Depression Literacy and Misconceptions Scale (DepSter)

Abstract

The Depression Literacy and Misconceptions Scale (DepSter), also known by its Polish name Skala Przekonań na Temat Depresji, is a 14-item self-report inventory developed by Kulwicka and Gasiorowska in 2023. This instrument was created to measure multidimensional beliefs regarding depression, specifically focusing on two distinct factors: accurate Depression Literacy (DL) and common misconceptions about depression (MiscD).

The development process was robust, drawing item content from established diagnostic criteria, including the DSM-V and ICD-10 for major depressive episodes, alongside current scientific knowledge (Hammen, 2018) and qualitative data gathered from focus groups regarding social stereotypes. Initial content validity was assessed using interrater consistency and the CVR index, leading to the final 14-item structure. The scale was validated across ten studies spanning Poland, the U.S., and the U.K., and a Confirmatory Factor Analysis supported the hypothesized two-factor model. Although the authors noted some instances of relatively low Cronbach’s alpha, possibly due to the limited item count, overall psychometric properties concerning reliability, validity, and measurement invariance were reported as satisfactory.

Keywords

Beliefs About Depression, Depression Literacy, Misconceptions About Depression, Divergent Validity, Convergent Validity, Criterion Validity, Social Perceptions, Measurement Invariance

Authors

Katarzyna Kulwicka, Agata Gasiorowska

Purpose

The DepSter Scale was created to provide a comprehensive and psychometrically sound measure of the public’s understanding of depression. Its primary aim is to assess both the knowledge of depression’s clinical characteristics (literacy) and the prevalence of non-clinical, often stigmatizing, beliefs (misconceptions) within a population.

This dual measurement capacity allows researchers and public health practitioners to evaluate the efficacy of mental health education programs and identify specific targets for intervention aimed at reducing stigma and improving help-seeking behaviors across different national contexts.

Construct

The DepSter scale measures beliefs about depression, which is conceptualized as a two-dimensional construct comprising:

• Depression Literacy (DL): This subscale assesses the degree to which an individual holds scientifically accurate beliefs regarding depression, covering its status as a medical illness, its core symptoms (e.g., anhedonia, fatigue), prognosis, and potential lethality (suicide risk). Items in this subscale are positively keyed to reflect accurate knowledge.

• Misconceptions about Depression (MiscD): This subscale measures the endorsement of common stereotypes and erroneous beliefs that often trivialize the disorder or attribute its cause and persistence to personal failings (e.g., lack of willpower, self-pity, mental weakness). Items in this subscale are designed to capture social stigma and inaccurate causal beliefs.

The empirical distinction between these two factors supports the scale’s utility in providing nuanced data on mental health beliefs that go beyond a simple knowledge deficit measure.

Validity

The validity evidence for the DepSter scale is comprehensive, encompassing content, criterion, convergent, and divergent validity.

• Content Validity: Content validity was established through expert consensus, resulting in a minimum CVR index of 0.60 across the items. This level of agreement confirmed the relevance and representativeness of the items in measuring the intended constructs of literacy and misconceptions.

• Criterion Validity: Support for criterion validity was demonstrated by correlating scale scores with relevant external variables. Specifically, individuals who reported formal psychological education or prior personal exposure to depression showed statistically significant higher levels of depression literacy and fewer misconceptions.

• Convergent Validity: Convergent evidence showed that high Depression Literacy scores and low Misconceptions scores were positively associated with related measures, including general mental health literacy, scores on the Depression Literacy Questionnaire (D-Lit), empathetic sensitivity, perspective-taking ability, and emotional stability. These correlations confirm that the DepSter measures constructs aligned with existing theories of mental health awareness and social cognition.

• Divergent Validity: The distinction between the two subscales was confirmed by divergent validity analysis, which showed that despite a substantial correlation, the DL and MiscD dimensions maintained unique meanings and variance, confirming that they are not redundant measures of a single underlying factor.

Reliability

The reliability of the DepSter scale was assessed using multiple psychometric indices across diverse cultural samples.

• Interrater Reliability: The interrater consistency for the scale items during the content development phase was satisfactory, indicated by an Intraclass Correlation Coefficient (ICC) of 0.725 (95% CI [0.65, 0.79]).

• Internal Consistency: Internal consistency, measured by Cronbach’s alpha, ranged widely (0.49 to 0.93) across the multiple international samples utilized. The authors noted that instances of lower alpha values were likely constrained by the brevity of the scale (14 total items).

• Test-Retest Reliability: Temporal stability was assessed across both language versions. The English version, re-administered after a three-week interval, yielded test-retest reliability values of alpha = 0.92 for misconceptions and alpha = 0.65 for depression literacy. The Polish version, tested over a longer, three-month interval, demonstrated strong stability: alpha = 0.76 for misconceptions and alpha = 0.83 for depression literacy.

Factor Analysis

Structural analysis was conducted using Confirmatory Factor Analysis (CFA) to confirm the scale structure and test its generalizability.

• Confirmatory Factor Analysis (CFA): The CFA provided evidence of a good fit for the theorized two-factor model, with key fit indices reported as: χ²/df = 4.24, RMSEA = 0.075 (90% CI = [0.067, 0.084]), SRMR = 0.060, TLI = 0.85, and CFI = 0.88. These results confirm that the instrument effectively measures Depression Literacy and Misconceptions as separate factors.

• Measurement Invariance: The model demonstrated configural and metric measurement invariance across the Polish, U.S., and U.K. samples. This indicates that the factors have the same structure and meaning across these national groups. However, the study reported only partial scalar invariance for the DL subscale, and scalar invariance was absent for the MiscD subscale. This suggests that while the factors are structurally equivalent, mean differences observed between countries may not purely reflect true latent differences in the construct.

Instrument

Test Type: Original Instrument Type: Inventory/Questionnaire

Format: The instrument uses a 5-point Likert scale, requiring participants to indicate their level of agreement with each statement, ranging from 1 = “strongly disagree” to 5 = “strongly agree.” Administration is typically electronic.

Language Available: English; Polish

Population Group: Human; Male; Female

Age Group: Adulthood (18 yrs & older); Young Adulthood (18-29 yrs); Thirties (30-39 yrs); Middle Age (40-64 yrs); Aged (65 yrs & older)

Population Details: Validation samples consisted of adults recruited from Poland, the United States, and the United Kingdom, primarily sourced via online crowdsourcing platforms like Amazon Mechanical Turk and Prolific Academic Users.

Test Methodology: The scale utilized rigorous psychometric methodology, including assessments of Test Validity (Construct Validity, Content Validity, Convergent Validity, Criterion Validity, Discriminant Validity), Test Reliability (Internal Consistency, Interrater Reliability, Test-Retest Reliability), and Factor Analysis (Confirmatory Factor Analysis, Measurement Invariance).

Keywords

Beliefs About Depression, Depression Literacy, Misconceptions About Depression, DSM-V, Cronbach’s alpha, Social Perceptions, Stigma, Psychological Assessment

Authors

Author ORCID Identifier:

• Katarzyna Kulwicka: http://orcid.org/0000-0002-4731-1901

Affiliation:

• Katarzyna Kulwicka: SWPS University of Social Sciences and Humanities Faculty of Psychology in Wroclaw

• Agata Gasiorowska: SWPS University of Social Sciences and Humanities Faculty of Psychology in Wroclaw

Email addresses:

• Katarzyna Kulwicka: [email protected]

Correspondence Address:

• Katarzyna Kulwicka: [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching.

Commercial Use: No

Fee: No

Test Year: 2023

Website for Permissions: creativecommons.org/licenses/by/4.0/

Reference’s

• Kulwicka, K., & Gasiorowska, A. (2023). Depression literacy and misconceptions scale (DepSter): A new two-factorial tool for measuring beliefs about depression. BMC Psychiatry, 23(1), Article 300. https://doi.org/10.1186/s12888-023-04796-8

Items of the Depression Literacy and Misconceptions Scale (DepSter)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The DepSter scale is a 14-item measure, comprising two factors: Depression Literacy (DL) and Misconceptions about Depression (MiscD). The specific items are available in the supplemental materials:

• 2023-70000-001, Supplemental Material 1, Pages 1-2

• 2023-70000-001, Supplemental Material 2, Pages 1-2

Polish Version

Instructions: Używając poniższej skali, zaznacz, do jakiego stopnia zgadzasz się z poniższymi twierdzeniami.

Response Scale:

1. Zdecydowanie się nie zgadzam

2. Nie zgadzam się

3. Ani się nie zgadzam, ani się zgadzam

4. Zgadzam się

5. Zdecydowanie się zgadzam

Items:

1. Depresja jest chorobą

2. Depresja to zwykła fanaberia

3. Depresja może dotknąć każdego

4. Depresja to tylko chwilowe pogorszenie samopoczucia

5. Depresja sprawia, że ludzie tracą zainteresowanie nawet tymi rzeczami, które kiedyś sprawiały im radość

6. Depresja dotyka tylko ludzi słabych, którzy nie radzą sobie z własnym życiem

7. Depresja sprawia, że ludzie nie mają siły do zrobienia czegokolwiek

8. Wystarczy silna wola, żeby pozbyć się depresji

9. Osoby, które mają depresję, często myślą o samobójstwie

10. Wystarczy wziąć się w garść, żeby pozbyć się depresji

11. Depresja wiąże się z ogromnym cierpieniem

12. Leki przeciwdepresyjne działają od razu po zażyciu

13. Depresja to użalanie się nad sobą

14. Osoby, które mają depresję, są słabe psychicznie

Scoring Key (Klucz odpowiedzi):

• Depression Literacy (DL): Średnia z 1, 3, 5, 7, 9, 11

• Misconceptions About Depression (MiscD): Średnia z 2, 4, 6, 8, 10, 12, 13, 14

English Version

Instructions: Please Indicate Your Agreement with The Following Statements Using the Scale Below.

Response Scale:

1. Strongly disagree

2. Disagree

3. Neither agree or disagree

4. Agree

5. Strongly agree

Items:

1. Depression is an illness

2. Depression is just a fad

3. Depression can affect anyone

4. Depression is just a temporary mood deterioration

5. Depression makes people lose interest even in the things they used to enjoy doing

6. Depression affects only the people who are weak and cannot cope with their life

7. Depression makes people lack the strength to do anything

8. To overcome depression, all you need is willpower

9. People with depression often think about suicide

10. To overcome depression, all you need is to get yourself together

11. Depression is associated with great suffering

12. Antidepressant medication start to work right after the intake

13. Depression is just a self-pity

14. People with depression are mentally weak

Scoring:

• Depression Literacy (DL): Average of 1, 3, 5, 7, 9, 11

• Misconceptions About Depression (MiscD): Average 2, 4, 6, 8, 10, 12, 13, 14