Predictors of help‐seeking behavior: Distinction between help‐seeking intentions and help‐seeking behavior

The overall goals of this research were to: (a) examine whether help‐seeking intentions, subjective needs, depressive symptoms, and social support can predict actual help‐seeking behavior; and (b) clarify the moderating effects of social support on help‐seeking behavior using a longitudinal design. University students (N = 370) completed questionnaires that measured social support, subjective needs, depressive symptoms, and help‐seeking intentions during Time1, and questionnaires that measured actual help‐seeking behavior during Time2. Only subjective needs showed a positive effect on both help‐seeking intentions and actual help‐seeking behavior. Although depressive symptoms had a negative effect on help‐seeking intentions, they had a positive effect on actual help‐seeking behavior. Moreover, social support had a positive effect on help‐seeking intentions, and moderated the influence of subjective needs on actual help‐seeking behavior. Simple slope analysis indicated that subjective needs did not facilitate help‐seeking behavior among those with low levels of social support.     

Coping and physical health outcomes: an overview

The aim of the present study was to investigate longitudinally the sensitivity of optimistic beliefs (positive outcome expectancies, efficacy expectancies, and optimistic bias) to disease-related stress (measured by disease duration, depressive symptoms, physical symptoms, physical impairment, and life-events) in Type 1 diabetes (n = 90) and multiple sclerosis (n = 90). First, we examined whether chronically ill patients were less optimistic than a healthy control group (n = 60), which showed that patients reported lower levels of optimistic bias but similar levels of the two other optimistic beliefs. Next, we analyzed the stability of the three types of optimistic beliefs across time (one year) for both disease groups, which demonstrated that optimistic bias in MS patients decreased. Finally, the impact of disease-related stressors on optimistic beliefs during a one-year period was determined, showing that all three optimistic beliefs decreased when patients reported depressive symptoms. Together, these findings show that positive outcome expectancies and efficacy expectancies were unaffected by being ill and fairly stable unless patients reported depressive symptoms while optimistic bias appeared to decrease as a result of being ill. Results are discussed in terms of the role of control and depression in optimistic bias.     

Depressive symptom manifestation and help‐seeking among Chinese college students in Taiwan

One longstanding hypothesis in the research of depression among Chinese populations is that they tend to express depressive symptoms in somatic terms, which, in turn, prevent them from seeking assistance from mental health services. This study aimed to examine the manifestation of depressive symptoms and its relationship to help‐seeking attitudes among Chinese college students. The Chinese Beck Depression Inventory‐II (BDI‐II; Beck, Steer, & Brown, 1996 ) and the Attitudes Toward Seeking Professional Psychological Help: Shortened Form (ATSPPH‐SF; Fischer & Farina, 1995 ) were administered to 1039 Chinese college students in a private university in Taiwan. Factor ratio scores analyses revealed that Chinese college students generally emphasized somatic complaints compared to cognitive‐affective complaints in expressing depressive symptoms. Probably‐depressed Chinese students (BDI‐II scores?16), however, placed significantly less emphasis on somatic symptoms than did nondepressed students. Additionally, multiple regression analyses showed that while Chinese students with elevated BDI‐II scores were less likely to seek professional psychological help, neither somatic nor cognitive‐affective symptoms were correlated with their attitudes toward seeking and avoiding professional psychological help. These findings seem to run counter to the common assumption that Chinese people tend to express depression in somatic terms and that somatic complaints help to explain their reluctance to seek professional psychological assistance. The current results suggest that Chinese students with elevated depressive symptoms readily acknowledged and expressed cognitive‐affective symptoms of depression and they were likely to distance themselves from professional psychological help. However, somatic symptoms did not explain their reluctance to utilize mental health services.     

Does Working Memory Mediate the Link Between Dispositional Optimism and Depressive Symptoms?

The aim of this study was to explore the interplay between working memory (WM), dispositional optimism, and depressive symptoms in participants across a wide age band (16–79 years) in a nonclinical sample using a computer‐based interface. We administered tests of visuospatial WM (processing and recall), dispositional optimism (optimism and pessimism), and self‐reported depression. There were two main findings: 1) both optimism and pessimism were independent predictors of a self‐rated depression score; 2) WM recall scores predicted both optimism and pessimism. The findings suggest the following pattern: according to the negativity bias, a pessimistic outlook presents as a strong stimulus for attentional allocation, which results in depression. However, a strong WM can counter this pattern, as individuals can allocate attention to the weaker stimulus, which is an optimistic outlook. Copyright © 2016 John Wiley & Sons, Ltd.     

Depressive‐symptom onset during toddlerhood in a sample of depressed preschoolers: Implications for future investigations of major depressive disorder in toddlers

This study investigated the occurrence of depressive symptoms prior to age 36 months as retrospectively reported by parents of preschoolers with clinical depression. The study provides some of the first empirical data on the manifestations of depressive symptoms during the toddler period, advancing existing theoretical and case‐report literature. A sample of 301 (depressed, disruptive, and healthy) children between the ages of 3.0 and 6.0 years were screened and oversampled for depressive symptoms from community sites. Primary caregivers (parents) were interviewed about their child's symptoms of depression (as well as other symptoms of mental disorders and developmental parameters), and age of first onset of depressive symptoms was ascertained. Findings suggest that clinical‐level symptoms of depression may arise as early as age 24 months. The domain of negative self‐concept during the toddler period evidenced by self‐deprecation and difficulty making choices emerged as the two strongest variables predictive of preschool depression. Our results suggest that prospective empirical studies of depressive symptoms in children younger than 3 years of age should now be undertaken.     

Depressive symptoms are associated with unrealistic negative predictions of future life events

This study examined the relationship between depressive symptoms and bias in the prediction of future life events. Responding to internet announcements, 153 participants varying widely in self-reported depression symptom severity estimated the probability of 40 events occurring over the succeeding 30 days. After the 30-day period, participants reported which events occurred. Optimistic/pessimistic biases were related to level of depressive symptoms. A non-significant optimistic bias characterized participants with low depressive symptoms whereas a significant pessimistic bias characterized participants with high depressive symptoms. Those reporting mild symptoms did not exhibit a systematic pessimistic or optimistic bias. General imprecision in predictions for undesirable events was associated with depressive symptoms. These findings suggest that depression is associated with pessimistic bias rather than accuracy in judgment.     

Physical Activity,Exercise Motivations,Depression, and Nonsuicidal Self‐Injury in Youth

This study explored the relationship between physical activity, depression, and nonsuicidal self‐injury (NSSI) in 167 high school and undergraduate students (mean age = 17.37, range 14–25). Results indicated that NSSI frequency had a significant negative relationship with physical activity, and physical activity moderated the relationship between depressive symptoms and self‐harm. Specifically, high levels of depressive symptoms and low levels of physical activity had the greatest frequency of NSSI. Lastly, appearance‐based exercise motivations were significantly related to increased frequencies of NSSI. Overall, physical activity may possess a protective nature against NSSI, especially in individuals with depressive symptoms.     

Self‐criticism and self‐reassurance as mediators between mental health attitudes and symptoms: Attitudes toward mental health problems in Japanese workers

Japanese workers suffer high rates of mental health symptoms, recognised recently by the Japanese government, which has enacted workplace well‐being initiatives. One reason for poor mental health concerns negative attitudes about mental health problems such as shame, which may be mediated by self‐reassurance and self‐criticism. This study aimed to evaluate shame‐based attitudes toward mental health problems and explore the relationship between mental health attitudes, self‐criticism, self‐reassurance, and mental health symptoms. Japanese workers (n = 131) completed three measures: attitudes toward mental health problems, mental health symptoms, and self‐criticism/reassurance. A high proportion of workers reported negative attitudes about mental health problems. There were strong relationships between mental health attitudes, mental health symptoms, self‐criticism, and self‐reassurance. Path analyses revealed that the total and indirect effects (through self‐criticism and self‐reassurance) of mental health attitudes on mental health were larger than the direct effect alone. Hated‐self and family reflected shame were identified as predictors for mental health symptoms. The findings suggest the importance of self‐criticism and self‐reassurance in mental health and mental health attitudes. Implications for help‐seeking behaviours also are discussed. Interventions aimed at reducing self‐criticism and enhancing self‐reassurance are recommended to improve mental health attitudes and increase help‐seeking in Japanese workers.     

En Route to Depression: Self‐Esteem Discrepancies and Habitual Rumination

Dual‐process models of cognitive vulnerability to depression suggest that some individuals possess discrepant implicit and explicit self‐views, such as high explicit and low implicit self‐esteem (fragile self‐esteem) or low explicit and high implicit self‐esteem (damaged self‐esteem). This study investigated whether individuals with discrepant self‐esteem may employ depressive rumination in an effort to reduce discrepancy‐related dissonance, and whether the relationship between self‐esteem discrepancy and future depressive symptoms varies as a function of rumination tendencies. Hierarchical regressions examined whether self‐esteem discrepancy was associated with rumination in an Australian undergraduate sample at Time 1 (N = 306; M_age = 29.9), and whether rumination tendencies moderated the relationship between self‐esteem discrepancy and depressive symptoms assessed 3 months later (n = 160). Damaged self‐esteem was associated with rumination at Time 1. As hypothesized, rumination moderated the relationship between self‐esteem discrepancy and depressive symptoms at Time 2, where fragile self‐esteem and high rumination tendencies at Time 1 predicted the highest levels of subsequent dysphoria. Results are consistent with dual‐process propositions that (a) explicit self‐regulation strategies may be triggered when explicit and implicit self‐beliefs are incongruent, and (b) rumination may increase the likelihood of depression by expending cognitive resources and/or amplifying negative implicit biases.     

In Eating‐Disordered Inpatient Adolescents,Self‐Criticism Predicts Nonsuicidal Self‐Injury

We examined the role of depressive traits—self‐criticism and dependency—in nonsuicidal self‐injury (NSSI) and suicidal ideation among inpatient adolescents with eating disorders. In two studies (N = 103 and 55), inpatients were assessed for depressive traits, suicidal ideations, and NSSI. In Study 2, motivation for carrying out NSSI was also assessed. In both studies, depression predicted suicidal ideation and self‐criticism predicted NSSI. In Study 2, depression and suicidal ideation also predicted NSSI. The automatic positive motivation for NSSI was predicted by dependency and depressive symptoms, and by a two‐way interaction between self‐criticism and dependency. Consistent with the “self‐punishment model,” self‐criticism appears to constitute a dimension of vulnerability for NSSI.     

Self‐Stigma,Mental Health Literacy,and Attitudes Toward Seeking Psychological Help

This study examined self‐stigma of seeking psychological help and mental health literacy as predictors of college students’ (N = 1,535) help‐seeking attitudes, with additional attention to psychological and demographic correlates. Results indicated that mental health literacy predicted help‐seeking attitudes above and beyond self‐stigma. Asian American race/ethnicity, male gender, current psychological distress, and help‐seeking history were also significant predictors. Implications for addressing mental health literacy and self‐stigma while attending to demographic and psychological variations in help seeking are discussed.     

Stigma,Attitudes, and Help‐Seeking Intentions for Psychological Problems in Relation to Regional Suicide Rates

In this ecological study, we investigated whether help‐seeking related to stigma, intentions, and attitudes toward suicide are associated with the suicide rates of 20 regions within the Netherlands and Belgium. Significant associations were found between regional suicide rates and the intention to seek informal help (β = ?1.47, p = .001), self‐stigma (β = 1.33, p = .038), and shame (β = .71, p = .030). The association between self‐stigma and suicide rate was mediated by intentions to seek informal help. These results suggest that to promote suicide prevention at the level of the regional population, stigma, shame, and intentions to seek help should be targeted in the public domain.     

Thoughts of Self‐Harm and Help‐Seeking Behavior among Youth in the Community

The association between thoughts of self‐harm and help‐seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School‐aged Children Study (n = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help‐seeking behaviors among youth with and without thoughts of deliberate self‐harm (DSH) when depressed. Depressed youth with thoughts of DSH exhibited different patterns of help‐seeking than those without. Both groups most frequently sought help from friends and parents. However, adolescents with thoughts of DSH were statistically more likely than youth without to seek help from friends (DSH: 69.9%; no DSH: 57.8%; AOR = 1.46), but less likely to seek help from parents (DSH: 53.7%; no DSH: 73.1%; AOR = 0.47). Youth with DSH were more likely to seek help from school officials (AOR = 1.05), health professionals (AOR: 1.83), or a counselor (AOR = 1.93) compared with those without thoughts of DSH who were more likely to seek help from a sibling (AOR: 0.77) or other relatives (AOR: 0.78). Results may help inform programs to improve identification of youth at risk of self‐harm in community and school settings.     

The association between stress,self‐esteem and depressive symptoms in adolescents

This cross‐sectional study investigated gender and age differences on domains of stress, self‐esteem and depressive symptoms, as well as the association between those domains using a sample of Norwegian adolescents (N = 1,239). The data was analysed using Pearson product moment correlation, t‐tests, and hierarchical multiple regression analyses. The results showed significant differences between genders. Girls scored higher on five of seven stressor domains comprising peer pressure, home life, school attendance, school/leisure conflict and school performance as well as depression, while boys scored significantly higher on self‐esteem. The hierarchical multiple regression analysis showed that higher stress from school performance and school attendance related significantly to more depressive symptoms in both genders. Additionally, stress of home life significantly related to more depressive symptoms in girls, whereas stress of peer pressure was significant in association with depressive symptoms in boys. A strong, inverse association was found between self‐esteem and depression controlled for stress, especially in girls. Self‐esteem was not found to be a moderator of any stressor‐depression interactions. In conclusion, the results give support for the significant role of stress and self‐esteem on the experience of depressive symptoms in adolescents.     

The stigma of seeking help for mental health issues: mediating roles of support and coping and the moderating role of symptom profile

A key factor to the prevalence of mental illness might be the disinclination to seek help, perhaps owing to the stigma of mental illness. In two studies, the contribution of severity of depressive symptoms, social support, and unsupport, coping strategies, and salience of psychological versus biological features of depression in relation to perceived self‐ and other‐stigma of help‐seeking for mental health issues were examined. Participants were first year students experiencing a transitional stressor, namely entry to university. Together, the findings point to the contribution of social support and unsupportive interactions, and coping methods to the prediction of perceived stigma of seeking help, but that the framing of mental illness can limit or strengthen these relations.     

Reviewers for Special Issue

Objective: An enhanced stress and coping model was used to explain depression among HIV‐positive women in healthcare and community settings where highly active anti‐retroviral treatment (HAART) was commonplace. Method: HIV‐infected women in four cities (N=978) were assessed, cross‐sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self‐reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self‐efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self‐efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self‐efficacy, bolstering social supports, and decreasing stress in the lives of HIV‐positive women may help to reduce the negative effects of HIV disease on mood.     

An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self‐directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self‐directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self‐directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.     

Investigating the link between liking versus wanting self-esteem and depression in a nationally representative sample of american adults

The self‐esteem movement has been around since the 1970s, and may have influenced how much value people place on self‐esteem. We predicted a negative relationship between age and the amount of value placed on self‐esteem boosts. We also investigated the correlates of liking versus wanting self‐esteem boosts (and other pleasant rewards) on depression. A nationally representative sample of American adults (N = 867) indicated how much they liked and wanted several pleasant rewards (i.e., sex, food, alcohol, money, friendship, self‐esteem boost). They also completed a standardized measure of depressive symptoms. As expected, there was a negative relationship between age and valuing self‐esteem boosts, sex, and alcohol. People with depressive symptoms wanted self‐esteem boosts, even though they did not like them very much. Similar effects were obtained for depressive symptoms and alcohol and friendship. This is the first research to show that self‐esteem boosts are more valued among a nationally representative sample of younger American adults. It also is the first research to explore the association between depression and the motivation to boost self‐esteem. People with depressive symptoms want self‐esteem, and may pursue it, but this pursuit may feel unrewarding because they do not derive pleasure from it.     

Longitudinal Model Predicting Self‐Concept in Pediatric Chronic Illness

Although self‐concept has been identified as salient to the psychosocial adjustment of adolescents dealing with a chronic illness (CI), little research has focused on its predictors it. Given that depression and parent–child attachment have been linked to self‐concept in the population at large, the goal of this study was to evaluate these relationships longitudinally in a sample of adolescents with CI. Using participant data from the Mastering Each New Direction (MEND) program, a 3‐month psychosocial, family based intensive outpatient program for adolescents with CI, we employed multilevel modeling to test longitudinal changes in self‐concept, as predicted by depressive symptoms and parent–child attachment, in a sample of 50 youths (M_age = 14.56, SD_age = 1.82) participating in MEND. Both “time spent in the program” and decreases in depressive symptoms were associated with increases in self‐concept over time. Higher baseline levels of avoidant attachment to both mother and father were also associated with greater initial levels of self‐concept. Targeting depressive symptoms and supporting adaptive changes in attachment may be key to promoting a healthy self‐concept in pediatric CI populations. The association between avoidant attachment and higher baseline self‐concept scores may reflect differences in participants’ autonomy, self‐confidence, or depression. Limitations of the study include variability in the amount of time spent in the program, attrition in final time point measures, and the inability to fully examine and model all potential covariates due to a small sample size (e.g. power).     

Are Perfectionism Dimensions Vulnerability Factors for Depressive Symptoms After Controlling for Neuroticism? A Meta‐analysis of 10 Longitudinal Studies

Extensive evidence suggests neuroticism is a higher‐order personality trait that overlaps substantially with perfectionism dimensions and depressive symptoms. Such evidence raises an important question: Which perfectionism dimensions are vulnerability factors for depressive symptoms after controlling for neuroticism? To address this, a meta‐analysis of research testing whether socially prescribed perfectionism, concern over mistakes, doubts about actions, personal standards, perfectionistic attitudes, self‐criticism and self‐oriented perfectionism predict change in depressive symptoms, after controlling for baseline depression and neuroticism, was conducted. A literature search yielded 10 relevant studies (N = 1,758). Meta‐analysis using random‐effects models revealed that all seven perfectionism dimensions had small positive relationships with follow‐up depressive symptoms beyond baseline depression and neuroticism. Perfectionism dimensions appear neither redundant with nor captured by neuroticism. Results lend credence and coherence to theoretical accounts and empirical studies suggesting perfectionism dimensions are part of the premorbid personality of people vulnerable to depressive symptoms. Copyright © 2016 European Association of Personality Psychology