The revision and factor analytic evaluation of the German version of the depression literacy scale (D-Lit-R German)
Authors: Gökce Feyza , Jais Denise , Sterner Philipp , Schneider Antonius , Gensichen Jochen , Pitschel-Walz Gabriele ,   For the POKAL-Group, Bühner Markus , Dreischulte Tobias , Falkai Peter , Gensichen Jochen , Henningsen Peter , Jung-Sievers Caroline , Krcmar Helmut , Lochbühler Kirsten , Lukaschek Karoline , Pitschel-Walz Gabriele , Prommegger Barbara , Schmitt Andrea , Schneider Antonius , Biersack Katharina , Brand Constantin , Brisnik Vita , Ebert Christopher , Eder Julia , Gökce Feyza , Haas Carolin , Hattenkofer Lisa , Kaupe Lukas , Raub Jonas , Reindl-Spanner Philipp , Schillok Hannah , Schönweger Petra , Teusen Clara , Vogel Marie , von Schrottenberg Victoria , Vukas Jochen , Younesi Puya 
Published: April 2024

Abstract
Background
Depression is a common mental health disorder and the second leading cause of disability worldwide. In people with depression, low depression literacy, which could be characterized by a poor recognition of depressive symptoms and less knowledge about the availability of treatment options, can hinder adequate therapy for depression. Nevertheless, questionnaires measuring depression literacy in Germany are rare. Consequently, for the present study, the German Depression Literacy Scale (D-Lit) has been revised and evaluated.

Methods
First, a team of clinical psychologists revised the D-Lit German scale. Next, cognitive interviews were conducted with patients with depression to improve the comprehensibility of the scale items. Our revision of the D-Lit-R German scale was then subjected to an anonymous online study. Finally, the data went through an exploratory factor analysis, and sociodemographic subgroup analyses were performed.

Results
N = 524 individuals (age 18–80) completed the D-Lit-R German scale and a questionnaire on their sociodemographic data. Cronbach´s alpha was estimated as α = .72, and McDonald's Omega (categorical) was estimated as ω = .77. The mean Item difficulty was M = .75 (SD = .15). An EFA was performed for a unidimensional model, a 5-factor-model and at last a 3-factor-model. The 5-factorial model showed a good model fit (χ2emp,WLSMV(131) = 92.424, p > .05; CFI = 1, RMSEA = 0, SRMR = .07) but was rejected since the content of the potential 5 factors could not be determined. The 3-factor model showed an arguable model fit. The Chi2 test was significant (χ2emp,WLSMV(168) = 199.912, p < .05), but the CFI and the RMSEA met an acceptable model fit (CFI = .990, RMSEA of .019, 90% CI[.003, .029]). Substantively, the three factors were defined as (1) Distractors and other symptoms, (2) Depressive symptoms, and (3) Pharmacological and psychotherapeutic depression treatment. Furthermore, there were significant differences in sum scores regarding the subgroup's gender, treatment for mental health problems, depression treatment, experience with depression, and different career fields.

Conclusions
The D-Lit-R German scale is a time-efficient scale to assess some aspects of the depression literacy construct that can be easily applied. Since there was no perfect model fit, it is recommended to continue to revise the scale. Further evaluation studies could ask for knowledge of the etiological factors of depression. Future studies could then use this instrument to convey depression literacy. This instrument could assess the growth of knowledge after psychoeducational interventions in different settings.

Trial registration
This trial was preregistered at the platform osf.io (https://osf.io/49xdh).
Registration number: https://doi.org/10.17605/OSF.IO/49XDH
Date of registration: 28 April 2022.