Comparing responses to differently framed and formatted persuasive messages to encourage help-seeking for depression in Japanese adults: a cross-sectional study with 2-month follow-up

OBJECTIVE: To examine audience’s responses to differently framed and formatted persuasive messages in the context of developing depression help-seeking messages. DESIGN: Cross-sectional followed by 2-month follow-up study. SETTING AND PARTICIPANTS: A web-based survey was conducted in July 2017 among Japanese adults aged 35–45 years. There were 1957 eligible respondents without psychiatric history. Of these, 1805 people (92.2%) completed the 2-month follow-up questionnaire. MAIN OUTCOME MEASURES: Six depression help-seeking messages were prepared with three frames (neutral, loss and gain framed)×2 formats (formatted and unformatted). Participants were asked to rate one of the messages in terms of comprehensibility, persuasiveness, emotional responses, design quality and intended future use. Help-seeking intention for depression was measured using vignette methodology before and after exposure to the messages. Subsequent 2-month help-seeking action for their own mental health (medical service use) was monitored by the follow-up survey. RESULTS: The loss-framed messages more strongly induced negative emotions (surprise, fear, sadness and anxiety), while the gain-framed messages more strongly induced a positive emotion (happiness). The message formatting applied the Centres for Disease Control and Prevention Clear Communication Index, enhanced the emotional responses and increased the likelihood that the message will be read. The loss-framed formatted message alone had a significantly greater OR of having help-seeking intention for depression compared with the neutral-framed unformatted message as a reference group. All messages had little impact on maintaining help-seeking intention or increasing help-seeking action. CONCLUSION: Message framing and formatting may influence emotional responses to the depression help-seeking message, willingness to read the message and intention to seek help for depression. It would be recommendable to apply loss framing and formatting to depression help-seeking messages, to say the least, but further studies are needed to find a way to sustain the effect of messaging for a long time.