BackgroundWhile the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung’s Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ).MethodA total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS.ResultsOverall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of ‘Misses’ and ‘False Positives’ to those obtained with the DASS.ConclusionsGiven these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

Background: Zung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research Scott N, Depress Res Treat 2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal. Method: The current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder. Results: Mathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung.Conclusions: Consideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.

Background Zung’s Self-rating Depression Scale (SDS) is an established norm-referenced screening measure used to identify the presence of depressive disorders in adults. Despite widespread usage, issues exist concerning the recommended cut-off score for a positive diagnosis. First, confusion arising from the conversion of raw scores to index scores had resulted in a considerably higher cut-off score than that recommended being used by many researchers. Second, research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] and Australia [BMC Psychiatry. 17:329; 2017] had suggested that the current recommended cut-off is lower than ideal, at least in those countries. Method To explore these matters further, sensitivity and specificity figures for alternative cut-off points were examined in positive clinical and negative community samples respectively. The positive clinical sample ( n = 57) consisted of adults receiving treatment from a medical professional for some kind of depressive disorder, whose diagnosis was positively confirmed using the Patient Health Questionnaire (PHQ). The negative community sample ( n = 172) was derived from a representative sample of adults whose absence of any depressive disorder was similarly confirmed by the PHQ. Results Mathematical models, including Youden’s Index and the Receiver Operating Characteristics Curve, suggest that the recommended cut-off (a raw score of 40) is indeed too low. More detailed comparisons, including consideration of the likely numbers of false positives and negatives given prevalence rates, confirm that, ironically, the incorrect SDS cut-off score mistakenly applied by many researchers (a raw score of 50) would appear to provide far greater accuracy. Conclusions Research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] has resulted in an elevated SDS cut-off score of 42 being used in many Chinese studies. Research by Dunstan and Scott [BMC Psychiatry. 17:329; 2017] in an Australian context, suggested that a greater increase, to a raw score of 44 might be required. Based on this study, an even larger adjustment is required. Specifically, we recommend the use of an SDS raw score of 50 as the cut-off point for clinical significance.

Objective: Young men are very reluctant to seek help for anxiety disorders. In particular, the factors that facilitate mental health help-seeking in adolescent males are poorly understood. This study aimed to investigate the barriers and facilitating factors to help-seeking behaviour for clinical anxiety in Australian adolescent males. Method: The views of 29 adolescent males, both with and without experience of clinical anxiety symptoms, were elicited using semi-structured interviews and focus groups. Verbatim transcripts were analysed using grounded theory. Results: Primary barriers to help-seeking included stigma (particularly in relation to social norms of masculinity), effort, limited awareness/knowledge of symptoms of anxiety and a sense of being 'confronted' by private emotions through help-seeking. Facilitating factors included increasing the accessibility of schoolbased mental health literacy programs and providing a wider range of formal and informal help-seeking options. Other facilitators related to amendments in how mental health information is presented and investments into high speed/low effort help-seeking options. A preliminary model of mental health help-seeking in adolescent males with clinical anxiety is presented. Conclusion: Adolescent males feel that they risk significant stigma by help-seeking for mental health problems but lack information as to the benefits or the experience of help seeking. A stepped approach to options for mental health support and information for this population should be evaluated. What is already known about this topicWhat this topic adds 1. The current investigation is one of the first to investigate help-seeking for anxiety disorders specifically in adolescent males. 2. This investigation identified barriers to help-seeking that included stigma (particularly in relation to social norms of masculinity), effort, limited awareness/ knowledge of symptoms of anxiety and a sense of being 'confronted' by private emotions through helpseeking. 3. This investigation also identified facilitating factors to help-seeking that included increasing the accessibility of school-based mental health literacy programs and providing a wider range of formal and informal helpseeking options. Other help-seeking facilitators related to how mental health information is presented and investments into high-speed/low-effort help-seeking options. 4. A preliminary model is proposed to illustrate how barriers and facilitating factors may influence different components of the help-seeking process.

One of the biggest growth areas in e-mental health resources has been the development and use of mobile mental health apps for smartphones and tablet devices. Such apps are being downloaded at increasing rates, but there have been questions about their efficacy and the research methodologies used to examine this. A review of the major app marketplaces, the Apple App Store and Google Play store, was conducted to locate apps claiming to offer a therapeutic treatment for depression and/or anxiety, and have research evidence for their effectiveness, according to their app store descriptions. App store descriptions were also analyzed to determine whether the app had been developed with mental health expert input; whether they had been developed in association with a government body, academic institution, or medical facility; and, whether or not they were free to download. Overall, 3.41% of apps had research to justify their claims of effectiveness, with the majority of that research undertaken by those involved in the development of the app. Other results indicated that 30.38% of shortlisted apps claimed to have expert development input; 20.48% had an affiliation with a government body, academic institution, or medical facility; and, 74.06% were free to download. Future research must consider other methodologies that may facilitate more research being completed on a greater number of apps, and future development needs to incorporate greater levels of input by mental health experts. Ways in which app stores could play a key role in encouraging more scientific research into the effectiveness of the mental health apps they sell are discussed.