Depression prevention and mental health promotion interventions: is stigma taken into account? An overview of the Italian initiatives.

Dear Editor Depressive disorders represent a major public health concern in European countries and Italian epidemiological studies confirm that despite being highly prevalent in the general population and in clinical settings, their recognition and treatment are often inadequate (Balestrieri et al. 2004). Research suggested that the public stigma of mental disorders (defined as the general public’s negative attitudes towards individuals with mental disorders) increases self-stigma (e.g. internalized attitudes held by people suffering from a mental disorder) with the consequences that individuals avoid seeking treatment and increase their social isolation (Kanter et al. 2008). In a survey on the Australian general population (Griffiths et al. 2008), personal stigma was associated with greater current psychological distress and lower depression literacy. Based on this evidence, the European Union (EU) mental health conference in 2008 launched the European Pact for Mental Health and Well-Being indicating the prevention of depression and suicide and the fight against stigma as priorities for EU members. In Italy, the National Preventive Plan 2010–2012, launched by Ministry of Health, underlined the need to improve early detection of depression, the evaluation of prevention programmes and the use of evidence-based practices. A recent review on Italian anti-stigma campaigns toward mental illness (Zoppei & Lasalvia, 2011) found that only 12.7% of these initiatives were promoted at the national level and 80% were conducted at the local level. Remarkably, the majority of these studies did not report any information on their outcomes or effectiveness and the methodology was often inappropriate. However, the review was focused on campaigns addressing mental disorders in general, rather than depression per se. This study aims to review anti-stigma activities in depression prevention programmes delivered to date in Italy in order to evaluate their impact from a public health perspective. Owing to the overlap between prevention and treatment, we considered a broad concept of prevention, including interventions occurring before the onset of depression and those aiming to prevent comorbidity, relapse, disability and the consequences of severe mental illness for families (NIMH, 1998).