Aims. Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future. Methods. In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire - Depression), and whether respondents had previously sought mental healthcare. Results. Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help. Conclusions. While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.

Conceptualizing own symptoms as potential signs of a mental illness is an important, yet under-researched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the 'Self-Identification as Having a Mental Illness' scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELF-I showed good reliability in terms of internal consistency (Cronbach's alpha, 0.85-0.87) and re-test reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of self-identification as having a mental illness that offers useful research perspectives.

This study aims to develop and implement brief implicit association tests (BIATs) assessing stigmatizing attitudes towards mental illness, awareness of mental distress and self-identification as having a mental illness. We recruited 229 people (age range 18–80 years) with currently untreated depressive symptoms. In addition to BIATs, explicit measures assessed depression severity, contact experience and self-identification as having a mental illness. BIATs showed good feasibility. Age and educational differences were observed for each BIAT. Regarding depression severity, people with mild depression severity showed stronger implicit label-avoidance. Novel BIATs proved feasible and future research should investigate the predictive value of implicit measures on help seeking in people with mental illness.

Backgrounds: The concept of mental health literacy suggests that higher literacy increases the likelihood of seeking treatment. However, previous studies mostly use vignettes, and do not investigate actual help-seeking behaviour. Methods: We assessed depression literacy and type of mental illness in a convenience sample of 207 adults with currently untreated mental health problems from the general population. Our analysis sample comprised 152 adults (M-age=52.12; 73.0% female) with a depressive disorder. Help-seeking behaviour was measured 3 and 6 months after the initial assessment. We conducted multiple logistic regression models to test whether depression literacy predicted help-seeking from mental health professionals, general practitioner, family and friends, or counselling, controlling for sociodemographic data, and depression severity. Results: Depression literacy was lower in men and older participants, and higher in participants with prior treatment experience. Depression literacy was negatively linked to informal help-seeking (aOR=0.33 [ 0.13; 0.84]) when included as a dichotomous predictor (i.e., 'high' versus 'low' literacy). Limitations: Our sample was small, thus we did not differentiate between types of depressive disorders in our analysis. Conclusion: We could not corroborate most postulated associations between depression literacy and help-seeking, except for the negative association with informal help. Our findings underline differences between previous vignette-based and community-based investigations of the help-seeking process for mental health problems. To explore underlying mechanisms, future research should investigate the role of intermediary variables and processes in the association between depression literacy and help-seeking, such as self-efficacy and symptom attribution, which might be more clinically relevant in help-seeking for depressive symptoms.

OBJECTIVE:Translation and psychometric testing of a German adaptation of the Australian Depression Literacy Scale.METHODS:Translation of the Depression Literacy Scale by Griffith et al. (2004) into German and testing for depression literacy in a sample of 229 people with depressive syndrome.RESULTS:The investigated sample had a mean age of 49.4 years (18 - 80 years). On average, 51 % of the 22 questions were correctly answered. The scale showed a satisfactory internal consistency with α = .74. The first-time application of the translated D-Lit German scale showed significant differences in subgroup analyzes of sex, age, and education. Hence, women, younger persons and persons with a higher school education reported higher values on the Depression Literacy Scale.CONCLUSION:The translation of the Depression Literacy Scale (D-Lit German) resulted in an easy-to-understand and applicable questionnaire. Items relating to therapeutic and drug-related treatments of depressen were more difficult to answer. The D-Lit scale proved to be a reliable and economic instrument for the investigation of depression literacy. Future studies should include depression literacy in investigations on the demands and help-seeking behaviour of people with depression.

Weltweite Befragungen weisen auf eine Versorgungslücke bei psychischen Erkrankungen hin – in Deutschland nehmen zwei Drittel der Personen mit depressiver Störung keine professionelle Hilfe in Anspruch. Denkbar ist, dass diese Personen sich an anderer Stelle Hilfe suchen.

Alcohol dependence is a highly stigmatized mental illness, and self-stigmatization has severe consequences for treatment outcomes and help seeking. To better understand the process of self-stigmatization for persons with alcohol dependence, this paper explores the impact of negative childhood experiences on self-stigmatization in alcohol dependence. Eighty-six patients with alcohol dependence of different severity were interviewed. Measurements included the Self-Stigma of Alcohol Dependence scale, Childhood Trauma Questionnaire (CTQ), Severity Scale of Alcohol Dependence, and Brief Symptom Inventory. Childhood trauma was associated with stronger self-stigma. Within the progressive model of self-stigma, childhood trauma was associated with stronger agreement with negative stereotypes, stronger applying negative stereotypes to oneself, and more harm because of the loss of self-esteem. Associations with agree and apply remained significant when controlling for current type of treatment seeking, severity of alcohol dependence, and depression in multiple regression analyses. Mediation analyses indicated that the association of the CTQ score with apply was fully mediated by stronger personal agreement with negative stereotypes, and the association of the CTQ score with harm was fully mediated by the severity of depression. Childhood trauma aggravates self-stigma in alcohol dependence. Stronger agreement with negative stereotypes seems a crucial step in this process.

The aim of this study was to investigate whether personal stigma decreases self-identification as having a mental illness in individuals with untreated mental health problems. We interviewed 207 persons with a currently untreated mental health problem as confirmed by a structured diagnostic interview. Measures included symptom appraisal, self-identification as having a mental illness (SELFI), self-labeling (open-ended question on the nature of their problem) stigma-related variables (explicit and implicit), as well as sociodemographics, current symptom severity, and previous treatment. Support for discrimination and implicit stigmatizing attitude were both associated with lower likelihood of self-identification. More social distance and support for discrimination were associated with less self-labeling. Previous treatment was the strongest predictor of symptom appraisal, SELFI, and self-labeling. Destigmatizing mental illness could increase awareness of personal mental health problems, potentially leading to lower rates of untreated mental illness.

Zusammenfassung Ziel der Studie Übersetzung und psychometrische Testung einer Skala zum Depressionswissen. Methodik Übersetzung der Depression Literacy Scale von Griffith et al. (2004) ins Deutsche und Testung der Skala in einer Stichprobe von 229 Menschen mit depressivem Syndrom. Ergebnisse Im Durchschnitt war die Stichprobe 49,4 Jahre alt und es wurden 51 % der 22 Fragen richtig beantwortet. Die Skala zeigte eine zufriedenstellende interne Konsistenz. Die erstmalige Anwendung der übersetzten Skala D-Lit German konnte signifikante Unterschiede im Depressionswissen in Subgruppenanalysen zu Geschlecht, Alter und Schulbildung aufzeigen. So berichteten Frauen, jüngere Personen und Personen mit höherem Schulabschluss höhere Werte auf der Depressionskompetenzskala. Schlussfolgerung Die Übersetzung der Skala zur Depressionskompetenz (D-Lit German) resultierte in einem leicht verständlichen und gut beantwortbaren Fragebogen. Vor allem Items, die sich auf therapeutische und medikamentöse Behandlungsansätze bezogen, waren jedoch schwerer zu beantworten. Insgesamt erwies sich die D-Lit-Skala als reliables und ökonomisches Instrument zur Erfassung des Depressionswissens. Zukünftige Studien sollten Depressionswissen als Prädiktor zur Untersuchung von Inanspruchnahme und Hilfesuchverhalten einbeziehen.

Objectives: The aim of the current study was to analyze whether biographical writing interventions have an impact on depression and QoL compared to daily diary writing. We also wanted to investigate differential effects between structured and unstructured interventions.Method: In two Northern regions of Germany, 119 older adults aged 64-90 were randomly assigned to three different types of narrative writing interventions: written structured and unstructured biographical disclosure as well as daily diary writing. Depression (PHQ-9), QoL (SF-12, EUROHIS) and trauma-related symptoms (PCL-C) were obtained pre- and post-interventions as well as at three-month follow-up. Results: Follow-up measures were obtained from 85 participants (29% loss to follow-up; mean age = 73.88; 68.2% female). Results of repeated measurement analysis demonstrated a significant effect on depression with the daily diary writing group showing lower depressive symptoms than structured biographical writing. We did not find a significant impact on QoL. Post-hoc analyses showed that posttraumatic symptoms lead to increases in depressive symptoms.Conclusion: In a non-clinical sample of community-dwelling older adults, biographical writing interventions were not favorable to daily diary writing concerning the outcomes of the study. This might be related to the association of traumtic reminiscences of former children of World War II and outcome measures.

Past research has shown that among the general public, certain causal explanations like biomedical causes are associated with stronger desire for social distance from persons with mental illness. Aim of this study was to find out how different causal attributions of persons with untreated mental health problems regarding their own complaints are associated with stigmatizing attitudes, anticipated self-stigma when seeking help and perceived stigma-stress. Altogether, 207 untreated persons with a current depressive syndrome were interviewed. Biomedical causes, but also belief in childhood trauma or unhealthy behavior as a cause of the problem, were associated with stronger personal stigma and with more stigma-stress. Similarities and differences to findings among the general population and implications for future research are discussed.

The Tilburg frailty indicator (TFI) is a self-report measurement instrument which integrates the physical, psychological and social domains to assess frailty in older adults. The aim of this study was the adaptation of the TFI to a German version and testing of the psychometric properties. This study surveyed 210 individuals aged 64-91 years living at home. The mean age of participants was M = 75.3 +/- 5.7 years with 62 % females. The internal consistency was tested with Cronbach's alpha. The test-retest reliability was calculated after 20 weeks. The German TFI was validated using alternative measures for assessment of the quality of life, e.g. Eurohis-QoL-8 and short form health survey (SF-12), the patient health questionnaire (PHQ), the geriatric anxiety inventory short form (GAI-SF), the social support scale (F-Soz-U-K-14) and the resilience scale (RS-11). The internal consistency was acceptable with a value for Cronbach's alpha of 0.67. The test-retest reliability was good after 5 months alpha = 0.87 (physical domain r = 0.85, psychological domain r = 0.75 and social domain r = 0.84). The inter-item correlations ranged between -aEuro parts per thousand 0.06 and 0.57. Correlations with alternative frailty measures showed good convergent and divergent validity. This study showed acceptable psychometric properties of the German adaptation of the TFI which was found to be age and frailty sensitive. The results of the validity of the TFI support the three domains integrated in the frailty score. Further application and testing of the German TFI in primary care and clinical settings are suggested to consolidate the findings.

German Abstract: Seit den 1980er Jahren untersuchen Forscher den positiven Einfluss von Tieren auf die menschliche Gesundheit. Die aktuelle Studienlage ist durch Heterogenität der Befunde, Seltenheit von Längsschnittstudien, wenige Studien mit deutscher Bevölkerung und der Suche nach Moderatoren und Mediatoren zur Erklärung des möglichen Zusammenhangs gekennzeichnet. Ziel dieser Untersuchung ist eine quer- und längsschnittliche Betrachtung des (möglicherweise unterschiedlichen) Einflusses von Hunden und Katzen auf v. a. die subjektive mentale und physische Gesundheit ihrer Besitzer in einer deutschen Stichprobe mit älteren Menschen, da diese Personengruppe womöglich besonders von den Gesundheitsgewinnen durch Heimtiere profitiert. Weiterhin werden neben demografischen Faktoren auch Einsamkeit und menschliche soziale Unterstützung der Besitzer als potentielle Wirkmechanismen auf querschnittlicher Ebene betrachtet. Es werden sozioökonomische Daten der Berliner Altersstudie II verwendet. Die Gesamtstichprobe umfasst 1 286 ältere Personen ab 60 Jahren, welche 2012 und 2014 an der Fragebogenerhebung teilnahmen. Die Querschnittsbefunde zeigen überwiegend eine schlechtere mentale und physische Gesundheit bei Heimtierbesitzern im Vergleich zu Nicht-Heimtierbesitzern, auch unter Berücksichtigung demografischer Charakteristika der (Nicht-) Besitzer. Lediglich die gesundheitlichen Nachteile der Katzenbesitzer können durch ihre Einsamkeitsgefühle erklärt werden, während für Hundebesitz kein erklärendes Konstrukt in dieser Untersuchung gefunden wird. Auf längsschnittlicher Ebene lassen sich allerdings v. a. mentale Verbesserungen bei Heimtier-, insb. Hundeerwerb im Vergleich zu dauerhaftem Nicht-Heimtierbesitz feststellen, während dauerhafter Heimtierbesitz nicht mit (weiteren) gesundheitlichen Gewinnen einherzugehen scheint und Katzenverlust physische Gesundheitsverbesserungen birgt. Die vorliegende Untersuchung bestätigt die Wichtigkeit längsschnittlicher Analysen, deckt Unterschiede zwischen Hunde- und Katzenbesitz auf, und rückt die Frage der Kurz- oder Langfristigkeit und möglichen Grenzen der gesundheitlichen Effekte durch Heimtierbesitz bei älteren Personen in den Vordergrund.

Since the 1980s researchers are investigating the beneficial effects of pets on human health. The current state of research is characterized by heterogeneity of results, rarity of longitudinal analysis, few studies with German population and search for moderators and mediators in order to explain the possible association. The present study aims at examining the (possibly differential) impact of dogs and cats primarily on their owner's self-rated physical and mental health both, cross-sectional and longitudinal, using a German sample of elderly as in particular older people may benefit from pet ownership. In addition to demographic characteristics, the owner's loneliness and human social support are investigated cross-sectional for being potential mediators. Socioeconomic data is provided by the Berliner Altersstudie II. The total sample comprises 1 286 people aged 60 years or older, who completed the survey questionnaire 2012 and 2014. Cross-sectional results predominantly show inferior physical and mental health of pet owners compared to nonowners, even if considering the (non-) owner's demographic characteristics. Merely the cat owner's disadvantages in health can be explained by the owner's feeling of loneliness, whereas no explanatory construct can be found accounting for dog ownership in this study. However, longitudinal results most notably reveal gains in mental health after pet, especially dog acquisition compared to permanent non-ownership, whilst permanent pet ownership is not accompanied with (any more) advantages in health and loss of a cat seems to provide gains in physical health. The present study confirms the importance of longitudinal analysis, indicates differences between cat and dog ownership and spotlights the question of short or long term effects as well as possible limits of the improvement of the elderly pet owner's health.

Background: The aim of this study was to investigate psychosocial variables associated with frailty status. Moreover, gender differences in the psychosocial variables associated with frailty were examined. Methods: This cross-sectional study examined a community-dwelling sample of N = 210 older adults (M = 75.31 years). Frailty was measured with the Tilburg Frailty Indicator. Quality of life, depression, resilience, social support, self-efficacy, traumata experienced, and trauma severity were assessed as psychosocial variables. Logistic regression analyses were performed. Results: In total, 41.4% of the participants were frail (49.6% women, 27.8% men). Main correlates of frailty were depressive symptoms, quality of life, and resilience. Gender differences for frailty correlates were found. Depressive symptoms and perceived social support were mainly associated with frailty in women. Furthermore, age was only significantly associated with frailty in women. Quality of life was significantly associated with frailty being a protective factor in both women and men. Trauma count and trauma severity were associated with an elevated risk for frailty in men. Conclusions: The results show that the psychosocial variables depressive symptoms, quality of life, and resilience are associated with frailty. Gender-specific differences in psychosocial correlates of frailty were revealed. Results suggest that gender-specific assessments and interventions should be developed to prevent frailty in late life.

Background: Frailty is a syndrome of increased vulnerability with adverse outcomes, increasing with age for elderly people. So far, intervention programs have mainly addressed the physical components of frailty. As biographical writing approaches have shown positive effects on cognition and health, the aim of this study is to investigate the effects of a biographical disclosure intervention on psychological frailty and health in older adults.Methods: In total, 198 elderly people (mean age = 75.1 years) were recruited and randomly assigned to four disclosure conditions: oral biographical disclosure, written structured and unstructured biographical disclosure, daily diary and a control group. Frailty was measured with the Tilburg Frailty Indicator, and physical and mental health were assessed with the Short Form (12-item) Health Survey. Measurements were assessed pre- and post-intervention, and at a three month follow-up. Mixed design ANOVAs with repeated measures, correlations and Wilcoxon tests were calculated.Results: The sample showed a frailty prevalence of 39.9% pre-intervention. Participants in the oral biographical disclosure, structured biographical writing, and daily diary groups showed improvements in their frailty and mental health, with small effect sizes. No effect for physical health was evident. People with high frailty symptoms and low mental health benefitted from the intervention. Frailty was negatively correlated with physical and mental health components.Conclusions: The results of the intervention indicate a short-term positive effect on frailty and mental health in elderly people, who benefitted from the disclosure intervention in terms of improved mental health and lower frailty levels. Early frailty detection is therefore crucial in the treatment and care of older adults, and biographical disclosure approaches can help to maintain health at old age. (C) 2016 Elsevier Ltd. All rights reserved.