Reducing Depression-related Stigma and Increasing-treatment Seeking Among Black Adolescents

The DSS (Christensen, Jorm, Evans, & Groves, 2004) is a self-report instrument composed of two 9-item subscales. The first subscale measures the participants' own/ personal attitudes, and the second measures participants' beliefs about the attitudes of others ('Depression is sign of weakness' vs. 'Most people believe that depression is a sign of weakness'). We will use the Personal subscale (DSS-Personal) in this study. The DSS has a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The total score comprises the sum of its item scores, and a higher score indicates more stigma (worse outcome). The DSS-Personal subscale has shown adequate psychometric properties: 0.71 test-retest reliability, 0.76 internal consistency (Griffiths et al., 2004). In our earlier study (Amsalem and Martin, 2021), Cronbach's a was .83.

The General Help-Seeking Questionnaire (GHSQ) (Wilson, Deane, Marshall, & Dalley, 2008) was developed to measure help-seeking intentions from different sources (friend, parent, mental health professional, and others) and is divided into personal-emotional problems and suicidal thoughts (Ibrahim et al., 2019). The instrument consists of 10 items for each part, measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). One question is stated as 'I would not seek help from anyone' and is reverse-scored. Higher scores on this scale indicate more help seeking (better outcome). The GHSQ has shown good psychometric properties: Cronbach's alpha = .70 and test-retest of .86 for personal-emotional problems, and Cronbach's alpha = .83 and test-retest of .88 for suicidal thoughts.

We will use a feelings thermometer, modeled after Norton and Herek, 2013:

"Using a scale from zero to 100, please tell us your personal feelings toward each of the following groups of friends, teachers, or colleagues. As you do this task, think of an imaginary thermometer. The warmer or more favorable you feel toward the group, the higher the number you should give it. The colder or less favorable you feel, the lower the number. If you feel neither warm nor cold toward the group, rate it 50." To familiarize respondents with the response format, they will be first presented with thermometers for "Men in general" and "Women in general," with each respondent rating her or his own sex first. Next, they rate racially different groups (white women, white men, Black women, Black men) with the order of presentation randomized. Higher ratings (maximum 100) indicate warmer, more favorable feelings toward the target whereas lower ratings (minimum 0) indicate colder, more negative feelings.

People with depression could snap out of it if they wanted

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

Depression is a sign of personal weakness

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

Depression is not a real medical illness

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

People with depression are dangerous

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

It is best to avoid people with depression, so you don't become depressed yourself

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

People with depression are unpredictable

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

If I had depression, I would not tell anyone

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

I would not employ someone if I knew they had been depressed

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

I would not vote for a politician if I knew they had been depressed

Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).

Intimate partner (e.g., girlfriend, boyfriend)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Friend (not related to you)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Parent

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Other relative/family member

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Mental health professional (e.g., psychologist, social worker, counselor)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Phone helpline (e.g., lifeline)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Doctor/GP

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Minister or religious leader (e.g., Priest, Rabbi, Chaplain)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

I would not seek help from anyone

**REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome).

I would seek help from another not listed above

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Intimate partner (e.g., girlfriend, boyfriend)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Friend (not related to you)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Parent

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Other relative/family member

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Mental health professional (e.g., psychologist, social worker, counselor)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Phone helpline (e.g., lifeline)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Doctor/GP

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

Minister or religious leader (e.g., Priest, Rabbi, Chaplain)

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).

I would not seek help from anyone

**REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome).

I would seek help from another not listed above

Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).