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Recent research: five papers on depression, stigma, biology, & extending the reach of psychotherapy

This set of five papers documents, in part, our mixed viewpoints on depression.  Worryingly, Mehta & colleagues show deteriorating public attitudes towards mental illness in England (and to a lesser extent Scotland) between 1994 and 2003.  Meanwhile Blumner et al demonstrate a shift towards a more biological view on causes and treatment of depression in the US between 1996 and 2006.

In contrast, Miranda et al's editorial (and Grote et al's research) highlight the growing evidence showing psychotherapies for depression can be "very effective for low-income and minority populations in the United States and abroad" - extending their validity well beyond more privileged groups in developed countries.  Andersson too discusses a further way to make psychotherapies more widely available and helpful - in this case, the increasing literature documenting the widespread value of delivering cognitive behavioural therapy via the internet.     

Mehta, N., A. Kassam, et al. (2009). "Public attitudes towards people with mental illness in England and Scotland, 1994-2003." The British Journal of Psychiatry 194(3): 278-284.  [Abstract/Full Text]
Background: Understanding trends in public attitudes towards people with mental illness informs the assessment of ongoing severity of stigma and evaluation of anti-stigma campaigns. Aims: To analyse trends in public attitudes towards people with mental illness in England and Scotland using Department of Health Attitudes to Mental Illness Surveys, 1994-2003. Method: We analysed trends in attitudes for 2000 respondents in each survey year (6000 respondents in 1996 and 1997) using quota sampling methods and the adapted Community Attitudes Toward the Mentally Ill scale. Results: Comparing 2000 and 2003, there was significant deterioration for 17/25 items in England and for 4/25 items in Scotland. Neither country showed significant improvements in items between 2000 and 2003. Conclusions: Public attitudes towards people with mental illness in England and Scotland became less positive during 1994-2003, especially in 2000-2003, and to a greater extent in England. The results are consistent with early positive effects for the `see me' anti-stigma campaign in Scotland.

Blumner, K. H. and S. C. Marcus (2009). "Changing Perceptions of Depression: Ten-Year Trends From the General Social Survey." Psychiatr Serv 60(3): 306-312.  [Abstract/Full Text
OBJECTIVE: The authors examined the changes in beliefs about the causes of and appropriate treatments for major depression between 1996 and 2006 in a representative sampling of U.S. adults. METHODS: The authors compared data about depression from the mental health modules of the General Social Survey from 1996 (300 respondents) and 2006 (397 respondents), which measured perceptions of mental illness through use of vignettes. RESULTS: There was an increase in the belief that depression is attributable to biological causes, from 77% in 1996 to 88% in 2006 (risk ratio [RR]=1.14, 95% confidence interval [CI]=1.04-1.23). Attitudes toward the treatment of depression changed as well, with 60% of respondents prioritizing a biological focus for treatment in 2006 compared with 48% in 1996 (RR=1.29, CI=1.04-1.59). These changes varied modestly by sociodemographic variables and were most pronounced among male, white, and elderly populations. CONCLUSIONS: There have been changes in attitudes about the causes and treatments of depression among the American public in the past decade, with a shift toward a biological framework. A greater understanding of beliefs about depression may lead to more effective outreach and education efforts.

Miranda, J., I. Lagomasino, et al. (2009). "Robustness of Psychotherapy for Depression." Psychiatr Serv 60(3): 283-.  [Free Full Text]
In this issue, Grote and colleagues (see below) contribute to a growing literature documenting that short-term, evidence-based interventions are very effective for low-income and minority populations in the United States and abroad. In this study, brief interpersonal psychotherapy was provided to low-income, primarily African-American and white pregnant women. Six months postpartum, 88% of the women in the intervention group had improved, compared with only 25% of those in enhanced usual care.  Despite growing evidence that established depression treatments are extremely robust, concerns remain that such interventions may not be appropriate for low-income individuals, who must deal with substantial real-life problems, for individuals from ethnic minority groups, who might need extensive cultural adaptations, and for pregnant women, who may have different biological and psychological needs for treatment. Fortunately, global dissemination efforts are finding that depression treatments, such as interpersonal psychotherapy, lead to substantial improvements in groups that are as different from middle-class white Americans as rural Ugandans ...

Grote, N. K., H. A. Swartz, et al. (2009). "A Randomized Controlled Trial of Culturally Relevant, Brief Interpersonal Psychotherapy for Perinatal Depression." Psychiatr Serv 60(3): 313-321.  [Abstract/Full Text]
OBJECTIVES: Depression during pregnancy is one of the strongest predictors of postpartum depression, which, in turn, has deleterious, lasting effects on infant and child well-being and on the mother's and father's mental health. The primary question guiding this randomized controlled trial was, Does culturally relevant, enhanced brief interpersonal psychotherapy (IPT-B) confer greater advantages to low-income, pregnant women than those that accrue from enhanced usual care in treating depression in this population? Enhanced IPT-B is a multicomponent model of care designed to treat antenatal depression and consists of an engagement session, followed by eight acute IPT-B sessions before the birth and maintenance IPT up to six months postpartum. IPT-B was specifically enhanced to make it culturally relevant to socioeconomically disadvantaged women. METHODS: Fifty-three non-treatment-seeking, pregnant African-American and white patients receiving prenatal services in a large, urban obstetrics and gynecology clinic and meeting criteria for depression on the Edinburgh Postnatal Depression Scale (score >12 on a scale of 0 to 30) were randomly assigned to receive either enhanced IPT-B (N=25) or enhanced usual care (N=28), both of which were delivered in the clinic. Participants were assessed before and after treatment on depression diagnoses, depressive symptoms, and social functioning. RESULTS: Intent-to-treat analyses showed that participants in enhanced IPT-B, compared with those in enhanced usual care, displayed significant reductions in depression diagnoses and depressive symptoms before childbirth (three months postbaseline) and at six months postpartum and showed significant improvements in social functioning at six months postpartum. CONCLUSIONS: Findings suggest that enhanced IPT-B ameliorates depression during pregnancy and prevents depressive relapse and improves social functioning up to six months postpartum.

Andersson, G. (2009). "Using the Internet to provide cognitive behaviour therapy." Behaviour Research and Therapy 47(3): 175-180.  [Abstract/Full Text
A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.


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