Implicit and explicit attitudes towards the controllability of depressive symptoms in the Dutch adult population: a cross-sectional study on barriers to mental healthcare
Michelle M E Zandbergen, Inge M C M de Kok, Lea J Jabbarian, Ida J Korfage, Erik E L JansenObjectives
Early intervention for depressive symptoms improves outcomes, but attitudes towards the controllability of depressive symptoms may influence help-seeking. This study aimed to examine the relationship between implicit and explicit attitudes towards the controllability of depressive symptoms in the Dutch adult population, explore demographic differences in these attitudes and investigate their association with help-seeking intentions.
Design
Cross-sectional, web-based survey using Qualtrics, combining implicit behavioural measures and self-report questionnaires. Data were analysed using Spearman correlations and one-way analysis of variance.
Setting
Dutch adult population.
Participants
In total, 137 Dutch adults completed the full protocol.
Interventions
Observational study with a single measurement.
Main outcome measures
Implicit attitudes were measured using the Implicit Association Test (D-score range –2 to 2), assessing automatic associations using reaction times between depressive symptoms and the attributes ‘controllable’ versus ‘uncontrollable’, relative to physical illness. Explicit attitudes were measured using item one of the Depression Stigma Scale: ‘People with depression can get out of it if they want to’ (five-point Likert scale). Secondary outcomes included self-reported help-seeking intentions and mental-health history. Demographic variables included age, gender, education, ethnicity and marital status.
Results
The mean implicit D-score was −0.18 (SD=0.53), indicating a slight tendency to view depressive symptoms as less controllable than physical illness. The mean explicit score was –0.01 (SD=0.97), indicating a neutral explicit attitude. Implicit attitudes appeared to be negatively associated with age (r=−0.264, p=0.002) and education (r=−0.169, p=0.049), indicating lower perceived controllability of depressive symptoms compared with physical illness among older age categories and more highly educated participants. Explicit attitudes varied by gender (p=0.008, η²=0.051) and education (r=−0.228, p=0.008), with women and more highly educated participants explicitly reporting depressive symptoms as less controllable. Implicit and explicit attitudes were not associated (r=0.078, p=0.365). Explicit attitudes were more associated with help-seeking intentions.
Conclusion
Implicit and explicit attitudes towards the controllability of depressive symptoms appear to develop independently. Older age categories and more highly educated adults tended to implicitly perceive depressive symptoms as less controllable compared with physical illness, while explicitly, lower controllability beliefs were more common among women and more highly educated participants. As explicit attitudes were more strongly related to help-seeking intentions, these findings highlight the relevance of explicit beliefs when examining barriers to help-seeking for depressive symptoms.
Registration number
MEC-2024-0581