「新型うつ」の社会的背景についての試論

Social backgrounds of
“modern type” depression (MTD)
The history of psychoeducation and formation
of the prototypes of depression
Jun KASHIHARA
Nihon University
Japan Society for the Promotion of Science
kashihara.jun@nihon-u.ac.jp

Jun KASHIHARA  Page 2
Overview
 Prototypic images of patients with depression exist in Japan
- “Gloomy” and “Mentally weak” as prototypes (Kashihara, 2016)
- Dr. Matsuura: Patients who do not match prototypes or traditional types
are recognized as “MTD patients”
- Prof. Sakamoto: Perceptions of the MTD patients are worse than those
of the TTD patients
 This talk: How these prototypes were formed in the first
place?
- This presentation focuses on influences of psychoeducation
carried out in Japan

Outline
1. Brief introduction of the speaker
2. History of psychoeducation about depression
-Shift from biological model toward psychosocial model
-“Cold in Soul“ and “Gatekeepers“ campaigns in Japan
1. Relations between psychoeducation and prototypes of
depression
-Study 1: Cross-sectional design
-Study 2: Experimental design
1. General Discussion

1. Brief introduction of the speaker

Jun KASHIHARA (http://researchmap.jp/junkashihara/)
 Certificated clinical psychologist
 Joined Prof. Sakamoto’s lab in this April
- Used to belong to the University of Tokyo
(2011–2016; doctoral course)
 Research interest: Public psychoeducation
about depression in general
- Stigma (or prejudice) reduction
- Promotion of social supports
- Development of educational programs about
depression including MTD (planning)

2. History of psychoeducation
about depression
(see Kashihara et al., 2014; Rusch et al.,
2009 for reviews)

Emphases on biomedical models in former days
 Explained biological causes of depression
- e.g.) chemical imbalances in brain, genetics
 Aimed to improve recognition of depression
- Reduce “weak, not sick” beliefs about depression
- Encourage patients to take anti-depressant drugs
 “Cold in Soul” campaign in Japan from 1991
- Resulted in explosive spread of anti-depressants
- Caused some social problems on the other hand

Does Your Soul Have a Cold? (2007; United States)
 A documentary film
- Followed the lives of young Japanese
who take anti-depressants habitually and
dependently
 Focused on both good and bad effects of
the “Cold in Soul” campaign from 1991
- Problems of depression became widely
recognized in Japan
- Some people came to rely only on
medical treatments and to take too much
anti-depressants
邦題 : マイク・ミルズのうつの話

Shift toward psychosocial models in recent days
 Explained psychological and social factors of depression
- e.g.) poor cognitive outlook, learned helplessness
- e.g.) low social support, general stress
 Aimed to reduce social distance between people with/without
depression
- Encourage patients to seek psychological help
- Promote social support from people without depression
 “Gatekeepers” campaign in Japan
(Ministry of Health Labour and Welfare, Japan, 2010)

“Gatekeepers“ campaign (2010; Japan)
 Mental Health First Aid programs in
Australia (Kitchener & Jorm, 2008) as
references
 Aimed to promote social support toward
people with depression and at risk of
suicide
- Based on psychosocial models
- Carried out workshops to improve mental
health literacy and basic mental health
care skills

3. Relations between psychoeducation
and prototypes of depression

Overview of the two studies
 Aims
- Argue that the prototypes of depression were possibly formed as a
result of education based on psychosocial models
 Study 1 (Reanalysis of the data reported in Kashihara, 2016)
- Stronger prototypic beliefs were predicted psychosocial beliefs
about depression
 Study 2 (Reported as a part in Kashihara, 2015)
- Show how biological/psychosocial beliefs were changed through
psychoeducation about depression

Study 1: Aims & Method
Aims
 Examine relations between psychosocial beliefs and
prototypic images about people with depression
- Conduct multiple regression analyses
Method: Participants & Procedures
 155 university students participated
- Mage = 21.25 (SD = 3.78)
 Cross-sectional survey
- Questionnaires were distributed at introductory psychology classes

Study 1: Method (continued)
Independent variables
 Biomedical beliefs (Nieuwsma & Pepper, 2010)
- 6 items (e.g., chemical imbalance causes depression), α = .88
 Psychosocial beliefs (Nieuwsma & Pepper, 2010)
- 11 items (e.g., poor cognitive outlook causes depression), α = .72
 Contact with people with depression (Holmes et al., 1999)
- Based on rank order scores from 1 to 12
Dependent variables
 Prototypes about people with depression (Kashihara, 2016)
- Gloomy subscale (3 items, α = .74)
- Weak subscale (2 items, α = .93)

Study 1: Results of multiple regression

Study 1: Results of multiple regression (continued)

Study 1: Discussion
 Show that holding psychosocial beliefs predict stronger
prototypic images
- Psychosocial beliefs → Gloomy: β = 0.24, p = .005
- Psychosocial beliefs → Weak: β = 0.23, p = .005
 Attributing causes of depression to psychosocial factors
possibly lead to holding prototypic images
Psychosocial
beliefs
Prototypes of
depression

Study 2: Aims & Method
Aims
 Examine effects of education about depression on
biomedical / psychosocial beliefs
Method: Participants & Procedures
 130 university students participated
- Mage = 20.18 (SD = 1.07)
 Experiment with a 3 (conditions) × 3 (time points) design
- Presented one of the three types (biomedical, psychosocial, or bio-
psycho-social) of educational texts
- Pre-, post-, and 4-week follow-up assessments were administered

Study 2: Method (continued)
Dependent variables
 Biomedical beliefs (Nieuwsma & Pepper, 2010)
- 6 items, α = .87 at the pretest
 Psychosocial beliefs (Nieuwsma & Pepper, 2010)
- 11 items, α = .75 at the pretest
Data Analyses
 Mixed-design ANOVAs
- Types of educational texts (between-participants, 3 types)
- Assessment time points (within-subjects, 3 types)
- Interaction effects

Study 2: Results of ANOVAs
*** ***
***
*** p < .001

Study 2: Results of ANOVAs (continued)
*
***
* p < .05, *** p < .001

Study 2: Discussion
 Education based on either biological or psychosocial
models could narrow the understanding of depression
 Possible side-effects of education which emphasizes
psychosocial viewpoint of depression
Psychosocial
beliefs
Biomedical
beliefs
Education
based on
psychosocial model
×

4. General Discussion

Overview of the research
 Research question: How the prototypic or traditional
images of depression were formed in the first place?
 Study 1 examined predictors of prototypic images
- Holding psychosocial beliefs predict stronger prototypic images
 Study 2 examined effects of psychoeducation about
depression
- Education based on psychosocial models could narrow the
understanding of depression

Conclusion
 Prototypic or traditional images of depression were possibly
formed as a result of the recent psychoeducation
 Integrative figure of the findings
Psychosocial
beliefs
Biomedical
beliefs
Education
based on
psychosocial model
× Prototypes of
depression
Historical review Study 2 Study 1

References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders. (5th ed). Arlington, VA: American Psychiatric Publishing.
Holmes, E. P., Corrigan, P. W., Williams, P., Canar, J., & Kubiak, M. A. (1999). Changing
attitudes about schizophrenia. Schizophrenia Bulletin, 25(3), 447–456.
Kashihara, J. (2015). Examination of stigmatizing beliefs about depression and stigma-
reduction effects of education by using implicit measures. Psychological Reports, 116(2),
337–362.
Kashihara, J. (2016). Prototype analysis on beliefs about people with depression: Examining
Japanese university students. The Japanese Journal of Psychology 87(2), 111–121. (in
Japanese with English Abstract)
Kashihara, J., Kawai, T., & Umegaki, Y. (2014). A comprehensive review of research on
stigmatizing attitudes toward depression: Proposing the use of implicit measures for future
investigation. Japanese Psychological Review, 57(4), 455–471. (in Japanese with English
Abstract)
Kitchener, B. A., & Jorm, A. F. (2008). Mental Health First Aid: An international programme for
early intervention. Early Intervention in Psychiatry, 2(1), 55–61.

References (continued)
Mills, M. (Director). (2007). Does Your Soul Have a Cold? [Motion Picture]. United States:
Rainbow Media.
Ministry of Health Labour and Welfare, Japan. (2010). Jisatsu utsubyo tou taisaku team
torimatome ni tsuite. [About the formation of the team for coping with depression and
suicide etc.] Retrieved from http://www.mhlw.go. jp/bunya/shougaihoken/jisatsu/
torimatome.html (October 30, 2013; in Japanese)
Nieuwsma, J. A., & Pepper, C. M. (2010). How etiological explanations for depression impact
perceptions of stigma, treatment effectiveness, and controllability of depression. Journal of
Mental Health, 19(1), 52–61.
Rusch, L. C., Kanter, J. W., & Brondino, M. J. (2009) ． A comparison of contextual and
biomedical models of stigma reduction for depression with a nonclinical undergraduate
sample. Journal of Nervous and Mental Disease, 197(2), 104–110.

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