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

With regard to change in OR for male gender, para 1 on page 43 states that the addition of past behavior and family history explained most of the change. We conducted analyses to examine which variables explained the change in OR for ethnicity (which did not end up in the final version due to space constraints). With regard to ethnicity and gender, we found that past behavior was the most important variable.

In short, med and ethnic minorities tended to have less exposure to past treatment and perceived those experiences to be less helpful than white woman in this sample. However, if you sequentially add each variable to the model, attitudes and social norms also have an incremental impact. There are some important variations by ethnicity, African Americans are more likely to endorse the statement that "prayer can heal depression".

Competing interests:   None declared

We recently discussed this article in a journal club with some first year medical students. Some questions arose about the data. In Table 2, the subgroups for each factor add up to close to 100% except for Treatment preferences, which only add up to 86.8%.

In Table 3, the odds ratio for several of the factors (gender, specific ethnicities) change not only in magnitude after adjustment, but also in direction – from greater than one to less than one. So before adjustment, the factor is correlated with greater Intention, but after adjustment, the same factor is correlated with less Intention. There is no comment on this extreme change after adjustment in the text.

According to Figure 1 explaining the theory of reasoned action, external factors act on Intention, mediated through Internal Factors, Subjective Norms and Past Behavior. Would a different statistical analysis such as path analysis be more appropriate?

Competing interests:   None declared

In this issue of Annals of Family Medicine, Dr. Van Voorhees and colleagues’ study adds much to our understanding of factors associated with intention not to accept depression diagnosis among an under-studied population. Applying theory of reasoned action, the authors surveyed a large number of 16-29 year olds using the Internet. Compared to primary care populations, this study population included more young men and those with no prior depression treatment. This investigation found that specific beliefs and attitudes account for much of the variance (86%) in the intention not to accept depression diagnosis. Findings related to lower intention to accept depression diagnosis such as - negative beliefs of biological basis of depression, ineffectiveness of medications, and preference of counseling, have practical implications for interventions. Tailoring interactive education materials according to individual beliefs about cause and treatment expectations can help depressed persons gain better understanding of depression and engage in evidence-based treatment. It is interesting that preference for counseling was negatively association with intention to accept depression diagnosis. This finding can guide us to create educational information that demonstrate benefits of psychotherapy and how these benefits link closely to biologic aspects of depression.

In this elegant survey, Dr. Van Voorhees and colleagues made important contributions in our knowledge toward a more patient- centered approach for depression, and provide guides for clinical applications.

Respectfully submitted by Elizabeth HB Lin MD, MPH

Competing interests:   None declared