In Session With Janine G. Walker, PhD

Mental Health Literacy and Depression Outcomes

Research Fellow, Centre for Mental Health Research, Australian National University

First published in Psychiatry Weekly, Volume 5, Issue 26, on November 1, 2010

Q: How can patient education improve mental health outcomes?

A: We conducted a large community-based randomized controlled trial, the Beyond Ageing Project, over a 2-year period. Participants included ~900 older adults (aged 60–74 years) with elevated levels of distress. We examined the effectiveness of mental health literacy, folic acid and vitamin B₁₂ supplementation, and promoting physical activity for reducing depressive symptoms in an indicated sample. The trial focused on inexpensive interventions for managing depressive symptoms that can be disseminated on a large public health scale. The study had a completely crossed factorial design, and each intervention had an appropriate control comparator intervention. The interventions were delivered via mail with accompanying telephone follow-ups over a 2-year period. The mental health literacy intervention focused on four main areas: (1) identifying the symptoms of depression and potential risk factors, (2) addressing stigmatizing beliefs, (3) evidenced-based information on what works for treating depression, and (4) where to go for help.

In the short term (6 weeks), mental health literacy significantly reduced depressive symptoms, as measured by the Patient Health Questionnaire, compared to the comparator intervention. Mental health literacy programs may promote positive mental health by helping subjects to recognize symptoms, which can influence help seeking behaviors. Addressing stigmatizing beliefs and fears, and informing subjects that depression is not a normal aspect of the aging process, may have a significant impact on treatment-seeking behavior. It is important that high quality evidence-based information is disseminated to the community so that people can make appropriate and informed decisions about depression treatment with their doctor.

We cannot comment on the role of increased physical activity for depressive symptoms, as the participants’ physical activity behavior did not alter as a result of the intervention. This highlights the challenge of promoting increased activity in older adults. Also, folic acid and vitamin B₁₂ supplementation did not affect depressive symptoms over time.

Q: Why is patient education helpful?

A: Patient education is important in facilitating positive help seeking behaviors. People need to know what depression is and what to look out for before seeking help. Mental health literacy is important for dispelling stigmatizing beliefs and alleviating fears that may undermine willingness to seek necessary treatment. Further, knowing what treatments are available, and what is known to work, may strengthen and inform the patient-clinician relationship.

Further, mental health literacy may be an important strategy for preventing depression in those particularly at risk. If an approach such as mental health literacy can reduce depression symptoms in potentially vulnerable subjects, then this is good news, as it is evidence-based, inexpensive, and easy to access. We may be able to reduce new cases of depressive disorder in the future.

Disclosure: This study was supported by beyondblue: the national depression initiative and the Australian Government Department of Health and Ageing. Dr. Walker is supported by National Health and Medical Research Council Capacity Building Grant 418020.

Reference: Walker JG, Makinnon AJ, Batterham P, et al. Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial. Br J Psychiatry. 2010;197(1):45-54.

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