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Beliefs and Attitudes Associated With the Intention to Not Accept the Diagnosis of Depression Among Young Adults

¹ Departments of Medicine and Pediatrics, The University of Chicago, Chicago, Ill
² Business Program, Department of Economics, Brooklyn College of the City University of New York, Brooklyn, NY
³ Department of Medicine and the Center for Outcomes and Effectiveness Research and Education, University of Alabama School of Medicine, Birmingham, Ala
⁴ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
⁵ Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Md
⁶ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
⁷ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Md

CORRESPONDING AUTHOR: Benjamin W. Van Voorhees, MD, MPH, Section of General Internal Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 20007, Chicago, IL 60637 bvanvoor{at}medicine.bsd.uchicago.edu

PURPOSE Negative attitudes and beliefs about depression treatment may prevent many young adults from accepting a diagnosis and treatment for depression. We undertook a study to determine the association between depressive symptom severity, beliefs about and attitudes toward treatment, subjective social norms, and past behavior on the intent not to accept a physician’s diagnosis of depression.

METHODS We conducted a cross-sectional study of 10,962 persons aged 16 to 29 years who participated and had positive screening results on the Center for Epidemiologic Studies Depression (CES-D) score in an Internet-based public health depression screening program. Participants reported whether they would accept their physician’s diagnosis of depression. Based on the theory of reasoned action, we developed a multivariate model of the factors that predict intent not to accept a diagnosis of depression.

RESULTS Twenty-six percent of the participants stated their intent not to accept their physician’s diagnosis of depression. Disagreeing that medications are effective in treating depression (strongly disagree, odds ratio ( OR ) = 6.5, 95% confidence interval (CI), 4.6–9.3), that there is a biological cause for depression (strongly disagree, OR = 1.9, 95% CI, 1.3–2.7), and agreeing that you would be embarrassed if your friends knew you had depression were associated with the intent not to accept a diagnosis of depression (strongly agree, OR = 2.3, 95% CI, 1.8–2.9). Beliefs and attitudes, subjective social norms, and past behavior explained most of the variance in this model (84%).

CONCLUSIONS Negative beliefs and attitudes, subjective social norms, and lack of past helpful treatment experiences are associated with the intent to not accept the diagnosis of depression and may contribute to low rates of treatment among young adults.

Key Words: Depression/therapy • attitude • stereotyping • adolescent • young adult

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