Young Adult’s Mental Health Literacy in Relation to Depression and Their Attitudes Towards Complementary Medicine Practice
Mental Health Researcher, School of Medicine | Western Sydney University, Macarthur Clinical School, Locked Bag 1797 Penrith NSW 2751, Australia
Academic Editor: Marianna Mazza
Received: July 11, 2022 | Accepted: September 22, 2022 | Published: October 09, 2022
OBM Integrative and Complementary Medicine 2022, Volume 7, Issue 4, doi:10.21926/obm.icm.2204047
Recommended citation: Foroughi N, Douglass L, Smith CA, Hay P. Young Adult’s Mental Health Literacy in Relation to Depression and Their Attitudes Towards Complementary Medicine Practice. OBM Integrative and Complementary Medicine 2022; 7(4): 047; doi:10.21926/obm.icm.2204047.
© 2022 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
Mental Health (MH) disorders such as depression are the most common health-related issues in young adults , but MH Literacy (MHL) or understanding of depression (its recognition and treatment) particularly in men can be poor . It may lead to a delay in help seeking and can contribute to high rates of people with poor MH going untreated each year [3,4,5] and other adverse outcomes . However, MHL can improve over time [7,8].
In addition to recommend treatments for depression (e.g., antidepressants and cognitive behavioral and other therapies)  Complementary Therapies (CTs) including acupuncture and herbal remedies (e.g., St John’s Wort) have been used. These are reported to be associated with positive outcomes and may be more frequently used than other evidence-based treatments for depression [8,10,11]. A more recent systematic review of 49 registered clinical trials have suggested St. John's wort comparative effectiveness towards standard antidepressants for the treatment of depressive symptoms with less adverse events .
In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.
In this study we used the National Integrative and Complementary Medicine (NICM) definitions which were derived from the Cochrane Collaboration :
“Broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. Complementary medicine includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within complementary medicine and between the complementary medicine domain and that of the dominant system are not always sharp or fixed.”
To treat depression, it is essential to understand what knowledge the population holds about the ailment, including recognition of the symptoms and where, or if they would seek help and treatment. Further research into preventative measures, self-help and complementary health treatment options are necessary. Notably, there are gaps in knowledge about MHL regarding CTs for depression in younger adults, in particular men. Therefore, we aimed to further explore depression related MHL in a convenience community sample, and to investigate the effects of current MH status and other sociodemographic features on MHL.
2. Materials and Methods
2.1 Study Design
Western Sydney University’s Human Research Ethics Committee approved this observational analytical study (H11080, April 2015). Participants were recruited from a research database stablished 15 years ago  (The Women’s Eating and Health Literacy (WEHL)) and by advertising in public spaces of the University and sporting groups in 2015. Participants of the WEHL study (aged over 18 years) were invited to enroll in the current project in 2015. The cohort of this study consisted of the community women and university students of all gender identities who responded to our advertisements. Surveys were distributed to those who were interested to participate. Surveys were completed online or by post and all the participants provided informed consent.
2.2 Depression: MHL Survey
Based on Jorm et al.  the following open-ended questions were asked about what participants believe is wrong with “John” who has depression (Appendix A): 1. What condition the participants believed the symptoms in the vignette presented?, 2. How could John best be helped by the treatment?, and 3. What group of people were essential to John’s recovery? Participants then rated the helpfulness/harmfulness/no effects, outcomes, and CT effects for his problem.
2.3 Assessment Instruments
Depression and anxiety symptoms were assessed via Kessler-10 (K10) questionnaire with moderate reliability . An average score to indicate positive mental health ranges from 10-15 . Participant’s physical and mental health  was measured via SF12 questionnaire which has a sound reliability and validity . The scoring is from 0-100 (lowest to highest health level) with the mean and standard deviation score of 50±10 . The reminder of our instruments were questionaries that collect information about the participants’ personal views and experiences in using complementary therapies. The survey is not constructed with multiple responses. It measures the same construct and thus can’t be subjected to psychometric testing such as internal consistency. This survey was adapted from a widely used survey instrument used to assess mental health literacy in Australian population by Jorm et al, [8,17] who have demonstrated face validity over the course of numerous publications in mental health literacy and also in our previous publications in mental health survey [8,12,17,18,19].
2.4 Statistical Analysis
All analyses used IBM Statistical Package (SPSS 23) and the data was inspected for normality. Chi-square and T tests were employed, p < 0.05. Open-ended responses were collated and presented by frequency of response. Regard for treatments were assigned six different categories: very positive, positive, neutral, negative, and very negative. As missing data was low (<10%) no imputation was made.
The response rates of the mailed surveys (n = 96) and emailed surveys (n = 125) to the previously established research database were 45.83% (n = 44) and 42.4% (n = 53), respectively. The total response rate was 43%. We received 59 surveys by advertising in the university and sport clubs; however, the response rate for this group is unknown, because we couldn’t identify the exact number of people who have viewed the recruitment posters. Approximately, 76.3% (n = 156) of the returned surveys (n = 119) were fully completed. For the purposes of this study, we only included those participants who have responded to any question on CTs (n = 118) including the questions in Table 4.
As shown in Table 1 (participant features) the 118 survey respondents had moderate levels of psychological distress, and impaired quality of life. As shown in Table 2, the majority (70.3%) reported using at least one form of CTs 12-months prior to study participation. The most widely utilized CTs were vitamins. Favorable attitudes towards CTs and experiences of using them are reported in Table 2.
Most participants considered John was suffering from ‘body image related lack of self-confidence’. Recognition of depressive symptoms was higher with age (≤34 vs. ≥35, p < 0.001); higher in females than males (37.7% vs. 5.3%, p = 0.006); was associated with the level of education (p = 0.047), but not related to mental health status of the participants (e.g., depression) (Table 3).
When a list of potential conditions that John may have suffered from was provided, 32.2% of the participants were able to correctly identify John’s display of depressive symptoms. Table 4 presents beliefs about the helpfulness of treatments and the majority selected seeking social support in conjunction with counselling, visiting a psychiatrist and anti-depressant use. The most helpful CTs were physical activity, relaxation, regular meditation, and yoga. Just over 19% of the participants believed that John would recover based on the provided treatment but, indicated that relapse was likely (39%). Exercise was perceived as the most beneficial therapy for John’s symptoms (96.6%) followed by acupuncture (42.4%) and St John’s Wort (43.2%) (see Table 5).
Limitations of this study include the use of self-reported surveys which may be prone to reporting and recall biases. The cohort of this study consisted of a combination of general population sample [20,21] that was representative of young woman living in the Australian Capital Territory, and a convenience sample of higher education university and college students. The population was broadly representative of young woman with at least a high school education in Australia [12,22], and the campuses surveyed were from diverse socio-economic background. Although there is a very high proportion (56%) of the Australian population who engage in higher education  this sample was not representative of the wider Australian population and the results may not be generalizable to men, more senior and asymptomatic people. The findings can be used to inform future studies to examine in greater depth issues concerning MH, for example differences in gender, age, and education. Such groups may be imported to target in interventions aimed to improve MHL in the future.
In this study of moderately symptomatic participants there was a low level of MHL when participants were asked to identify the condition John was suffering. This finding is consistent with Burns and Cotton [3,24]. However, when the participants were presented with a list of possible conditions, recognition of depressive symptoms was higher. We observed increases in symptom recognition when advised the possible diagnosis. This demonstrates a moderate understanding of the symptoms. Older and more educated females had a better recognition of the depressive symptoms.
Overall, the participants had a good knowledge of how to treat and manage depressive symptoms, electing a range of clinical practitioners along with a strong personal support network comprising of family and friends. Participants were aware of the importance of treatment for full or partial recovery, for symptom management and recognition. Attitudes towards antidepressants were also more favorable that previously reported .
This may be due to differences in sample demographics, our sample being a relatively young, predominately female, and symptomatic community sample. In this study males aged ≤34 had the lowest recognition of depressive symptoms which is consistent with Cotton et al. . However, the current evidence is insufficient to support or contest the efficacy of antidepressant medication for mild depression mainly due to increased adverse effects and added or combination of antidepressants to manage the adverse effects .
Over half of the surveyed participants had used CT therapies in the 12 months prior to the study. Use included vitamins/minerals, relaxation techniques, yoga, and massage which is consistent with previous studies . Participants believed that using CTs positively improved their symptoms by reducing the stress levels, increasing relaxation, relieving chronic pains, and other health conditions. Exercise, relaxation, meditation, and yoga were perceived the most helpful forms of CTs. The high regard for exercise is supported by evidence based studies for the treatment of depression . However, less extensive evidence supports positive effects of relaxation, meditation , and acupuncture in treating depression .
The top three types of therapies regarded as harmful by our cohort were homeopathy, magnet therapy and hypnotherapy are in accord with the limited and mixed evidence reported for these approaches [30,31,32]. In contrast, acupuncture and St John Wort were rated more highly and had a greater evidence base [33,34,35]. Similarly, the use of self-help strategies offer many benefits to the user .
Identification of depression was found to be low suggesting a need for greater education to enhance the ability of young adults to recognize the symptoms of a mental health issue. The use of CTs is growing, yet people may be unaware of their potential benefits. On the other hand, the results indicate people would access an appropriate professional clinician for help over a self-help or complementary practitioner.
The Authors would like to acknowledge the valuable time and effort of the volunteers who have participated in this study.
PH & NF conceived of the presented idea and developed the theory. NF & LD performed the computations and verified the analytical methods. NF, PH and CS supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.
PH receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry and royalties from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, and she has received research grants from the NHMRC and ARC. She is Deputy Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2012-) and Member of the ICD-11 Working Group for Eating Disorders (2012-) and was Chair Clinical Practice Guidelines Project Working Group (eating disorders) of RANZCP (2012-2015). She has prepared a report under contract for Shire Pharmaceuticals (July 2017). All views in this paper are her own.
PH receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry and royalties from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications. She has received research grants from the NHMRC and ARC. She is the Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2019-) and was Member of the ICD-11 Working Group for Eating Disorders (2012-2019) and was Chair Clinical Practice Guidelines Project Working Group (eating disorders) of RANZCP (2012-2015). She is a Consultant for Takeda (formerly Shire) Pharmaceuticals (July 2017-2020). All views in this paper are her own. CS declares as a medical research institute, NICM Health Research Institute receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. NF, and LD have no conflict of interests.
The following additional material is uploaded at the page of this paper.
1. Appendix 1
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