626188

research-article2016
ISP0010.1177/0020764015626188International Journal of Social PsychiatryEconomou et al.

E CAMDEN SCHIZOPH

Original Article

International Journal of

Attitudes towards depression, psychiatric Social Psychiatry

2016, Vol. 62(3) 243­–251
© The Author(s) 2016
medication and help-seeking intentions Reprints and permissions:
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amid financial crisis: Findings from DOI: 10.1177/0020764015626188

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Athens area

Marina Economou1,2, Joanna Despina Bergiannaki1,2,

Lily Evangelia Peppou1, Ismini Karayanni1, George Skalkotos1,
Athanasios Patelakis1, Kyriakos Souliotis3 and Costas Stefanis1

Abstract
Background: The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated
rates of major depression. International recommendations for offsetting the mental health impact of the recession
highlight the need for effective treatment, including reduction in the stigma attached to the disorder.
Aims: This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of
financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions.
Method: A random and representative sample of 621 respondents from Athens area participated in the study (Response
Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping
attitudes to psychiatric medication and one question addressing help-seeking intentions.
Results: The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal
weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless,
stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering
one’s personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions
were predicted by education, unemployment and attitudes to psychiatric medication solely.
Conclusion: Research on the mental health effects of the global recession should encompass studies investigating the
stigma attached to mental disorders and its implications.

Keywords
Stigma, depression, stereotypes, mental illness, recession

Introduction
The global financial crisis has incurred untoward effects on
the mental health of the population worldwide, especially in
the form of increasing prevalence rates of major depression
(Economou, Madianos, Peppou, Patelakis, & Stefanis,
2013; Gili, Roca, Basu, McKee, & Stuckler, 2013; Wang
et al., 2010; World Health Organization (WHO), 2011). This
is particularly worrisome, if one takes into consideration
that prior to the recession depression already constituted a
major public health concern due to its high prevalence
(Baumeister & Harter, 2007; Kessler et al., 2003; Wittchen
et al., 2011) and its impact on patients (Collins et al., 2011;
Consistent with this, its treatment and prevention have
become top priority (Wahlbeck & McDaid, 2012; WHO,
2011).
Although many promising treatments are available for
people who suffer from it (Cipriani et al., 2009), with anti-
depressants and brief structured therapy being effective in
1University Mental Health Research Institute, Athens, Greece
2First
Department of Psychiatry, Eginition Hospital, Medical School,
University of Athens, Athens, Greece
3Faculty of Social Sciences, University of Peloponnese, Corinth, Greece

ten Doesschate, Koeter, Bockting, Schene, & the Delta

Corresponding author:
Study Group, 2010) and financial resources (Luppa, Marina Economou, University Mental Health Research Institute, 2
Heinrich, Angermeyer, Konig, & Riedel-Heller, 2007; Soranou tou Efesiou St., 11527 Athens, Greece.
McDaid, Knapp, Medeiros, & the MHEEN Group, 2008). Email: antistigma@epipsi.eu

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244 International Journal of Social Psychiatry 62(3)
60%–80% of cases (National Institute for Health and
Clinical Excellence (NICE), 2009), less than half of people
with depression seek professional help for their symptoms
(Fernández et al., 2007; Kohn, Saxena, Levav, & Saraceno,
2004). Some studies have suggested that the decision to
seek help for depression is linked to recognition of the dis-
order and its causes (Jorm, Korten, Rodgers, et al., 1997),
the ability to identify appropriate modes of treatment and
having confidence in the positive outcome of such treat-
ments (Barney, Griffiths, Jorm, & Christensen, 2006).
Furthermore, stigma and the fear of being labelled as
‘mentally ill’ impinges on these patients’ decision to resort
to mental health professionals (Barney et al. 2006; Chandra
& Minkovitz, 2006; Lasalvia et al., 2013).
Stigma, defined as an unfavourable label that separates
an individual from others, links him or her with undesired
characteristics and leads to rejection or avoidance in soci-
ety (Link & Phelan, 1999), is commonplace towards peo-
ple with mental disorders (Angermeyer & Dietrich, 2006).
Although adverse public reactions towards people with
depression are less strong as compared to people suffering
from schizophrenia (Angermeyer & Dietrich, 2006;
Angermeyer & Matschinger, 2003; Sartorius, 2007), peo-
ple with depression also face a considerable amount of
stigma and discrimination (Barney, Griffiths, Christensen,
& Jorm, 2009; Lasalvia et al., 2013). In particular, the
general public considers them to be weak, lazy, responsi-
ble for their condition, unpredictable and dangerous
(Aromaa, Tolvanen, Tuulary, & Wahlbeck, 2011; Coppens
et al., 2013; de Toledo, Peluso, & Blay, 2009; Griffiths
et al., 2006; Wang & Lai, 2008); with unfavourable atti-
tudes being associated with male gender, older age, less
familiarity with mental illness, lower educational attain-
ment and less mental health literacy (Aromaa et al., 2011;
Coppens et al., 2013; Griffiths, Christensen, & Jorm,
2008).
The knowledge and beliefs one holds with regard to
mental disorders – that is, one’s mental health literacy – are
often linked to the attitudes he or she endorses towards
available interventions for treating it (Jorm, Korten,
Jacomb, et al., 1997). For example, a person who believes
that depression is not a real medical condition might believe
that it can be managed without professional help. Congruent
with this, it has been suggested that lay people who espouse
the stereotypical belief that depression is caused by per-
sonal weakness are more likely to decide to deal with it by
themselves (Jorm et al., 2006). In a similar vein, converg-
ing evidence indicates that the general public considers
effective and opts for various non-medical interventions for
depression, namely, exercising, social encounters, stress
management and relaxation (Jorm et al., 2005; Lauber,
Nordt, & Rossler, 2005), while medical treatment options
are less preferred, especially due to concerns with side
effects and fear of addiction (Munizza et al., 2013; Ozmen
et al., 2005). Therefore, despite significant advances in the
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pharmacological therapy of depression (Cipriani et al.,
2009), the general population does not share health profes-
sionals’ beliefs and attitudes.
The exploration of the link between the abovemen-
tioned stigmatising beliefs and attitudes and seeking pro-
fessional help for depression has yielded contradictory
results in the literature, with some studies documenting an
association (Barney et al., 2006; Schomerus, Matschinger,
& Angermeyer, 2009), while others do not (Blumenthal &
Endicott, 1996; Ng et al., 2008). Methodological differ-
ences, such as which dimension of stigma is being meas-
ured (self-stigma, perceived stigma or personal stigma),
how help seeking is conceptualised (actual help seeking,
intention to seek help or attitudes to help seeking) or/and
sampling differences (e.g. lay population vs clinical popu-
lation), may underpin this discrepancy.
The present study was conducted following the outset
of the financial crisis in Greece and it is in concordance
with epidemiological evidence corroborating a substantial
increase in the prevalence of major depression, as a corol-
lary of the recession in the Greek population (Economou
et al., 2013; Madianos, Economou, Alexiou, & Stefanis,
2011). Interestingly, Angermeyer, Matschinger, and
Schomerus (2013) have recently called attention to the
investigation of public attitudes towards people with
depression amid financial crisis arguing that in times of
uncertainty, individuals who are in a socially advantaged
position would discriminate more strongly against those
who are in a socially disadvantaged position, especially in
the realm of employment, which is greatly influenced by
the current socio-economic turmoil. Furthermore, recom-
mendations for alleviating the mental health impact of the
recession stress the importance of addressing the stigma
attached to the disorder (Wahlbeck & McDaid, 2012). In
line with this, exploring lay beliefs and attitudes towards
people with major depression amid economic downturn
should facilitate effective interventions for mitigating the
mental health effects of the crisis in the country.
Consistent with the aforementioned, this study aimed to
explore lay attitudes to depression and psychiatric medica-
tion during a period of financial crisis and to identify their
correlates. Additionally, it investigated their link to help-
seeking intentions.
Methods
Sample
A total of 621 people took part in this study, residents of
Athens area. The sampling frame of the study was the
national phone-number databank, which provides cover-
age for the vast majority of households in the country. The
databank entails residential lines as well as telephone
numbers belonging to businesses, while mobile phone
numbers are not included. Consistent with this, telephone
Economou et al. 245

Table 1.  Sample characteristics. Interview schedule

N % The interview schedule consisted of the following parts.
Gender
Male 297 47.8 Attitudes to depression.  The Personal Stigma Subscale, of
Female 324 52.2 the Depression Stigma Scale (Griffiths, Christensen, Jorm,
Age (years) Evans, & Groves, 2004), was employed in order to address
<24 46 7.4 lay attitudes to depression. The particular subscale encom-
25–34 94 15.1 passes nine items which tap participants’ personal attitudes
35–44 146 23.5 to depression and the people who suffer from it. Ratings on
45–54 146 23.5 each item are made on a five-point Likert scale, ranging
55–64 116 18.7 from 1 = strongly agree to 5 = strongly disagree. A compos-
>65 73 11.8 ite score can be computed with higher scores indicating
Education (years) more stigmatising attitudes. The questionnaire displays
<11 294 47.3 good psychometric properties (Coppens et al., 2013; Grif-
12 260 41.9 fiths et al., 2004), while the internal consistency of the sub-
>13 67 10.8 scale in this study was deemed adequate (Cronbach’s
Marital status α = .72). The Perceived Stigma Subscale of the instrument
Single 170 27.4 was excluded as the majority of respondents in the pilot
Married 391 63 study displayed difficulty in understanding its items. The
Divorced 42 6.8
sole inclusion of the Personal Stigma Subscale is in line
Widowed 18 2.9
with methods employed by other studies as well (e.g.
Employment status
Wang, Fick, Adair, & Lai, 2007).
Employed 399 64.3
For adapting the instrument in Greek, translation and
Unemployed 78 12.6
Non-working population 144 23.2
back-translation of the questionnaire was implemented by
two bilingual mental health professionals. The content of
the questionnaire and the wording of the items were dis-
numbers belonging to residents of Athens were separated cussed among clinicians as well as among people with a
from the rest of the directory, thus creating a subset of diagnosis of depression. Amendments were made in an
telephone lines. A random sample of numbers belonging attempt to strike a balance between the comparability of
to individuals was selected from the aforementioned sub- the questionnaire with its original form and its cultural
set. For ethical and methodological reasons, telephone appropriateness in Greek.
lines belonging to businesses were not taken into consid-
eration. In particular, it was considered unethical to Attitudes to psychiatric medication.  To measure beliefs and
occupy a respondent while he or she was working, while attitudes to psychiatric medication, an original scale was
employed population would display twice the odds of constructed. Selected items were based on a literature
being selected in the sample (via a residential line as well review on the topic, interviews with people suffering from
as a business line), therefore interfering with the random- depression, interviews with mental health professionals
ness of the sampling strategy. and narratives of lay people calling on a Depression Hel-
Within each household, the person who had their birth- pline. In general, nine items were drafted, one item was
day last was selected for an interview and at least five call excluded during the item review phase and three items
backs were allowed. Telephone interviews were conducted were dropped as a result of alpha testing in a sample of 50
with people aged 16–75 years during the time period students. Congruent with this, the scale entailed five items
November–December 2010. Out of the 760 calls made, 26 reflecting lay beliefs and attitudes to psychiatric medica-
people hung up immediately (3.4%), 78 refused to partici- tion. Responses are made on a five-point Likert scale
pate (10.3%) and 35 did not complete the interview (4.6%), (1 = strongly disagree, 2 = disagree, 3 = neither agree nor
resulting in an 81.7% response rate. In order to test for the disagree, 4 = agree, 5 = strongly agree), with higher com-
presence of non-participation bias, participants and non- posite scores indicating more stigmatising attitudes. The
participants were compared in terms of gender with no sta- third item is reverse worded in order to avoid response
tistically significant differences being observed between bias. The internal consistency of the scale was considered
the two groups. Sample characteristics can be found in adequate (Cronbach’s α = .76).
Table 1.
The study was approved by the Ethics Committee of the Help-seeking intention. Similar to Mojtabai’s study (2010),
University Mental Health Research Institute and all par- participants’ willingness to seek help from a mental health
ticipants provided oral consent for their participation. professional was ascertained by asking the following

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246 International Journal of Social Psychiatry 62(3)

question: ‘If you persistently feel depressed, where would Table 2.  Participants’ attitudes to depression and psychiatric
you seek help from first?’. Available response options medication.
included the following: (1) ‘psychologist/ psychiatrist/men- Disagree (%) Neither agree/ Agree
tal health professional’, (2) medical doctor/health profes- disagree (%) (%)
sional, (3) a friend or relative, (4) a priest (5) no one, (6)
Personal Stigma Scale
other. For this study, willingness to seek help from mental People with depression could 12.6 5.0 82.4
health professional was defined by choosing the first option. snap out of it, if they wanted
Depression is a sign of 28.7 10.0 61.3
Socio-demographic characteristics.  Information about partici- personal weakness
Depression is not a real 66.6 6.9 26.5
pants’ gender, age, family status, educational attainment,
medical illness
employment status and personal experience with mental ill- People with depression are 65.3 8.3 26.4
ness (suffering themselves or a close relative/friend) was dangerous
also gleaned. It is best to avoid people with 84.4 5.3 10.3
The survey instrument was pilot tested in a random depression
People with depression are 31.3 15.0 53.7
sample of 50 phone numbers with regard to its comprehen-
unpredictable
sibility and flow. The interviews were carried out by If I had depression, I would 73.4 11.5 15.1
researchers and mental health professionals of the not tell anyone
University Mental Health Research Institute after appro- I would not employ someone 77.9 10.0 12.1
priate training, involving 10 hours of lectures, role playing if I knew they had depression
I would not vote for a 65.6 10.2 24.2
and pilot phone interviews.
politician if I knew they had
depression
Statistical analysis Attitudes to Psychiatric Medication Scale
Psychiatric drugs are addictive 17.6 15.0 67.3
In terms of descriptive statistics, percentages were calcu- Natural products and 18.2 39.5 42.3
lated for categorical and ordinal variables, while means homeopathic remedies are
more effective than psychiatric
and standard deviations were computed for numerical con- medication
tinuous variables. To identify correlates of depression Psychiatric drugs do more 47.7 22.8 29.4
stigma, a series of univariate analyses were performed good than harm
with the dependent variable being depression stigma scale Psychiatric drugs can alter 26.0 17.4 56.6
your personality
score and the independent variables were gender, age,
Psychiatric drugs are harmful 49.2 16.5 34.4
family status, educational status, employment status and
personal experience with mental illness. Variables that
were found to bear a significant association with depres-
snap out of it if they wanted to (82.4%) and that depression
sion stigma score were then entered into a multiple linear
is a sign of personal weakness (61.3%). One in two
regression model in order to explore independent effects.
respondents was found to regard people with depression as
Categorical variables were entered into the linear regres-
unpredictable, while one in four participants reported that
sion model as dummy variables. A similar analysis was
depression is not a real medical illness and that people
conducted for psychiatric medication stigma score.
with depression are dangerous. Furthermore, one in four
Regarding help-seeking intentions, a series of univariate
individuals expressed their reluctance to vote for a politi-
analyses were performed with the following independent
cian, if they knew he/she had depression.
variables: gender, age, family status, educational attain-
A series of univariate analyses indicated that the depres-
ment, employment status, personal experience with mental
sion stigma composite score is influenced by the following
illness, depression stigma score and psychiatric medication
variables in a statistically significant manner: gender, age,
stigma score. The variables that were found to have a statis-
family status, education, employment status and personal
tically significant association with help-seeking intentions
experience with mental illness. Congruent with this, the
were then entered into a multiple logistic regression model
aforementioned variables were included in a linear regres-
to explore independent effects.
sion model with attitudes to depression being the outcome
variable. As indicated in Table 3, being female, age, educa-
Results tion and having personal experience with mental illness
were independently associated with depression stigma.
Attitudes to depression While age displayed a positive association with depression
The present sample appears to hold stigmatising beliefs stigma score, in other words, as age increases, depression
and attitudes towards depression and the people who suffer stigma increases as well, the same did not hold true for the
from it. As illustrated in Table 2, the vast majority of remaining variables. In particular, being female, having
respondents believe that people with depression could personal experience with mental illness and higher

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Economou et al. 247

Table 3.  Multiple linear regression models for depression Table 4.  Logistic regression model for help-seeking intentions.
stigma and psychiatric medication stigma.
OR 95% CI p-value
B SE p-value
Gender
Depression Stigma Scale Male (Reference Category)  
Age 0.09 0.02 <.001 Female 1.54 (1.05–2.26) <.05
Female −1.57 0.47 <.01 Age (years)
Married −0.65 0.53 >.05 <24 (Reference Category)  
Unemployed −0.18 0.51 >.05 25–34 1.83 (0.80–4.17) NS
Non-working population −0.32 1.03 >.05 35–44 1.79 (0.77–4.17) NS
Personal experience −1.59 0.46 <.001 45–54 1.78 (0.76–4.12) NS
Education −2.00 0.37 <.001 55–64 1.66 (0.71–3.84) NS
Psychiatric Medication Stigma Scale >65 1.67 (0.69–4.02) NS
Age 0.004 0.013 >.05 Marital status
Female −0.794 0.37 <.05 Married (Reference Category)  
Education −0.812 0.296 <.01 Single 0.73 (0.46–1.41) NS
Personal experience −0.774 0.369 <.05 Widowed/divorced 1.42 (0.59–3.03) NS
Employment status
SE: standard error.
Employed (Reference  
Category)
educational attainment resulted in lower depression stigma Unemployed 0.61 (0.38–0.95) <.05
(negative beta coefficients). It is noteworthy that the strong- Non-working population 0.53 (0.23–1.21) NS
est association, evident by the beta coefficient, was found Personal Stigma Scale 0.99 (0.96–1.02) NS
between depression stigma and educational attainment. Psychiatric Medication Scale 0.89 (0.85–0.92) <.01

OR: odds ratio; CI: confidence interval.

Attitudes to psychiatric medication
Lay beliefs and attitudes to psychiatric medication also
appear to be rejecting and unfavourable (Table 2). The
majority of the sample was found to believe that psychiatric
drugs are addictive, can alter one’s personality and do more
harm than good. Interestingly, one in two participants did not
espouse the belief that they are harmful. With regard to their
effectiveness in comparison with natural products and home-
opathic remedies, most of participants were either unsure
about their relative effectiveness or believed in the prepon-
derance of natural products and homeopathy remedies.
A series of univariate analyses revealed gender, age,
educational status and personal experience with mental ill-
ness as the variables that exerted a statistically significant
effect on psychiatric medication stigma. Multiple linear
regression models displayed that being female, having per-
sonal experience with mental illness and having a higher
educational status were independently associated with less
stigmatising attitudes towards psychiatric medication
(Table 3). Similar to the linear regression model of depres-
sion stigma, the strongest association was observed for the
educational attainment variable.
Help seeking
Concerning participants’ willingness to seek help from
mental health professionals, if they persistently feel
depressed, the majority of the sample stated that they would
resort to a mental health professional (65.2%). One in five
participants would instead seek support from relatives or
friends (20.6%), while a slim minority responded ‘nowhere’
(5.8%), ‘from a health professional’ (5.7%), ‘from a priest’
(2.1%) or ‘other’ (0.6%) in the germane question.
From the univariate analyses performed, the following
variables were found to have a statistically significant asso-
ciation with help seeking from a mental health professional:
gender, age, education, family status, employment status,
depression stigma and psychiatric medication stigma. In
other words, only personal experience with mental illness
was not found to have a statistically significant effect.
A logistic regression with seeking help from a mental
health professional as the outcome variable (0 = not seek-
ing help from a mental health professional, 1 = seeking
help from a mental health professional) and the afore-
mentioned characteristics as independent variables
showed that women display increased odds of resorting
to a mental health professional in comparison with men
(odds ratio (OR)  = 1.54, 95% confidence interval
(CI) = 1.06–2.26), unemployed individuals display lower
probability of seeking help from a mental health profes-
sional than employed people (OR = 0.63, 95% CI = 0.5–
0.79) and every unit increase in the psychiatric medication
scale score results in reduced odds of seeking help from a
mental health professional by 11% (OR = 0.89, 95%
CI = 0.85–0.93). Findings from the logistic regression
model can be found in Table 4.
Discussion
This study endeavoured to explore lay attitudes towards
depression and psychiatric medication during a period of

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248 International Journal of Social Psychiatry 62(3)
economic crisis and identify their correlates. Additionally,
it investigated their link to help-seeking intentions.
Regarding the first study objective, the sample was
found to hold erroneous beliefs about depression and the
people who suffer from it. The preponderant misconcep-
tions pertained to the conceptualisation of depression as a
sign of personal weakness and the conviction that people
with depression could snap out of it, if they wanted to.
Upon comparing findings of this survey with those of a
recent study conducted in Germany, Hungary, Portugal
and Ireland, by employing the same questionnaire
(Coppens et al., 2013), one can discern some important
differences. In two items, the Greek sample appears more
stigmatising that the respondents of these four European
countries. In particular, while in Hungary, 60.4% of the
sample was found to believe that people with depression
could snap out of it, if they wanted to, in our sample, the
corresponding figure was 82%. Similarly, 46% of the pop-
ulation in Hungary viewed depression as a sign of personal
weakness, while in Greece the corresponding percentage
was as high as 61%. In the opposite direction, the Greek
population appears less stigmatising than Portuguese with
regard to the unpredictability of people with depression
(54% vs 70%) and less likely to espouse the view that peo-
ple with depression are dangerous (26%) as compared to
people in Hungary and Portugal (roughly 35% in both
countries). This pattern of results indicates that in Greece,
depression is considered to be within the locus of control
of an individual, and therefore, the disorder is probably not
attributed to biogenetic causal explanations, which have
been shown to be linked to lack of self control, unpredict-
ability and dangerousness (Dietrich, Matschinger, &
Angermeyer, 2006). The outset of the financial crisis in the
country with its ensuing negative impact on the prevalence
of major depression (Economou et al., 2013; Madianos
et al., 2011) might have influenced lay beliefs about the
disorder, stressing its socio-economic causes at the expense
of its biological ones. A replication study exploring lay
beliefs and attitudes towards depression in Greece after
roughly 6 years of enduring recession might cast light on
the causal attributions of the disorder and its impact on
stigma endorsement in the country.
Apart from bolstering non-biogenetic causal of explana-
tions of major depression, the financial crisis may influence
attitudes to the disorder through the mechanism proposed
by Angermeyer and colleagues (2013). In particular, they
have contended that during times of uncertainty, people
would not support access to work for disadvantaged groups
due to potential rivalry for the dearth of available work
opportunities. However, in the results of our study,
employed and unemployed participants did not display sta-
tistically significant differences in terms of their attitudes
towards depression, as employment status was not found to
yield an independent effect in the related linear regression
model. Additionally, with respect to the item of the scale
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tapping an employment situation, only a minority of
respondents (i.e. 12.1%) expressed their reluctance to
employ a person, if they knew he/she had depression.
Nonetheless, there are no pre-crisis data in Greece to
explore whether this percentage has increased, decreased or
has remained at similar levels. However, it indicates that in
a proxy measure of employment discrimination, people in
Greece are not particularly stigmatising against persons
with depression, in spite of the fact that the crisis has
increased the competition for the available work positions.
In terms of attitudes to psychiatric medication, the sam-
ple of this study appeared baffled – especially with regard
to the comparable effectiveness of psychiatric medication
in relation to natural products and homeopathic remedies
– and stigmatising. While the majority viewed psychiatric
drugs as addictive, capable of altering one’s personality,
ineffective and doing more bad than good, they had diffi-
culty in denouncing them as being ‘harmful’. This incon-
sistency in findings can be explained in terms of social
desirability bias, where participants indirectly viewed psy-
chiatric drugs as harmful but did not explicitly state it, or
by a popular held belief that psychiatric medication can
adversely influence the person who takes it, but on the
other hand, it is a ‘necessary evil’. In other words, they are
addictive, they can alter one’s personality, they do more
harm than good, but they do some good. Similar prejudices
against psychiatric drugs have been documented in other
studies as well (Munizza et al., 2013; Ozmen et al., 2005).
It would be interesting in a subsequent study to try to elu-
cidate whether these rejecting attitudes are limited to psy-
chiatric medication or tap a sense of ubiquitous suspicion
towards all types of medication among the Greek popula-
tion. This particular finding is of primary importance as it
highlights the gap between existing evidence about the
effectiveness of antidepressants (Cipriani et al., 2009) and
lay beliefs. Congruent with this, scientific advances in the
pharmaceutical therapy of mental disorders should run in
parallel with efforts to reduce the stigma surrounding psy-
chiatric medication.
Concerning the correlates of attitudes to depression
and psychiatric medication, male gender, older age, no
experience with mental illness and low educational
attainment were found to bear an independent effect on
stigma endorsement, a finding which is in agreement
with existing literature (Aromaa et al., 2011; Coppens
et al., 2013; Griffiths et al., 2008). Similarly, men, people
of low educational attainment and individuals with no
experience of mental illness, held the most unfavourable
attitudes to psychiatric medication.
With regard to participants’ willingness to seek help
from mental health staff, the majority of the sample stated
that they would resort to mental health professionals, in
case they manifested symptoms of depression. The high
percentage of people endorsing this view is in sharp con-
trast to the minority of people who actually receive
Economou et al. 249
treatment for depression worldwide (Fernández et al.,
2007; Kohn et al., 2004). This can be explained by the
nature of the question, which taps intention and not actual
behaviour, or/and by its wording, where the inclusion of
the phrase ‘if you persistently feel depressed’ may con-
note a more serious condition that cannot be resolved on
its own. Concerning the incompatible evidence in the lit-
erature regarding the presence of an association between
depression stigma and help seeking (e.g. Schomerus
et al., 2009 vs Ng et al., 2008), findings of this study
showed that while depression stigma exerted a statisti-
cally significant effect on help-seeking intentions in the
context of a univariate analysis, its effect was eliminated
when the variable was entered in a multiple linear regres-
sion model. This is of primary importance, as it illustrates
that it is not the depression stigma that impinges on help-
seeking intentions in Greece amid the recession, but
rather, it is the stigma attached to psychiatric medication
which hinders people from seeking professional help.
The decreased likelihood of unemployed individuals to
seek professional help in case of depression may be
ascribed to their heightened concerns about their employ-
ment status, which in turn render seeking professional
help for depression of secondary importance, or to their
scarce financial resources.
Limitations
The study has certain drawbacks which warrant attention.
In contrast to the majority of studies in the literature, the
study design did not incorporate a vignette describing a
person suffering from depression. Congruent with this, it
remains nebulous what participants conceptualised as
‘depression’, and therefore, there may be variability in
attitudes to depression as a corollary of these potential dif-
ferences in conceptualisation. It merits noting that the
general public in Greece is unfamiliar with the employ-
ment of vignettes in research, and therefore, this study fol-
lowed the paradigm of national surveys exploring lay
attitudes to severe mental illness and to schizophrenia,
conducted a few years ago (Economou, Richardson,
Gramandani, Stalikas, & Stefanis, 2009; Madianos et al.,
2012). Furthermore, personal stigma has been suggested
to be particularly susceptible to social desirability bias, as
opposed to perceived stigma (Coppens et al., 2013;
Griffiths et al., 2006); however, the Perceived Stigma
Subscale of the Depression Stigma Scale had to be
excluded due to the confusion it created to participants
during the pilot phase of the study. Congruent with this,
the particular results may constitute an under-estimation
of the true prevalence of stigmatising beliefs and attitudes
towards depression among respondents. Finally, the sam-
ple was drawn from Athens region, and therefore, study
findings cannot be extrapolated to the general population
in Greece.
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Conclusion
The recent financial crisis has incurred adverse effects on
the mental health of the population in Greece, as evidenced
by elevated rates of major depression amid the economic
downturn (Economou et al., 2013; Madianos et al., 2011).
International recommendations for offsetting the mental
health impact of the recession highlight the need for effec-
tive treatment and prevention of the disorder, including the
reduction in the stigma attached to it (Wahlbeck & McDaid,
2012; WHO, 2011). However, any intervention or policy
course taken should fit the needs of the population.
Congruent with this, findings from this study indicate that
the ongoing recession may have fostered the promulgation
of non-biogenetic causal explanations of depression, while
at first glance it does not appear to have encouraged dis-
crimination against the people who suffer from it. On the
contrary, attitudes to psychiatric medication were found to
be particularly unfavourable and to greatly impinge on
help-seeking intentions. Therefore, any effort to ensure
timely and effective treatment of major depression in
Greece should place greater emphasis on the stigma sur-
rounding psychiatric medication as compared to the stigma
attached to the disorder. Finally, it should prioritise target-
ing unemployed individuals, as despite the strong associa-
tion between depression and unemployment worldwide
(Paul & Moser, 2009) and in Greece (Madianos et al.,
2011), this population subgroup was found to be less likely
to resort to mental health professionals in case of manifest-
ing persistent symptoms of depression.
In conclusion, research on the mental health effects of
the global recession should encompass studies investi-
gating the stigma attached to mental disorders and its
implications.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship and/or publication of this article.
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