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.
METHODSWe 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% confi dence 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.
INTRODUCTIONT wenty-fi ve percent of young adults will experience a depressive episode by age 24 years, the highest incidence rate of any adult agegroup.1-3 Although depression during this critical period may increase the likelihood of substance abuse, impair work and relationship function, and negatively infl uence an individual' s subsequent development, 1,4-11 fewer than 20% of young adults with depression receive high-quality care.
12Lack of health insurance coverage and affi liation with a primary care physician do not fully explain these low treatment rates. 13,14 Obtaining treatment for depression is a multistage process that includes self-evaluation of need for care, seeking services, and fi nally accepting a diagnosis and treatment for the disorder, which is substantially infl uenced by patient attitudes. 15,16 Patient reluctance to accept diagnosis and treatment for depression has been identifi ed by primary care physicians as a major barrier to implementing 17 and may be associated with poor quality of care and outcomes. [18][19][20][21][22][23][24] Why patients refuse the diagnosis and treatment for depression remains poorly understood, however.The theory of reasoned action, which ha...