Helen M. Aucote

Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men

BACKGROUND The last decade has seen the burgeoning publication of male-specific depression rating scales designed to assess externalising depression symptoms (e.g., substance use, risk-taking, and aggression). These symptoms are theorised to reflect the behavioural manifestation of depression amongst men who rigidly conform to masculine norms. To date, research findings from these scales have been mixed, and each scale is limited by psychometric shortcomings or constrained assessment of symptom sub-domains. METHODS The Male Depression Risk Scale (MDRS-22) was developed from online, non-clinical, community samples. Following best-practice recommendations, initial scale items were subject to expert review. Study 1 (male n=386) reduced the item pool via exploratory factor analysis while Study 2 (male n=499, female n=291) refined and validated the factor structure using confirmatory factor analysis. Sex and masculinity comparisons were evaluated. RESULTS Goodness of fit indices validated the six-factor solution with subscales assessing: emotional suppression, drug use, alcohol use, anger and aggression, somatic symptoms and risk-taking. Between-groups analyses indicated higher MDRS-22 scores for males reporting higher conformity to masculine norms. LIMITATIONS Data were drawn from an online community sample without use of diagnostic interview. Test-retest correlations were not evaluated. Future research should look to examine longitudinal typical-externalising symptom trajectories across a range of clinical and non-clinical settings. CONCLUSIONS The MDRS-22 reports satisfactory preliminary psychometric properties with validated subscales enabling multidimensional assessment of theorised externalising symptom sub-domains. MDRS-22 scale brevity may facilitate use in primary care settings enabling better identification of at-risk males.

Longitudinal sex differences of externalising and internalising depression symptom trajectories: Implications for assessment of depression in men from an online study

Background: Clinical reports indicate that men tend to engage in a range of externalising behaviours in response to negative emotional states. Such externalising behaviours have been theorised to reflect a male sub-type of depression that is inconsistent with current diagnostic criteria, resulting in impeded detection and treatment rates of depressed men. Aims: In addressing previous study design limitations, this article presents self-report longitudinal data for the multidimensional Male Depression Risk Scale (MDRS-22) against ratings of diagnostic criteria for major depressive disorder as assessed by the Patient Health Questionnaire–Depression Module (PHQ-9). Longitudinal psychometric properties of the MDRS-22 are reported and symptom trajectories described. Method: A sample of 233 adults (males = 125; 54%) completed measures of externalising and prototypic depression symptoms at Time 1, and again at Time 2 (15 weeks later). Psychometric properties were examined and within-subjects analyses undertaken. Results: The MDRS-22 demonstrated stable internal consistency and test–retest correlations equivalent to those observed for the PHQ-9. Both prototypic and externalising depression symptoms increased with experiences of recent negative life events. Marked gender differences were observed. Males experiencing ≥ 2 stressful negative life events reported significantly higher MDRS-22 scores at both Time 1 and Time 2 relative to comparable females. Conclusion: Findings contribute to the validity of the MDRS-22 as a measure of externalising depression symptoms. Results suggest that while both males and females experience externalising depression symptoms, these symptoms may be particularly elevated for men following experiences of negative life events. Findings suggest that externalising symptoms may be a special feature of depression for men. Given the problematic nature of such externalising symptoms (e.g. excessive substance use, aggression, risk-taking), their clinical assessment appears warranted.

Men’s perceived barriers to help seeking for depression: Longitudinal findings relative to symptom onset and duration

Men’s help seeking for depression continues to gain focussed research and clinical attention. In this study, 125 men (M = 39.02 years) provided data on perceived barriers to mental health help seeking, and self-reported depression at baseline, and 15 weeks. Longitudinal depression caseness was used to investigate group differences in perceived barriers to help seeking. Those experiencing unremitting depression reported the highest perceived help-seeking barriers. This finding was consistent over all domains of help-seeking barriers, and it was independent of previous mental health help-seeking efforts. Findings are discussed in the broader context of men’s mental health and health psychology.

Co-morbid depression and chronic illness related to coping and physical and mental health status

A partial latent structural regression analysis was used to evaluate the role of coping resources, depression, diet and exercise on mental and physical health status. The sample consisted of 113 participants (59 females and 54 males) with a mean age of 59.38 years (SD = 10.52). Coping resources, depression and exercise explained 52 and 26% of the variance in mental and physical health status, respectively. Fewer coping resources predicted higher levels of depression and both predicted worse mental health. Only higher levels of depression predicted worse physical health status. There were also significant indirect effects of coping on mental and physical health status through depression. The development of cognitive, social and emotional coping strategies is important for managing depression and supporting positive mental health. These results highlight the important role of health psychologists in the care of individuals with chronic illness. Additionally, the management of depression is important in maintaining positive physical health.

Rockfalls: predicting high‐risk behaviour from beliefs

Purpose – The purpose of this paper is to gain an understanding of the publics beliefs, attitudes and knowledge regarding rockfalls, and to see whether these variables could predict whether a person is likely to enter high‐risk rockfall areas.Design/methodology/approach – A questionnaire was developed to measure beliefs (informed by the health belief model), knowledge, and previous behaviour in relation to rockfalls. Questions were also included to measure attitudes regarding rockfall caution signs. In total, 138 members of the general public completed the questionnaire.Findings – High‐risk behaviour was more likely if the person was male and if the person had the belief that sign‐posted high‐risk areas were not dangerous. Further, believing that the sign‐posted areas were not dangerous was more likely among people who held negative attitudes towards cautionary signs; specifically, these participants were more likely to doubt the validity of the warning signs.Research limitations/implications – The resea...

Confirmatory Factor Analysis of the Gotland Male Depression Scale in an Australian Community Sample

The Gotland Male Depression Scale (GMDS) was developed to improve the assessment and identification of depression in men by assessing symptoms that fall outside DSM-V/ICD-10 diagnostic criteria for depression. However, research findings from the GMDS have been markedly discrepant. Attempts to validate the latent GMDS factor structure using exploratory factor analysis (EFA) have yielded inconsistent results, bringing the validity and public health utility of the scale into question. The current study used confirmatory factor analysis to test the construct validity of five competing latent factor models identified from prior research. Data were obtained and analyzed separately from an Australian community sample of adult males (n = 318) and females (n = 345). Fit indices demonstrated the original GMDS two-factor model (distress, depression) to be a poor fit to the data. An alternative mixed three-factor model demonstrated improved model fit, although indices remained marginal. Results question the factor structure validity of the GMDS in the present sample and highlight the need for further psychometric development of the scale.

Interpretation and misinterpretation of warning signage: Perceptions of rockfalls in a naturalistic setting

The aim of the present study was to investigate the factors relating to non-adherence to warning signs about falling rocks from coastal cliff faces. Face-to-face interviews (n = 62) in a naturalistic setting (in the vicinity of a high-risk rockfall area) were conducted to investigate attention to and comprehension of warning signs, as well as beliefs relating to non-adherence of the signage. It was found that, while most participants could correctly identify the danger in the area and had noticed the warning signage, less than half of the participants could correctly interpret the signage. The perception of danger did not differ significantly between the participants who had, or had not, entered the high-risk zone. Differences in knowledge and beliefs between local residents and visitors to the area were identified. It was concluded that the warning signs did not provide enough detail for people to make informed decisions about safe behaviours. Comprehension of the signage may have been hampered by a lack of prior-knowledge of the particular risk, a failure to think carefully about the situation (i.e. low-effort processing), and the pictorial representation on the signs misleading the participants as to the true danger.

Measuring the psychological consequences of breast cancer screening: a confirmatory factor analysis of the Psychological Consequences Questionnaire

ObjectivesTo use confirmatory factor analysis (CFA) to test the proposed factor structure of the Psychological Consequences Questionnaire (PCQ), a measure of the psychological impact of breast cancer screening. A further aim was to examine the robustness of the proposed factor structure across key demographic and clinical variables.MethodFollowing visits to breast cancer screening clinics, women who received a false-positive diagnosis and a matched sample of women who had received all-clear diagnoses were sent a questionnaire package containing the PCQ and a demographics measure. A total of 220 women returned completed questionnaires. CFA was used to test the factor structure and multiple indicator–multiple cause (MIMIC) models were used to test the robustness of the factor structure across the test result group, age, and family history of breast cancer diagnosis.ResultsThe CFA results suggested support for both a three- and a one-factor model; a one-factor model was preferred, however, due to the very high covariance between the three latent factors in the three-factor model. A CFA MIMIC model suggested that the test result impacted on the latent factor: women who initially received a false-positive diagnosis showed significantly higher levels of psychological dysfunction after screening.ConclusionsThe PCQ appears to be a promising tool for assessing psychological dysfunction after breast cancer screening; however, a one-factor model received more support than the initially proposed three-factor model. There was little evidence of differential item functioning across key demographic and clinical variables for the PCQ.

Changing perception of average person's risk does not suffice to change perception of comparative risk

The direct method of assessing “unrealistic optimism” employs a question of the form, “Compared with the average person, what is the chance that event X will occur to you?” It has been proposed that when individuals construct their responses to this question (direct-estimates) they focus much more strongly on estimates of their own risk (self-estimates) than on estimates of the average persons risk (other-estimates). A challenge to this proposal comes from findings that interventions that alter other-estimates also change direct-estimates. Employing a novel intervention technique, we tested the possibility that such interventions may indirectly also change self-estimates and that this is what accounts for their effect on direct-estimates. Study 1 (n = 58) showed that an intervention which was designed to (and did) affect other-estimates also affected self-estimates, while Study 2 (n = 101) showed that it affected direct-estimates. Study 3 (n = 79) confirmed that we could modify the intervention so as to maintain the effect on other-estimates, but eliminate that on self-estimates. Study 4 (n = 112) demonstrated that when this was done, there was no longer any effect on direct-estimates. The findings are consistent with the proposal that direct-estimates are constructed largely just out of self-estimates. Implications for heath education programs are discussed.

Prevalence and co-occurrence of internalizing and externalizing depression symptoms in a community sample of Australian male truck drivers

Trucking industry employees are known to be at risk of elevated levels of stress and a range of behaviors that may compromise their mental health. Clinical reports indicate that in response to negative emotional states, men tend to engage in a cluster of externalizing behaviors including irritability, anger and aggression, risk taking, and substance misuse. However, as such symptoms fall outside standard diagnostic depression criteria, the diagnosis and treatment of depression in men may be impeded. The present exploratory study reports retrospective symptom ratings of internalizing and externalizing depression symptoms from 91 Australian male truck drivers. Moderate correlation between externalizing and internalizing symptoms was reported across the sample, though internalizing symptoms were reported more frequently. However, consistent with prediction, those meeting probable depression caseness (n = 20) reported three times the number of externalizing symptoms relative to those in the nonclinical group (Cohen’s d = 1.31). Externalizing symptoms may be a particular phenotypic feature of depression in men, and assessment of such symptoms may assist in the detection of those unwilling to disclose typical internalizing symptoms (i.e., sadness, hopelessness). Results also highlight the need for targeted research into stress-related and mental health outcomes of men in high health risk occupations such as truck driving.