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      Effects of a Multilingual Information Website Intervention on the Levels of Depression Literacy and Depression-Related Stigma in Greek-Born and Italian-Born Immigrants Living in Australia: A Randomized Controlled Trial

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        , BSc(Hons) MClinPsych PhD 1 , 2 , , , PhD 3 , , MD MBBS FRACGP 4
      (Reviewer)
      Journal of Medical Internet Research
      Gunther Eysenbach
      Depression literacy, depression-related stigma, immigrants, Internet-based interventions, depression, randomized control trial

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          Abstract

          Background

          Little is known about the efficacy of Internet-based information interventions in increasing depression literacy or reducing depression stigma and depressive symptoms in people from non–English-speaking backgrounds.

          Objective

          Our objective was to investigate the effects of Multicultural Information on Depression Online (MIDonline), an Internet-based multilingual depression-specific information resource, on depression literacy, depression stigma, and depressive symptoms in Greek-born and Italian-born immigrants to Australia.

          Method

          In all, 202 Greek- and Italian-born immigrants aged 48 to 88 years were randomly allocated to an online depression information intervention (n =110) or a depression interview control group (n = 92). Participants allocated to the information intervention only had access to the website during the 1- to 1.5-hour intervention session. The primary outcome measures were depression literacy (depression knowledge), personal stigma (personal stigma toward people with a mental illness), perceived stigma (participants’ views about the probable attitude of the general community toward people with mental illness), and depressive symptoms. Depression literacy, personal and perceived stigma, and depressive symptoms were assessed at preassessment, postassessment, and at a 1-week follow-up assessment. The trial was undertaken at Monash University, Melbourne, Australia. Randomization and allocation to trial group were carried out using a computer-generated table.

          Results

          For depression literacy, there was a significant difference between the MIDonline and the control group with those in the MIDonline intervention displaying higher depression literacy scores postassessment (F 1,178 = 144.99, P < .001) and at the follow-up assessment (F 1,178 = 129.13, P < .001) than those in the control group. In addition, those in the MIDonline intervention showed a significantly greater decrease in mean personal stigma scores postassessment (F 1,178 = 38.75, P < .001) and at the follow-up assessment (F 1,176 = 11.08, P = .001) than those in the control group. For perceived stigma, there was no significant difference between the MIDonline intervention and the control group at postassessment (F 1,178 = 0.60, P = .44) and at the follow-up assessment (F 1,176 = 1.06, P = .30). For level of depression, there was no significant difference between the MIDonline intervention and the control group at preassessment (F 1,201 = 0.56, P = .45), postassessment (F 1,178 = 0.03, P = .86), or at the follow-up assessment, ( F 1,175 = 1.71, P = .19). Within group effect sizes for depression literacy were −1.78 (MIDonline) and −0.07 (control); for personal stigma, they were 0.83 (MIDonline) and 0.06 (control); for perceived stigma, they were 0.14 (MIDonline) and 0.16 (control); and for depressive symptoms, they were 0.10 (MIDonline) and 0.10 (control).

          Conclusions

          Current results suggested that the Internet may be a feasible and effective means for increasing depression knowledge and decreasing personal stigma in non–English-speaking immigrant populations residing in English-speaking countries. The lack of change in perceived stigma in this trial is consistent with results in other trials examining online depression stigma interventions in English-speaking groups.

          Trial Registration

          ISRCTN76460837; http://www.controlled-trials.com/ISRCTN76460837 (Archived by WebCite at http://www.webcitation.org/5xjxva4Uq)

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          Most cited references29

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          Mental health literacy. Public knowledge and beliefs about mental disorders.

          A. JORM (2000)
          Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area. A narrative review within a conceptual framework. Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved. If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.
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            Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.

            Little is known about the efficacy of educational interventions for reducing the stigma associated with depression. To investigate the effects on stigma of two internet depression sites. A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive-behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention. Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive-behavioural therapy literacy. The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.
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              "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

              To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (Centre for Global eHealth Innovation, Toronto, Canada )
                1438-8871
                Apr-Jun 2011
                19 April 2011
                : 13
                : 2
                : e34
                Affiliations
                [4] 4simpleNossal Institute for Global Health simpleThe University of Melbourne MelbourneAustralia
                [3] 3simpleDepression & Anxiety Consumer Research Unit, ehub: emental health Research & Development simpleCentre for Mental Health Research simpleThe Australian National University ACTAustralia
                [2] 2simpleSchool of Psychology & Psychiatry and School of Primary Health Care simpleMonash University MelbourneAustralia
                [1] 1simpleThe University of Melbourne simplePsychological Sciences MelbourneAustralia
                Article
                v13i2e34
                10.2196/jmir.1527
                3221382
                21504872
                bc616fab-9105-4e7e-bfd0-c8524f320610
                ©Litza A Kiropoulos, Kathleen M Griffiths, Grant Blashki. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.04.2011.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 10 March 2010
                : 02 April 2010
                : 15 February 2011
                : 21 March 2011
                Categories
                Original Paper

                Medicine
                depression literacy,depression-related stigma,immigrants,internet-based interventions,depression,randomized control trial

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