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7 Depression Research Paper Topic Ideas

Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

Cara Lustik is a fact-checker and copywriter.

questions about depression for research paper

In psychology classes, it's common for students to write a depression research paper. Researching depression may be beneficial if you have a personal interest in this topic and want to learn more, or if you're simply passionate about this mental health issue. However, since depression is a very complex subject, it offers many possible topics to focus on, which may leave you wondering where to begin.

If this is how you feel, here are a few research titles about depression to help inspire your topic choice. You can use these suggestions as actual research titles about depression, or you can use them to lead you to other more in-depth topics that you can look into further for your depression research paper.

What Is Depression?

Everyone experiences times when they feel a little bit blue or sad. This is a normal part of being human. Depression, however, is a medical condition that is quite different from everyday moodiness.

Your depression research paper may explore the basics, or it might delve deeper into the definition of clinical depression or the difference between clinical depression and sadness .

What Research Says About the Psychology of Depression

Studies suggest that there are biological, psychological, and social aspects to depression, giving you many different areas to consider for your research title about depression.

Types of Depression

There are several different types of depression that are dependent on how an individual's depression symptoms manifest themselves. Depression symptoms may vary in severity or in what is causing them. For instance, major depressive disorder (MDD) may have no identifiable cause, while postpartum depression is typically linked to pregnancy and childbirth.

Depressive symptoms may also be part of an illness called bipolar disorder. This includes fluctuations between depressive episodes and a state of extreme elation called mania. Bipolar disorder is a topic that offers many research opportunities, from its definition and its causes to associated risks, symptoms, and treatment.

Causes of Depression

The possible causes of depression are many and not yet well understood. However, it most likely results from an interplay of genetic vulnerability and environmental factors. Your depression research paper could explore one or more of these causes and reference the latest research on the topic.

For instance, how does an imbalance in brain chemistry or poor nutrition relate to depression? Is there a relationship between the stressful, busier lives of today's society and the rise of depression? How can grief or a major medical condition lead to overwhelming sadness and depression?

Who Is at Risk for Depression?

This is a good research question about depression as certain risk factors may make a person more prone to developing this mental health condition, such as a family history of depression, adverse childhood experiences, stress , illness, and gender . This is not a complete list of all risk factors, however, it's a good place to start.

The growing rate of depression in children, teenagers, and young adults is an interesting subtopic you can focus on as well. Whether you dive into the reasons behind the increase in rates of depression or discuss the treatment options that are safe for young people, there is a lot of research available in this area and many unanswered questions to consider.

Depression Signs and Symptoms

The signs of depression are those outward manifestations of the illness that a doctor can observe when they examine a patient. For example, a lack of emotional responsiveness is a visible sign. On the other hand, symptoms are subjective things about the illness that only the patient can observe, such as feelings of guilt or sadness.

An illness such as depression is often invisible to the outside observer. That is why it is very important for patients to make an accurate accounting of all of their symptoms so their doctor can diagnose them properly. In your depression research paper, you may explore these "invisible" symptoms of depression in adults or explore how depression symptoms can be different in children .

How Is Depression Diagnosed?

This is another good depression research topic because, in some ways, the diagnosis of depression is more of an art than a science. Doctors must generally rely upon the patient's set of symptoms and what they can observe about them during their examination to make a diagnosis.

While there are certain laboratory tests that can be performed to rule out other medical illnesses as a cause of depression, there is not yet a definitive test for depression itself.

If you'd like to pursue this topic, you may want to start with the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition, known as DSM-5, offers a very detailed explanation that guides doctors to a diagnosis. You can also compare the current model of diagnosing depression to historical methods of diagnosis—how have these updates improved the way depression is treated?

Treatment Options for Depression

The first choice for depression treatment is generally an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are the most popular choice because they can be quite effective and tend to have fewer side effects than other types of antidepressants.

Psychotherapy, or talk therapy, is another effective and common choice. It is especially efficacious when combined with antidepressant therapy. Certain other treatments, such as electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), are most commonly used for patients who do not respond to more common forms of treatment.

Focusing on one of these treatments is an option for your depression research paper. Comparing and contrasting several different types of treatment can also make a good research title about depression.

A Word From Verywell

The topic of depression really can take you down many different roads. When making your final decision on which to pursue in your depression research paper, it's often helpful to start by listing a few areas that pique your interest.

From there, consider doing a little preliminary research. You may come across something that grabs your attention like a new study, a controversial topic you didn't know about, or something that hits a personal note. This will help you narrow your focus, giving you your final research title about depression.

Remes O, Mendes JF, Templeton P. Biological, psychological, and social determinants of depression: A review of recent literature . Brain Sci . 2021;11(12):1633. doi:10.3390/brainsci11121633

National Institute of Mental Health. Depression .

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . American Psychiatric Association.

National Institute of Mental Health. Mental health medications .

Ferri, F. F. (2019). Ferri's Clinical Advisor 2020 E-Book: 5 Books in 1 . Netherlands: Elsevier Health Sciences.

By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

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Frequently Asked Questions about Depression

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Impactful Depression Research Discoveries by Foundation Grantees:

Rapid-Acting Antidepressant Heralded as Biggest Breakthrough in Depression Research in 50 years
Development of TMS for Treatment-Resistant Depression
Interactive Parent-Child Therapy Reduced Depression Symptoms in Very Young Children
Foundation Grantee Shows Treating Inflammation May Improve Resistant Depression

Recent Depression Research Discoveries by Foundation Grantees:

Impact of Mother’s Depressive Symptoms Just Before and After Childbirth Upon Child’s Brain Development
Study Links Brain Connectivity Patterns with Response to Specific Antidepressant and Placebo
Over Two Decades, 90 BBRF Grants Helped Build a Scientific Foundation for the First Rapid-Acting Antidepressants
After 60 Years, Study Finds Children of Mothers with Bacterial Infections During Pregnancy Have Elevated Psychosis Risk

For more lay-friendly, summarized Depression Research Discoveries, click here .

Clinical depression is a serious condition that negatively affects how a person thinks, feels, and behaves. In contrast to normal sadness, clinical depression is persistent, often interferes with a person’s ability to experience or anticipate pleasure, and significantly interferes with functioning in daily life. Untreated, symptoms can last for weeks, months, or years; and if inadequately treated, depression can lead to significant impairment, other health-related issues, and in rare cases, suicide.

A person is diagnosed with a major depression when he or she experiences at least five of the symptoms listed below for two consecutive weeks. At least one of the five symptoms must be either (1) depressed mood or (2) loss of interest or pleasure. Symptoms include:

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in activities most of the day, nearly every day
Changes in appetite that result in weight losses or gains unrelated to dieting
Changes in sleeping patterns
Loss of energy or increased fatigue
Restlessness or irritability
Feelings of anxiety
Feelings of worthlessness, helplessness, or hopelessness
Inappropriate guilt
Difficulty thinking, concentrating, or making decisions
Thoughts of death or attempts at suicide

The first step to being diagnosed is to visit a doctor for a medical evaluation. Certain medications, and some medical conditions such as thyroid disorder, can cause similar symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor eliminates a medical condition as a cause, he or she can implement treatment or refer the patient to a mental health professional. Once diagnosed, a person with depression can be treated by various methods. The mainstays of treatment for depression are any of a number of antidepressant medications and psychotherapy, which can also be used in combination.

For severe, treatment-resistant depression, studies have been done showing Deep Brain Stimulation may be an option. Learn more in this webinar featuring Dr. Helen Mayberg :

Depression is twice as common among women as among men. About 20 percent of women will experience at least one episode of depression across their lifetime. Scientists are examining many potential causes for and contributing factors to women’s increased risk for depression. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women’s higher depression rates. Researchers have shown, for example, that hormones affect brain chemistry, impacting emotions and mood. Before adolescence, girls and boys experience depression at about the same frequency. By adolescence, however, girls become more likely to experience depression than boys. Research points to several possible reasons for this imbalance. The biological and hormonal changes that occur during puberty likely contribute to the sharp increase in rates of depression among adolescent girls. In addition, research has suggested that girls are more likely than boys to continue feeling bad after experiencing difficult situations or events, suggesting they are more prone to depression.

Women are particularly vulnerable to depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the “baby blues.” These symptoms usually dissipate by the 10th day. PPD lasts much longer than 10 days, and can go on for months following child birth. Acute PPD is a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience PPD often have had prior depressive episodes.

Menopause is defined as the state of an absence of menstrual periods for 12 months. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

For older adults who experience depression for the first time later in life, other factors, such as changes in the brain or body, may be at play. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels become less flexible. They may harden and prevent blood from flowing normally to the body’s organs, including the brain. If this occurs, an older adult with no family or personal history of depression may develop what some doctors call “vascular depression.” Those with vascular depression also may be at risk for a coexisting cardiovascular illness, such as heart disease or a stroke.

Researchers are looking for ways to better understand, diagnose and treat depression among all groups of people. Studying strategies to personalize care for depression, such as identifying characteristics of the person that predict which treatments are more likely to work, is an important goal.

The ability of ketamine to produce a rapid and efficacious antidepressant response by a completely novel mechanism is considered by many experts the most important finding in the depression field in 50 years. Originally developed as an anesthetic, ketamine is an antagonist of the NMDA receptor on a subset of brain cells. It often produces rapid (within hours) antidepressant actions in patients who have failed to respond to conventional antidepressants (i.e., are considered treatment-resistant). Ketamine is psychoactive and has potentially dangerous side effects; it has a past history of being abused as a street drug. Studies aimed at characterizing the mechanisms by which ketamine works rapidly and effectively in severely depressed individuals is likely to lead to novel targets and agents that are safer and more long-lasting, and could revolutionize the treatment of depression. Numerous BBRF Grants support this work , including a number that are attempting to develop ketamine analogs – compounds that act like ketamine but lack its side-effects.

Treatment-resistant depression (TRD) is a term used in clinical psychiatry to describe cases of major depressive disorder that do not respond to standard treatments (at least two courses of antidepressant treatments). For many people, antidepressant treatment and/or ‘talk’ therapy (such as Cognitive Behavioral Therapy) ease symptoms of depression, but with treatment-resistant depression, little to no relief is realized. Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps. (Source: Biological Psychiatry)

Treatment of resistant depression has most commonly been treated with electroconvulsive therapy (ECT). ECT has been modified to avoid the pain previously associated with it and is the most effective and quick-acting treatment for resistant depression. The downside is that it works by inducing brain seizures and can impair memory. Its therapeutic benefits can also fade over time. New methods of brain stimulation also offer the possibility of relief. These technologies exploit the fact that the brain is an electrical organ: it responds to electrical and magnetic stimulation to modulate brain circuits and change brain activity. Repetitive transcranial magnetic stimulation (rTMS), pioneered by Dr. Mark George with the support of NARSAD grants, was approved by the FDA in 2008 as a treatment for some otherwise untreatable depressions. rTMS is a noninvasive method that works through a coil held over the target area of the brain. A magnetic field passes through the skull to activate the appropriate brain circuit and no seizures are induced. Deep brain stimulation (DBS), a technique adapted for treating depression by Dr. Helen Mayberg with the support of NARSAD grants, works through electrodes planted deep in the brain. Another method, vagus nerve stimulation (VNS), stimulates the vagus nerve in the neck to therapeutically activate brain function. Magnetic seizure therapy (MST) combines rTMS and ECT to achieve a safer form of seizure therapy. MST has been supported through NARSAD Grants to Dr. Sarah Lisanby. Recently, Foundation grantees at the University of Pittsburgh have successfully experimented on a small number of patients with treatment-resistant depression, discovering underlying metabolic deficiencies and successfully treating these. In one subset of patients, a deficiency in cerebral folate was addressed by administering folinic acid. Patients’ depression symptoms declined significantly when these metabolic problems were treated. For some individuals, depression reached remission.

Learn more about TMS for depression in this webinar featuring Dr. Sarah Lisanby :

The first attempts at defining depression as a biologically-based illness hinged on a theory of a ‘chemical imbalance’ in the brain. It was thought that too much or too little of essential signal-transmitting chemicals—neurotransmitters—were present in the brain. This idea has been useful—that the brain is a kind of chemical soup in which there may be too much dopamine or too little serotonin, but it is now begin replaced by much more sophisticated knowledge about how the brain works, made possible by basic research. All the current antidepressants were developed during the period when the chemical-soup theory was in vogue. But now, many researchers are looking to understand in greater detail the brain biology that underlies depression’s symptoms so that novel therapies can be found.

Throughout this website you will find ideas for new depression treatments in greater detail. Efforts to create new classes of antidepressants, based on novel targets have borne fruit. A docking port on brain cells called the mu opioid receptor is the focus of one such effort. Other efforts focus not on the serotonin pathway, as do current “SSRI” drugs such as Prozac, but another pathway, that of another key neurotransmitter, called glutamate. A previously obscure brain area called the lateral habenula may be involved in depression pathology in some instances, due to glutamate hyperactivity. A drug able to specifically lower the activity in that region is a plausible drug discovery objective. Other researchers have been working on the idea that drugs that can mimic the biochemical and biological factors rendering certain people resilient to factors such as severe or chronic stress may have a future in depression treatment. A drug is now being tested that in preliminary trials has helped to reduce postpartum depression. Other researchers have been studying the ability to help women resist depression in the perinatal period through hormone treatments, or, in other work, via treatments that target the maternal immune system, which may be implicated in a subset of postpartum depression. Research has begun to see if administering certain strains of bacteria in depressed individuals might give a boost to their immune system and help reduce depression symptoms. Trying to alleviate depression via changes in diet – e.g., a Mediterranean diet, in one recent study – or omega-3 (“fish oil”) supplements is the subject of other Foundation-supported research. Yet another path that may lead to better outcomes in the future is bright-light therapy, which was first used to help people with seasonal affective disorder. It may have wider applications. It is also important to note research by grantees that has suggested the ability of even a short course of talk therapy to help alleviate depression in mothers with major depression, while at the same time helping their children. Such therapy worked best when it focused on the mother’s relationship with her child, the research revealed.

Dr. J. John Mann presented a webinar titled: Brain Plasticity: The Effects of Antidepressants on Major Depression in which he discusses why we need to better understand how antidepressants including SSRIs, lithium, and ketamine exert their therapeutic effects, so we can find newer more effective and rapidly acting treatments for depression:

Brain imaging has confirmed the biological nature of many psychiatric illnesses over the past twenty years. Yvette Sheline, M.D., in the mid-1990s, used functional magnetic resonance imaging (fMRI) to identify structural brain changes in depressed patients and established depression as a brain disease.

Using positron emission tomography (PET) scan images, Dr. Helen Mayberg of the Icahn School of Medicine at Mount Sinai, identified, in 2013, specific brain activity that can potentially predict whether people with major depressive disorder will best respond to an antidepressant medication or psychotherapy. This important new work offers a first potential imaging biomarker for treatment selection. A team of researchers including NARSAD Grantee Stefan G. Hoffman, Ph.D., of Boston University and Frida E. Polli, Ph.D., of Massachusetts Institute of Technology have used brain imaging to predict the success of cognitive behavioral therapy, a specific type of talk therapy often used to help treat a wide range of mental illnesses including anxiety disorders, depression, and schizophrenia. Research by Dr. Conor Liston of Weill Cornell Medical School, and colleagues, has used brain scans to identify four distinct “biotypes” of depression. Strikingly, patients in one of these four categories were about three times more likely to respond to a noninvasive treatment known as transcranial magnetic stimulation (TMS) than patients in two of the other categories. This is a good example of the power that biomarkers can have in the years just ahead to help direct people with depression to treatments most likely to help them.

Variations in genes – different kinds of DNA mutations, both common and rare – have been solidly linked to a number of serious psychiatric disorders including schizophrenia, bipolar disorder and autism. It is reasonable to wonder why similar progress has not been made yet in the study of the genetic factors contributing to depression. Researchers have made many attempts to search for such factors, but have not come up with results that statisticians consider “statistically meaningful.” One way of explaining the issue in studying depression concerns that very large number of people whom it affects. The power of massive genomic studies of patients (who are compared with unaffected individuals) evaporates if the people being compared have similar illnesses that have very different underlying genetic profiles. People with major depression might be grouped according to sex; whether or not they have recurrent depression; age at onset; symptom patterns; whether or not they were abused or under chronic stress early in life, for example. There is very good reason for progress on the genetic front, however. Foundation grantee Patrick Sullivan, M.D. and others have had success in finding the first reliable signals of commonly seen genetic variations in people with schizophrenia. To do so, they need to assemble a patient sample, across continents, numbering in the tens of thousands. They founded the Psychiatric Genomic Consortium to accomplish this. PGC scientists estimate that the inflection point in depression studies may be 75,000 to 100,000 study participants, a goal the PGC is working toward. It’s not that there is no genetic signal in depression, in other words. It’s a question of assembling a well-documented sample of patients of sufficient size to “tease out” the embedded genetic “signals,” which will point toward risk genes for the illness.

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55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

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An Exploratory Study of Students with Depression in Undergraduate Research Experiences

Katelyn M. Cooper
Logan E. Gin
M. Elizabeth Barnes
Sara E. Brownell

*Address correspondence to: Katelyn M. Cooper ( E-mail Address: [email protected] ).

Department of Biology, University of Central Florida, Orlando, FL, 32816

Search for more papers by this author

Biology Education Research Lab, Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ 85281

Depression is a top mental health concern among undergraduates and has been shown to disproportionately affect individuals who are underserved and underrepresented in science. As we aim to create a more inclusive scientific community, we argue that we need to examine the relationship between depression and scientific research. While studies have identified aspects of research that affect graduate student depression, we know of no studies that have explored the relationship between depression and undergraduate research. In this study, we sought to understand how undergraduates’ symptoms of depression affect their research experiences and how research affects undergraduates’ feelings of depression. We interviewed 35 undergraduate researchers majoring in the life sciences from 12 research-intensive public universities across the United States who identify with having depression. Using inductive and deductive coding, we identified that students’ depression affected their motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing in undergraduate research experiences. We found that students’ social connections, experiencing failure in research, getting help, receiving feedback, and the demands of research affected students’ depression. Based on this work, we articulate an initial set of evidence-based recommendations for research mentors to consider in promoting an inclusive research experience for students with depression.

INTRODUCTION

Depression is described as a common and serious mood disorder that results in persistent feelings of sadness and hopelessness, as well as a loss of interest in activities that one once enjoyed ( American Psychiatric Association [APA], 2013 ). Additional symptoms of depression include weight changes, difficulty sleeping, loss of energy, difficulty thinking or concentrating, feelings of worthlessness or excessive guilt, and suicidality ( APA, 2013 ). While depression results from a complex interaction of psychological, social, and biological factors ( World Health Organization, 2018 ), studies have shown that increased stress caused by college can be a significant contributor to student depression ( Dyson and Renk, 2006 ).

Depression is one of the top undergraduate mental health concerns, and the rate of depression among undergraduates continues to rise ( Center for Collegiate Mental Health, 2017 ). While we cannot discern whether these increasing rates of depression are due to increased awareness or increased incidence, it is clear that is a serious problem on college campuses. The percent of U.S. college students who self-reported a diagnosis with depression was recently estimated to be about 25% ( American College Health Association, 2019 ). However, higher rates have been reported, with one study estimating that up to 84% of undergraduates experience some level of depression ( Garlow et al. , 2008 ). Depression rates are typically higher among university students compared with the general population, despite being a more socially privileged group ( Ibrahim et al. , 2013 ). Prior studies have found that depression is negatively correlated with overall undergraduate academic performance ( Hysenbegasi et al. , 2005 ; Deroma et al. , 2009 ; American College Health Association, 2019 ). Specifically, diagnosed depression is associated with half a letter grade decrease in students’ grade point average ( Hysenbegasi et al. , 2005 ), and 21.6% of undergraduates reported that depression negatively affected their academic performance within the last year ( American College Health Association, 2019 ). Provided with a list of academic factors that may be affected by depression, students reported that depression contributed to lower exam grades, lower course grades, and not completing or dropping a course.

Students in the natural sciences may be particularly at risk for depression, given that such majors are noted to be particularly stressful due to their competitive nature and course work that is often perceived to “weed students out”( Everson et al. , 1993 ; Strenta et al. , 1994 ; American College Health Association, 2019 ; Seymour and Hunter, 2019 ). Science course instruction has also been described to be boring, repetitive, difficult, and math-intensive; these factors can create an environment that can trigger depression ( Seymour and Hewitt, 1997 ; Osborne and Collins, 2001 ; Armbruster et al ., 2009 ; Ceci and Williams, 2010 ). What also distinguishes science degree programs from other degree programs is that, increasingly, undergraduate research experiences are being proposed as an essential element of a science degree ( American Association for the Advancement of Science, 2011 ; President’s Council of Advisors on Science and Technology, 2012 ; National Academies of Sciences, Engineering, and Medicine [NASEM], 2017 ). However, there is some evidence that undergraduate research experiences can add to the stress of college for some students ( Cooper et al. , 2019c ). Students can garner multiple benefits from undergraduate research, including enhanced abilities to think critically ( Ishiyama, 2002 ; Bauer and Bennett, 2003 ; Brownell et al. , 2015 ), improved student learning ( Rauckhorst et al. , 2001 ; Brownell et al. , 2015 ), and increased student persistence in undergraduate science degree programs ( Jones et al. , 2010 ; Hernandez et al. , 2018 ). Notably, undergraduate research experiences are increasingly becoming a prerequisite for entry into medical and graduate programs in science, particularly elite programs ( Cooper et al. , 2019d ). Although some research experiences are embedded into formal lab courses as course-based undergraduate research experiences (CUREs; Auchincloss et al. , 2014 ; Brownell and Kloser, 2015 ), the majority likely entail working with faculty in their research labs. These undergraduate research experiences in faculty labs are often added on top of a student’s normal course work, so they essentially become an extracurricular activity that they have to juggle with course work, working, and/or personal obligations ( Cooper et al. , 2019c ). While the majority of the literature surrounding undergraduate research highlights undergraduate research as a positive experience ( NASEM, 2017 ), studies have demonstrated that undergraduate research experiences can be academically and emotionally challenging for students ( Mabrouk and Peters, 2000 ; Seymour et al. , 2004 ; Cooper et al. , 2019c ; Limeri et al. , 2019 ). In fact, 50% of students sampled nationally from public R1 institutions consider leaving their undergraduate research experience prematurely, and about half of those students, or 25% of all students, ultimately leave their undergraduate research experience ( Cooper et al. , 2019c ). Notably, 33.8% of these individuals cited a negative lab environment and 33.3% cited negative relationships with their mentors as factors that influenced their decision about whether to leave ( Cooper et al. , 2019c ). Therefore, students’ depression may be exacerbated in challenging undergraduate research experiences, because studies have shown that depression is positively correlated with student stress ( Hish et al. , 2019 ).

While depression has not been explored in the context of undergraduate research experiences, depression has become a prominent concern surrounding graduate students conducting scientific research. A recent study that examined the “graduate student mental health crisis” ( Flaherty, 2018 ) found that work–life balance and graduate students’ relationships with their research advisors may be contributing to their depression ( Evans et al. , 2018 ). Specifically, this survey of 2279 PhD and master’s students from diverse fields of study, including the biological/physical sciences, showed that 39% of graduate students have experienced moderate to severe depression. Fifty-five percent of the graduate students with depression who were surveyed disagreed with the statement “I have good work life balance,” compared to only 21% of students with depression who agreed. Additionally, the study highlighted that more students with depression disagreed than agreed with the following statements: their advisors provided “real” mentorship, their advisors provided ample support, their advisors positively impacted their emotional or mental well-being, their advisors were assets to their careers, and they felt valued by their mentors. Another recent study identified that depression severity in biomedical doctoral students was significantly associated with graduate program climate, a perceived lack of employment opportunities, and the quality of students’ research training environment ( Nagy et al. , 2019 ). Environmental stress, academic stress, and family and monetary stress have also been shown to be predictive of depression severity in biomedical doctoral students ( Hish et al. , 2019 ). Further, one study found that self-esteem is negatively correlated and stress is positively correlated with graduate student depression; presumably research environments that challenge students’ self-esteem and induce stress are likely contributing to depressive symptoms among graduate students ( Kreger, 1995 ). While these studies have focused on graduate students, and there are certainly notable distinctions between graduate and undergraduate research, the research-related factors that affect graduate student depression, including work–life balance, relationships with mentors, research environment, stress, and self-esteem, may also be relevant to depression among undergraduates conducting research. Importantly, undergraduates in the United States have reported identical levels of depression as graduate students but are often less likely to seek mental health care services ( Wyatt and Oswalt, 2013 ), which is concerning if undergraduate research experiences exacerbate depression.

Based on the literature on the stressors of undergraduate research experiences and the literature identifying some potential causes of graduate student depression, we identified three aspects of undergraduate research that may exacerbate undergraduates’ depression. Mentoring: Mentors can be an integral part of a students’ research experience, bolstering their connections with others in the science community, scholarly productivity, and science identity, as well as providing many other benefits ( Thiry and Laursen, 2011 ; Prunuske et al. , 2013 ; Byars-Winston et al. , 2015 ; Aikens et al. , 2016 , 2017 ; Thompson et al. , 2016 ; Estrada et al. , 2018 ). However, recent literature has highlighted that poor mentoring can negatively affect undergraduate researchers ( Cooper et al. , 2019c ; Limeri et al. , 2019 ). Specifically, one study of 33 undergraduate researchers who had conducted research at 10 institutions identified seven major ways that they experienced negative mentoring, which included absenteeism, abuse of power, interpersonal mismatch, lack of career support, lack of psychosocial support, misaligned expectations, and unequal treatment ( Limeri et al. , 2019 ). We hypothesize negative mentoring experiences may be particularly harmful for students with depression, because support, particularly social support, has been shown to be important for helping individuals with depression cope with difficult circumstances ( Aneshensel and Stone, 1982 ; Grav et al. , 2012 ). Failure: Experiencing failure has been hypothesized to be an important aspect of undergraduate research experiences that may help students develop some the most distinguishing abilities of outstanding scientists, such as coping with failure, navigating challenges, and persevering ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, experiencing failure and the stress and fatigue that often accompany it may be particularly tough for students with depression ( Aldwin and Greenberger, 1987 ; Mongrain and Blackburn, 2005 ). Lab environment: Fairness, inclusion/exclusion, and social support within one’s organizational environment have been shown to be key factors that cause people to either want to remain in the work place and be productive or to want to leave ( Barak et al. , 2006 ; Cooper et al. , 2019c ). We hypothesize that dealing with exclusion or a lack of social support may exacerbate depression for some students; patients with clinical depression react to social exclusion with more pronounced negative emotions than do individuals without clinical depression ( Jobst et al. , 2015 ). While there are likely other aspects of undergraduate research that affect student depression, we hypothesize that these factors have the potential to exacerbate negative research experiences for students with depression.

Depression has been shown to disproportionately affect many populations that are underrepresented or underserved within the scientific community, including females ( American College Health Association, 2018 ; Evans et al. , 2018 ), first-generation college students ( Jenkins et al. , 2013 ), individuals from low socioeconomic backgrounds ( Eisenberg et al. , 2007 ), members of the LGBTQ+ community ( Eisenberg et al. , 2007 ; Evans et al. , 2018 ), and people with disabilities ( Turner and Noh, 1988 ). Therefore, as the science community strives to be more diverse and inclusive ( Intemann, 2009 ), it is important that we understand more about the relationship between depression and scientific research, because negative experiences with depression in scientific research may be contributing to the underrepresentation of these groups. Specifically, more information is needed about how the research process and environment of research experiences may affect depression.

Given the high rate of depression among undergraduates, the links between depression and graduate research, the potentially challenging environment of undergraduate research, and how depression could disproportionately impact students from underserved communities, it is imperative to begin to explore the relationship between scientific research and depression among undergraduates to create research experiences that could maximize student success. In this exploratory interview study, we aimed to 1) describe how undergraduates’ symptoms of depression affect their research experiences, 2) understand how undergraduate research affects students’ feelings of depression, and 3) identify recommendations based on the literature and undergraduates’ reported experiences to promote a positive research experience for students with depression.

This study was done with an approved Arizona State University Institutional Review Board protocol #7247.

In Fall 2018, we surveyed undergraduate researchers majoring in the life sciences across 25 research-intensive (R1) public institutions across the United States (specific details about the recruitment of the students who completed the survey can be found in Cooper et al. (2019c) ). The survey asked students for their opinions about their undergraduate research experiences and their demographic information and whether they would be interested in participating in a follow-up interview related to their research experiences. For the purpose of this study, we exclusively interviewed students about their undergraduate research experiences in faculty member labs; we did not consider students’ experiences in CUREs. Of the 768 undergraduate researchers who completed the survey, 65% ( n = 496) indicated that they would be interested in participating in a follow-up interview. In Spring 2019, we emailed the 496 students, explaining that we were interested in interviewing students with depression about their experiences in undergraduate research. Our specific prompt was: “If you identify as having depression, we would be interested in hearing about your experience in undergraduate research in a 30–60 minute online interview.” We did not define depression in our email recruitment because we conducted think-aloud interviews with four undergraduates who all correctly interpreted what we meant by depression ( APA, 2013 ). We had 35 students agree to participate in the interview study. The interview participants represented 12 of the 25 R1 public institutions that were represented in the initial survey.

Student Interviews

We developed an interview script to explore our research questions. Specifically, we were interested in how students’ symptoms of depression affect their research experiences, how undergraduate research negatively affects student depression, and how undergraduate research positively affects student depression.

We recognized that mental health, and specifically depression, can be a sensitive topic to discuss with undergraduates, and therefore we tried to minimize any discomfort that the interviewees might experience during the interview. Specifically, we conducted think-aloud interviews with three graduate students who self-identified with having depression at the time of the interview. We asked them to note whether any interview questions made them uncomfortable. We also sought their feedback on questions given their experiences as persons with depression who had once engaged in undergraduate research. We revised the interview protocol after each think-aloud interview. Next, we conducted four additional think-aloud interviews with undergraduates conducting basic science or biology education research who identified with having depression to establish cognitive validity of the questions and to elicit additional feedback about any questions that might make someone uncomfortable. The questions were revised after each think-aloud interview until no question was unclear or misinterpreted by the students and we were confident that the questions minimized students’ potential discomfort ( Trenor et al. , 2011 ). A copy of the final interview script can be found in the Supplemental Material.

All interviews were individually conducted by one of two researchers (K.M.C. and L.E.G.) who conducted the think-aloud interviews together to ensure that their interviewing practices were as similar as possible. The interviews were approximately an hour long, and students received a $15 gift card for their participation.

Personal, Research, and Depression Demographics

All student demographics and information about students’ research experiences were collected using the survey distributed to students in Fall 2018. We collected personal demographics, including the participants’ gender, race/ethnicity, college generation status, transfer status, financial stability, year in college, major, and age. We also collected information about the students’ research experiences, including the length of their first research experiences, the average number of hours they spend in research per week, how they were compensated for research, who their primary mentors were, and the focus areas of their research.

In the United States, mental healthcare is disproportionately unavailable to Black and Latinx individuals, as well as those who come from low socioeconomic backgrounds ( Kataoka et al. , 2002 ; Howell and McFeeters, 2008 ; Santiago et al. , 2013 ). Therefore, to minimize a biased sample, we invited anyone who identified with having depression to participate in our study; we did not require students to be diagnosed with depression or to be treated for depression in order to participate. However, we did collect information about whether students had been formally diagnosed with depression and whether they had been treated for depression. After the interview, all participants were sent a link to a short survey that asked them if they had ever been diagnosed with depression and how, if at all, they had ever been treated for depression. A copy of these survey questions can be found in the Supplemental Material. The combined demographic information of the participants is in Table 1 . The demographics for each individual student can be found in the Supplemental Material.

a Students reported the time they had spent in research 6 months before being interviewed and only reported on the length of time of their first research experiences.

b Students were invited to report multiple ways in which they were treated for their depression; other treatments included lifestyle changes and meditation.

c Students were invited to report multiple means of compensation for their research if they had been compensated for their time in different ways.

d Students were asked whether they felt financially stable, particularly during the undergraduate research experience.

e Students reported who they work/worked with most closely during their research experiences.

f Staff members included lab coordinators or lab managers.

g Other focus areas of research included sociology, linguistics, psychology, and public health.

Interview Analysis

The initial interview analysis aimed to explore each idea that a participant expressed ( Charmaz, 2006 ) and to identify reoccurring ideas throughout the interviews. First, three authors (K.M.C., L.E.G., and S.E.B.) individually reviewed a different set of 10 interviews and took detailed analytic notes ( Birks and Mills, 2015 ). Afterward, the authors compared their notes and identified reoccurring themes throughout the interviews using open coding methods ( Saldaña, 2015 ).

Once an initial set of themes was established, two researchers (K.M.C. and L.E.G.) individually reviewed the same set of 15 randomly selected interviews to validate the themes identified in the initial analysis and to screen for any additional themes that the initial analysis may have missed. Each researcher took detailed analytic notes throughout the review of an interview, which they discussed after reviewing each interview. The researchers compared what quotes from each interview they categorized into each theme. Using constant comparison methods, they assigned quotes to each theme and constantly compared the quotes to ensure that each quote fit within the description of the theme ( Glesne and Peshkin, 1992 ). In cases in which quotes were too different from other quotes, a new theme was created. This approach allowed for multiple revisions of the themes and allowed the authors to define a final set of codes; the researchers created a final codebook with refined definitions of emergent themes (the final coding rubric can be found in the Supplemental Material). Once the final codebook was established, the researchers (K.M.C. and L.E.G.) individually coded seven additional interviews (20% of all interviews) using the coding rubric. The researchers compared their codes, and their Cohen’s κ interrater score for these seven interviews was at an acceptable level (κ = 0.88; Landis and Koch, 1977 ). One researcher (L.E.G.) coded the remaining 28 out of 35 interviews. The researchers determined that data saturation had been reached with the current sample and no further recruitment was needed ( Guest et al. , 2006 ). We report on themes that were mentioned by at least 20% of students in the interview study. In the Supplemental Material, we provide the final coding rubric with the number of participants whose interview reflected each theme ( Hannah and Lautsch, 2011 ). Reporting the number of individuals who reported themes within qualitative data can lead to inaccurate conclusions about the generalizability of the results to a broader population. These qualitative data are meant to characterize a landscape of experiences that students with depression have in undergraduate research rather than to make claims about the prevalence of these experiences ( Glesne and Peshkin, 1992 ). Because inferences about the importance of these themes cannot be drawn from these counts, they are not included in the results of the paper ( Maxwell, 2010 ). Further, the limited number of interviewees made it not possible to examine whether there were trends based on students’ demographics or characteristics of their research experiences (e.g., their specific area of study). Quotes were lightly edited for clarity by inserting clarification brackets and using ellipses to indicate excluded text. Pseudonyms were given to all students to protect their privacy.

The Effect of Depressive Symptoms on Undergraduate Research

We asked students to describe the symptoms associated with their depression. Students described experiencing anxiety that is associated with their depression; this could be anxiety that precedes their depression or anxiety that results from a depressive episode or a period of time when an individual has depression symptoms. Further, students described difficulty getting out of bed or leaving the house, feeling tired, a lack of motivation, being overly self-critical, feeling apathetic, and having difficulty concentrating. We were particularly interested in how students’ symptoms of depression affected their experiences in undergraduate research. During the think-aloud interviews that were conducted before the interview study, graduate and undergraduate students consistently described that their depression affected their motivation in research, their creativity in research, and their productivity in research. Therefore, we explicitly asked undergraduate researchers how, if at all, their depression affected these three factors. We also asked students to describe any additional ways in which their depression affected their research experiences. Undergraduate researchers commonly described five additional ways in which their depression affected their research; for a detailed description of each way students’ research was affected and for example quotes, see Table 2 . Students described that their depression negatively affected their productivity in the lab. Commonly, students described that their productivity was directly affected by a lack of motivation or because they felt less creative, which hindered the research process. Additionally, students highlighted that they were sometimes less productive because their depression sometimes caused them to struggle to engage intellectually with their research or caused them to have difficulty remembering or concentrating; students described that they could do mundane or routine tasks when they felt depressed, but that they had difficulty with more complex and intellectually demanding tasks. However, students sometimes described that even mundane tasks could be difficult when they were required to remember specific steps; for example, some students struggled recalling a protocol from memory when their depression was particularly severe. Additionally, students noted that their depression made them more self-conscious, which sometimes held them back from sharing research ideas with their mentors or from taking risks such as applying to competitive programs. In addition to being self-conscious, students highlighted that their depression caused them to be overly self-critical, and some described experiencing imposter phenomenon ( Clance and Imes, 1978 ) or feeling like they were not talented enough to be in research and were accepted into a lab by a fluke or through luck. Finally, students described that depression often made them feel less social, and they struggled to socially engage with other members of the lab when they were feeling down.

The Effect of Undergraduate Research Experiences on Student Depression

We also wanted to explore how research impacted students’ feelings of depression. Undergraduates described how research both positively and negatively affected their depression. In the following sections, we present aspects of undergraduate research and examine how each positively and/or negatively affected students’ depression using embedded student quotes to highlight the relationships between related ideas.

Lab Environment: Relationships with Others in the Lab.

Some aspects of the lab environment, which we define as students’ physical, social, or psychological research space, could be particularly beneficial for students with depression.

Specifically, undergraduate researchers perceived that comfortable and positive social interactions with others in the lab helped their depression. Students acknowledged how beneficial their relationships with graduate students and postdocs could be.

Marta: “I think always checking in on undergrads is important. It’s really easy [for us] to go a whole day without talking to anybody in the lab. But our grad students are like ‘Hey, what’s up? How’s school? What’s going on?’ (…) What helps me the most is having that strong support system. Sometimes just talking makes you feel better, but also having people that believe in you can really help you get out of that negative spiral. I think that can really help with depression.”

Kelley: “I know that anytime I need to talk to [my postdoc mentors] about something they’re always there for me. Over time we’ve developed a relationship where I know that outside of work and outside of the lab if I did want to talk to them about something I could talk to them. Even just talking to someone about hobbies and having that relationship alone is really helpful [for depression].”

In addition to highlighting the importance of developing relationships with graduate students or postdocs in the lab, students described that forming relationships with other undergraduates in the lab also helped their depression. Particularly, students described that other undergraduate researchers often validated their feelings about research, which in turn helped them realize that what they are thinking or feeling is normal, which tended to alleviate their negative thoughts. Interestingly, other undergraduates experiencing the same issues could sometimes help buffer them from perceiving that a mentor did not like them or that they were uniquely bad at research. In this article, we use the term “mentor” to refer to anyone who students referred to in the interviews as being their mentors or managing their research experiences; this includes graduate students, postdoctoral scholars, lab managers, and primary investigators (PIs).

Abby: “One of my best friends is in the lab with me. A lot of that friendship just comes from complaining about our stress with the lab and our annoyance with people in the lab. Like when we both agree like, ‘Yeah, the grad students were really off today, it wasn’t us,’ that helps. ‘It wasn’t me, it wasn’t my fault that we were having a rough day in lab; it was the grad students.’ Just being able to realize, ‘Hey, this isn’t all caused by us,’ you know? (…) We understand the stresses in the lab. We understand the details of what each other are doing in the lab, so when something doesn’t work out, we understand that it took them like eight hours to do that and it didn’t work. We provide empathy on a different level.”

Meleana: “It’s great to have solidarity in being confused about something, and it’s just that is a form of validation for me too. When we leave a lab meeting and I look at [another undergrad] I’m like, ‘Did you understand anything that they were just saying?’ And they’re like, ‘Oh, no.’ (…) It’s just really validating to hear from the other undergrads that we all seem to be struggling with the same things.”

Developing positive relationships with faculty mentors or PIs also helped alleviate some students’ depressive feelings, particularly when PIs shared their own struggles with students. This also seemed to normalize students’ concerns about their own experiences.

Alexandra: “[Talking with my PI] is helpful because he would talk about his struggles, and what he faced. A lot of it was very similar to my struggles. For example, he would say, ‘Oh, yeah, I failed this exam that I studied so hard for. I failed the GRE and I paid so much money to prepare for it.’ It just makes [my depression] better, like okay, this is normal for students to go through this. It’s not an out of this world thing where if you fail, you’re a failure and you can’t move on from it.”

Students’ relationships with others in the lab did not always positively impact their depression. Students described instances when the negative moods of the graduate students and PIs would often set the tone of the lab, which in turn worsened the mood of the undergraduate researchers.

Abby: “Sometimes [the grad students] are not in a good mood. The entire vibe of the lab is just off, and if you make a joke and it hits somebody wrong, they get all mad. It really depends on the grad students and the leadership and the mood that they’re in.”

Interviewer: “How does it affect your depression when the grad students are in a bad mood?”

Abby: “It definitely makes me feel worse. It feels like, again, that I really shouldn’t go ask them for help because they’re just not in the mood to help out. It makes me have more pressure on myself, and I have deadlines I need to meet, but I have a question for them, but they’re in a bad mood so I can’t ask. That’s another day wasted for me and it just puts more stress, which just adds to the depression.”

Additionally, some students described even more concerning behavior from research mentors, which negatively affected their depression.

Julie: “I had a primary investigator who is notorious in the department for screaming at people, being emotionally abusive, unreasonable, et cetera. (…) [He was] kind of harassing people, demeaning them, lying to them, et cetera, et cetera. (…) Being yelled at and constantly demeaned and harassed at all hours of the day and night, that was probably pretty bad for me.”

While the relationships between undergraduates and graduate, postdoc, and faculty mentors seemed to either alleviate or worsen students’ depressive symptoms, depending on the quality of the relationship, students in this study exclusively described their relationships with other undergraduates as positive for their depression. However, students did note that undergraduate research puts some of the best and brightest undergraduates in the same environment, which can result in students comparing themselves with their peers. Students described that this comparison would often lead them to feel badly about themselves, even though they would describe their personal relationship with a person to be good.

Meleana: “In just the research field in general, just feeling like I don’t really measure up to the people around me [can affect my depression]. A lot of the times it’s the beginning of a little spiral, mental spiral. There are some past undergrads that are talked about as they’re on this pedestal of being the ideal undergrads and that they were just so smart and contributed so much to the lab. I can never stop myself from wondering like, ‘Oh, I wonder if I’m having a contribution to the lab that’s similar or if I’m just another one of the undergrads that does the bare minimum and passes through and is just there.’”

Natasha: “But, on the other hand, [having another undergrad in the lab] also reminded me constantly that some people are invested in this and meant to do this and it’s not me. And that some people know a lot more than I do and will go further in this than I will.”

While students primarily expressed that their relationships with others in the lab affected their depression, some students explained that they struggled most with depression when the lab was empty; they described that they did not like being alone in the lab, because a lack of stimulation allowed their minds to be filled with negative thoughts.

Mia: “Those late nights definitely didn’t help [my depression]. I am alone, in the entire building. I’m left alone to think about my thoughts more, so not distracted by talking to people or interacting with people. I think more about how I’m feeling and the lack of progress I’m making, and the hopelessness I’m feeling. That kind of dragged things on, and I guess deepened my depression.”

Freddy: “Often times when I go to my office in the evening, that is when I would [ sic ] be prone to be more depressed. It’s being alone. I think about myself or mistakes or trying to correct mistakes or whatever’s going on in my life at the time. I become very introspective. I think I’m way too self-evaluating, way too self-deprecating and it’s when I’m alone when those things are really, really triggered. When I’m talking with somebody else, I forget about those things.”

In sum, students with depression highlighted that a lab environment full of positive and encouraging individuals was helpful for their depression, whereas isolating or competitive environments and negative interactions with others often resulted in more depressive feelings.

Doing Science: Experiencing Failure in Research, Getting Help, Receiving Feedback, Time Demands, and Important Contributions.

In addition to the lab environment, students also described that the process of doing science could affect their depression. Specifically, students explained that a large contributor to their depression was experiencing failure in research.

Interviewer: “Considering your experience in undergraduate research, what tends to trigger your feelings of depression?”

Heather: “Probably just not getting things right. Having to do an experiment over and over again. You don’t get the results you want. (…) The work is pretty meticulous and it’s frustrating when I do all this work, I do a whole experiment, and then I don’t get any results that I can use. That can be really frustrating. It adds to the stress. (…) It’s hard because you did all this other stuff before so you can plan for the research, and then something happens and all the stuff you did was worthless basically.”

Julie: “I felt very negatively about myself [when a project failed] and pretty panicked whenever something didn’t work because I felt like it was a direct reflection on my effort and/or intelligence, and then it was a big glaring personal failure.”

Students explained that their depression related to failing in research was exacerbated if they felt as though they could not seek help from their research mentors. Perceived insufficient mentor guidance has been shown to be a factor influencing student intention to leave undergraduate research ( Cooper et al. , 2019c ). Sometimes students talked about their research mentors being unavailable or unapproachable.

Michelle: “It just feels like [the graduate students] are not approachable. I feel like I can’t approach them to ask for their understanding in a certain situation. It makes [my depression] worse because I feel like I’m stuck, and that I’m being limited, and like there’s nothing I can do. So then I kind of feel like it’s my fault that I can’t do anything.”

Other times, students described that they did not seek help in fear that they would be negatively evaluated in research, which is a fear of being judged by others ( Watson and Friend, 1969 ; Weeks et al. , 2005 ; Cooper et al. , 2018 ). That is, students fear that their mentor would think negatively about them or judge them if they were to ask questions that their mentor thought they should know the answer to.

Meleana: “I would say [my depression] tends to come out more in being more reserved in asking questions because I think that comes more like a fear-based thing where I’m like, ‘Oh, I don’t feel like I’m good enough and so I don’t want to ask these questions because then my mentors will, I don’t know, think that I’m dumb or something.’”

Conversely, students described that mentors who were willing to help them alleviated their depressive feelings.

Crystal: “Yeah [my grad student] is always like, ‘Hey, I can check in on things in the lab because you’re allowed to ask me for that, you’re not totally alone in this,’ because he knows that I tend to take on all this responsibility and I don’t always know how to ask for help. He’s like, ‘You know, this is my lab too and I am here to help you as well,’ and just reminds me that I’m not shouldering this burden by myself.”

Ashlyn: “The graduate student who I work with is very kind and has a lot of patience and he really understands a lot of things and provides simple explanations. He does remind me about things and he will keep on me about certain tasks that I need to do in an understanding way, and it’s just because he’s patient and he listens.”

In addition to experiencing failure in science, students described that making mistakes when doing science also negatively affected their depression.

Abby: “I guess not making mistakes on experiments [is important in avoiding my depression]. Not necessarily that your experiment didn’t turn out to produce the data that you wanted, but just adding the wrong enzyme or messing something up like that. It’s like, ‘Oh, man,’ you know? You can get really down on yourself about that because it can be embarrassing.”

Commonly, students described that the potential for making mistakes increased their stress and anxiety regarding research; however, they explained that how other people responded to a potential mistake was what ultimately affected their depression.

Briana: “Sometimes if I made a mistake in correctly identifying an eye color [of a fly], [my PI] would just ridicule me in front of the other students. He corrected me but his method of correcting was very discouraging because it was a ridicule. It made the others laugh and I didn’t like that.”

Julie: “[My PI] explicitly [asked] if I had the dedication for science. A lot of times he said I had terrible judgment. A lot of times he said I couldn’t be trusted. Once I went to a conference with him, and, unfortunately, in front of another professor, he called me a klutz several times and there was another comment about how I never learn from my mistakes.”

When students did do things correctly, they described how important it could be for them to receive praise from their mentors. They explained that hearing praise and validation can be particularly helpful for students with depression, because their thoughts are often very negative and/or because they have low self-esteem.

Crystal: “[Something that helps my depression is] I have text messages from [my graduate student mentor] thanking me [and another undergraduate researcher] for all of the work that we’ve put in, that he would not be able to be as on track to finish as he is if he didn’t have our help.”

Interviewer: “Why is hearing praise from your mentor helpful?”

Crystal: “Because a lot of my depression focuses on everybody secretly hates you, nobody likes you, you’re going to die alone. So having that validation [from my graduate mentor] is important, because it flies in the face of what my depression tells me.”

Brian: “It reminds you that you exist outside of this negative world that you’ve created for yourself, and people don’t see you how you see yourself sometimes.”

Students also highlighted how research could be overwhelming, which negatively affected their depression. Particularly, students described that research demanded a lot of their time and that their mentors did not always seem to be aware that they were juggling school and other commitments in addition to their research. This stress exacerbated their depression.

Rose: “I feel like sometimes [my grad mentors] are not very understanding because grad students don’t take as many classes as [undergrads] do. I think sometimes they don’t understand when I say I can’t come in at all this week because I have finals and they’re like, ‘Why though?’”

Abby: “I just think being more understanding of student life would be great. We have classes as well as the lab, and classes are the priority. They forget what it’s like to be a student. You feel like they don’t understand and they could never understand when you say like, ‘I have three exams this week,’ and they’re like, ‘I don’t care. You need to finish this.’”

Conversely, some students reported that their research labs were very understanding of students’ schedules. Interestingly, these students talked most about how helpful it was to be able to take a mental health day and not do research on days when they felt down or depressed.

Marta: “My lab tech is very open, so she’ll tell us, ‘I can’t come in today. I have to take a mental health day.’ So she’s a really big advocate for that. And I think I won’t personally tell her that I’m taking a mental health day, but I’ll say, ‘I can’t come in today, but I’ll come in Friday and do those extra hours.’ And she’s like, ‘OK great, I’ll see you then.’ And it makes me feel good, because it helps me take care of myself first and then I can take care of everything else I need to do, which is amazing.”

Meleana: “Knowing that [my mentors] would be flexible if I told them that I’m crazy busy and can’t come into work nearly as much this week [helps my depression]. There is flexibility in allowing me to then care for myself.”

Interviewer: “Why is the flexibility helpful given the depression?”

Meleana: “Because sometimes for me things just take a little bit longer when I’m feeling down. I’m just less efficient to be honest, and so it’s helpful if I feel like I can only go into work for 10 hours in a week. It declutters my brain a little bit to not have to worry about all the things I have to do in work in addition the things that I need to do for school or clubs, or family or whatever.”

Despite the demanding nature of research, a subset of students highlighted that their research and research lab provided a sense of stability or familiarity that distracted them from their depression.

Freddy: “I’ll [do research] to run away from those [depressive] feelings or whatever. (…) I find sadly, I hate to admit it, but I do kind of run to [my lab]. I throw myself into work to distract myself from the feelings of depression and sadness.”

Rose: “When you’re sad or when you’re stressed you want to go to things you’re familiar with. So because lab has always been in my life, it’s this thing where it’s going to be there for me I guess. It’s like a good book that you always go back to and it’s familiar and it makes you feel good. So that’s how lab is. It’s not like the greatest thing in the world but it’s something that I’m used to, which is what I feel like a lot of people need when they’re sad and life is not going well.”

Many students also explained that research positively affects their depression because they perceive their research contribution to be important.

Ashlyn: “I feel like I’m dedicating myself to something that’s worthy and something that I believe in. It’s really important because it contextualizes those times when I am feeling depressed. It’s like, no, I do have these better things that I’m working on. Even when I don’t like myself and I don’t like who I am, which is again, depression brain, I can at least say, ‘Well, I have all these other people relying on me in research and in this area and that’s super important.’”

Jessica: “I mean, it just felt like the work that I was doing had meaning and when I feel like what I’m doing is actually going to contribute to the world, that usually really helps with [depression] because it’s like not every day you can feel like you’re doing something impactful.”

In sum, students highlighted that experiencing failure in research and making mistakes negatively contributed to depression, especially when help was unavailable or research mentors had a negative reaction. Additionally, students acknowledged that the research could be time-consuming, but that research mentors who were flexible helped assuage depressive feelings that were associated with feeling overwhelmed. Finally, research helped some students’ depression, because it felt familiar, provided a distraction from depression, and reminded students that they were contributing to a greater cause.

We believe that creating more inclusive research environments for students with depression is an important step toward broadening participation in science, not only to ensure that we are not discouraging students with depression from persisting in science, but also because depression has been shown to disproportionately affect underserved and underrepresented groups in science ( Turner and Noh, 1988 ; Eisenberg et al. , 2007 ; Jenkins et al. , 2013 ; American College Health Association, 2018 ). We initially hypothesized that three features of undergraduate research—research mentors, the lab environment, and failure—may have the potential to exacerbate student depression. We found this to be true; students highlighted that their relationships with their mentors as well as the overall lab environment could negatively affect their depression, but could also positively affect their research experiences. Students also noted that they struggled with failure, which is likely true of most students, but is known to be particularly difficult for students with depression ( Elliott et al. , 1997 ). We expand upon our findings by integrating literature on depression with the information that students provided in the interviews about how research mentors can best support students. We provide a set of evidence-based recommendations focused on mentoring, the lab environment, and failure for research mentors wanting to create more inclusive research environments for students with depression. Notably, only the first recommendation is specific to students with depression; the others reflect recommendations that have previously been described as “best practices” for research mentors ( NASEM, 2017 , 2019 ; Sorkness et al. , 2017 ) and likely would benefit most students. However, we examine how these recommendations may be particularly important for students with depression. As we hypothesized, these recommendations directly address three aspects of research: mentors, lab environment, and failure. A caveat of these recommendations is that more research needs to be done to explore the experiences of students with depression and how these practices actually impact students with depression, but our national sample of undergraduate researchers with depression can provide an initial starting point for a discussion about how to improve research experiences for these students.

Recommendations to Make Undergraduate Research Experiences More Inclusive for Students with Depression

Recognize student depression as a valid illness..

Allow students with depression to take time off of research by simply saying that they are sick and provide appropriate time for students to recover from depressive episodes. Also, make an effort to destigmatize mental health issues.

Undergraduate researchers described both psychological and physical symptoms that manifested as a result of their depression and highlighted how such symptoms prevented them from performing to their full potential in undergraduate research. For example, students described how their depression would cause them to feel unmotivated, which would often negatively affect their research productivity. In cases in which students were motivated enough to come in and do their research, they described having difficulty concentrating or engaging in the work. Further, when doing research, students felt less creative and less willing to take risks, which may alter the quality of their work. Students also sometimes struggled to socialize in the lab. They described feeling less social and feeling overly self-critical. In sum, students described that, when they experienced a depressive episode, they were not able to perform to the best of their ability, and it sometimes took a toll on them to try to act like nothing was wrong, when they were internally struggling with depression. We recommend that research mentors treat depression like any other physical illness; allowing students the chance to recover when they are experiencing a depressive episode can be extremely important to students and can allow them to maximize their productivity upon returning to research ( Judd et al. , 2000 ). Students explained that if they are not able to take the time to focus on recovering during a depressive episode, then they typically continue to struggle with depression, which negatively affects their research. This sentiment is echoed by researchers in psychiatry who have found that patients who do not fully recover from a depressive episode are more likely to relapse and to experience chronic depression ( Judd et al. , 2000 ). Students described not doing tasks or not showing up to research because of their depression but struggling with how to share that information with their research mentors. Often, students would not say anything, which caused them anxiety because they were worried about what others in the lab would say to them when they returned. Admittedly, many students understood why this behavior would cause their research mentors to be angry or frustrated, but they weighed the consequences of their research mentors’ displeasure against the consequences of revealing their depression and decided it was not worth admitting to being depressed. This aligns with literature that suggests that when individuals have concealable stigmatized identities, or identities that can be hidden and that carry negative stereotypes, such as depression, they will often keep them concealed to avoid negative judgment or criticism ( Link and Phelan, 2001 ; Quinn and Earnshaw, 2011 ; Jones and King, 2014 ; Cooper and Brownell, 2016 ; Cooper et al. , 2019b ; Cooper et al ., unpublished data ). Therefore, it is important for research mentors to be explicit with students that 1) they recognize mental illness as a valid sickness and 2) that students with mental illness can simply explain that they are sick if they need to take time off. This may be useful to overtly state on a research website or in a research syllabus, contract, or agreement if mentors use such documents when mentoring undergraduates in their lab. Further, research mentors can purposefully work to destigmatize mental health issues by explicitly stating that struggling with mental health issues, such as depression and anxiety, is common. While we do not recommend that mentors ask students directly about depression, because this can force students to share when they are not comfortable sharing, we do recommend providing opportunities for students to reveal their depression ( Chaudoir and Fisher, 2010 ). Mentors can regularly check in with students about how they’re doing, and talk openly about the importance of mental health, which may increase the chance that students may feel comfortable revealing their depression ( Chaudoir and Quinn, 2010 ; Cooper et al ., unpublished data ).

Foster a Positive Lab Environment.

Encourage positivity in the research lab, promote working in shared spaces to enhance social support among lab members, and alleviate competition among undergraduates.

Students in this study highlighted that the “leadership” of the lab, meaning graduate students, postdocs, lab managers, and PIs, were often responsible for establishing the tone of the lab; that is, if they were in a bad mood it would trickle down and negatively affect the moods of the undergraduates. Explicitly reminding lab leadership that their moods can both positively and negatively affect undergraduates may be important in establishing a positive lab environment. Further, students highlighted how they were most likely to experience negative thoughts when they were alone in the lab. Therefore, it may be helpful to encourage all lab members to work in a shared space to enhance social interactions among students and to maximize the likelihood that undergraduates have access to help when needed. A review of 51 studies in psychiatry supported our undergraduate researchers’ perceptions that social relationships positively impacted their depression; the study found that perceived emotional support (e.g., someone available to listen or give advice), perceived instrumental support (e.g., someone available to help with tasks), and large diverse social networks (e.g., being socially connected to a large number of people) were significantly protective against depression ( Santini et al. , 2015 ). Additionally, despite forming positive relationships with other undergraduates in the lab, many undergraduate researchers admitted to constantly comparing themselves with other undergraduates, which led them to feel inferior, negatively affecting their depression. Some students talked about mentors favoring current undergraduates or talking positively about past undergraduates, which further exacerbated their feelings of inferiority. A recent study of students in undergraduate research experiences highlighted that inequitable distribution of praise to undergraduates can create negative perceptions of lab environments for students (Cooper et al. , 2019). Further, the psychology literature has demonstrated that when people feel insecure in their social environments, it can cause them to focus on a hierarchical view of themselves and others, which can foster feelings of inferiority and increase their vulnerability to depression ( Gilbert et al. , 2009 ). Thus, we recommend that mentors be conscious of their behaviors so that they do not unintentionally promote competition among undergraduates or express favoritism toward current or past undergraduates. Praise is likely best used without comparison with others and not done in a public way, although more research on the impact of praise on undergraduate researchers needs to be done. While significant research has been done on mentoring and mentoring relationships in the context of undergraduate research ( Byars-Winston et al. , 2015 ; Aikens et al. , 2017 ; Estrada et al. , 2018 ; Limeri et al. , 2019 ; NASEM, 2019 ), much less has been done on the influence of the lab environment broadly and how people in nonmentoring roles can influence one another. Yet, this study indicates the potential influence of many different members of the lab, not only their mentors, on students with depression.

Develop More Personal Relationships with Undergraduate Researchers and Provide Sufficient Guidance.

Make an effort to establish more personal relationships with undergraduates and ensure that they perceive that they have access to sufficient help and guidance with regard to their research.

When we asked students explicitly how research mentors could help create more inclusive environments for undergraduate researchers with depression, students overwhelmingly said that building mentor–student relationships would be extremely helpful. Students suggested that mentors could get to know students on a more personal level by asking about their career interests or interests outside of academia. Students also remarked that establishing a more personal relationship could help build the trust needed in order for undergraduates to confide in their research mentors about their depression, which they perceived would strengthen their relationships further because they could be honest about when they were not feeling well or their mentors might even “check in” with them in times where they were acting differently than normal. This aligns with studies showing that undergraduates are most likely to reveal a stigmatized identity, such as depression, when they form a close relationship with someone ( Chaudoir and Quinn, 2010 ). Many were intimidated to ask for research-related help from their mentors and expressed that they wished they had established a better relationship so that they would feel more comfortable. Therefore, we recommend that research mentors try to establish relationships with their undergraduates and explicitly invite them to ask questions or seek help when needed. These recommendations are supported by national recommendations for mentoring ( NASEM, 2019 ) and by literature that demonstrates that both social support (listening and talking with students) and instrumental support (providing students with help) have been shown to be protective against depression ( Santini et al. , 2015 ).

Treat Undergraduates with Respect and Remember to Praise Them.

Avoid providing harsh criticism and remember to praise undergraduates. Students with depression often have low self-esteem and are especially self-critical. Therefore, praise can help calibrate their overly negative self-perceptions.

Students in this study described that receiving criticism from others, especially harsh criticism, was particularly difficult for them given their depression. Multiple studies have demonstrated that people with depression can have an abnormal or maladaptive response to negative feedback; scientists hypothesize that perceived failure on a particular task can trigger failure-related thoughts that interfere with subsequent performance ( Eshel and Roiser, 2010 ). Thus, it is important for research mentors to remember to make sure to avoid unnecessarily harsh criticisms that make students feel like they have failed (more about failure is described in the next recommendation). Further, students with depression often have low self-esteem or low “personal judgment of the worthiness that is expressed in the attitudes the individual holds towards oneself” ( Heatherton et al. , 2003 , p. 220; Sowislo and Orth, 2013 ). Specifically, a meta-analysis of longitudinal studies found that low self-esteem is predictive of depression ( Sowislo and Orth, 2013 ), and depression has also been shown to be highly related to self-criticism ( Luyten et al. , 2007 ). Indeed, nearly all of the students in our study described thinking that they are “not good enough,” “worthless,” or “inadequate,” which is consistent with literature showing that people with depression are self-critical ( Blatt et al. , 1982 ; Gilbert et al. , 2006 ) and can be less optimistic of their performance on future tasks and rate their overall performance on tasks less favorably than their peers without depression ( Cane and Gotlib, 1985 ). When we asked students what aspects of undergraduate research helped their depression, students described that praise from their mentors was especially impactful, because they thought so poorly of themselves and they needed to hear something positive from someone else in order to believe it could be true. Praise has been highlighted as an important aspect of mentoring in research for many years ( Ashford, 1996 ; Gelso and Lent, 2000 ; Brown et al. , 2009 ) and may be particularly important for students with depression. In fact, praise has been shown to enhance individuals’ motivation and subsequent productivity ( Hancock, 2002 ; Henderlong and Lepper, 2002 ), factors highlighted by students as negatively affecting their depression. However, something to keep in mind is that a student with depression and a student without depression may process praise differently. For a student with depression, a small comment that praises the student’s work may not be sufficient for the student to process that comment as praise. People with depression are hyposensitive to reward or have reward-processing deficits ( Eshel and Roiser, 2010 ); therefore, praise may affect students without depression more positively than it would affect students with depression. Research mentors should be mindful that students with depression often have a negative view of themselves, and while students report that praise is extremely important, they may have trouble processing such positive feedback.

Normalize Failure and Be Explicit about the Importance of Research Contributions.

Explicitly remind students that experiencing failure is expected in research. Also explain to students how their individual work relates to the overall project so that they can understand how their contributions are important. It can also be helpful to explain to students why the research project as a whole is important in the context of the greater scientific community.

Experiencing failure has been thought to be a potentially important aspect of undergraduate research, because it may provide students with the potential to develop integral scientific skills such as the ability to navigate challenges and persevere ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, in the interviews, students described that when their science experiments failed, it was particularly tough for their depression. Students’ negative reaction to experiencing failure in research is unsurprising, given recent literature that has predicted that students may be inadequately prepared to approach failure in science ( Henry et al. , 2019 ). However, the literature suggests that students with depression may find experiencing failure in research to be especially difficult ( Elliott et al. , 1997 ; Mongrain and Blackburn, 2005 ; Jones et al. , 2009 ). One potential hypothesis is that students with depression may be more likely to have fixed mindsets or more likely to believe that their intelligence and capacity for specific abilities are unchangeable traits ( Schleider and Weisz, 2018 ); students with a fixed mindset have been hypothesized to have particularly negative responses to experiencing failure in research, because they are prone to quitting easily in the face of challenges and becoming defensive when criticized ( Forsythe and Johnson, 2017 ; Dweck, 2008 ). A study of life sciences undergraduates enrolled in CUREs identified three strategies of students who adopted adaptive coping mechanisms, or mechanisms that help an individual maintain well-being and/or move beyond the stressor when faced with failure in undergraduate research: 1) problem solving or engaging in strategic planning and decision making, 2) support seeking or finding comfort and help with research, and 3) cognitive restructuring or reframing a problem from negative to positive and engaging in self encouragement ( Gin et al. , 2018 ). We recommend that, when undergraduates experience failure in science, their mentors be proactive in helping them problem solve, providing help and support, and encouraging them. Students also explained that mentors sharing their own struggles as undergraduate and graduate students was helpful, because it normalized failure. Sharing personal failures in research has been recommended as an important way to provide students with psychosocial support during research ( NASEM, 2019 ). We also suggest that research mentors take time to explain to students why their tasks in the lab, no matter how small, contribute to the greater research project ( Cooper et al. , 2019a ). Additionally, it is important to make sure that students can explain how the research project as a whole is contributing to the scientific community ( Gin et al. , 2018 ). Students highlighted that contributing to something important was really helpful for their depression, which is unsurprising, given that studies have shown that meaning in life or people’s comprehension of their life experiences along with a sense of overarching purpose one is working toward has been shown to be inversely related to depression ( Steger, 2013 ).

Limitations and Future Directions

This work was a qualitative interview study intended to document a previously unstudied phenomenon: depression in the context of undergraduate research experiences. We chose to conduct semistructured interviews rather than a survey because of the need for initial exploration of this area, given the paucity of prior research. A strength of this study is the sampling approach. We recruited a national sample of 35 undergraduates engaged in undergraduate research at 12 different public R1 institutions. Despite our representative sample from R1 institutions, these findings may not be generalizable to students at other types of institutions; lab environments, mentoring structures, and interactions between faculty and undergraduate researchers may be different at other institution types (e.g., private R1 institutions, R2 institutions, master’s-granting institutions, primarily undergraduate institutions, and community colleges), so we caution against making generalizations about this work to all undergraduate research experiences. Future work could assess whether students with depression at other types of institutions have similar experiences to students at research-intensive institutions. Additionally, we intentionally did not explore the experiences of students with specific identities owing to our sample size and the small number of students in any particular group (e.g., students of a particular race, students with a graduate mentor as the primary mentor). We intend to conduct future quantitative studies to further explore how students’ identities and aspects of their research affect their experiences with depression in undergraduate research.

The students who participated in the study volunteered to be interviewed about their depression; therefore, it is possible that depression is a more salient part of these students’ identities and/or that they are more comfortable talking about their depression than the average population of students with depression. It is also important to acknowledge the personal nature of the topic and that some students may not have fully shared their experiences ( Krumpal, 2013 ), particularly those experiences that may be emotional or traumatizing ( Kahn and Garrison, 2009 ). Additionally, our sample was skewed toward females (77%). While females do make up approximately 60% of students in biology programs on average ( Eddy et al. , 2014 ), they are also more likely to report experiencing depression ( American College Health Association, 2018 ; Evans et al. , 2018 ). However, this could be because women have higher rates of depression or because males are less likely to report having depression; clinical bias, or practitioners’ subconscious tendencies to overlook male distress, may underestimate depression rates in men ( Smith et al. , 2018 ). Further, females are also more likely to volunteer to participate in studies ( Porter and Whitcomb, 2005 ); therefore, many interview studies have disproportionately more females in the data set (e.g., Cooper et al. , 2017 ). If we had been able to interview more male students, we might have identified different findings. Additionally, we limited our sample to life sciences students engaged in undergraduate research at public R1 institutions. It is possible that students in other majors may have different challenges and opportunities for students with depression, as well as different disciplinary stigmas associated with mental health.

In this exploratory interview study, we identified a variety of ways in which depression in undergraduates negatively affected their undergraduate research experiences. Specifically, we found that depression interfered with students’ motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing. We also identified that research can negatively affect depression in undergraduates. Experiencing failure in research can exacerbate student depression, especially when students do not have access to adequate guidance. Additionally, being alone or having negative interactions with others in the lab worsened students’ depression. However, we also found that undergraduate research can positively affect students’ depression. Research can provide a familiar space where students can feel as though they are contributing to something meaningful. Additionally, students reported that having access to adequate guidance and a social support network within the research lab also positively affected their depression. We hope that this work can spark conversations about how to make undergraduate research experiences more inclusive of students with depression and that it can stimulate additional research that more broadly explores the experiences of undergraduate researchers with depression.

Important note

If you or a student experience symptoms of depression and want help, there are resources available to you. Many campuses provide counseling centers equipped to provide students, staff, and faculty with treatment for depression, as well as university-dedicated crisis hotlines. Additionally, there are free 24/7 services such as Crisis Text Line, which allows you to text a trained live crisis counselor (Text “CONNECT” to 741741; Text Depression Hotline , 2019 ), and phone hotlines such as the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can also learn more about depression and where to find help near you through the Anxiety and Depression Association of American website: https://adaa.org ( Anxiety and Depression Association of America, 2019 ) and the Depression and Biopolar Support Alliance: http://dbsalliance.org ( Depression and Biopolar Support Alliance, 2019 ).

ACKNOWLEDGMENTS

We are extremely grateful to the undergraduate researchers who shared their thoughts and experiences about depression with us. We acknowledge the ASU LEAP Scholars for helping us create the original survey and Rachel Scott for her helpful feedback on earlier drafts of this article. L.E.G. was supported by a National Science Foundation (NSF) Graduate Fellowship (DGE-1311230) and K.M.C. was partially supported by a Howard Hughes Medical Institute (HHMI) Inclusive Excellence grant (no. 11046) and an NSF grant (no. 1644236). Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF or HHMI.

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Submitted: 4 November 2019 Revised: 24 February 2020 Accepted: 6 March 2020

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Frequently Asked Questions

What is Depression?

Major Depression, also known as clinical or unipolar depression, is one of the most common mental illnesses. Over 9 million American adults suffer from clinical depression each year. This estimate is likely to be higher since depression commonly remains undiagnosed and untreated in a large percentage of the U.S. population. Major Depression is more than a temporary state of feeling sad; rather, it is a persistent state that can significantly impair an individual's thoughts, behavior, daily activities, and physical health.

Major Depressive Disorder impacts all racial, ethnic, and socioeconomic groups and can occur at any age. The average lifetime prevalence of depression is 17%: 26% for women and 12% for men. The mean age for a first episode is in the thirties. Demographic differences show that rates are higher in urban rather than in rural areas. No racial significance has been noted. Along gender lines, women suffer from depression at twice the rate of men. Statistics have shown that one out of every seven women will experience at least one depressive episode in their lifetime. This gender difference is best explained by looking at the interplay between biological, genetic, psychological, social, and environmental factors.

Classified as mood disorders, major depression, along with other depressive disorders such as dysthymia (a chronic less severe form of depression), and bipolar disorder (manic depression) fall along a spectrum. On one end of the spectrum is unipolar or major depression and on the opposite is bipolar disorder or manic depression, both with varying degrees of severity and duration. Along this spectrum, there are several categories of mood disorders, such as postpartum depression, seasonal affective disorder (SAD) and psychotic depression, as well as variants of bipolar disorder. Bipolar disorder is characterized by severe and disabling cycles of depression and mania.

Mood disorders are highly treatable conditions, with each type requiring different treatment approaches and modalities. Antidepressant medications and psychotherapies offer useful treatment approaches and are commonly employed in treating the debilitating effects of depression. However, if mood disorders are left untreated for long periods of time, the debilitating effects of depression can lead to suicide.

SYMPTOMS OF MAJOR DEPRESSIVE DISORDER

Symptoms of Major Depression represent a significant change from the individual's normal level of functioning. Together the symptoms cause significant distress or impairment in the individual's life and his/her ability to function. Depression symptoms can occur with either a sudden onset or in a more gradual fashion, with the severity of symptoms ranging from mild to severe.

A Major Depressive Episode is defined as having five or more of the following symptoms present for the same two-week period, and represents a change from the individual's normal level of functioning when well. At least one of the five required symptoms must be (1) depressed mood or (2) loss of interest.

1. depressed mood experienced most of the day, nearly every day;

2. diminished interest or pleasure in all or almost all activities most of the day, nearly every day;

3. significant change in appetite (increase or decrease) or weight (loss or gain);

4. insomnia or hypersomnia nearly every day;

5. observable psychomotor agitation (feeling restless or fidgety) or retardation (feeling slowed down) nearly every day;

6. loss of energy or fatigue nearly every day;

7. feelings of worthlessness, or excessive or inappropriate guilt, nearly every day (not merely self reproach about being sick);

8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective account or observed by others);

9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

What are the Symptoms of Major Depression with Psychotic Features (PMD)?

Symptoms of major depression with psychotic features include all of the symptoms of major depressive disorder listed above. In addition, patients experience delusions and/or hallucinations. Examples of these latter symptoms include feelings as though other people are out to harm them, feeling as though one has special powers to do things that other people cannot do, feeling overwhelmed with guilt, or hearing voices that put one down.

In psychotic major depression, the delusions and/or hallucinations only occur when the person is also experiencing significant depression. These symptoms do not occur when the person is no longer depressed. If one experiences these psychotic symptoms when they are not depressed, there are other diagnoses that would need to be considered.

What are the Symptoms of Dysthymic Disorder?

The differentiation of dysthymic disorder from major depressive disorder can be difficult. Key features of dysthymia are a mild to moderate depressed mood that has a chronic course (greater than 2 years). Dysthymia is characterized by the following:

1. Depressed mood for most of the day, for more days than not, for at least two years.

2. While depressed, there must be present 2 or more of the following: poor appetite or over-eating, insomnia or hypersomnia, low energy/fatigue,

low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

3. During the two-year period, the patient has never been without the symptoms in number 1 or 2 for more than 2 months at a time.

4. No history of a major depressive episode, manic episode, mixed episode, hypomanic episode or cyclothymic disorder.

5. The symptoms cause significant impairment or distress.

What are the Symptoms of Bipolar Disorder?

SYMPTOMS OF BIPOLAR DISORDER

Bipolar Disorder is a spectrum of disorders that are distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. During the depressed periods, patients experience symptoms of major depression (see above). Contrasted by the manic periods where patients experience mania episodes. A manic episode is characterized as follows:

Manic Episode

1. Distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting for at least one week (or any duration if hospitalization is

necessary).

2. During the period of mood disturbance, three (or more) of the following symptoms (four if the mood is only irritable) have been present to a significant

degree:

a. inflated self-esteem or grandiosity

b. decreased need for sleep

c. more talkative than usual or pressure to keep talking

d. disconnected or racing thoughts

e. distractibility

f. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

g. excessive involvement in inappropriate social behavior

3. The mood symptoms cause significant impairment or distress, or severity of illness requires hospitalization to prevent harm to self or others,

or there are psychotic features.

For more information on Bipolar Disorder: http://www.ndmda.org/

What are Causes of Depression?

The exact etiology of depression is yet to be determined; however, multiple factors, including biological, psychological, and environmental factors are involved in the presentation of depression. For example, an individual who has a first-degree relative with depression has a four times higher risk of developing depression than the general population. Twin studies have shown that an individual with a monozygotic twin with depression has as high as a fifty percent chance of developing the disorder.

Major depression is caused by imbalance of certain neurotransmitters (chemical messengers) in the brain, such as serotonin, norepinephrine, and dopamine. Antidepressants work either by changing the sensitivity of the receptors or by increasing the availability of neurotransmitters in the brain.

In addition to genetic components, there are many psychosocial factors that contribute to the development of mood disorders. For example, an individual with little or no social support will have fewer resources to handle stress and thereby will be at a greater risk of developing a mood disorder.

What are Treatments for Depression?

Major depression is a highly treatable illness. Between 80 to 90% of individuals who suffer from severe depression are effectively treated and return to a normal level of functioning. Treatment of depression depends on the individual as well as the severity and duration of the illness. Basic types of treatment for depression include antidepressant medications, psychotherapy, or electroconvulsive therapy (ECT). Often these basic treatment approaches are used in combination. Antidepressants are one of the largest groups of pharmaceuticals produced in the world and the second largest produced in the United States. Currently, over two-dozen antidepressants are on the market.

Antidepressants are successful in 60-80% of patients. No single antidepressant drug has been shown to be more effective than another. Antidepressants work by correcting imbalances in neurotransmitters. Generally, antidepressants take several weeks and up to months to show efficacy and each has their own side effect profile.

Additionally, several methods of short-term, goal-oriented psychotherapy have proven successful in the treatment of depression, such as cognitive behavioral therapy (CBT) and interpersonal therapy. Cognitive behavioral therapy addresses the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression. In contrast, interpersonal therapy has a focus on improving disturbed or unhealthy personal relationships, which may be contributing to the individual's depression.

The final treatment approach, electroconvulsive therapy (ECT), is employed in cases of severe treatment-resistant depression. An electric current is passed through the brain to produce a seizure, thereby affecting chemical activity in all regions of the brain. It is believed that, with repeated treatments, chemical changes build upon one another to help restore the normal chemical balance in the brain and help to alleviate symptoms of depression.

For more information about ECT and other treatment approaches: http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129

Depression Research Paper

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Even for professionals the use of the term depression can vary. In 1987, Kendall and colleagues noted that “The professional use of the term depression has several levels of reference: symptom, syndrome, nosologic disorder . . . . Depression itself can be a symptom – for example, being sad. As a syndrome, depression is a constellation of signs and symptoms that cluster together . . . . The syndrome of depression is itself a psychological dysfunction but can also be present, in secondary ways, in other diagnosed disorders. Finally, for depression to be a nosologic category careful diagnostic procedures are required during which other potential diagnostic categories are excluded. The presumption, of course, is that a discrete nosologic entity will ultimately prove to be etiologically distinct from other discrete entities, with associated differences likely in course, prognosis, and treatment response.” It is this likely nosologic disorder of depression that we will discuss.

I. Definition of Depression

A. symptoms of depression, b. comorbidity: the relationship between depression and anxiety, ii. diagnostic classification, a. major depressive disorder, b. dysthymic disorder, c. bipolar i disorder, d. bipolar ii disorder, e. cyclothymic disorder, iii. exploratory categories of depressive disorders, a. premenstrual dysphoric disorder, b. minor depressive disorder, c. recurrent brief depressive disorder, d. mixed anxiety-depressive disorder, iv. epidemiology, a. prevalence, 1. national prevalence, 2. international prevalence, b. age differences, c. sex and ethnic differences, d. environmental correlates, v. etiological theories of depression, a. psychological theories, 1. psychoanalytic approaches, 2. interpersonal approaches, 3. cognitive approaches, b. biological theories, 1. genetic approaches, 2. neurotransmitter approaches, vi. protective factors, a. social support, b. coping styles.

Any definition of depression must begin with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-IV represents the official diagnostic classification system of the American Psychiatric Association and provides the criteria that are used to diagnosis depression. These criteria consist of the symptoms of depression. In order to make a diagnosis of depression, at least five out of nine possible symptoms must be present. These include (1) depressed mood; (2) diminished pleasure or interest in activities; (3) significant weight loss or weight gain; (4) insomnia or hypersomnia; (5) agitation; (6) fatigue or loss of energy; (7) thoughts of worthlessness or inappropriate guilt; (8) diminished concentration ability; and (9) thoughts of death or suicide.

Symptoms of depression may vary according to an individual’s age and culture. Children who are depressed, for instance, may express symptoms of irritability rather than sadness. They may also fail to make expected weight gains rather than lose weight. On the other end of the age continuum, older adults are more likely than younger adults to experience symptoms such as loss of appetite, loss of interest, and thoughts of death. Cultural differences also exist in report of depressive symptoms. One study, for example, found that depressed Jewish patients reported more somatic symptoms, and less guilt, than did non-Jewish patients. Another study that examined depressive symptomatology in American, Korean, Philippine, and Taiwanese college students found that Taiwanese students reported the lowest numbers of somatic symptoms and the highest numbers of affective symptoms. The other ethnic groups reporting similar levels of these symptoms. One’s age and culture thus seems to affect how depression is expressed.

Comorbidity refers to the occurrence of more than one disorder at the same time. Although researchers and clinicians generally acknowledge depression as a distinct disorder, it does overlap with a variety of other difficulties. Much current research on this overlap has focused on the relationship between anxiety and depression. This is not surprising, given the high rates of comorbidity found in studies of the two disorder types. For example, one study found that 63% of a group of patients with panic disorder also experienced major depression. One possible explanation provided for such overlap lies in the concept of “negative affectivity.” In 1984, Watson and Clark described individuals with high levels of negative affectivity as having a tendency “to be distressed and upset and have a negative view of self, whereas those low on the dimension are relatively content and secure and satisfied with themselves.” Other characteristics of high negative affectivity include nervousness, tension, worry, anger, scorn, revulsion, guilt, self-dissatisfaction, rejectedness, and sadness.

Both anxiety and depression seem to consist of high negative affectivity. There are however, important differences between depression and anxiety. While both depression and anxiety are characterized by high levels of negative affect, only depression is related to lowered levels of positive affect. Thus, depressed individuals tend to display both high negative affect and low positive affect, whereas anxious individuals display high negative affect and may or may not have lowered positive affect–the level of positive affect is unrelated to one’s anxiety state. Research on negative affect as a link between anxiety and depression is continuing at a rapid pace.

Earlier we noted the DSM-IV. The DSM-IV is the most widely used classification scheme for psychiatric disorders in North America. According to this manual, there are five types of mood disorders that include depression as a significant component. These are (1) Major Depressive Disorder; (2) Dysthymic Disorder; (3) Bipolar I Disorder; (4) Bipolar II Disorder; and (5) Cyclothymic Disorder. Each of these classifications differs in terms of etiology, course, and symptomatology.

For a diagnosis of Major Depressive Disorder (MDD), DSM-IV specifies that at least five symptoms must occur for a period of at least 2 weeks. Chief among these symptoms is depressed mood that occurs most of the day, nearly every day for at least 2 weeks, or significantly diminished interest or pleasure in virtually all activities most of the day, nearly every day for the 2-week period.

MDD can be further classified according to severity (i.e., mild, moderate, severe without psychotic features, severe with psychotic features), course (e.g., single episode versus recurrent episodes), and presentation (e.g., with catatonic features, with melancholic features). Psychotic features of depression include such experiences as delusions (i.e., false beliefs) and hallucinations (i.e., sensory experiences that have no basis in reality). A delusion, for example, would be a person who believes that she is dead. Catatonic features of depression involve psychomotor disturbances such as excessive movement or stupor. Melancholic features include the inability to experience pleasure even when good things happen and a lack of interest in previously pleasurable activities. No matter what the specific characteristics of a given individual’s disturbance, MDD is, by definition, extremely distressing to the sufferer and is associated with significant impairment in important areas of the person’s life (e.g., at work, home or school).

Dysthymic Disorder is characterized by a chronic depressed mood that lasts at least 2 years in adults and at least 1 year in children and adolescents. This depressed mood is accompanied by at least two of the following six depressive symptoms: (1) poor appetite or overeating; (2) insomnia or hypersomnia; (3) low energy or fatigue; (4) low self-esteem; (5) poor concentration or difficulty making decisions; and (6) feelings of hopelessness. As fewer depressive symptoms are required to make a diagnosis, Dysthymic Disorder is often considered a milder form of depression than MDD. However, it can be just as upsetting to the sufferer and can cause just as much impairment. In addition, Dysthymic Disorder may occur in combination with episodes of major depression. When Dysthymic Disorder occurs along with major depression, the individual is considered to be suffering from a “double depression.” The co-occurrence of MDD and dysthymia is not uncommon.

The hallmark characteristic of Bipolar I Disorder is mania. According to DSM-IV, a manic episode is characterized by elevated, expansive, or irritable mood that is persistent and distinctly different from normal elevated or irritable moods. This period is accompanied by at least three of seven possible symptoms. These symptoms include (1) inflated self-esteem; (2) a decreased need for sleep; (3) unusual talkativeness; (4) the feeling that one’s thoughts are racing; (5) increased distractibility; (6) increased activity; (7) involvement in pleasurable but potentially harmful activities (e.g., sexual indiscretions).

Bipolar I Disorder is typically recurrent; according to DSM-IV, additional episodes occur in more than 90% of individuals who have had a single manic episode. The manic episodes of those with Bipolar I Disorder are often intermixed with periods of depression. Like those with MDD, people with Bipolar I Disorder may exhibit psychotic, catatonic, and melancholic features as part of either their mania or their depression.

Bipolar II Disorder is characterized by periods of hypomania intermixed with periods of depression. Hypomanic episodes are characterized by the same symptoms as manic episodes. However, hypomanic episodes are shorter (e.g., 4 days in duration) and are associated with less impairment. While manic episodes may include psychotic features, interrupt daily functioning, and require hospitalization, hypomanic episodes typically do not. The depression experienced as part of Bipolar II Disorder, however, can be just as severe as that experienced in MDD and Bipolar I Disorder.

Cyclothymic disorder is characterized by hypomanic periods intermixed with depressive periods that are not as severe as those experienced in MDD, Bipolar I Disorder, and Bipolar II Disorder. In Cyclothymia, the periods of mood disturbance may alternate rapidly, with little respite from affective difficulties. For a diagnosis of Cyclothymia these periods of shifting moods must be problematic for at least 2 years in adults and at least i year in children and adolescents.

In addition to the five official diagnoses, DSM-IV has denoted four classifications for further study that include depression as a significant component. Such classifications are not yet considered to be disorders and more information is needed on factors such as symptom presentation, etiology, and degree of impairment to sufferers before these might be considered disorders in their own right. Nevertheless, these may represent serious problems and even though they are currently exploratory, we describe them here. They are: (1) Premenstrual Dysphoric Disorder; (2) Minor Depressive Disorder; (3) Recurrent Brief Depressive Disorder; and (4) Mixed Anxiety-Depressive Disorder.

Premenstrual Dysphoric Disorder is characterized by several hallmark symptoms of depression (e.g., decreased interest in usual activities, depressed mood, difficulty sleeping or sleeping too much) in addition to symptoms such as affective lability, feelings of being overwhelmed or out of control, and food cravings. In order to meet the criteria that have been proposed for this diagnosis, such symptoms must have occurred during the late luteal phase of most of a woman’s menstrual cycles in the past year. As a number of authors have pointed out, such a classification has potentially serious social, political, and legal ramifications for women. For example, some have argued that if this classification is adopted as an orificial diagnosis then women might be stigmatized as more unstable than or inferior to men. Arguments such as this keep the classification of Premenstrual Dysphoric Disorder a topic of considerable debate.

Minor Depressive Disorder is characterized by fewer depressive symptoms than are seen in MDD. The level of impairment is also less than that associated with MDD. To meet the proposed criteria for Minor Depressive Disorder, a person must demonstrate either a depressed mood or loss of interest and two additional symptoms of a Major Depressive Episode. If this classification were included in future DSM editions as a disorder, it would constitute a residual category to be used only after the other mood disorders have been ruled out.

The principle difference between Recurrent Brief Depressive Disorder and MDD is one of duration. Recurrent Brief Depressive Disorder is characterized by periods of depression that meet all of the criteria for a Major Depressive Episode except for the duration requirement. While in major depressive episodes, symptoms must last at least 2 weeks, in recurrent brief depressive episodes, symptoms must last at least 2 but less than 14 days. In addition, these brief episodes must occur at least once a month for 12 months to meet criteria for the classification of Recurrent Brief Depressive Disorder. Recurrent Brief Depressive Disorder is quite similar to MDD in its age of onset and family incidence rates, thus raising questions as to whether this should be considered a distinct disorder.

The impetus behind a mixed anxious-depressed category lies in the finding that there are many people suffering from symptoms of anxiety and depression who do not meet criteria for any DSM anxiety or mood disorder, but who are nonetheless significantly impaired by their difficulties. The classification of Mixed Anxiety-Depressive Disorder is characterized by a dysphoric mood for at least 1 month in addition to at least four additional symptoms that primarily reflect anxiety (e.g., mind going blank, worry, hypervigilance). The primary argument in favor of adopting this proposed disorder is that it would cover the large number of people who have significant impairment linked to depression and anxiety but who do not fall into any currently existing diagnostic category. The primary argument against this classification is that people suffering from both depression and anxiety could in fact be categorized into already existing disorders with the use of more precise assessment methods.

Epidemiology refers to information about the incidence and prevalence of disorders in a population. A prevalence rate refers to the number of people who have a given disorder during a particular time period (e.g., the percentage of people in given location diagnosed with MDD within a 1-year period of time). An incidence rate refers to the number of new cases of a disorder which occur during a given time period (e.g., the number of people diagnosed with Dysthymic Disorder during April 1996). Because the distribution of a disorder can be examined to determine whether it correlates with other factors, epidemiological information can be important for understanding some of the possible causes and correlates of depression.

Two recent large-scale surveys of psychopathology in the United States have provided differing prevalence data on depression. Using diagnostic criteria from the revised 3rd Edition of the DSM (DSM-III-R), the Epidemiologic Catchment Area (ECA) study examined the rates of depression in five sites: New Haven, Baltimore, St. Louis, Los Angeles, and Durham. The ECA study found the lifetime prevalence of major depression (i.e., the number of people experiencing major depression during any point in life) to be 4.9% and the lifetime prevalence of dysthymia to be 3.2%. Alternatively, the National Comorbidity Survey (NCS) reported much higher prevalence rates: 14.9% for lifetime major depression and 6.4% for dysthymia. The discrepancies between these two studies may be accounted for by the different assessment instruments used, slightly different diagnostic criteria employed, and different age ranges studied (i.e., the ECA sample was 18 years of age or older, whereas the NCS sample ranged in age from 15 to 54 years). According to the ECA study, prevalence rates for bipolar disorders were much lower; lifetime prevalence of these disorders was .8% for Bipolar I and .5% for Bipolar II. The NCS lifetime prevalence for manic episode was somewhat higher: 1.6 %. Even though these epidemiological studies reported somewhat discrepant rates, they are in agreement that mood disorders are relatively common in the United States.

A number of studies have examined the community prevalence of major depression in countries besides the United States. International lifetime prevalence rates vary widely, from a low of 3.3% in Seoul to a high of 15.1% among New Zealand residents aged 25 to 46. While such differences may indeed reflect true international differences in the occurrence of depression, other factors such as cultural differences in the sensitivity of the instruments used to assess disorder and different sample ages may also account for this range. In prevalence studies focusing on bipolar illness, ranges from .07% in Sweden to 7% in Ireland have been reported. Most studies, however, place prevalence at about 1% for bipolar illnesses, consistent with data from the ECA and NCS studies.

The ECA study also reported incidence rates of depression for various age groups. For men, major depression was highest among those aged 18 to 29. A large decline in incidence was noted for men aged 45 and older. For women, the incidence of major depression was highest in the group aged 30 to 44 and did not decline until age 65.

According to the ECA study, lifetime prevalence rates of major depression, dysthymia, and all mood disorders are approximately twice as high for women as for men. Women’s lifetime rates were 7.0%, 4.1%, and 10.2%, respectively, while rates for men were 2.6%, 2.2 %, and 5.2 %, respectively. These differences occur across a variety of ethnic groups (e.g., African American, Hispanic, Caucasian) even when differences in education, income, and occupations are controlled. Sex differences are also found in countries besides the United States. While sex differences in depression are among the most stable of findings across studies, no sex differences in the rates of bipolar disorder are reliably found.

Although sex difference in the incidence of depression occur across different ethnic groups, there are some differences among these groups overall. For instance, the ECA study found higher rates of Major Depression and Dysthymia among Caucasians and Hispanics than among African Americans. However, few difference in the rates of bipolar disorders among the three groups were found.

The ECA study also examined a number of environmental correlates of depression and bipolar disorders. This study found that people who were separated or divorced had higher 1-year prevalence rates of major depression (6.3%) than those who were never married (2.8%), currently married (2.1%), or widowed (2.1%). This was also true of those with bipolar disorders, although the rates for those separated or divorced versus never married were nearly identical (1.7% versus 1.6%). The 1-year prevalence rate of major depression was also higher among the unemployed than the employed (3.4% versus 2.2%), but the rate was nearly identical for those with bipolar disorders (1.1% versus 1.0%). In addition, the ECA study found higher rates of major depression among white-collar workers and those with at least 12 years of education, but lower rates of depression among those with annual incomes of $15,000 or more. Consistent with the major depression findings, bipolar disorders were also less prevalent among those with annual incomes of $15,000 or more. Bipolar disorders were also found to be the most prevalent among none-white-collar workers with less than 12 years of education. Overall, these socioeconomic status differences were quite small.

A variety of different psychological theories of the causes of depression have been proposed. These can be grouped in psychoanalytic, interpersonal, and cognitive.

The first psychoanalytic writers to theorize about the etiology of depression were Sigmund Freud and his student, Karl Abraham. As would be expected, there are a number of similarities in the theories proposed by Freud and Abraham. First, both Freud and Abraham believed that some people are predisposed to experience depression. For Abraham, this predisposition consisted of anatomical anomalies that allowed a person to experience a great deal of oral eroticism. For Freud, this predisposition consisted of narcissistic object choices (e.g., object choices which are so similar to the self that love of the object is truly love of self). Second, both believed that a predisposition to experience depression was not, in and of itself, enough to cause depression. In order to experience a depression, a predisposed individual must also experience the loss of a loved object (e.g., through death or rejection).

Despite these basic similarities, the two theorists diverge somewhat on how depression occurs once a loss has been experienced. For Abraham, the loss of a loved object in a person predisposed to depression triggers a regression to the oral stage of psychosexual development. Such a regression is meant to achieve three purposes: (1) to increase pleasure; (2) to hold on to the object through oral incorporation; and (3) to discharge one’s aggressive impulses on to the object. Such a regression manifests itself most saliently in the depressive symptoms of eating too much or too little. For Freud, the loss of a loved object possesses different implications. Since the lost object was a narcissistic choice and thus represented the self, loss of the object means loss of the self. This loss of self triggers feelings of anger and depression. The energy associated with these negative feelings is withdrawn from the lost object and brought inward, in a process called introjection. Thus, depression as conceptualized by Freud is often summarized as “anger turned inward.” For Freud, the difference between sadness and “true” depression was the difference between “this is awful” and “I am awful.” Freud further extended his theory to account for the mania characteristic of bipolar depressive disorders. He hypothesized that, once the feelings of anger and depression over loss of the object are resolved, the energy associated with these negative feelings is freed for other purposes. In a person with bipolar disorder, this freed energy is used to zealousy search for new objects, thus accounting for the symptoms of mania.

More recent psychoanalytic theorists have focused on the superego’s role in depression. Some theorists, for example, have suggested that depression is distinguished from other states such as shame, apathy, or resentment by the presence of guilt. As guilt results only from an intrapsychic conflict of the superego, the superego is necessarily implicated in depression. One result of these differences in etiological focus has been the proposition of two forms of depression: anaclitic and introjective. Anaclitic depression is characterized by feelings of helplessness, inferiority, and being unloved. Anaclitic depression is proposed to be associated with the earlier stages of development and is most closely associated with the theorizing of Abraham and Freud. Alternatively, introjective depression focuses on feelings of unworthiness and failure to measure up to expectations and standards. It is associated with later stages of development, and more closely aligned with the works of later psychoanalytic theorists. Although much of psychoanalytic theory has been criticized on grounds that it has not been empirically tested, the distinction between anaclitic and introjectire depressions has been empirically examined and found to be valid. Psychoanalytic theorists have accounted for the development of bipolar disorders as well. Most notable amongst these theorists is Melanie Klein, who expanded upon the work of Freud.

Interpersonal approaches to the etiology and maintenance of depression focus on the interplay between a depressed person and his or her relations with others. Empirical research in this area has taken several directions. For example, some researchers focus on the role of social skills in depression, asking such questions as whether depressed people have poor social skills and whether the lack of such skills results in decreased reinforcement from others and consequent depression. Other research has evaluated the types of communications depressed people emit (e.g., sadness, hopelessness) and the effects these communications have on others. If others find the communications of depressed persons aversive, they will likely avoid such persons, which may then exacerbate depressive symptoms such as isolation and loneliness. Still others address the interplay between stress, social support, and depression. All of these lines of research have found some support; interpersonal research highlights the fact that depression is caused by a multitude of factors in interplay with one another.

Much of the research converges on the theoretical idea that depression is maintained by a vicious cycle that is caused by disruptions in interpersonal interactions. For instance, many depressed individuals quite understandably seek out social support from others. If this support does not alleviate the negative feelings, further support is sought. This intensified support seeking, however, has the paradoxical effect of pushing away those who have been supportive. That is, as individuals begin to feel that their support capacity has been exhausted they pull back from the depressed person, leading to an even further intensification of social support seeking, and the further distancing of potentially supportive people.

Interpersonal factors in the etiology of bipolar depressive disorders have not received as much research attention as such factors in unipolar depressive disorders. Nonetheless, persons with both types of depressive disorders seem to have difficulties in retaining social support. Indeed, in one recent study, people with bipolar disorder perceived their social supports as less available to them and as less adequate in the amount of support received than people in a community sample. Furthermore, perceptions of social support availability seemed to decrease as the duration of illness increased. Thus, it seems likely that social support plays a role in bipolar as well as unipolar depressive disorders.

Currently, cognitive approaches are among the most widely studied theories in the etiology of depression. One of the most influential of these theories was proposed by Aaron Beck in 1967. Beck argued that all individuals possess cognitive structures called schemas that guide the ways information in the environment is attended to and interpreted. Such schemas are determined from childhood by our interactions with the external world. For example, a child who is constantly criticized may begin to believe she is worthless. She might then begin to interpret every failure experience as further evidence of her worthlessness. If this negative processing of information is not changed, it will become an enduring part of her cognitive organization, that is, a schema. When this schema is activated (e.g., by a poor grade on a test or any other failure experience), it will predispose her to depressive feelings (e.g., I’m no good). Beck stated that, as a result of this faulty information processing, depressed persons demonstrate a cognitive triad of negative thoughts about themselves, the world, and the future. He further extended his argument to include the manic phases of bipolar depressive disorders. Beck stated that such phases are characterized by a manic triad of irrationally positive thoughts about oneself, the world, and the future. Like the depressive triad in unipolar depressive disorders, the manic triad in bipolar depressive disorders was hypothesized to lead to the symptoms of mania, such as inflated selfesteem and extremely elevated mood.

There is widespread agreement that depression can be caused by different factors. Some theorists have argued that dysfunctional cognitions cause only a subset of depressions. Termed the “negative cognition” subtype, this type of depression is brought about by either the kinds of schemas discussed by Aaron Beck or by dysfunctional attributional patterns that lead depressed people to take responsibility for the occurrence of negative events, and to avoid taking responsibility for positive events. This dysfunctional attributional pattern can lead to a sense of hopelessness that results in a “hopelessness depression,” a component of negative cognition depression.

Although there are a variety of biologically based theories of depression, they can be broken down into two general approaches: genetic and neurotransmitter.

Genetic approaches suggest that depression is the result of inheriting genes that predispose to occurrence of depression. Three types of studies that are used to investigate genetic inheritance of depression illustrate this approach. These studies consist of family studies, twin studies, and adoption studies. In a typical family study, families with a depressed member are interviewed to determine how many other family members have or had an affective disorder. In twin studies, the concordance rate of affective disorder between monozygotic and dizygotic twin pairs is compared. Because monozygotic twins have identical genes, if genetic theories are correct then concordance rates of depression should be higher than for dizygotic twins (who have similar but not identical genes). In adoption studies, two strategies are most often used. In the first, the rate of depressive disorder in the biological parents of adopted persons with and without affective disorders is compared. In the second, the rate of depressive disorders is compared between adopted children with and without affectively disordered biological parents. Adoption studies have an advantage over family and twin studies, as the effects of environment on affective disorder are reduced in this design. However, adoption studies constitute the least-used approach to investigating genetic factors in depression; the difficulty of obtaining complete records on adoptees and their biological parents makes this design quite prohibitive.

Despite design differences, all three genetic approaches to the etiology of depression have yielded similar results: depression is heritable to at least some degree. A recent review of the research literature, for example, found rates of affective disorders among first-degree relatives of unipolar-disordered individuals ranging from 11.8% to 32.2%. Rates of affective disorders among first-degree relatives of bipolardisordered individuals ranged from 10.6% to 33.1%. Rates of affective disorder among first-degree relatives of normal individuals ranged from 4.8% to 6.3. In twin studies of unipolar and bipolar depression, concordance rates ranged from .04 to 1.0 for monozygotic twins, and from 0.0 to .43 to dizygotic twins, with the majority of studies reviewed reporting no concordance for dizygotic twins. The results of genetic investigations clearly suggest that there is a genetic component to depression, although the exact nature and functioning of this component is thus far still unknown.

Research on brain chemistry as an etiological factor in unipolar depression has focused on two monoamine neurotransmitters: norepinephrine (NE) and serotonin (5-HT). Initially, researchers believed that depression was due to a lack of NE in the brain, and later, to a lack of both NE and 5-HT. However, several difficulties with these hypotheses arose: (1) While the effects of antidepressants on monoamine levels start within hours of taking the medication, decreased depression levels do not become apparent until weeks later. (2) Some drugs that do not affect monoamine levels alleviate depression. (3) Some drugs that increase monoamine levels do not alleviate depression. Thus, researchers have directed their efforts to investigating more complicated relations between these neurotransmitters and depression. Recent efforts have included the study of receptor site hyposensitivity, relationships between NE and 5-HT, and relationships between. 5-HT and the neurotransmitter dopamine (DA).

Research on brain chemistry as in etiological factor in bipolar depression has followed much the same course as such research on unipolar depression. Initially, researchers believed that the mania characteristic of bipolar disorders was due to excesses of the neurotransmitters NE and 5-HT, exactly opposite the belief for depression. However, difficulties arose with this hypothesis, including findings that (1) lithium, the medical treatment of choice for bipolar disorder which seems to affect both NE and 5-HT, was effective at controlling both depression and mania, and (2) both depression and mania may be characterized by lower levels of 5-HT. Thus, as with unipolar depression, researchers of bipolar depression have begun investigating more complicated relationships between bipolar depression and neurotransmitters. Similar to the recent efforts concerning unipolar depression, researchers have investigated interactions between 5-HT and DA, interactions between NE and DA, and receptor site hypersensitivity. These types of investigations represent promising areas of research in elucidating the multifaceted etiology of depression. Certainly, biology and psychology are implicated in the causes of depression, both unipolar and bipolar forms.

Given the potentially devastating effects of depression, many researchers have devoted their efforts to studying factors that decrease the likelihood of becoming depressed or decrease the amount of time spent in depressive episodes. Among the most widely studied of such protective factors are social support and coping styles.

There are numerous facets to the concept of social support. For example, social support can be conceived as the number of persons one can rely on for support. Social support can also be conceived as the amount of support received, regardless of the number of persons one receives support from. In addition, socially supportive relationships can be conceptualized on a continuum of quality from very poor to very good. Examination of all these facets has proven important in understanding relationships between depression and social support.

Overall, people in contact with numerous socially supportive persons are less likely to have mental health difficulties, including depression. In addition, those who perceive a great deal of support from others are less likely to be negatively affected by stressors that might lead to depression. For people who have become depressed, having a confidant such as a spouse or best friend and a supportive family is related to greater success in treatment. The quality of such relationships is also important to treatment. In one study, for example, depressed persons with good-quality confidant relationships needed shorter periods of treatment than those with poor-quality confidant relationships.

The effects of social support for people with bipolar depressive disorders have not been as well studied as the effects for people with unipolar depressive disorders. Nonetheless, research suggests that social support is indeed beneficial for people with bipolar disorders. In one study, for example, a great deal of available social support was related to fewer psychological symptoms, better social adjustment, and better overall functioning.

Ways of coping with stressors can be roughly divided into two categories: approach strategies and avoidance strategies. Approach strategies are characterized by identifying the problematic situation, devising reasonable solutions to it, an implementing those solutions. Avoidance strategies include trying not to think about the problem, wishing the problem did not exist, and fantasizing about life without the problem. Overall, approach strategies seem to help people cope with stressors that might otherwise lead to depression. In addition, use of approach strategies is associated with better treatment outcome for those who become depressed. Conversely, people who use avoidance strategies to cope with stress seem more likely to become depressed and to have poorer treatment outcomes.

As with the effects of social support, research on coping styles among people with bipolar depressive disorders is scarce. Nonetheless, one recent study that examined differences in coping between high- and low-functioning people with bipolar disorders suggested that avoidant coping styles are associated with poorer functioning. Thus, relationships between coping styles and bipolar depressive disorders and coping and unipolar depressive disorders may be similar.

Bibliography:

Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
Beckham, E. E., & Leber W. R. (1995). (Eds.). Handbook of depression (2nd ed. ). New York: Guilford Press.
Cicchetti, D., & Toth, S. L. (1992). (Eds.). Developmental perspectives on depression. Rochester, NY: University of Rochester Press.
Craig, K. D., & Dobson, K. S. (1995). (Eds.). Anxiety and depression in children and adults. Thousand Oaks, CA: Sage.
Kendall, P. C., Hollon, S. D., Beck, A. T., Hammen, C. L., & Ingram, R. E. (1987). Issues and recommendations regarding use of the Beck Depression Inventory. Cognitive Therapy and Research, 11,289-299.
Ingrain, R. E., Miranda, J., & Segal, Z. V. (in press). Cognitive vulnerability to depression. New York: Guilford Press.
Robins, L. N., & Regier, D. A. (1991). (Eds.). Psychiatric disorders in America. New York: The Free Press.

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Department of Agricultural, Food, and Resource Economics Innovation Lab for Food Security Policy, Research, Capacity and Influence

Effect of Pesticide Use on Crop Production and Food Security in Uganda

May 14, 2024 - Linda Nakato, Umar Kabanda, Pauline Nakitende, Tess Lallemant & Milu Muyanga

The increasing pest proliferation has continued to cause a serious threat to food security in Uganda. This study explores the impact of pesticide adoption on food security in Uganda. Specifically, it seeks to assess whether the use of pesticides ensures food security, with crop productivity serving as an intervening variable. Employing the control function approach with fixed effects estimation on a dataset comprising 1,656 households spanning the periods 2013/2014, 2016/2015, and 2018/19 to 2019/20 obtained from the Uganda National Panel Survey, the study reveals several determinants influencing pesticide use in Uganda. The findings also highlight that the adoption of pesticides demonstrates a positive influence on crop productivity. However, when assessed through indicators such as Food Consumption Score (FCS), Minimum Acceptable Household Food Consumption (MAHFP), and Household Dietary Diversity Score (HDDS) at the pre-harvest stage, the results do not indicate a statistically significant correlation of pesticide use and food security outcomes. Consequently, beyond enhanced crop productivity and the pre-harvest activities focused on in the study, it is imperative to consider the post-harvest application of pesticides to comprehensively explain how pesticide use effects food security in Uganda. Based on the positive link between pesticides and crop productivity, its recommended that government should increase awareness on and access of insecticides among farmers. Given that insects are the main pests damaging crops in Uganda. It is also important for Uganda to reform and reactive a regulatory framework having a licensing system to regulate private local market dealers’ sale of pesticides. Given that the majority of the households purchase their pesticides from private traders in the local/village market. This approach might improve the quality of pesticide purchased by farmers and, increase pesticide use to diversify produce of more nutritious foods, to ultimately enhance access and nutrient intake per meal in Uganda.

Pesticide use, crop productivity, food security.

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v.4(2); Apr-Jun 2017

Gathering Opinions on Depression Information Needs and Preferences: Samples and Opinions in Clinic Versus Web-Based Surveys

Matthew t bernstein.

1 Faculty of Arts, Department of Psychology, University of Manitoba, Winnipeg, MB, Canada

John R Walker

2 Faculty of Health Sciences, Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada

Kathryn A Sexton

3 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Brooke E Beatie

Mobilizing minds research group, associated data.

Website survey notice.

Complete version of survey.

Administrative aspects of treatment.

Sociodemographic characteristics of respondents who received or did not receive honorarium.

Treatment options: what information would be important to you if you were considering help? Responses with or without honorarium.

How likely would you be to talk to one of the following people for advice if you were having a serious problem with depression? Responses with and without honorarium.

Preferred method of receiving information about services. Responses with and without honorarium.

How helpful would the following types of assistance be if you were having a problem with depression? Responses with and without honorarium.

There has been limited research on the information needs and preferences of the public concerning treatment for depression. Very little research is available comparing samples and opinions when recruitment for surveys is done over the Web as opposed to a personal invitation to complete a paper survey.

This study aimed to (1) to explore information needs and preferences among members of the public and (2) compare Clinic and Web samples on sample characteristics and survey findings.

Web survey participants were recruited with a notice on three self-help association websites (N=280). Clinic survey participants were recruited by a research assistant in the waiting rooms of a family medicine clinic and a walk-in medical clinic (N=238) and completed a paper version of the survey.

The Clinic and Web samples were similar in age (39.0 years, SD 13.9 vs 40.2 years, SD 12.5, respectively), education, and proportion in full time employment. The Clinic sample was more diverse in demographic characteristics and closer to the demographic characteristics of the region (Winnipeg, Canada) with a higher proportion of males (102/238 [42.9%] vs 45/280 [16.1%]) and nonwhites (Aboriginal, Asian, and black) (69/238 [29.0%] vs 39/280 [13.9%]). The Web sample reported a higher level of emotional distress and had more previous psychological (224/280 [80.0%] vs 83/238 [34.9%]) and pharmacological (202/280 [72.1%] vs 57/238 [23.9%]) treatment. In terms of opinions, most respondents in both settings saw information on a wide range of topics around depression treatment as very important including information about treatment choices, effectiveness of treatment, how long it takes treatment to work, how long treatment continues, what happens when treatment stops, advantages and disadvantages of treatments, and potential side effects. Females, respondents with a white background, and those who had received or felt they would have benefited from therapy in the past saw more information topics as very important. Those who had received or thought they would have benefited in the past from medication treatment saw fewer topics as important. Participants in both groups expressed an interest in receiving information through discussion with a counselor or a physician, through written brochures, or through a recommended website.

Conclusions

The recruitment strategies were helpful in obtaining opinions from members of the public with different concerns and perspectives, and the results from the two methods were complementary. Persons coping with emotional distress and individuals not specifically seeking help for depression would be interested in information to answer a wide range of important questions about depression treatment. The Clinic sample yielded more cultural diversity that is a closer match to the population. The Web sample was less costly to recruit and included persons who were most interested in receiving information.

Introduction

Importance of health information.

Major depression is one of the most common and disabling mental health problems in the community [ 1 ]. It is important to understand how persons with depression prefer to receive information about treatment and what they want to know about treatment options. The exchange of information about treatment options is essential in shared decision-making and obtaining informed consent for treatment [ 2 ]. There are large differences among people in the amount of information they wish to receive concerning treatment options and how they prefer to receive this information [ 3 ]. In a wide range of health conditions, information needs early in the course of treatment may differ from information needs later in the course of treatment, or when considering changes in treatment [ 4 ]. Often even those who are well connected with health services have information needs that have not been addressed in the course of regular clinical contacts [ 5 ]. It is helpful to have information resources available that are flexible enough to allow for differing information needs and that are low enough in cost to be easily accessible to patients receiving health care and to those searching for health information on the Web [ 3 , 4 ].

Health information preferences are influenced by attitudinal and motivational factors [ 6 ]. The theory of planned behavior [ 7 , 8 ], for example, suggests that the approach people take to health information seeking will be influenced by anticipated benefits (attitudes), the influence of important individuals (subjective norms), confidence in one’s ability to use information (perceived behavioral control), and the degree to which the person intends to actually seek information (intent) [ 3 ]. Given this context, it is helpful to explore what information people consider to be important in decision making around treatments for depression (attitudes), whom people consider turning to for help in making health decisions (subjective norms), and their views on preferred ways to receive information (perceived behavioral control).

Whereas there is a great deal of health information on the Web, and the public increasingly uses the Web to access health information [ 9 ], there are questions about the quality and the comprehensiveness of the information available [ 10 ]. Previous research suggests that currently available information does not address many of the important questions that patients have about managing health [ 11 ] and mental health problems [ 12 ]. Current information on the Web often focuses on a description of the health problem with a description of the treatment options with little evaluative information based on research evidence [ 13 , 14 ]. In a recent systematic review of the information and decision-making needs of people with mental disorders [ 15 ], only 12 studies were identified with 6 addressing depression. The results suggest that much more research is needed in this area. One study [ 16 ] found that many patients received very limited information when making treatment choices and most desired more information.

Paper- and Web-Based Survey Methods

Obtaining the opinions of those who may be interested in specific types of health information is challenging in survey research. The most favorable research situation [ 17 ] is when the researchers can clearly establish the survey population (the group they wish to generalize results to—in this case people wanting information about depression and its treatment), the sampling frame (a list of possible participants from which a sample is to be drawn), and a random sample from this sampling frame. Whereas in some cases, this information is available (such as national health and social surveys which obtain a representative sample from a specific geographic area), in many situations there is not a good source of information to provide a list of potential survey participants. In these situations, it is often necessary for researchers to consider opportunity or convenience samples that may not be clearly representative of a larger population but may provide helpful information about a research question in any case. We identified two approaches to obtaining survey samples to consider the information needs of persons who are currently or may in the future be seeking information about treatments for depression. The first was to sample persons visiting a primary care medical setting for routine care. When people decide to seek treatment for depression, this is often where they first go, and many people receive treatment for depression exclusively in a primary care setting [ 18 ]. People with chronic medical conditions are also at greater risk for the development of mood disorders [ 19 ]. A second approach was to post a notice about the survey on the websites of organizations focused on informing the public about mental health problems. Members of the public frequently search for information about health problems and treatment on the Web [ 9 ].

With the increased use of the Web in the last 20 years, Web-survey research has become very prevalent. There has been limited research comparing the results when recruitment is done over the Web (responding to a mass mailing or clicking on a link in a posted invitation) as opposed to being done with a personal invitation to complete a paper survey in a community setting [ 20 ]. Much of the research in this area has focused on comparing the measurement properties of established measures administered in Web-based and paper-based formats [ 21 - 24 ]. The comparability of Web-based and paper-based surveys has been assessed in a variety of different situations and generally, this research has found that responses are reasonably similar between paper and Web-based questions and structured measures, especially when demographic factors are considered [ 20 , 25 ].

One advantage of traditional survey administration is that it is possible to determine response rate. Whether the survey is administered via mail or email invitations to specific persons or when participants are approached in a medical clinic waiting room in person, researchers are able to determine how many persons responded out of the total number invited to participate. It is also possible to obtain more information about the representativeness of respondents as compared with nonrespondents when there is a sampling frame with detailed information about those invited to participate. In surveys carried out in public areas (such as a medical waiting room), it is possible to gather information about respondents but no information is available on the characteristic of nonrespondents. For both the medical clinic survey and the Web survey, it is possible to compare the characteristics of respondents with characteristics of persons in the region.

Web survey recruitment and administration, on the other hand, has the advantage of lower cost and of reaching a broader audience, that is, people that differ demographically and geographically [ 26 ]. Another advantage is convenience; there are few restrictions on the time and place participants can access the survey, as long as they have access to the Web. Web-based surveys can be constructed to minimize the number of missed questions and to easily branch into different questions based on earlier answers.

Aims of This Study

Professionals commonly produce resources for the public with limited knowledge of what information is of interest to consumers and the public at large. Hence, there remains a need to understand the information needs and preferences of the public concerning treatment choices for depression. The first aim was to explore the following questions using two different survey approaches: (1) What information would be important to members of the public? (2) To whom would they turn for advice? (3) How would they prefer to receive information? and (4) What treatment services would they see as most helpful if they were experiencing problems with depression?

The second aim of this study was to compare respondent characteristics and information needs and preferences between participants recruited in a clinical setting for paper surveys and those recruited on the Web through self-help organization websites.

This study was approved by the University of Manitoba Research Ethics Board (REB).

Participants

Clinic survey.

This survey was conducted in two medical clinics in Winnipeg, Canada. One was a large clinic near a teaching hospital where patients had scheduled appointments with family physicians. The second clinic, near a large shopping center, provided both walk-in services and a limited number of scheduled appointments with family physicians. Under Canada’s publicly funded health care system, there is no charge for physician visits. Of 340 patients in the waiting rooms invited to complete the survey, 241 agreed to participate and 231 were included in the analyses (67.9% of the total).

Persons visiting the websites of the Anxiety Disorders Association of Manitoba, the Canadian Mental Health Association (Winnipeg Region), and the Mood Disorders Association of Manitoba were invited to participate in the survey by a notice posted on each of these websites (see Multimedia Appendix 1 for recruitment notice). These websites are widely visited by members of the public searching for information about common mental health problems. We made the survey available on the Anxiety Disorders Association of Manitoba website because persons with anxiety problems have a higher rate of problems with major depression than the public in general. Website visitors who were interested in participating could click on a link to the survey, which was presented through a web-based survey tool called SurveyGizmo (SurveyGizmo, 4888 Pearl East Cir. Suite 100, Boulder, Colorado). Once the link was clicked, participants viewed the information and informed consent page.

A research assistant invited persons waiting for appointments to participate. Those who provided consent completed the 20-min anonymous survey in the waiting room. An honorarium (a gift card, Can $5 value) was provided.

The same measures were used in the Web survey as in the Clinic survey. After the participants provided their consent, they were presented with the survey. Enrollment continued for approximately 2 months without providing compensation to participants. After 2 months of data collection, in order to increase participation, we provided a $10 gift card to a grocery or coffee retailer as compensation for participation. Whereas 280 participants answered the demographic questions, approximately 262 individuals answered the information needs and preferences questions. Just over half (54.3%) of this group of respondents received an honorarium for participating in the study. The survey duration was approximately 20 min.

Measurement

In developing questions, we considered what information might be important to a well-informed person making treatment decisions. The questions considered the logical sequence of events in decisions about treatment: treatment choices; the characteristics of each treatment; treatment cost, effectiveness, and duration; what happens when the treatment is stopped; and the risks of treatment. Draft questions were reviewed in a consensus meeting involving members of a self-help anxiety association, psychiatrists and psychologists specializing in the treatment of anxiety, and a family physician from a teaching clinic. There was a high degree of consensus on the final questions. These questions have been used in previous research on information needs of young adults [ 27 ], parents of anxious children [ 28 ], and persons with inflammatory bowel disease [ 29 ] and have provided consistent findings in these different contexts. The topic areas were consistent with themes developed in focus groups with young adults (unpublished data). The complete survey is shown in Multimedia Appendix 2 .

Sociodemographic Information

Participants provided information concerning their gender, age, marital status, education level, main activity (employment), and cultural or ethnic background.

Information Preferences

To set the context, respondents read a vignette describing a person with depression matching their gender. The vignette was brief (7 lines) and described a person with significant depression meeting five of the nine Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria for major depression [ 30 ] with no mention of suicidal thoughts. Next, they were asked whether or not they had used the Web to search for health care information and how familiar they are with the types of help available for depression. Then they received the instructions: “At some time in your life you, a close friend, or a close family member might be having a problem with depression. What information would be important to you in considering the kinds of help available for depression?” These instructions were followed by 27 questions focusing on content areas of information that they might consider important in making decisions.

Then participants were asked 5 questions about the medium they would prefer in receiving information. They were also asked, “How likely would you be to talk to one of the following people for advice if you were having a serious problem with depression?” and a list of options was provided. Next participants were asked: “If YOU were having difficulty with depression at some point in your life, how helpful would the following be?” and a list of service options was provided. Finally, participants were asked about past treatment experience.

Emotional Distress

Current emotional distress was assessed using the Kessler Psychological Distress Scale (K6), a validated measure of anxiety and depressive symptoms [ 31 ]. The 6-item survey asks: “During the past 30 days, about how often did you feel...nervous,...hopeless,...restless or fidgety,...so depressed that nothing could cheer you up,...that everything was an effort,...worthless.” Items were rated on a 5-point rating scale from 1 (none of the time) to 5 (all of the time). This measure has been found to be both valid and reliable, with a Cronbach alpha of .92 in previous research [ 31 ], .88 in the Clinic sample, and .91 in the Web sample.

Statistical Methods

IBM SPSS statistics version 23.0 was used to conduct the data analysis. Demographic characteristics between the 2 samples were compared using independent samples t test for mean differences and chi-square comparisons for the proportions in the 2 groups. The information preferences questions’ 0-8 rating scales were categorized into three categories as follows: 0-2: not important, not likely, not preferred, not helpful; 3-5: moderately important, moderately likely, moderately preferred, moderately helpful; and 6-8: very important, very likely, very preferred, very helpful. The proportions of respondents providing high ratings (ie, very important, very likely, very preferred, or very helpful) on the information preferences questions as well as mean ratings with CIs are presented in Tables 2 - -5. 5 . CIs are often used in survey research and have been recommended rather than pairwise significance tests for comparisons between and within groups because they help the reader understand the magnitude of differences rather than simply concluding that a difference is statistically significant [ 32 , 33 ]. When making comparisons between means (ie, between groups and across different question items), it should be noted that in approximately one case out of 20, the 95% CIs will be nonoverlapping even in the absence of a difference in that measure within the underlying populations.

Treatment options: What information would be important to you if you were considering help (for yourself, a close friend, or a close family member)?

a Web sample and Clinic sample CIs do not overlap.

b Each source was rated on a 9-point rating scale with the anchors 0-2 (not important), 3-5 (moderately important), and 6-8 (very important).

c “-” indicates items in Clinic but not Web survey.

How helpful would the following types of assistance be if you were having a problem with depression?

b Upon examination of the CIs with 3 decimal places, the CIs of the two samples do not overlap.

c “-” indicated items were in Clinic but not Web survey.

d Each source was rated on a 9-point rating scale with the anchors 0-2 ( not helpful ), 3-5 ( moderately helpful ), and 6-8 ( very helpful ).

We conducted a linear regression analysis to explore the sociodemographic predictors of the number of information topics considered to be very important by participants in the Clinic sample with different characteristics. We were particularly interested in the relationships between information needs and previous experience with depression and its treatment as predictors.

In the Clinic sample, the mean age of participants was 40 years, and it was reasonably well balanced for gender with 57.1% being female (136/238; Table 1 ). In terms of cultural background, 71.0% (169/238) of this sample were white, whereas 17.2% (41/238) were Aboriginal. The Web sample was similar to the Clinic sample in demographic characteristics; the mean age of participants was 39 years, 86.0% were white (241/280) and 12.1% (34/280) had an Aboriginal background. However, the Web sample had a much larger proportion of females (83.9%, 235/280). On average, respondents in both samples had completed 2 years of education after high school, and more than half had been working full-time in the prior year. Although Web surveys have the potential to reach a broader audience, almost all participants responding on the Web were from Manitoba (92.9%, 260/280). In the previous 12 months, 63.0% (150/238) of respondents in the Clinic sample indicated that they had searched the Internet for health-related information compared with 92.9% (260/280) in the Web group (χ 2 1 =66.9, P <.001). Respondents rated how familiar they were with types of help available for depression on a 0-8 rating scale (not at all familiar to very familiar). More of those (55.0%, 154/280) in the Web sample indicated that they were very familiar with types of help for depression (rating of 6-8; mean 5.42, 95% CI 5.16-5.68), compared with 28.2% (67/238) in the Clinic sample (mean 3.70, 95% CI 3.38-4.02).

Sample characteristics.

a SD: standard deviation.

b Significantly different means or proportions between the 2 samples, where P <.05.

The Clinic sample was minimally distressed with an average K6 score of 5.1 (K6 sum scores range from 0 to 24). In contrast, the Web sample was significantly more distressed with a K6 score of 10.5 ( P <.001). The recommended threshold for identifying a likely mental disorder is 13 or higher [ 34 ]. Approximately 80.0% (224/280) of the Web sample reported previously receiving counseling or therapy for depression at some time in their life, whereas 72.1% (202/280) reported receiving medication. This is compared with only 34.9% (83/238) and 24.0% (57/238) in the Clinic sample.

Important Information Content When Considering Help

Table 2 shows ratings of importance of 20 information topics concerning the depression treatment. The overall impression is that both samples of respondents viewed most of the topics as very important. In both groups, participants placed a high level of importance on information about the effectiveness of treatment, goal, or outcome of treatment, how the treatment works, what happens when the treatment stops, and the advantages and disadvantages of a treatment approach. Mean ratings of importance as well as proportions rating a topic as very important were both greater overall in the Web sample compared with the Clinic sample. We also asked about seven other administrative topics (such as timing of appointments, hours of service, location of services). As these administrative issues will differ by geographic region, they are presented in Multimedia Appendix 3 .

Preferred Source of Advice

In the Clinic sample, respondents reported that if they were having serious problems with depression, they would be very likely to speak with a romantic partner or spouse (63.2%, 146/231), a family doctor (60.2%, 139/231), or a counselor or therapist (58.9%, 136/231; see Table 3 ). Those in the Web sample showed similar preferences in general, although this group reported a higher likelihood of speaking to a counselor or therapist (80.2%, 210/262) as compared with a family doctor (69.9%, 183/262), or a romantic partner or spouse (61.1%, 160/262). Few people reported being very likely to speak with a religious leader or elder in either sample (15.2%, 35/231 and 17.2%, 45/262).

How likely would you be to talk to one of the following people for advice if you were having a serious problem with depression?

b Each source was rated on a 9-point rating scale with the anchors 0-2 (not likely), 3-5 (moderately likely), and 6-8 (very likely).

Preferred Method of Receiving Information

There are several ways to receive information about depression and its treatment. Table 4 shows that Clinic participants indicated a high level of preference for receiving information through discussion with a medical doctor (61.9%, 143/231), a counselor or therapist (61.0%, 141/231), or through a written information sheet or a website that could be accessed from home (50.2%, 116/231). The Web sample not only indicated a greater preference for a discussion with a counselor or therapist (74.1%, 194/262 very preferred) but also indicated preference for information in written form (61.8%, 162/262 very preferred) through discussion with a medical doctor (59.2%, 155/262) or a website accessed from home (56.9%, 149/262). Video information through a website had the lowest level of preference for both the Clinic and Web surveys (about 30% highly preferred).

Preferred method of receiving information about services.

b Each source was rated on a 9-point rating scale with the anchors 0-2 (not preferred), 3-5 (moderately preferred), and 6-8 (very preferred).

Helpfulness of Various Forms of Assistance

In considering various forms of assistance for depression, many approaches to treatment were seen as likely to be very helpful by clinic respondents including in-person meetings with a counselor (68.8%, 159/231), exercise (66.2%, 153/231), and medication recommended by a psychiatrist (51.0%, 118/231; Table 5 ). A similar pattern of responses was found for the Web sample, but that group provided higher ratings of the helpfulness for most forms of assistance. (Note that the Web survey did not ask about exercise, meditation, herbal medication, or bright light therapy.)

Web Respondents Who Did and Did Not Receive an Honorarium

We evaluated the impact of the introduction of an honorarium to increase recruitment for the Web sample by comparing the subsamples before and after the introduction of the honorarium. The samples that received and did not receive an honorarium were very similar in demographic characteristics (see Multimedia Appendix 4 ). One noteworthy difference was that a higher proportion of males responded after the introduction of the honorarium, although there continued to be a high proportion of female respondents. Similar mean ratings and pattern of responses were also found for the information needs and preferences questions for both those who received the honorarium and those who did not receive it (see Multimedia Appendices 5 - 8 ). By adding the honorarium we were able to double our participation in half the time (1 month), which is consistent with previous research on improving response to Web- and paper-based surveys [ 35 , 36 ].

Predictors of Information Topics Considered Very Important

Table 6 describes the regression analysis for predictors of the number of information topics considered to be very important by participants in the Clinic sample. We focused on the Clinic sample because it was more diverse in terms of gender and ethnic background. The partial correlation ( pr ) reported in the table, when squared, indicates the unique proportion of the variance in the outcome that is accounted for by each predictor variable when all other predictors and their shared variance have been accounted for in the model. Gender (beta=−1.94, P =.007, pr =−.19), ethnicity (beta=1.85, P =.02, pr =.17), therapy received or needed (beta=2.07, P =.03, pr =.16), and medication received or needed (beta=−2.78, P =.005, pr =−.20) were found to be significant predictors of number of information topics after accounting for marital status, age, education, and distress level. Overall the females indicated more information topics as important than males (13.8 information topics as very important vs 12.2), the white respondents saw more topics as important than those from other groups (13.6 vs 11.8), those who had received or needed therapy saw more topics as important than those who had not (13.6 vs 12.8), and those who received or needed medication saw fewer topics as important than those who had not (12.6 vs 13.4). The reader should note that the magnitude of the difference in amount of information desired by the different demographic groups is small and that personal preferences may play a stronger role here than demographic characteristics [ 3 ].

Predictors of composite information topic score for topics given a very important rating for the Clinic sample.

a B : unstandardized coefficients (weights).

b SE B : standard error of unstandardized coefficient.

c Beta: standardized coefficients (weights).

d pr : partial correlation.

e Therapy received or needed includes individuals who indicated that they had previously received counseling or therapy for depression in the past or there was a time that they would have benefited from counseling or therapy but did not receive it.

f Medication received or needed includes individuals who indicated that they had previously received medication for depression in the past or there was a time that they would have benefited from medication but did not receive it.

g This includes the Clinic sample (N=231) data only. Information importance composite score was calculated by summing the topics that respondents provided a rating of 6-8 (very important). The range of scores on this variable is from 0 to 20.

Principal Findings

In considering how typical respondents in the Clinic and Web surveys were of people living in the region, we compared characteristics of survey respondents with people living in the city of Winnipeg (population of about 700,000) and to those living in the province (population of about 1.3 million). Most of the Clinic participants would live in Winnipeg, whereas persons visiting the websites could have come from anywhere in the province. The Clinic sample is primarily from white (71.0%) and Aboriginal or First Nations (16.5%) cultural groups. Manitoba has an Aboriginal population of 14% [ 37 ], whereas Winnipeg has an Aboriginal population of 11% [ 38 ]. The Clinic sample, which was much more balanced for gender compared with the Web sample, had slightly more females than the general population of Manitoba and Winnipeg, which are 50% and 51% female, respectively [ 39 , 40 ]. There were smaller proportions of individuals in both samples who were working full-time compared with the general population (79% in the Manitoba population are working full-time; [ 41 ]). Both samples were similarly educated compared with the population of Manitoba with an average of 2 years of postsecondary education. It was found that 88% of the Manitoba population (aged 25-64 years) has attained a high school diploma or equivalent [ 42 ]. There were slightly more individuals in the two samples that indicated that they were married or living together in a marital like relationship (common law) compared with a rate of 46% in the general population of Manitoba and Winnipeg [ 40 , 43 ].

The Clinic sample reported less current distress and had less experience with previous treatments for depression than the Web sample. This is understandable because the Clinic sample was recruited from people seeking general medical assessment and treatment, whereas those visiting the self-help association websites were more likely focused on getting information on depression and anxiety. Furthermore, persons who have sought help in the past are more likely to seek help in the future [ 44 ]. In considering the higher proportion of females in the Web sample than the Clinic sample, possible explanations may be the higher prevalence of depression among females [ 45 ] and the greater tendency of them to seek help [ 46 ]. In the Clinic sample, we also found that females judge information on more topics to be very important.

The Clinic sample appears to produce more cultural diversity that is a closer match to the population. Both surveys had an underrepresentation of males relative to the population. In the case of the Web survey, this was improved somewhat by the use of an honorarium to encourage participation.

We found that in both Clinic and Web samples, people are interested in information on a wide range of topics. Participants were especially interested in psychological treatments, physical exercise, and medication treatments. Characteristics of treatments such as the effectiveness of treatments, their goals, duration, side effects, and what happens when treatment stops were also considered to be important. This finding that people are interested in information on many topics is consistent with previous research on mental health information needs and preferences [ 47 , 48 ].

One can imagine how difficult it would be to review this amount of information in the typical primary care visit of 10-15 min and even in a specialist visit of 20-50 min. More importantly from the patient’s perspective it would also be very challenging to remember this amount of information if it were presented orally, especially when struggling with depression. In these situations, it is often helpful for the clinician to provide information in some form that can be reviewed over a longer time period by the patient and concerned family and friends. This type of written information is commonly provided in the form of patient-oriented brochures [ 13 ] or Web-based information [ 14 ]. Even in text format, it would take considerable space to address all of the topics identified as important and to put this in the context of the quality of the scientific evidence available. One way of dealing with differences in preference among individuals for more or less information is to produce information focused on each topic and allow information users to choose the areas of information that are of most interest to them.

Other researchers [ 47 ] have found that Web-based resources about depression are reasonably good, although these researchers did not present information on the specific content areas covered by these websites. Current resources tend to describe the diagnosis and some of the treatments available but they provide little or no evidence-based information to answer most of the questions identified as important in this survey. The shortcoming in Web-based information is not limited to information concerning depression, but is also seen in information concerning other mental health problems such as children’s anxiety [ 12 ], and medical conditions such as inflammatory bowel disease [ 11 ]. A challenge for those developing information resources is that there is a limited amount of evidence available to answer some of these questions and some of the information is difficult for professionals to access. Whereas there is a wide range of evidence concerning the effectiveness of psychological and pharmacological treatments for depression, there is little research available on self-help approaches, herbal remedies, exercise, meditation, and bright light therapy. Members of the public would have difficulty locating and evaluating the quality of this evidence. It would be valuable to take a knowledge synthesis approach [ 48 ] to review the evidence available to answer these questions and to provide information in a form that would be clear for the public and for health professionals.

A specific example of challenges in accessing evidence to answer an important question is the topic of what happens when psychological or medication treatment stops. Many medication treatment trials are of relatively short duration (eg, 8-12 weeks), include no follow-up period, and report no data on what happens after medication is discontinued. Psychological treatment trials often report follow-up after treatment is terminated but the time period is often limited (6-12 months; [ 49 ]). Studies including longer follow-up after treatment is discontinued, suggest that return of symptoms after treatment is discontinued is a common experience [ 50 ]. These studies would be difficult for the layperson and even a reasonably well-informed professional to locate and digest. Again, a knowledge synthesis approach of reviewing information, assessing the quality of research, and summarizing the information in clear language would be very helpful.

Ratings of importance of most topics were both greater overall in the Web sample compared with the Clinic sample. This is not surprising as those in the Web survey were seeking information, whereas those attending the clinic would have been seeking care for a wide range of health problems. The Web sample also reported higher levels of psychological distress, which could be associated with a higher interest in depression information.

In considering people to speak to for advice, respondents reported a broad range of people that were seen as important sources of advice. Counselors and family doctors were seen as important sources of advice along with romantic partners and friends. In the Web group, a counselor or therapist was rated particularly highly as a source of advice. This may have been related to the high amount of experience in this group with counseling for depression.

Participants in both samples indicated preferences for receiving information in a variety of ways including discussion with a counselor or therapist, written form (such as a brochure), and discussion with a medical doctor. Despite being Web users, receiving information in written form or brochure was highly rated in the respondents to the Web survey. These findings demonstrate the importance of having information available to be delivered via different formats or methods, which is consistent with previous research in this area [ 3 , 51 ]. People do not have to choose a single source of information, and brochure or Web-based information can complement discussion with a health service provider and vice versa.

Overall, the pattern of responses on the helpfulness of assistance types between the Clinic and Web samples was quite similar. However, the Web sample provided higher ratings of helpfulness of most assistance types. The Web sample was more distressed and had more treatment experience so they may have seen treatment options as more helpful for this reason. In both samples, counseling or therapy was rated highest among the different forms of assistance, which is not surprising given the literature on preference for psychological treatments [ 52 ]. Medication as a treatment for depression has also been widely studied, has been shown to be effective, and is widely available [ 53 ]. Therefore, it is reasonable that many respondents also provided high ratings for medication recommended by a family doctor or psychiatrist. Self-help approaches to treating depression were rated significantly higher by the Web sample compared with the Clinic sample. As the Web sample participated in this survey by accessing self-help association websites, it is not surprising that they would be interested in self-help methods of treatment. Self-help resources are advantageous in that they are potentially widely available and usually associated with lower cost [ 54 ].

When we considered characteristics of respondents related to the number of information topics considered to be very important, we found that females, whites, and those who had received or felt they would have benefited from therapy in the past saw more topics as very important. Those who had received or thought that they would have benefited in the past from medication treatment saw fewer topics as important. The magnitude of these differences was modest however. This finding was similar to findings by Cunningham and colleagues [ 3 ] in a large survey with more than 1000 respondents from primary care clinics. Cunningham [ 3 ] found that there were larger differences based on patterns of information preferences and suggested that the best solution is to make information available in a variety of formats (paper and Web formats) in a variety of settings, allowing people to choose the type of information they prefer. Taken together, the results suggest that both persons coping with depression and persons seeking information about depression would be interested in information developed to answer important questions concerning depression treatment. It is likely that information needs for other common mental health problems would be quite similar but this should be the subject of future research. Guidelines about the development and evaluation of health information for the public are available from the International Patient Decision Aids Standards collaboration [ 55 ]. The wide range of information topics judged to be important by members of the public suggests that it would be very difficult to address these information needs via oral communication during health care visits or using currently available materials. A resource with Web-based information and downloadable fact sheets has the advantage that it can provide information in a format that can be accessed by the public (searching for information for themselves or family members) and by health professionals interested in information to use to supplement discussions with their patients. Our team has been developing resources to address these needs with material address each of the main topics identified as important by community members. This resource focused on information for Canadians is available on the Web [ 56 ]. This information has been evaluated favorably by service providers in primary care settings [ 4 ]. Much of this information would be suitable for the public in many countries. National and regional information would be particularly helpful around questions concerning cost of treatment and resources available to support consumers in paying for treatment. The topics concerning the administrative aspects of treatment (health care providers providing treatment, waiting periods, location of services, hours) were also considered to be very important by many respondents. It is necessary to tailor this information at the regional and local level.

Limitations

This study has a few main limitations. One major limitation is the differences in the characteristics of the samples. Therefore, some of the differences found in the results may have been a consequence of the different make-up of the two samples. Recruiting more similar samples would have allowed for more control of potential sample effects. A second limitation is that the response rate for the Web survey is unknown. Due to a link to the survey being available on a number of websites, we do not know who might have reviewed the invitation to participate in the survey, and not clicked on the link to start completing the survey. In comparison, 71% of the people approached for the paper-based survey agreed to participate. Another limitation is that most of the respondents to the Web-based survey were female (84%). This limits the generalizability of those findings. However, we compared the results reported by males and females within the Clinic survey (57% female) and the response patterns were very similar (data not shown). The final limitation is related to the Clinic survey. Participants were recruited from primary health care settings and their opinions may not be generalizable to the opinions of the general public.

This is one of few studies that addresses the information needs and preferences concerning treatment options for depression. The findings may help practitioners in making resources available that assist members of the public in decision making. Each survey format has its advantages. The Clinic survey includes a more broad and representative sample. The Web survey through self-help association websites captures individuals who are clearly seeking information. Web surveys are considerably lower in cost than a survey administered by a research assistant inviting participation by visitors to a primary care medical clinic. The use of an honorarium to encourage participation increases response rate and likely representativeness of the sample (compared with the population at large), although it also increases the cost. The similarities in the broad findings between the Clinic and the Web surveys is reassuring and suggests that helpful opinions may be gathered by each method as long as the limitations of the sampling approach are recognized.

Acknowledgments

Funding for this study was provided by a Knowledge Translation Team Grant from the Canadian Institutes of Health Research and the Mental Health Commission of Canada (TMF 88666). The authors thank the staff at the St Boniface and St James Medical Clinics and the Family Medical Centre (St Boniface) for allowing us to recruit participants in their settings.

Members of The Mobilizing Mind Research Group include the following (in alphabetical order): Young adult partners: Chris Amini, Amanda Aziz, Meagan DeJong, Pauline Fogarty, Mark Leonhart, Alicia Raimundo, Kristin Reynolds, Allan Sielski, Tarannum Syed, and Alexandria Tulloch; community partners: Maria Luisa Contursi and Christine Garinger from mindyourmind (mindyourmind.ca); research partners: Lynne Angus, Chuck Cunningham, John D. Eastwood, Jack Ferrari, Patricia Furer, Madalyn Marcus, Jennifer McPhee, David Phipps, Linda Rose-Krasnor, Kim Ryan-Nicholls, Richard Swinson, John Walker, and Henny Westra; and research associates Jennifer Volk and Brad Zacharias.

Abbreviations

Multimedia appendix 1, multimedia appendix 2, multimedia appendix 3, multimedia appendix 4, multimedia appendix 5, multimedia appendix 6, multimedia appendix 7, multimedia appendix 8.

Authors' Contributions: MTB participated in study design, data analysis, data interpretation, and prepared the manuscript. JRW participated in survey design, data interpretation, and manuscript preparation. KAS participated in survey design and manuscript preparation. AK participated in survey design and manuscript preparation. BEB participated in data collection. All authors read and approved the final manuscript.

Conflicts of Interest: None declared.

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