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Actions that young people can take to prevent depression, anxiety and psychosis: Beliefs of health professionals and young people
Journal of Affective Disorders 126 (2010) 278–281
Contents lists available at ScienceDirect
Journal of Affective Disorders j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j a d
Brief report
Actions that young people can take to prevent depression, anxiety and psychosis: Beliefs of health professionals and young people Anthony F. Jorm ⁎, Amy J. Morgan, Annemarie Wright Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia
a r t i c l e
i n f o
Article history: Received 5 February 2010 Received in revised form 17 March 2010 Accepted 17 March 2010 Available online 13 April 2010 Keywords: Prevention Public beliefs
a b s t r a c t Background: Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance. Methods: Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12–25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Results: Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety. Limitations: The surveys assessed beliefs, but not actual use of preventive strategies. Conclusions: Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety. © 2010 Elsevier B.V. All rights reserved.
1. Introduction Mental health literacy has been defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (Jorm et al., 1997). While there has been research in many countries to examine public beliefs about recognition and management of depression and other mental disorders (e.g. Lauber et al., 2003; Angermeyer et al., 2005; Angermeyer and Matschinger, 2005; Goldney et al., 2005; Jorm et al., 2005; Lauber et al., 2005; Wright et al., 2005; Schomerus et al., 2006; Wang et al., 2007; Dahlberg et al., 2008; Furnham, 2009; Kermode et al., 2009), knowl⁎ Corresponding author. Tel.: + 61 3 93423747; fax: + 61 3 93423745. E-mail address: [email protected] (A.F. Jorm). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.03.011
edge and beliefs about prevention have been relatively neglected. The only study to date on the topic involved a national survey of the German public aged 14 years or over (Schomerus et al., 2008). This survey asked about the prevention of depression and found that 75% of respondents believed that it was possible to take preventive action and 58% of this group would be willing to pay to take part in a prevention program. When presented with a list of potential preventive strategies, the ones rated as helpful by N80% of respondents were: stable friendships, enjoyable leisure activities, family support, thinking positively, disclosing oneself to a confidante, activities that increase self-confidence, meaningful activities, getting enough sleep, being constantly active, abstaining from drugs, doing exercise, and relaxing while listening to music.
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
In view of the limited research on this topic, we included questions about prevention as part of an Australian national survey of youth mental health literacy. In order to compare public with professional views, we also asked the same questions in postal surveys of GPs, psychiatrists, psychologists and mental health nurses. The preventive actions included, based on evidence from prospective or intervention studies, were: support from family and friends (Van Voorhees et al., 2008), physical activity (Penedo and Dahn, 2005), relaxing activities (Morgan and Jorm, 2008), avoiding stressors (Garber, 2006; Van Voorhees et al., 2008), avoiding substances (Degenhardt et al., 2003; Fergusson et al., 2009), and having a religious or spiritual belief (Van Voorhees et al., 2008). A theoretically implausible strategy (avoiding sugary foods) was also included in case respondents developed a response set of agreeing with all items.
279
Having a religious or spiritual belief”. The response options recorded by the interviewer were: yes, no, depends, don't know, refused. 2.4. Professional surveys Professionals received the same randomly assigned vignettes, but only male versions. The items in the professional questionnaires were: “The next few questions are about things John might do to reduce his risk of developing the problem in the first place. If a young person did the following, do you think it would reduce their risk of developing a problem like John's?” The items were identical with those given to young people, but the rating options on the questionnaire were: helpful, harmful, neither, depends, don't know. These options were used for consistency with the rest of the questionnaire.
2. Methods 2.5. Statistical analysis 2.1. Youth sample The details of this sample have been previously published (Jorm and Wright, 2007; Jorm et al., 2007), so are only described briefly here. In 2006, a telephone survey was carried out with a national sample of young Australians aged 12–25 years. Interviews were completed for 3746 young people out of 6087 who could be contacted and were confirmed as in scope, giving a response rate of 61.5%. 2.2. Professional samples Details of the professional samples have also been published (Jorm et al., 2008a,b). Briefly, questionnaires were posted to all 1710 psychiatrists and a random sample of 2000 GPs listed with the national health insurance scheme, all 1628 Australian members of the Australian and New Zealand College of Mental Health Nurses, and a random sample of 2000 psychologists registered in the state of Victoria. Number of completed surveys and response rates were: GPs 470, 24.0%; psychiatrists: 591, 35.4%; mental health nurses: 522, 32.3%; and psychologists 736, 40.3%. 2.3. Youth survey The survey was based on a vignette of a young person with a mental disorder (Jorm et al., 2007). Participants were randomly given a vignette with depression, depression with alcohol misuse, social phobia or psychosis. Vignettes were matched to the gender (John or Jenny) and age group of the participant (a 15 year old in the vignette for those 12–17 years and a 21 year old for those 18–25 years). The youth survey contained the following section on prevention beliefs: “The next few questions are about things John/Jenny might do to reduce his/her risk of developing the problem in the first place. If a young person did the following, do you think it would reduce their risk of developing a problem like John's/Jenny's? This is just a “yes” or “no” question. Keeping physically active. Avoiding situations that might be stressful. Keeping regular contact with friends. Keeping regular contact with family. Avoiding sugary foods. Not using marijuana. Never drinking alcohol in excess. Making regular time for relaxing activities.
Percentages endorsing a preventive strategy were calculated for each vignette for both the professionals and young people. Because of the large samples, even quite small differences in ratings can be statistically significant. Therefore comparisons of young people and the average across the four professions were made in terms of effect sizes, with medium and large effect sizes noted. Following Rosenthal (1996), a medium effect size was defined as a difference in percentages of at least 18 points and a large effect size as a difference of at least 30 points. 2.6. Ethics approval Approval was given by the University of Melbourne Human Research Ethics Committee. 3. Results Table 1 shows the percentage of young people and professionals rating each strategy as likely to be helpful. The preventive strategies endorsed by N80% of young people for all disorders were: keeping physically active, keeping regular contact with family and friends, avoiding substances, and making time for relaxing activities. The table also indicates where there were medium or large differences between young people and professionals. Across all disorders, the professionals were less likely to endorse the value of avoiding stressful situations and avoiding sugary foods. A more detailed examination of the professionals' beliefs about avoiding stressful situations showed that, for depression, the modal rating was “depends”, while for social phobia it was “harmful”, and for psychosis it was “helpful” (although this option was endorsed by b50%). For young people, endorsement of avoiding stressful situations tended to decline with age, but even in the older group there was still a major gap between professionals' and young people's beliefs. The professionals were also less likely to endorse a range of strategies for preventing psychosis: keeping physically active, keeping regular contact with family and friends,
280
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
Table 1 Percentages of professionals and young people believing in preventive strategies for various disorders. Group
Depression 15 years
Depression 21 years
Depression and alcohol 15 years
Depression and alcohol 21 years
Social phobia 15 years
Social phobia 21 years
Psychosis 15 years
Psychosis 21 years
90 94
89 94
92 93
82 90
74 a 92 a
63 b 94 b
58 b 91 b
Avoiding situations that might be stressful 29 b Professionals 28 b Youth 85 b 79 b
31 b 85 b
33 b 78 b
10 b 74 b
9b 56 b
40 b 86 b
44 a 71 a
Keeping regular contact with friends Professionals 92 95 Youth 97 97
94 96
94 97
93 98
93 99
73 a 98 a
72 a 98 a
Keeping regular contact with family Professionals 85 82 Youth 98 98
86 98
82 96
90 98
90 98
72 a 98 a
71 a 96 a
Not using marijuana Professionals 95 Youth 95
94 92
96 93
93 93
89 91
86 89
96 95
95 91
Never drinking alcohol in excess Professionals 89 89 Youth 92 87
90 91
92 89
86 89
77 82
84 89
76 85
Making regular time for relaxing activities Professionals 96 95 Youth 97 98
96 98
98 98
93 96
91 98
76 a 96 a
77 a 98 a
Having a religious or spiritual belief Professionals 44 50 Youth 55 55
55 53
48 59
37 55
39 52
26 b 60 b
29 a 51 a
Avoiding sugary foods c Professionals 17 b Youth 52 b
15 b 46 b
20 b 50 b
9b 39 b
9b 41 b
8b 41 b
8a 35 a
Keeping physically active Professionals 88 Youth 92
a b c
13 b 48 b
Difference between professionals and youth is at least a medium effect size. Difference between professionals and youth is at least a large effect size. This item was theoretically implausible as a prevention strategy, but was included in case respondents developed a response set of agreeing with all items.
making regular time for relaxing activities, and having a spiritual or religious belief. 4. Discussion While the list of potential preventive strategies presented to respondents in the present survey is much smaller than the one used by Schomerus et al. (2008) for depression, all of the strategies endorsed here were also highly endorsed in the German survey. However, the strategies were seen as broadly preventive across all the mental disorders considered here, not just for depression. The strategies that were highly endorsed by young people were generally also endorsed by health professionals and are consistent with the available evidence. The one exception was avoiding situations that might be stressful, which was endorsed as likely to be helpful by around three-quarters of young people, but by only a minority of health professionals. In fact, for social phobia, the most common response (held by N40%) was to see avoidance as harmful. The survey did not collect data on the reasons for this rejection by professionals. However, there is evidence in the literature that young people can benefit from mastering stressful
situations (Andrews et al., 1993) and that avoidance of unpleasant internal experiences can contribute to the development of anxiety disorders (Berman et al., 2010). Another difference between young people and professionals is that the young people saw the strategies as broadly applicable across a range of disorders, whereas the professionals were less optimistic that the strategies would be helpful in preventing psychosis. The strategy that the professionals most strongly supported for psychosis was not using marijuana, which is consistent with the available evidence (D'Souza et al., 2009). The present findings have some limitations: they are based on questions about beliefs, not on actual preventive behaviors, and the brief response format did not allow participants to give reasons for their responses. The findings are consistent with those of Schomerus et al. (2008) in showing that the public are open to the possibility of prevention, including at an age when there is high risk of first onset. These findings encourage the development of health promotion programs about what young people can do to reduce their risk. Messages promoted at this age are potentially relevant across the lifespan. One message that may be important to convey is that dealing with stressful
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
situations by avoidance may not be beneficial for people with anxiety problems. Role of funding source The funding sources had no role in the study design, collection, analysis or interpretation of data, in the writing of the report, and in the decision to submit the paper for publication. Conflict of interest All authors declare that they have no conflicts of interest.
Acknowledgements Claire Kelly, Robyn Langlands, Betty Kitchener and Len Kanowski had input into the survey content. Darren Pennay and Graham Challice provided advice on the survey methodology. The Australian Government Department of Health and Ageing and the Australian and New Zealand College of Mental Health Nurses assisted with the sampling of professionals. Funding was provided by the National Health and Medical Research Council, the Colonial Foundation and “beyondblue: the national depression initiative”. References Andrews, G., Page, A.C., Neilson, M., 1993. Sending your teenagers away — controlled stress decreases neurotic vulnerability. Arch. Gen. Psychiatry 50, 585–589. Angermeyer, M.C., Matschinger, H., 2005. Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001. Acta Psychiatr. Scand. 111, 68–73. Angermeyer, M.C., Breier, P., Dietrich, S., Kenzine, D., Matschinger, H., 2005. Public attitudes toward psychiatric treatment. Soc. Psychiatry Psychiatr. Epidemiol. 40, 855–864. Berman, N.C., Wheaton, M.G., McGrath, P., Abramowitz, J.S., 2010. Predicting anxiety: the role of experiential avoidance and anxiety sensitivity. J. Anxiety Disord. 24, 109–113. Dahlberg, K.M., Waern, M., Runeson, B., 2008. Mental health literacy and attitudes in a Swedish community sample — investigating the role of personal experience of mental health care. BMC Public Health 8, 8. Degenhardt, L., Hall, W., Lynskey, M., 2003. Exploring the association between cannabis use and depression. Addiction 98, 1493–1504. D'Souza, D.C., Sewell, R.A., Ranganathan, M., 2009. Cannabis and psychosis/ schizophrenia: human studies. Eur. Arch. Psychiatry Clin. Neurosci. 259, 413–431. Fergusson, D.M., Boden, J.M., Horwood, L.J., 2009. Tests of causal links between alcohol abuse or dependence and major depression. Arch. Gen. Psychiatry 66, 260–266. Furnham, A., 2009. Psychiatric and psychotherapeutic literacy: attitudes to, and knowledge of, psychotherapy. Int. J. Soc. Psychiatry 55, 525–537. Garber, J., 2006. Depression in children and adolescents — linking risk research and prevention. Am. J. Prev. Med. 31, S104–S125.
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Goldney, R.D., Fisher, L.J., Dal Grande, E., Taylor, A.W., 2005. Changes in mental health literacy about depression: South Australia, 1998 to 2004. Med. J. Aust. 183, 134–137. Jorm, A.F., Wright, A., 2007. Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Aust. NZ J. Psychiatry 41, 656–666. Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B., Pollitt, P., 1997. “Mental health literacy”: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med. J. Aust. 166, 182–186. Jorm, A.F., Nakane, Y., Christensen, H., Yoshioka, K., Griffiths, K.M., Wata, Y., 2005. Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan. BMC Med. 3, 12. Jorm, A.F., Wright, A., Morgan, A.J., 2007. Beliefs about appropriate first aid for young people with mental disorders: findings from an Australian national survey of youth and parents. Early Interv. Psychiatry 1, 61–70. Jorm, A.F., Morgan, A.J., Wright, A., 2008a. A comparison of clinician, youth, and parent beliefs about helpfulness of interventions for early psychosis. Psychiatr. Serv. 59, 1115–1120. Jorm, A.F., Morgan, A.J., Wright, A., 2008b. Interventions that are helpful for depression and anxiety in young people: a comparison of clinicians' beliefs with those of youth and their parents. J. Affect. Disord. 111, 227–234. Kermode, M., Bowen, K., Arole, S., Joag, K., Jorm, A.F., 2009. Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Public Health 123, 476–483. Lauber, C., Nordt, C., Falcato, L., Rossler, W., 2003. Do people recognise mental illness? Factors influencing mental health literacy. Eur. Arch. Psychiatry Clin. Neurosci. 253, 248–251. Lauber, C., Nordt, C., Rossler, W., 2005. Recommendations of mental health professionals and the general population on how to treat mental disorders. Soc. Psychiatry Psychiatr. Epidemiol. 40, 835–843. Morgan, A.J., Jorm, A.F., 2008. Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Ann. Gen. Psychiatry 7, 13. Penedo, F.J., Dahn, J.R., 2005. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr. Opin. Psychiatry 18, 189–193. Rosenthal, J.A., 1996. Qualitative descriptors of strength of association and effect size. J. Soc. Serv. Res. 21, 37–59. Schomerus, G., Borsche, J., Matschinger, H., Angermeyer, M.C., 2006. Public knowledge about causes and treatment for schizophrenia — a representative population study. J. Nerv. Ment. Dis. 194, 622–624. Schomerus, G., Angermeyer, M.C., Matschinger, H., Riedel-Heller, S.G., 2008. Public attitudes towards prevention of depression. J. Affect. Disord. 106, 257–263. Van Voorhees, B.W., Paunesku, D., Kuwabara, S.A., Basu, A., Gollan, J., Hankin, B.L., Melkonian, S., Reinecke, M., 2008. Protective and vulnerability factors predicting new-onset depressive episode in a representative of US adolescents. J. Adolesc. Health 42, 605–616. Wang, J.L., Adair, C., Fick, G., Lai, D., Evans, B., Perry, B.W., Jorm, A., Addington, D., 2007. Depression literacy in Alberta: Findings from a general population sample. Can. J. Psychiatry 52, 442–449. Wright, A., Harris, M.G., Wiggers, J.H., Jorm, A.F., Cotton, S.M., Harrigan, S.M., Hurworth, R.E., McGorry, P.D., 2005. Recognition of depression and psychosis by young Australians and their beliefs about treatment. Med. J. Aust. 183, 18–23.
Contents lists available at ScienceDirect
Journal of Affective Disorders j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j a d
Brief report
Actions that young people can take to prevent depression, anxiety and psychosis: Beliefs of health professionals and young people Anthony F. Jorm ⁎, Amy J. Morgan, Annemarie Wright Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia
a r t i c l e
i n f o
Article history: Received 5 February 2010 Received in revised form 17 March 2010 Accepted 17 March 2010 Available online 13 April 2010 Keywords: Prevention Public beliefs
a b s t r a c t Background: Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance. Methods: Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12–25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Results: Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety. Limitations: The surveys assessed beliefs, but not actual use of preventive strategies. Conclusions: Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety. © 2010 Elsevier B.V. All rights reserved.
1. Introduction Mental health literacy has been defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (Jorm et al., 1997). While there has been research in many countries to examine public beliefs about recognition and management of depression and other mental disorders (e.g. Lauber et al., 2003; Angermeyer et al., 2005; Angermeyer and Matschinger, 2005; Goldney et al., 2005; Jorm et al., 2005; Lauber et al., 2005; Wright et al., 2005; Schomerus et al., 2006; Wang et al., 2007; Dahlberg et al., 2008; Furnham, 2009; Kermode et al., 2009), knowl⁎ Corresponding author. Tel.: + 61 3 93423747; fax: + 61 3 93423745. E-mail address: [email protected] (A.F. Jorm). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.03.011
edge and beliefs about prevention have been relatively neglected. The only study to date on the topic involved a national survey of the German public aged 14 years or over (Schomerus et al., 2008). This survey asked about the prevention of depression and found that 75% of respondents believed that it was possible to take preventive action and 58% of this group would be willing to pay to take part in a prevention program. When presented with a list of potential preventive strategies, the ones rated as helpful by N80% of respondents were: stable friendships, enjoyable leisure activities, family support, thinking positively, disclosing oneself to a confidante, activities that increase self-confidence, meaningful activities, getting enough sleep, being constantly active, abstaining from drugs, doing exercise, and relaxing while listening to music.
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
In view of the limited research on this topic, we included questions about prevention as part of an Australian national survey of youth mental health literacy. In order to compare public with professional views, we also asked the same questions in postal surveys of GPs, psychiatrists, psychologists and mental health nurses. The preventive actions included, based on evidence from prospective or intervention studies, were: support from family and friends (Van Voorhees et al., 2008), physical activity (Penedo and Dahn, 2005), relaxing activities (Morgan and Jorm, 2008), avoiding stressors (Garber, 2006; Van Voorhees et al., 2008), avoiding substances (Degenhardt et al., 2003; Fergusson et al., 2009), and having a religious or spiritual belief (Van Voorhees et al., 2008). A theoretically implausible strategy (avoiding sugary foods) was also included in case respondents developed a response set of agreeing with all items.
279
Having a religious or spiritual belief”. The response options recorded by the interviewer were: yes, no, depends, don't know, refused. 2.4. Professional surveys Professionals received the same randomly assigned vignettes, but only male versions. The items in the professional questionnaires were: “The next few questions are about things John might do to reduce his risk of developing the problem in the first place. If a young person did the following, do you think it would reduce their risk of developing a problem like John's?” The items were identical with those given to young people, but the rating options on the questionnaire were: helpful, harmful, neither, depends, don't know. These options were used for consistency with the rest of the questionnaire.
2. Methods 2.5. Statistical analysis 2.1. Youth sample The details of this sample have been previously published (Jorm and Wright, 2007; Jorm et al., 2007), so are only described briefly here. In 2006, a telephone survey was carried out with a national sample of young Australians aged 12–25 years. Interviews were completed for 3746 young people out of 6087 who could be contacted and were confirmed as in scope, giving a response rate of 61.5%. 2.2. Professional samples Details of the professional samples have also been published (Jorm et al., 2008a,b). Briefly, questionnaires were posted to all 1710 psychiatrists and a random sample of 2000 GPs listed with the national health insurance scheme, all 1628 Australian members of the Australian and New Zealand College of Mental Health Nurses, and a random sample of 2000 psychologists registered in the state of Victoria. Number of completed surveys and response rates were: GPs 470, 24.0%; psychiatrists: 591, 35.4%; mental health nurses: 522, 32.3%; and psychologists 736, 40.3%. 2.3. Youth survey The survey was based on a vignette of a young person with a mental disorder (Jorm et al., 2007). Participants were randomly given a vignette with depression, depression with alcohol misuse, social phobia or psychosis. Vignettes were matched to the gender (John or Jenny) and age group of the participant (a 15 year old in the vignette for those 12–17 years and a 21 year old for those 18–25 years). The youth survey contained the following section on prevention beliefs: “The next few questions are about things John/Jenny might do to reduce his/her risk of developing the problem in the first place. If a young person did the following, do you think it would reduce their risk of developing a problem like John's/Jenny's? This is just a “yes” or “no” question. Keeping physically active. Avoiding situations that might be stressful. Keeping regular contact with friends. Keeping regular contact with family. Avoiding sugary foods. Not using marijuana. Never drinking alcohol in excess. Making regular time for relaxing activities.
Percentages endorsing a preventive strategy were calculated for each vignette for both the professionals and young people. Because of the large samples, even quite small differences in ratings can be statistically significant. Therefore comparisons of young people and the average across the four professions were made in terms of effect sizes, with medium and large effect sizes noted. Following Rosenthal (1996), a medium effect size was defined as a difference in percentages of at least 18 points and a large effect size as a difference of at least 30 points. 2.6. Ethics approval Approval was given by the University of Melbourne Human Research Ethics Committee. 3. Results Table 1 shows the percentage of young people and professionals rating each strategy as likely to be helpful. The preventive strategies endorsed by N80% of young people for all disorders were: keeping physically active, keeping regular contact with family and friends, avoiding substances, and making time for relaxing activities. The table also indicates where there were medium or large differences between young people and professionals. Across all disorders, the professionals were less likely to endorse the value of avoiding stressful situations and avoiding sugary foods. A more detailed examination of the professionals' beliefs about avoiding stressful situations showed that, for depression, the modal rating was “depends”, while for social phobia it was “harmful”, and for psychosis it was “helpful” (although this option was endorsed by b50%). For young people, endorsement of avoiding stressful situations tended to decline with age, but even in the older group there was still a major gap between professionals' and young people's beliefs. The professionals were also less likely to endorse a range of strategies for preventing psychosis: keeping physically active, keeping regular contact with family and friends,
280
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
Table 1 Percentages of professionals and young people believing in preventive strategies for various disorders. Group
Depression 15 years
Depression 21 years
Depression and alcohol 15 years
Depression and alcohol 21 years
Social phobia 15 years
Social phobia 21 years
Psychosis 15 years
Psychosis 21 years
90 94
89 94
92 93
82 90
74 a 92 a
63 b 94 b
58 b 91 b
Avoiding situations that might be stressful 29 b Professionals 28 b Youth 85 b 79 b
31 b 85 b
33 b 78 b
10 b 74 b
9b 56 b
40 b 86 b
44 a 71 a
Keeping regular contact with friends Professionals 92 95 Youth 97 97
94 96
94 97
93 98
93 99
73 a 98 a
72 a 98 a
Keeping regular contact with family Professionals 85 82 Youth 98 98
86 98
82 96
90 98
90 98
72 a 98 a
71 a 96 a
Not using marijuana Professionals 95 Youth 95
94 92
96 93
93 93
89 91
86 89
96 95
95 91
Never drinking alcohol in excess Professionals 89 89 Youth 92 87
90 91
92 89
86 89
77 82
84 89
76 85
Making regular time for relaxing activities Professionals 96 95 Youth 97 98
96 98
98 98
93 96
91 98
76 a 96 a
77 a 98 a
Having a religious or spiritual belief Professionals 44 50 Youth 55 55
55 53
48 59
37 55
39 52
26 b 60 b
29 a 51 a
Avoiding sugary foods c Professionals 17 b Youth 52 b
15 b 46 b
20 b 50 b
9b 39 b
9b 41 b
8b 41 b
8a 35 a
Keeping physically active Professionals 88 Youth 92
a b c
13 b 48 b
Difference between professionals and youth is at least a medium effect size. Difference between professionals and youth is at least a large effect size. This item was theoretically implausible as a prevention strategy, but was included in case respondents developed a response set of agreeing with all items.
making regular time for relaxing activities, and having a spiritual or religious belief. 4. Discussion While the list of potential preventive strategies presented to respondents in the present survey is much smaller than the one used by Schomerus et al. (2008) for depression, all of the strategies endorsed here were also highly endorsed in the German survey. However, the strategies were seen as broadly preventive across all the mental disorders considered here, not just for depression. The strategies that were highly endorsed by young people were generally also endorsed by health professionals and are consistent with the available evidence. The one exception was avoiding situations that might be stressful, which was endorsed as likely to be helpful by around three-quarters of young people, but by only a minority of health professionals. In fact, for social phobia, the most common response (held by N40%) was to see avoidance as harmful. The survey did not collect data on the reasons for this rejection by professionals. However, there is evidence in the literature that young people can benefit from mastering stressful
situations (Andrews et al., 1993) and that avoidance of unpleasant internal experiences can contribute to the development of anxiety disorders (Berman et al., 2010). Another difference between young people and professionals is that the young people saw the strategies as broadly applicable across a range of disorders, whereas the professionals were less optimistic that the strategies would be helpful in preventing psychosis. The strategy that the professionals most strongly supported for psychosis was not using marijuana, which is consistent with the available evidence (D'Souza et al., 2009). The present findings have some limitations: they are based on questions about beliefs, not on actual preventive behaviors, and the brief response format did not allow participants to give reasons for their responses. The findings are consistent with those of Schomerus et al. (2008) in showing that the public are open to the possibility of prevention, including at an age when there is high risk of first onset. These findings encourage the development of health promotion programs about what young people can do to reduce their risk. Messages promoted at this age are potentially relevant across the lifespan. One message that may be important to convey is that dealing with stressful
A.F. Jorm et al. / Journal of Affective Disorders 126 (2010) 278–281
situations by avoidance may not be beneficial for people with anxiety problems. Role of funding source The funding sources had no role in the study design, collection, analysis or interpretation of data, in the writing of the report, and in the decision to submit the paper for publication. Conflict of interest All authors declare that they have no conflicts of interest.
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