Effect of web-based depression literacy and cognitive–behavioural therapy interventions on stigmatising attitudes to depression: Randomised controlled trial
Open accessAbstract
Background: Little is known about the efficacy of educational interventions for reducing the stigma associated with depression. Aims: To investigate the effects on stigma of two internet depression sites. Method: A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive–behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention. Results: Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive–behavioural therapy literacy. Conclusions: The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.
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The D-LIT short form has high internal consistency and test-retest reliability.
“an 11-item scale with high internal consistency and test-retest reliability.”
From A brief intervention to increase uptake and adherence of an online program for depression and anxiety: Protocol for the Enhancing Engagement with Psychosocial Interventions (EEPI) Randomized Controlled Trial (2019) · cites this paper as [44]
The Depression Literacy section (page unavailable) describes D-Lit as a 22-item test, not an 11-item short form. The reported internal consistency and test–retest reliability concern depression stigma scales, not D-Lit. Our copy does not establish the claimed reliability of an 11-item D-Lit. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredParticipation in web-based interventions is associated with decreases in personal stigmatizing attitudes toward depression in the mainstream population.
“Participation has also been associated with decreases in personal stigmatizing attitudes toward depression in the mainstream population [17]”
From Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review (2022) · cites this paper as [17]
The Results report that the two web-based interventions reduced personal stigma relative to the control group. However, the Participants and Limitations sections specify that the trial enrolled adults with elevated depressive symptoms who met other eligibility criteria, not a representative mainstream population. The population qualifier therefore extends beyond what the study establishes. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBoth BluePages and MoodGYM improved depression literacy in adults.
“As might be expected, BluePages improved depression literacy in adults 20,21 as did MoodGYM. 20”
From Internet-based mental health programs: A powerful tool in the rural medical kit (2007) · cites this paper as [21]
Both programs lowered personal stigma in adults, but neither reduced perceived stigma in adults nor personal stigma in school students.
“Both programs led to reduced personal stigma among adults 21 but were not helpful in reducing perceived stigma in adults 21 or in decreasing personal stigma among school students. 27”
From Internet-based mental health programs: A powerful tool in the rural medical kit (2007) · cites this paper as [21]
All four studies investigating personal stigma measured depression stigma using the Depression Stigma Scale (DSS).
“All four studies investigating personal stigma measured depression stigma using the Depression Stigma Scale (DSS: Griffiths et al., 2004).”
From Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review (2020) · cites this paper as Griffiths et al., 2004
Similar changes in attitudes have been reported for adults in Internet-based interventions.
“Similar changes have been reported for adults in Internet-based interventions.74”
From Adolescent and parent experiences with a primary care/Internet-based depression prevention intervention (CATCH-IT) (2011) · cites this paper as [74]
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BackgroundMethodInfluentialSelf-citationStigma in Male Depression and Suicide: A Canadian Sex Comparison Study
Oliffe, J., Ogrodniczuk, J. S., Gordon, S. J., Creighton, G. M., Kelly, M., Black, N., & Mackenzie, C. (2016) · Community mental health journal · doi:10.1007/s10597-015-9986-x · Cited by 140 · see citing works
“The reverse-scored item, ‘‘I would feel like I was good Table 1 DSS Sex Comparison company’’, drew more endorsement from female respondents than male respondents (66.4 vs. 53.3 %).”
BackgroundMethodInfluentialBrijnath, B., Protheroe, J., Mahtani, K. R., & Antoniades, J. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5463 · Cited by 159 · see citing works
Mental Illness Stigma Reduction Interventions: Review of Intervention Trials
Dalky, H. F. (2012) · Western Journal of Nursing Research · doi:10.1177/0193945911400638 · Cited by 158 · see citing works
“Studies that reported lower follow-up response rates resulted in a small effect size of their outcome measurements and generally had a small sample size initially (Griffiths et al., 2004; Lincoln et al., 2008).”
BackgroundMethodResultInfluentialMental health first aid responses of the public: results from an Australian national survey
Jorm, A. F., Blewitt, K. A., Griffiths, K. M., Kitchener, B. A., & Parslow, R. (2005) · BMC Psychiatry · doi:10.1186/1471-244x-5-9 · Cited by 154 · see citing works
“To assess stigma, respondents were asked a series of nine questions designed to elicit their attitudes towards the person in the vignette (personal stigma) and nine items concerning what they thought others in the community would believe about the person in the vignette (perceived stigma) [7].”
BackgroundSelf-citationYap, M. B. H., Wright, A., & Jorm, A. F. (2011) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-010-0300-5 · Cited by 151 · see citing works
“stigma’, which refers to one’s own discriminating perceptions of others [ 10 , 12]; ‘social distance’, which refers to one’s desire to maintain distance from the stigmatised individual [14]; and ‘dangerousness’, which refers to one’s belief that the individual is dangerous [14, 15].”
BackgroundSelf-citationLópez, V., Sanchez, K., Killian, M., & Eghaneyan, B. H. (2018) · BMC Public Health · doi:10.1186/s12889-018-5516-4 · Cited by 152 · see citing works
“The first ten items of the DKM consist of a checklist to identify the five symptoms related to depression from a list of ten possible symptoms, and the last seven items were adapted from a true/false measure for depression literacy to assess depression treatment knowledge [31, 32].”
MethodMansfield, R., Patalay, P., & Humphrey, N. (2020) · BMC Public Health · doi:10.1186/s12889-020-08734-1 · Cited by 149 · see citing works
“to measure personal and perceived depression stigma [79].”
BackgroundArtificial intelligence and mobile apps for mental healthcare: a social informatics perspective
Gamble, A. (2020) · Aslib Journal of Information Management · doi:10.1108/ajim-11-2019-0316 · Cited by 149 · see citing works
Men's help seeking: Examination of differences across community size, education, and income.
Hammer, J. H., Vogel, D. L., & Edwards, S. R. (2012) · Psychology of Men & Masculinity · doi:10.1037/a0026813 · Cited by 147 · see citing works
Mental Health Stigma in the Military
Acosta, J., Becker, A., Cerully, J., Fisher, M., Martin, L. T., Vardavas, R., Slaughter, M. E., & Schell, T. L. (2014) · RAND Corporation eBooks · doi:10.7249/rr426 · Cited by 146 · see citing works
Griffiths, K. M., Crisp, D. A., Barney, L., & Reid, R. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-196 · Cited by 142 · see citing works
Self-citationLabeling of mental disorders and stigma in young people
Wright, A., Jorm, A. F., & Mackinnon, A. J. (2011) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.06.015 · Cited by 140 · see citing works
Self-citationBell, V. (2007) · Journal of Mental Health · doi:10.1080/09638230701482378 · Cited by 140 · see citing works
“Similarly, Strom et al. (2004) found equal improvement for the online therapy condition compared to waiting list controls and Griffiths et al. (2004) actually found a slight increase in perceived personal stigma for depression in the treatment group.”
ResultStigma of mental illness and help-seeking intention in university students
Lally, J., ó Conghaile, A., Quigley, S., Bainbridge, E., & McDonald, C. (2013) · The Psychiatrist · doi:10.1192/pb.bp.112.041483 · Cited by 143 · see citing works
Livingston, J., Tugwell, A., Korf-Uzan, K., Cianfrone, M., & Coniglio, C. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0617-3 · Cited by 139 · see citing works
“To assess respondents’ personal thoughts and beliefs about mental health issues, we administered a seven-item scale originally developed by Griffiths and colleagues [37] and subsequently adapted for younger populations [13].”
MethodHegerl, U., Wittenburg, L., Arensman, E., Audenhove, C. V., Coyne, J. C., McDaid, D., Feltz-Cornelis, C. M. V. D., Gusmão, R. M., Kopp, M., Maxwell, M., et al. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-428 · Cited by 138 · see citing works
Predictors of personal, perceived and self-stigma towards anxiety and depression
Grant, J. B., Bruce, C., & Batterham, P. J. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015000220 · Cited by 138 · see citing works
Dickstein, B. D., Vogt, D. S., Handa, S., & Litz, B. T. (2010) · Military Psychology · doi:10.1080/08995600903417399 · Cited by 135 · see citing works
Yap, M. B. H., Mackinnon, A. J., Reavley, N. J., & Jorm, A. F. (2014) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1433 · Cited by 135 · see citing works
Self-citationAn Intervention for Mental Health Literacy and Resilience in Organized Sports
Vella, S. A., Swann, C., Batterham, M. J., Boydell, K., Eckermann, S. D., Ferguson, H., Fogarty, A. S., Hurley, D., Liddle, S. K., Lonsdale, C., et al. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002433 · Cited by 139 · see citing works
Twomey, C., & O’Reilly, G. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416656258 · Cited by 133 · see citing works
“Moreover, RCTs have demonstrated MoodGYM’s effectiveness for reducing personal stigmatising attitudes to depression in community-dwelling adults (n = 525) (Griffiths et al., 2004), and anxiety symptoms (but not depression symptoms) in adolescent schoolchildren (n = 1477) (Calear et al.”
BackgroundDimoff, J. K., Kelloway, E. K., & Burnstein, M. D. (2015) · International Journal of Stress Management · doi:10.1037/a0039479 · Cited by 132 · see citing works
The Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety
Sethi, S., Campbell, A. J., & Ellis, L. A. (2010) · Journal of Technology in Human Services · doi:10.1080/15228835.2010.508317 · Cited by 129 · see citing works
Webb, M., Burns, J., & Collin, P. (2008) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2008.00066.x · Cited by 130 · see citing works
“Some studies show a correlation between Internet use and Internet addiction, which manifests itself as antisocial behaviour and may be associated with poorer social skills, lower selfesteem and confidence.18–21 However, Australian studies conducted in adult populations suggest that the Internet can play a significant…”
BackgroundAddressing stigma of depression in Latino primary care patients.
Vega, W., Rodríguez, M. A., & Ang, A. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.10.008 · Cited by 132 · see citing works
Personal and perceived depression stigma in Australian adolescents: Magnitude and predictors
Calear, A. L., Griffiths, K. M., & Christensen, H. M. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.08.019 · Cited by 130 · see citing works
Self-citationHow Does Being Female Assist Help-Seeking for Mental Health Problems?
Judd, F., Komiti, A., & Jackson, H. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670701732681 · Cited by 128 · see citing works
“A multivariate analysis of variance was performed to find any group differences based on a linear combination of the measures of interest, that is, LSS, TAS-26, the six facets of the NEO-O, and the two subscales of the DSS. Independent analysis of variance (ANOVA) was used to find group differences on each of the sepa…”
MethodInfluentialBelief in the dangerousness of people with mental disorders: A review
Jorm, A. F., Reavley, N. J., & Ross, A. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412442406 · Cited by 132 · see citing works
“Personal and Perceived Stigma Scales (Griffiths et al., 2004) 18 questions are asked in relation to a vignette or the label ‘depression’.”
BackgroundSelf-citationGender specific correlates of stigma toward depression in a Canadian general population sample
Wang, J., Fick, G. H., Adair, C. E., & Lai, D. W. L. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.01.010 · Cited by 128 · see citing works
Rüsch, N., Müller, M., Ajdacic‐Gross, V., Rodgers, S., Corrigan, P. W., & Wulf Rössler, A. (2013) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579601300036x · Cited by 125 · see citing works
‘teen Mental Health First Aid’: a description of the program and an initial evaluation
Hart, L. M., Mason, R. J., Kelly, C. M., Cvetkovski, S., & Jorm, A. F. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0034-1 · Cited by 118 · see citing works
Self-citationObesity and Internalized Weight Stigma: A Formulation Model for an Emerging Psychological Problem
Ratcliffe, D., & Ellison, N. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000763 · Cited by 122 · see citing works
Mental Health First Aid Training by e-Learning: A Randomized Controlled Trial
Jorm, A. F., Kitchener, B. A., Fischer, J., & Cvetkovski, S. (2010) · Australian and New Zealand journal of psychiatry (Print) · doi:10.3109/00048674.2010.516426 · Cited by 112 · see citing works
Self-citationVella, S. A., Swann, C., Batterham, M. J., Boydell, K., Eckermann, S. D., Fogarty, A. S., Hurley, D., Liddle, S. K., Lonsdale, C., Miller, A., et al. (2018) · BMC Public Health · doi:10.1186/s12889-018-5319-7 · Cited by 120 · see citing works
“To measure mental health literacy, 13 items of the Depression Literacy Questionnaire [54], 13 items of the”
MethodMental health first aid training for Australian medical and nursing students: an evaluation study
Bond, K. S., Jorm, A. F., Kitchener, B. A., & Reavley, N. J. (2015) · BMC Psychology · doi:10.1186/s40359-015-0069-0 · Cited by 118 · see citing works
Self-citationSebbens, J., Hassmén, P., Crisp, D. A., & Wensley, K. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00911 · Cited by 116 · see citing works
“Knowledge of the signs and symptoms of depression and anxiety were measured using 11 items from the Depression Literacy questionnaire (D-lit; Griffiths et al., 2004), and 11 items from the Anxiety Literacy questionnaire (A-lit; Gulliver et al., 2012b) respectively.”
BackgroundMethodInfluentialDescriptive epidemiology of stigma against depression in a general population sample in Alberta
Cook, T. M., & Wang, J. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-29 · Cited by 116 · see citing works
“The depression stigma scale in our study yielded a Cronbach's alpha of 0.715, which was close to that of Griffiths et al. (alpha = 0.76) [ 22 ].”
BackgroundMethodResultInfluentialTwomey, C., O'Reilly, G., Byrne, M., Bury, M., White, A., Kissane, S., McMahon, A., & Clancy, N. (2014) · British Journal of Clinical Psychology · doi:10.1111/bjc.12055 · Cited by 100 · see citing works
Detecting depression stigma on social media: A linguistic analysis
Li, A., Jiao, D., & Zhu, T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.087 · Cited by 114 · see citing works
Determinants of help-seeking behavior in depression: a cross-sectional study
Boerema, A. M., Kleiboer, A., Beekman, A. T. F., van Zoonen, K., Dijkshoorn, H., & Cuijpers, P. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0790-0 · Cited by 110 · see citing works
Evaluation of a Fotonovela to Increase Depression Knowledge and Reduce Stigma Among Hispanic Adults
Unger, J. B., Cabassa, L. J., Molina, G. B., Contreras, S., & Baron, M. F. (2012) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-012-9623-5 · Cited by 110 · see citing works
Hart, L., Morgan, A. J., Rossetto, A., Kelly, C. M., Mackinnon, A. J., & Jorm, A. F. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417753552 · Cited by 115 · see citing works
“Measures of stigmatising beliefs included the Social Distance Scale (SDS; Link et al., 1999) and the Depression Stigma Scale (DSS; Griffiths et al., 2004), modified for use with the John/Jeanie vignettes (Hart et al., 2016) and evaluated as four distinct stigma scales: ‘social distance’,…”
MethodSelf-citationA Systematic Review of Parent and Caregiver Mental Health Literacy
Hurley, D., Swann, C., Allen, M., Ferguson, H. L., & Vella, S. (2019) · Community mental health journal · doi:10.1007/s10597-019-00454-0 · Cited by 99 · see citing works
Daehn, D., Rudolf, S., Pawils, S., & Renneberg, B. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04865-y · Cited by 131 · see citing works
Doll, C. M., Michel, C., Rosen, M., Osman, N., SCHIMMELMANN, B. G., & Schultze‐Lutter, F. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03435-4 · Cited by 114 · see citing works
Adherence to the MoodGYM program: outcomes and predictors for an adolescent school-based population
Calear, A. L., Christensen, H., Mackinnon, A., & Griffiths, K. M. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.036 · Cited by 105 · see citing works
Svensson, B., & Hansson, L. I. (2015) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2015.1109140 · Cited by 104 · see citing works
Singh, S., Zaki, R., & Farid, N. (2019) · Journal des adolescens · doi:10.1016/j.adolescence.2019.06.004 · Cited by 80 · see citing works
- Authors
- Griffiths, K. M., Christensen, H., Jorm, A. F., Evans, K., & Groves, C.
- Affiliations
- Australian National University (AU)
- Corresponding author
- Griffiths, Kathleen M.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-10
- Volume
- 185
- Issue
- 4
- Pages
- 342-349
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W1983994076
- Cited by
- 789
- References
- 34
- Citations by year
- 2026: 37 · 2025: 43 · 2024: 30 · 2023: 68 · 2022: 91 · 2021: 54 · 2020: 54 · 2019: 47 · 2018: 56 · 2017: 37 · 2016: 41 · 2015: 23 · 2014: 32 · 2013: 28 · 2012: 27
- FWCI
- 14.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression stigma, personal stigma, perceived stigma, online intervention, depression literacy, cognitive behavioral therapy, MoodGYM, educational websites, stigma reduction
- MeSH terms
- Adult, Analysis of Variance, Depressive Disorder, Female, Humans, Male, Patient Education as Topic, Perception, Sensitivity and Specificity, Stereotyping, Cognitive Behavioral Therapy, Internet
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