Treatment preferences and self-stigma in depression: Development and validation of the brief ATDT-SF

Patients' beliefs about depression and different antidepressant treatment options may influence help-seeking behaviour, treatment adherence, and ultimately clinical outcomes. The Attitudes Toward Depression and its Treatment (ATDT) questionnaire was developed to assess these attitudes and beliefs; however, subsequent research revealed limitations in its psychometric properties. We sought to develop and validate a shortened version (ATDT-SF) with improved reliability.

We used data from 321 patients with first-episode depression initiating treatment enrolled in the BrainDrugs-Depression cohort (age 18-65, 71 % female). We randomly divided the sample into development (n = 209) and validation (n = 112) subsets. Exploratory factor analysis identified a parsimonious factor structure, which was confirmed using confirmatory factor analysis. We assessed associations between the ATDT-SF factors and clinical variables, and compared attitudes across Danish, Canadian, and Australian samples.

A 13-item, four-factor model demonstrated an acceptable fit and resulted in the factors: negative attitudes toward antidepressants, help-seeking from medical professionals, self-stigma, and preference for psychotherapy. Age was positively associated with negative attitudes toward antidepressants (p = 0.004), while depression severity showed a significant positive association with experienced stigma (p = 0.004). Patients reported significantly stronger help-seeking from medical professionals and higher self-stigma compared to those from Canadian and Australian samples, while negative attitudes toward antidepressants were similar across countries.

The ATDT-SF provides a reliable measure of attitudes toward depression and its treatment and self-stigma, which may be important contextual factors in treatment planning and depression management.