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

Kristian H R Jensen; Malene Sørensen; Anders Spanggård; Andrea K Juvik; Sif Olsen; Vibeke H Dam; Martin B Jørgensen

doi:10.1016/j.jad.2025.120233

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

J Affect Disord. 2026 Jan 1:392:120233. doi: 10.1016/j.jad.2025.120233. Epub 2025 Sep 7.

Authors

Kristian H R Jensen¹, Malene Sørensen², Anders Spanggård³, Andrea K Juvik², Sif Olsen⁴, Vibeke H Dam⁵, Martin B Jørgensen²

Affiliations

¹ Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: kristian.reveles.jensen@nru.dk.
² Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³ Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Faculty of Health, University of Aarhus, Aarhus, Denmark.
⁴ Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark.
⁵ Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 40925484
DOI: 10.1016/j.jad.2025.120233

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Antidepressants; Attitudes; Depression; Discrimination; Psychotherapy; Stigma; Treatment preferences.

Publication types

Validation Study

MeSH terms

Adolescent
Adult
Aged
Antidepressive Agents / therapeutic use
Australia
Canada
Denmark
Depressive Disorder* / drug therapy
Depressive Disorder* / psychology
Depressive Disorder* / therapy
Factor Analysis, Statistical
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care / psychology
Patient Preference* / psychology
Psychometrics
Psychotherapy
Reproducibility of Results
Self Concept*
Social Stigma*
Surveys and Questionnaires
Young Adult

Substances

Antidepressive Agents