it 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 4. I had trouble sleeping at night 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 5. I ate as much as I used to 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 6. I still enjoyed sex 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time
62 7. I noticed that I was losing weight 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 8. I had trouble with constipation 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 9. My heart beat faster than usual 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 10. I got tired for no reason 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 11. My mind was as clear as it used to be 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 12. I found it easy to do the things I used to 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 13. I was restless and couldnt keep still 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 14. I felt hopeful about the future 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time
63 15. I was more irritable than usual 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 16. I found it easy to make decisions 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 17. I felt that I was useful and needed 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 18. My life was pretty full 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 19. I felt that others would be better off if I were dead 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time 20. I still enjoyed the th ings I used to do 1 2 3 4 A little of the time Some of the time G ood part of the time Most of the time
64 Do you think you are currently experiencing depression? Yes No Unsure Are you currently taking any prescrip tion medication for depression? Yes No Are you currently seeking counseling for depression? Yes No Have you in the past experienced depression? Yes No Unsure Have you ever taken prescripti on medication for depression? Yes No Have you ever sought counseling for depression? Yes No Do you know anybody who is/was experiencing depression? Yes No Unsure Is/was that person taking prescrip tion medication for depression? Yes No Unsure N/A Is/was that person seeking counseling for depression? Yes No Unsure N/A What is/was your relationship to this pers on or persons? Please choose all that apply. Spouse Sibling Parent Friend Coworker Other_____________
65 Which of the following variable(s) do you thi nk is/are responsible for depression? If you think there is more than one, please choose them all. Genetic Environmental fact ors (i.e. stress) Mental/personal weakness Chemical imbalance Other_______________ What is your sex? Male Female What is your ethnicity? Caucasian/White African American Hispanic Asian Other__________ How old are you? _________ What is the highest level of education you completed? High School AA/AS Some College Currently in college BA/BS Some graduate school MA/MS MD/JD/PhD
66 Thank you very much for your participation! PLEASE CLICK ON THE 'DONE' BU TTON BELOW TO SUBMIT YOUR RESPONSE If you would like to know the final results of the study, or if you have any questions or comments, please e-mail me at Krisztina.Schlessel@ncf.edu. In case you are interested in learning about depression, here are some basic facts. Prevalence: 5-8% of the US adult populat ion suffers from depression People of both sexes, all ages, and all et hnicities may experience depression; however, the experience is not the same for everyone. Symptoms: Persistently sad or irritable mood Pronounced changes in sleep, appetite, and energy Difficulty thinking, concentrating, and remembering Physical slowing or agitation Lack of interest in or pleasure fr om activities that were once enjoyed Feelings of guilt, worthlessness, hopelessness, and emptiness Recurrent thoughts of death or suicide Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain Causes: No single cause Psychological, biological, and environmen tal factors all seem to play a role Treatment: Medication Psychotherapy Electroconvulsive therapy
67 This information was retrieved from http://www.nami.org/Template.cfm?section= by_illness&template=/contentmanagement/ contentdisplay.cfm&contentid=7725 and http://www.nimh.nih.gov/health /publications/dep ression/complete-publication.shtml For more information, pleas e visit thes e websites. If you became distressed as the result of the study, you can call The National Hopeline Network at 1-800-784-2433 or the National Suicide Prevention Lifeline at 1-800-2738255.
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