Diabetes is a psychologically demanding disease with a major impact on a patient’s quality and quantity of life. The outcome of diabetes is highly dependent on the self-care activities of the person with diabetes. Depression is common among people with diabetes, complicating this self-management and thereby increasing the risk of developing diabetes-related complications. Despite depression’s specific relevance to diabetes and the serious impact it has on the disease, it is estimated that only one third of people with both diabetes and major depression are recognized and appropriately treated for both disorders. The aim of this thesis therefore was to investigate the interrelationship between depression and diabetes and evaluate methods of improving recognition rates and access treatment within a health care setting. Routine screening for depression using standardised depression screening instruments has been recommended for all adults in primary care to improve the low recognition rates of depression in this population. The aim of Study 1 was therefore to compare the effectiveness of four commonly used depression screening instruments (CES-D, HADS, DMI, SCAD) in identifying depression in a diabetes sample. This research was important as little previous research had investigated the efficacy of these depression screening measures within this specialist group and an evaluation of their comparative performance had not yet been conducted. 150 patients with diabetes receiving care at the endocrinology outpatient clinics of two major public hospitals in Brisbane, Australia completed a battery of questionnaires and were also involved in a structured clinical interview (CIDI-SF) to establish a criterion standard. Results indicated that three of the screening measures (CES-D, HADS, DMI-10) could be considered reliable predictors of depression in this sample. There was however evidence that the CES-D could be considered the preferred measure as it had the best ability to discriminate between depression and non-depression, it showed reasonable sensitivity, high specificity, and it was able to stand alone as a predictor of major depression with its predictive ability not improved with the inclusion of diabetes symptoms. Study two of this thesis investigated the demographic, medical, and psychosocial correlates of depression in patients with diabetes. This research was important as information about risk profiles can help improve rates of diagnosis and treatment and may provide a method by which screening can be more focused and cost effective. 1069 hospital outpatient patients with diabetes were asked to complete a battery of questionnaires to accomplish this aim. The results found that co-morbid depression in patients with diabetes was associated with type-1 diabetes, younger age, poor glycaemic control, insulin treatment, co-morbid medical illness, increased diabetes symptoms, lack of a partner, lower income, stressful life events, low social support, and poor quality of life. Of particular interest was the finding that the inclusion of psychosocial predictors reduced the predictive ability of many demographic and medical factors. Study three of this thesis investigated the impact of a depression screening and feedback procedure on a patient’s level of depression, glucose control, and quality of life. While routine screening for depression has recently been recommended for all patients with diabetes, no previous research had been conducted to evaluate the efficacy of this approach on treatment and patients outcomes. 164 patients with diabetes who were found to be depressed in study 2 were involved in a randomised controlled trial which compared patients who received feedback regarding their depression status with those patients who did not receive any feedback. The results found high rates of depression in this sample and suggested that screening for depression and providing feedback to patients regarding the outcomes of screening had beneficial effects on depression at six months but not on glycaemic control or quality of life. The final study in this thesis attempted to investigate the help seeking behaviours of patients following feedback and to identify barriers to seeking care. 82 participants who received feedback regarding their depression status in study 3 were contacted for a structured telephone interview. Results indicated that only 52.44% of depressed diabetes patients followed the recommended advice and sought help for their depression. Of the patients that did not seek help, several barriers to seeking care were reported. Overall, the results indicated that attitudes relating to the severity of the disorder and the need for treatment were more salient barriers for participants in this study than logistical issues, stigma, or current levels of depression.

Mental health challenges among Canadian post-secondary students have been on a steep upward trend in recent years, exacerbated by the COVID-19 pandemic. Yet, many students do not reach out to the mental health services available to them. To lessen or remove actual and perceived barriers, research has been exploring how to predict their intentions to seek help for their personal mental health challenges. Much of this work applies the widely used Theory of Planned Behaviour (TPB; Fishbein & Ajzen, 1980) which posits that behavioural intentions are best predicted by attitudes toward the behaviour; perceived normative expectations; and perceived behavioural control. Though the theory also posits that beliefs underlie and are formative of these three predictors, studies have largely neglected their measurement. This is problematic as it deviates from the TPB and frustrates efforts toward the development of interventions to enhance behaviours towards seeking help for mental health challenges. If they are to be effective, such interventions must be directed at changing salient beliefs. This research addresses this gap through a mixed-method sequential design. It provides a unique and valuable contribution to scholarship and practice by identifying and examining the role of students’ attitudinal, normative, and control beliefs with respect to their intentions to seek help. This is examined separately and together with the more traditionally studied direct predictors of attitudes, subjective norms, and perceived behavioural control (i.e., the formative constructs defined by the beliefs). Students relied on six salient beliefs concerning their intentions to seek mental health help: two behavioural, two normative, and two control beliefs. Student attitudes, subjective norms, and PBC mediated the links between salient beliefs and intentions, with PBC being the strongest predictor of intentions to help-seek. The findings help inform interventions to change the beliefs most associated with low intentions to get mental health support. / Thesis / Doctor of Philosophy (PhD) / This dissertation aims to advance the understanding of student intentions or—lack thereof—to seek mental health help following the onset of COVID-19. Salient beliefs that underlie student attitudes, subjective norms and perceived behavioural control are examined, using a Theory of Planned Behaviour approach. The research provides valuable theoretical and practical contribution. It identifies the beliefs held by post-secondary students post COVID-19, which can inform interventions intended to increase mental health service use. In Phase 1 of this study, students’ salient beliefs were examined through survey and interview methods. In Phase 2, I assessed these beliefs as direct predictors of their attitudes, subjective norms, perceived behaviour control, and as indirect predictors of mental health help-seeking intentions. Six beliefs were identified as relevant to student intentions to seek help, and findings lend support for the applied and scholarly value of the TPB to this area of study.

No description available.