A multifaceted intervention to improve mental health literacy in students of a multicampus university: a cluster randomised trial

The Stride program: Feasibility and pre-to-post program change of an exercise service for university students experiencing mental distress

Rates of mental illness are disproportionately high for young adult and higher education (e.g., university student) populations. As such, universities and tertiary institutions often devote significant efforts to services and programs that support and treat mental illness and/or mental distress. However, within that portfolio of treatment approaches, structured exercise has been relatively underutilised and greater research attention is needed to develop this evidence base. The Stride program is a structured 12-week exercise service for students experiencing mental distress. We aimed to explore the feasibility of the program and assess pre- and post-program change, through assessments of student health, lifestyle, and wellbeing outcomes. Drawing from feasibility and effectiveness-implementation hybrid design literatures, we conducted a non-randomised feasibility trial of the Stride program. Participants were recruited from the Stride program (N = 114, Mage = 24.21 years). Feasibility results indicated the program was perceived as acceptable and that participants reported positive perceptions of program components, personnel, and sessions. Participants' pre-to-post program change in depressive symptomatology, physical activity levels, mental health-related quality of life, and various behavioural outcomes were found to be desirable. Our results provide support for the feasibility of the Stride program, and more broadly for the delivery and potential effectiveness of structured exercise programs to support university students experiencing mental distress.

Mental Health First Aid as a tool for improving mental health and well-being

BACKGROUND

The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations.

OBJECTIVES

To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered.

SEARCH METHODS

We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries (ClinicalTrials.gov and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023.

SELECTION CRITERIA

We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months.

AUTHORS' CONCLUSIONS

We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.

An interactive video increasing French students' mental health literacy: a mixed-methods randomized controlled pilot study

Mental health literacy (MHL) is a determinant of psychological well-being in young people. A randomized controlled design was used to evaluate the appreciation and effectiveness of an interactive video on French University students' MHL (knowledge about depression and suicidal behavior, mental health help-seeking behaviors, stigma and misconceptions about mental health). At the baseline, all participants (n = 101) completed a questionnaire including several scales on MHL. One month after, participants were randomly assigned to two homogeneous groups (intervention, n = 50 or control, n = 51) and again completed the questionnaire on MHL. Through a mixed-methods approach, semi-structured interviews were also conducted with the intervention group to collect information on the appreciation of the interactive video. Quantitative data indicated that MHL scores increased or remained stable in the intervention group. Comparison with the control group and multivariate logistic regression models did not show statistically significant differences, due to the small sample of the study. According to qualitative data, users appreciated the content and the format of the intervention. It was suggested that the video could be disseminated in other University campuses in France and internationally to promote MHL among students.

Evolution of 'whole institution' approaches to improving health in tertiary education settings: a critical scoping review

In recent decades, 'whole school' approaches to improving health have gained traction, based on settings-based health promotion understandings which view a setting, its actors and processes as an integrated 'whole' system with multiple intervention opportunities. Much less is known about 'whole institution' approaches to improving health in tertiary education settings. We conducted a scoping review to describe both empirical and non-empirical (e.g. websites) publications relating to 'whole settings', 'complex systems' and 'participatory'/'action' approaches to improving the health of students and staff within tertiary education settings. English-language publications were identified by searching five academic and four grey literature databases and via the reference lists of studies read for eligibility. We identified 101 publications with marked UK overrepresentation. Since the 1970s, publications have increased, spanning a gradual shift in focus from 'aspirational' to 'conceptual' to 'evaluative'. Terminology is geographically siloed (e.g., 'healthy university' (UK), 'healthy campus' (USA)). Publications tend to focus on 'health' generally rather than specific health dimensions (e.g. diet). Policies, arguably crucial for cascading systemic change, were not the most frequently implemented intervention elements. We conclude that, despite the field's evolution, key questions (e.g., insights into who needs to do what, with whom, where and when; or efficacy) remain unanswered.

Digital interventions empowering mental health reconstruction among students after the COVID-19 pandemic

With the gradual end of the coronavirus disease 2019 (COVID-19) pandemic, the reconstruction of students’ mental health is urgently necessary. Digital interventions offer advantages such as high accessibility, anonymity, and accurate identification, which can promote the reconstruction of students’ mental health through the provision of psychological support platforms, psychological assessment tools, and online mental health activities. However, we recognize that digital interventions must undergo many adjustments, and corresponding ethical norms require further clarification. It is crucial for different stakeholders to collaborate and work toward maximizing the effectiveness of digital interventions for the reconstruction of mental health after the COVID-19 pandemic.

The well-being of Iranian adult citizens; is it related to mental health literacy?

Background

Subjective well-being (SWB) is a fundamental concept in the definition of mental health and is a significant health indicator for individuals and societies. Mental health literacy (MHL) is a modifiable variable with known effects on mental health, but its relationship with SWB is not recognized. In this study, the SWB is measured, and its relationship to MHL is investigated.

Methods

In this cross-sectional study conducted in Iran in 2019, 1,682 individuals participated using a convenient sampling method. Participants with a basic ability to use internet were included. A simple online form was used to collect data. SWB and MHL were measured with three questionnaires: WHO-5 Well-Being Index, Mental Health Literacy Scale, and Mental Health Positive Knowledge.

Results

Most of the participants were young (mean age 25.99, SD 9.14), female (71.9%), and had a university degree (78.5%). The mean SWB was 50.19 out of 100 (SD 20.92). More than half of the participants (50.4%) were screen-positive for clinical depression regarding their low well-being. Significant but very small correlations were detected between SWB and both MHL measures.

Conclusion

The well-being of half of the educated Iranian citizens who participated in this study was poor and lower than previous measurements. No strong correlation is detected between SWB and MHL measures in this study. This suggests that people's well-being cannot be improved by merely implementing mental health educational programs.

Health behavior interventions for university students measuring mental health outcomes: A scoping review

Introduction

Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students.

Methods

Six electronic databases were searched for RCTs published until the 18^th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome.

Results

Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15).

Discussion

This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

Cluster randomised controlled trial of a problem-solving, Story-bridge mental health literacy programme for improving Ghanaian community leaders' knowledge of depression

BACKGROUND

Low levels of mental health literacy about depression in the community impact negatively on attitudes towards people with the disorder and their help-seeking.

AIMS

The aim of this study was to assess the effectiveness of a problem-solving, Story-bridge mental health literacy programme, in improving community leaders' knowledge about helpful interventions for, and recognition of, depression.

METHODS

A cluster randomised controlled trial involving 140 assembly members, intervention (n = 70) and control (n = 70) groups. The intervention group received a three-hour mental health literacy programme. The control group received a plain language basic brochure about mental health issues. Data were collected at baseline and 12-week follow-up.

RESULTS

The intervention group demonstrated greater improvement in knowledge about helpful interventions for, and recognition of, depression compared to the control group at follow-up; however, the differences in both measures were small and not statistically significant.

CONCLUSION

The programme has the potential to improve participants' knowledge about helpful interventions for, and recognition of, depression. Positive outcomes have public mental health implications as they might enhance early help-seeking and contribute to better outcomes for individuals with mental health problems.

TRIAL REGISTRATION

ACTRN12617000033347. Date of registration - 9 January 2017.

Influencing factors, prediction and prevention of depression in college students: A literature review

The high prevalence of depression among college students has a strong negative impact on individual physical and mental health, academic development, and interpersonal communication. This paper reviewed the extant literature by identifying nonpathological factors related to college students' depression, investigating the methods of predicting depression, and exploring nonpharmaceutical interventions for college students' depression. The influencing factors of college students' depression mainly fell into four categories: biological factors, personality and psychological state, college experience, and lifestyle. The outbreak of coronavirus disease 2019 has exacerbated the severity of depression among college students worldwide and poses grave challenges to the prevention and treatment of depression, given that the coronavirus has spread quickly with high infection rates, and the pandemic has changed the daily routines of college life. To predict and measure mental health, more advanced methods, such as machine algorithms and artificial intelligence, have emerged in recent years apart from the traditional commonly used psychological scales. Regarding nonpharmaceutical prevention measures, both general measures and professional measures for the prevention and treatment of college students' depression were examined in this study. Students who experience depressive disorders need family support and personalized interventions at college, which should also be supplemented by professional interventions such as cognitive behavioral therapy and online therapy. Through this literature review, we insist that the technology of identification, prediction, and prevention of depression among college students based on big data platforms will be extensively used in the future. Higher education institutions should understand the potential risk factors related to college students' depression and make more accurate screening and prevention available with the help of advanced technologies.

Technology-Based Interventions to Improve Help-Seeking for Mental Health Concerns: A Systematic Review

Background

Despite the high prevalence of mental health disorders worldwide, a significant proportion of distressed individuals do not seek professional help. Digital technology can be a potential bridge to reduce the treatment gap for mental disorders. A systematic review was undertaken to examine the technology-based interventions aimed at improving help-seeking attitude, intention, or behavior for mental health concerns.

Methods

The literature search was conducted in January-February 2020 through various e-databases using relevant keywords that targeted help-seeking interventions for mental health disorders via different technology modes.

Results

21 studies (15 randomized controlled trials and six non-randomized studies) were reviewed. The included studies were published between April 2006 to February 2020. Majority of the interventions led to an increase in the help-seeking variables. The crucial role of online delivery, participant involvement, and embedded links to professional services in encouraging help-seeking is highlighted. The review emphasizes the need for understanding utility of multicomponent interventions with personalized elements targeting help-seeking behavior, particularly in low-middle-income countries, and studies involving longer duration follow-ups.

Conclusion

This systematic review is the first of its kind to examine technology-based interventions to improve help-seeking for mental health and suggests that such interventions play a crucial role in positively impacting help-seeking. The complex interplay between the relevant variables such as mental health literacy, stigma, help-seeking attitude, intention and behavior, and the intervention components that may have a differential bearing on these variables are issues that merit urgent attention in further research.

The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community

Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss 'Bern Epidemiological At-Risk' study (age 16-40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.

Work-Related Health Literacy: A Scoping Review to Clarify the Concept

The overall aim of this scoping review is to outline the current state of research on health literacy (HL) in the workplace: the primary objective is to clarify the concept of individual work-related HL; the secondary aims are to report on interventions that promote individual work-related HL and to present respective measurement instruments validated to date. A high level of work-related HL could support work ability and in the longer run employability. These topics are becoming increasingly important in current circumstances and in view of ongoing developments (e.g., digitalization and "new" work). A basic understanding and measurement of HL as an individual competence in the context of working life is necessary to develop future interventions to promote HL among people of working age. According to the participants, concept, and context (PCC) framework, we included articles on health literacy (concept) in the target group of people of working age in the workplace (population and context). Key information sources were the databases PubMed, CINAHL, PsycInfo, and PSYNDEX. A total of 30 articles were included. There are several terms for "health literacy in the workplace" (including individual work-related or occupational HL). The conceptualizations of the individual employee's competence covered all aspects of HL ("access", "understand", "appraise", and "apply" health information). The conceptualizations differed, among others, in the covered time horizon (referring either only to employees' current work situation or additionally to their employability in the lifespan) or whether they referred also to the viability of the respective company. Published interventions attempting to promote individual work-related HL seem mostly to be targeted at the promotion of mental HL. A variety of outcomes have been measured in intervention studies, while specific measurement instruments for individual work-related HL seem to be scarce. We recommend the development of country-specific instruments for the assessment of individual work-related health literacy and to measure mental and physical work-related health literacy.

The Impact of Mental Health Literacy Training Programs on the Mental Health Literacy of University Students: a Systematic Review

Student mental health is of growing concern for the university education sector. Supporting opportunities to increase mental health literacy of students is one strategy in which universities and colleges are actively investing to support students build their capacity to be well. This study is a systematic review of mental health literacy training (MHLT) programs, other than Mental Health First Aid training, to examine their impact on the mental health literacy of university students. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Online Resource 1) and A Measurement Tool to Assess Systematic Reviews (AMSTAR2) guidelines. Search terms related to mental health literacy concepts, mental health literacy training and university students were used in four major databases (i.e. EBSCOhost, Ovid, ProQuest and Web of Science), retrieving a total of 1219 articles, with 44 studies selected for full-text review, and a final number of 24 studies included for review based on pre-determined eligibility criteria. Results were reported against three main themes: types of MHLT offered; common practices, processes and implementation elements; and effectiveness of intervention. Results indicate a high level of variability in approaches to mental health literacy interventions and measures of assessment and reporting. Additionally, reported benefits to mental health literacy failed to report on comparable units of improvement or the sustainability of benefits. Although it is in the best interest of universities to prioritise early intervention programs to address mental health and improve wellbeing, more robust data is required to establish the effectiveness of MHLT programs in achieving this aim.

Brief training in child and adolescent mental health: Impact on the knowledge and attitudes of pediatric nurses in Nigeria

PROBLEM

Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital.

METHODS

A two group pretest-posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention.

FINDINGS

There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p < .001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups.

CONCLUSION

Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes.

Evaluating mental health literacy and help-seeking behaviours in UK university students: a country wide study

Purpose

Despite a high prevalence of mental health problems, few students know where to turn for support. The purpose of this study was to gain a UK wide perspective on levels of mental health literacy amongst university students and to examine the relationship between mental health literacy and mental health help-seeking behaviours.

Design/methodology/approach

A total of 300 university students in the UK participated in this online cross-sectional study. Participants filled out the mental health literacy scale, the general help-seeking questionnaire, Kessler psychological distress scale 10, The Warwick-Edinburgh mental well-being scale and the self-compassion scale: short form.

Findings

Overall, 78 per cent of participants indicated mild or more severe symptoms of distress. Students reported lower levels of mental health literacy when compared to students in other nations. Women, bisexuals, and those with a history of mental disorders indicated high levels of mental health literacy. Participants indicated they were most likely to seek support from intimate partners and least likely to seek support from religious leaders. No significant correlations were found between mental health literacy and help-seeking behaviours. Mental health literacy was not correlated with distress, mental well-being or self-compassion. Help-seeking behaviours were only significantly positively correlated with mental well-being.

Originality/value

Universities should address strategies to improve help-seeking behaviours in an effort to address overall mental well-being. Programmes may wish to help provide students with information about accessing face-to-face support systems. Environmental strategies to foster mental well-being on campus should also be explored.

Is Knowledge Enough? The Relationship Between Mental Health Knowledge and Stigmatising Attitudes Among Australian Adolescents

Background:

Young people carry mental health problems disproportionate to the size of their population, and rates of help-seeking are low. School mental health programs have been developed to address these issues, founded on an educational approach to target mental health literacy, and indirectly improve help-seeking. However, it has been suggested that knowledge does not necessarily predict health behaviour in young people.

Objective/Methods:

A cross-sectional study was conducted to explore whether knowledge about mental illness was related to attitudes towards mental illness and intentions to seek help in a sample of adolescent girls (N=327).

Results:

Results indicated a weak negative relationship between knowledge about mental health and stigmatising attitudes about mental illness, but no relationship between knowledge about mental health and intentions to seek help for mental health problems. When mental health was categorised (e.g., optimal vs. poorer mental health), a negative relationship between knowledge about and stigmatising attitudes toward mental health was shown in those with poor mental health, but not for adolescents categorised as having moderate or optimal mental health.

Conclusion:

Findings suggest that while the traditional adage - more information on mental health equals better attitude to mental health - may be true for those with ‘poorer’ levels of mental health (e.g., high levels of psychological distress), it may not reduce stigma associated with mental illness or motivate positive health behaviour in adolescent girls with ‘optimal’ mental health (e.g., low or no levels of psychological distress).

Population-based surveys and interventions for mental health literacy in China during 1997-2018: a scoping review

BACKGROUND

This scoping review maps population-based surveys and mental health literacy (MHL) interventions undertaken in China during 1997-2018 in order to identify research gaps.

METHOD

Following Arksey and O'Malley's framework for a scoping review, five English databases (Medline, PsycINFO, Cochrane library, Web of Science and CINAHL) and two Chinese ones (CNKI and WanFang) were systematically searched, identifying both reports of surveys and evaluation of interventions from Jan 1997 to Oct 2018.

RESULTS

MHL research has developed rapidly in China in terms of numbers of studies and geographic coverage over the past two decades. There were 350 peer-reviewed publications included in this review, covering diverse settings and participants. Of these publications, 313 (89.4%) were published in Chinese-language journals and 37 in English-language journals; 303 (86.6%) reported on survey findings and 47 reported on the evaluation of MHL interventions. MHL research in China has mainly focused on the assessment of mental health-related knowledge and beliefs. Much less attention has been given to developing and evaluating relevant interventions. MHL related to general mental health and suicide were most commonly studied, with less focus on specific disorders, although some studies covered depression, psychosis and anxiety disorders. The majority of MHL tools utilized in the studies reported in this review were developed in China (n = 97, 80.2% ) and almost half of these studies (57.8%) did not provide enough details concerning psychometrics.

CONCLUSIONS

More interventions targeting the general public and aiming to improve MHL and promote behaviour change, are needed in China. These should be evaluated with high-quality study designs, such as randomised controlled trials. Proper validation of tools used for measuring MHL should also be addressed in future studies.

Evaluation of Mental Health First Aid skills in an Australian university population

AIM

University students have high rates of mental health problems; however, most delay or fail to seek help altogether. Tertiary settings can offer educational and social programmes to increase mental health awareness and in turn increase the number of students seeking help for their problems. This study aimed to explore students' and staffs' knowledge of mental health issues, confidence to intervene and application of skills following Mental Health First Aid (MHFA) training.

METHODS

Students and staff at an Australian university who had completed MHFA training in the previous 24 months were invited to complete a validated online questionnaire.

RESULTS

Of the 566 eligible participants, 107 (19%) completed the questionnaire. The majority (65%) had applied their skills to someone in need, with the highest number applying it to students. Notably, of those who had applied their skills 23 participants (33%) had applied them in a crisis situation, the most common being panic attacks followed by suicidal thoughts. Although most (98%) applied their skills in a face-to-face capacity, 53% also reported assisting someone via electronic mediums and social media. The mean score for the literacy test was considered high, 12/16 (SD = 1.7) for students and 13/16 (SD = 2.5) for staff. The majority (94%) reported more confidence in providing support following training.

CONCLUSION

This study demonstrated that MHFA training on a university campus is associated with a high level of knowledge, confidence to intervene and apply MHFA skills to assist a student or friend in need, potentially impacting their long-term health outcomes and future professional careers.

Differential associations of health literacy with Austrian adolescents' tobacco and alcohol use

OBJECTIVES

Tobacco use and alcohol use have their origin in adolescence, and risky use of these substances is amongst the leading preventable causes of morbidity and mortality. Health literacy (HL) encompasses the skills that are decisive to make appropriate health decisions in this context. Given the paucity of evidence on the link between HL and adolescents' health behaviors, the present study examined overall HL and different components of HL and their associations with smoking and alcohol use among 13 to 17-year-old Austrian students.

STUDY DESIGN

Data were obtained from a national survey carried out in Austria (N = 4219; 56% females) as part of the Health Behaviour in School-aged Children: World Health Organization (WHO) collaborative cross-national study.

METHODS

We tested two structural equation models, one including the overall HL scale as the predictor and one with the three subscales of HL 'finding,' 'understanding and appraising,' and 'applying' health-related information as predictors of smoking and alcohol use.

RESULTS

Although overall HL was related to all indicators of adolescents' smoking and drinking, the three HL components had differential effects on these behaviors. The easier it was for the participants to 'understand and appraise' and 'apply' health-related information, the less frequently they had smoked and drunk alcohol and the less was the amount of alcohol they had consumed. Contrarily, the easier it was for the participants to 'find' information, the more they had smoked and drunk alcohol.

CONCLUSIONS

Our results indicate that availability of health-related information may be insufficient on its own to prevent or reduce risky substance use. This is of particular importance for the development and improvement of primary prevention programs targeting adolescent populations.

Effectiveness of information and communication technologies interventions to increase mental health literacy: A systematic review

AIM

Most mental health conditions affect adolescent and young adults. The onset of many mental disorders occurs in the young age. This is a critical period to implement interventions to enhance mental health literacy (MHL) and to prevent the occurrence of mental health problems. This systematic review examined the effectiveness of information and communication technologies interventions on MHL (recognition of conditions, stigma and help-seeking).

METHODS

The authors searched for both published and unpublished studies.

RESULTS

Nineteen studies were included with 9 randomized controlled trials and 10 quasi-experimental studies. Informational interventions were useful to enhance MHL of less-known disorders such as anxiety disorder and anorexia, but not depression. Interventions that were effective in enhancing depression MHL comprised active component such as videos or quizzes. Interventions that successfully elevated MHL also reduced stigma. Elevated MHL levels did not improve help-seeking, and reduction in stigma levels did not enhance help-seeking behaviours.

CONCLUSIONS

Future good quality, large-scale, multi-sites randomized controlled trials are necessary to evaluate MHL interventions.

Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials

Background

Symptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics.

Material and Methods

A systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995-2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges' g) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3-6 months, 7-12 months, and 13-18 months of post-intervention follow-up.

Results

About 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7-12 months post-intervention (standardized mean difference (Hedges' g) effect size (ES) = -0.28 (95% CI [-0.49, -0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13-18 months (ES = -0.30 (95% CI [-0.51, -0.08])), for anxiety up to 7-12 months (ES = -0.27 (95% CI [-0.54, -0.01])), and for stress up to 3-6 months (ES = -0.30 (95% CI [-0.58, -0.03])). The effects of interventions to enhance positive mental health were sustained up to 3-6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3-6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])).

Discussion

The evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education.

Protocol for the atWork trial: a randomised controlled trial of a workplace intervention targeting subjective health complaints

Background

Subjective health complaints, such as musculoskeletal and mental health complaints, have a high prevalence in the general population, and account for a large proportion of sick leave in Norway. It may be difficult to prevent the occurrence of subjective health complaints, but it may be possible to influence employees’ perception and management of these complaints, which in turn may have impact on sick leave and return to work after sick leave. Long term sick leave has many negative health and social consequences, and it is important to gain knowledge about effective interventions to prevent and reduce long term sick leave.

Methods/Design

This study is a cluster randomised controlled trial to evaluate the effect of the modified atWork intervention, targeting non-specific musculoskeletal complaints and mental health complaints. This intervention will be compared to the original atWork intervention targeting only non-specific musculoskeletal complaints. Kindergartens in Norway are invited to participate in the study and will be randomly assigned to one of the two interventions. Estimated sample size is 100 kindergartens, with a total of approximately 1100 employees. Primary outcome is sick leave at unit level, measured using register data from the Norwegian Labour and Welfare Administration. One kindergarten equals one unit, regardless of number of employees. Secondary outcomes will be measured at the individual level and include coping, health, job satisfaction, social support, and workplace inclusion, collected through questionnaires distributed at baseline and at 12 months follow up. All employees in the included kindergartens are eligible for participating in the survey.

Discussion

The effect evaluation of the modified atWork intervention is a large and comprehensive project, providing evidence-based information on prevention of long-term sick leave, which may be of considerable benefit both from a societal, organisational, and individual perspective.

Trial registration

Clinicaltrials.gov: NCT02396797. Registered March 23th, 2015.

Providing mental health first aid in the workplace: a Delphi consensus study

BACKGROUND

Mental health problems are common in the workplace, but workers affected by such problems are not always well supported by managers and co-workers. Guidelines exist for the public on how to provide mental health first aid, but not specifically on how to tailor one's approach if the person of concern is a co-worker or employee. A Delphi consensus study was carried out to develop guidelines on additional considerations required when offering mental health first aid in a workplace context.

METHODS

A systematic search of websites, books and journal articles was conducted to develop a questionnaire with 246 items containing actions that someone may use to offer mental health first aid to a co-worker or employee. Three panels of experts from English-speaking countries were recruited (23 consumers, 26 managers and 38 workplace mental health professionals), who independently rated the items over three rounds for inclusion in the guidelines.

RESULTS

The retention rate of the expert panellists across the three rounds was 61.7 %. Of the 246 items, 201 items were agreed to be important or very important by at least 80 % of panellists. These 201 endorsed items included actions on how to approach and offer support to a co-worker, and additional considerations where the person assisting is a supervisor or manager, or is assisting in crisis situations such as acute distress.

CONCLUSIONS

The guidelines outline strategies for a worker to use when they are concerned about the mental health of a co-worker or employee. They will be used to inform future tailoring of Mental Health First Aid training when it is delivered in workplace settings and could influence organisational policies and procedures.

Methodological review: quality of randomized controlled trials in health literacy

BACKGROUND

The growing move towards patient-centred care has led to substantial research into improving the health literacy skills of patients and members of the public. Hence, there is a pressing need to assess the methodology used in contemporary randomized controlled trials (RCTs) of interventions directed at health literacy, in particular the quality (risk of bias), and the types of outcomes reported.

METHODS

We conducted a systematic database search for RCTs involving interventions directed at health literacy in adults, published from 2009 to 2014. The Cochrane Risk of Bias tool was used to assess quality of RCT implementation. We also checked the sample size calculation for primary outcomes. Reported evidence of efficacy (statistical significance) was extracted for intervention outcomes in any of three domains of effect: knowledge, behaviour, health status. Demographics of intervention participants were also extracted, including socioeconomic status.

RESULTS

We found areas of methodological strength (good randomization and allocation concealment), but areas of weakness regarding blinding of participants, people delivering the intervention and outcomes assessors. Substantial attrition (losses by monitoring time point) was seen in a third of RCTs, potentially leading to insufficient power to obtain precise estimates of intervention effect on primary outcomes. Most RCTs showed that the health literacy interventions had some beneficial effect on knowledge outcomes, but this was typically for less than 3 months after intervention end. There were far fewer reports of significant improvements in substantive patient-oriented outcomes, such as beneficial effects on behavioural change or health (clinical) status. Most RCTs featured participants from vulnerable populations.

CONCLUSIONS

Our evaluation shows that health literacy trial design, conduct and reporting could be considerably improved, particularly by reducing attrition and obtaining longer follow-up. More meaningful RCTs would also result if health literacy trials were designed with public and patient involvement to focus on clinically important patient-oriented outcomes, rather than just knowledge, behaviour or skills in isolation.

McCann T, Cvetkovski S, F. Jorm A. A multifaceted intervention to improve mental health literacy in employees of a multi-campus university: a cluster randomised trial

Purpose

– The purpose of this study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in staff of a multi-campus university in Australia.

Design/methodology/approach

– In this cluster randomised trial (ACTRN12610001027000), nine campuses were paired, with one of each pair randomly assigned to either intervention or control. Interventions (which were whole-of-campus) included e-mails, posters, campus events, factsheets/booklets and mental health first aid training courses. A monitoring sample of staff were recruited from each campus. Participants had a 20-minute computer-assisted telephone interview at baseline, and at the end of academic years 1 and 2. The interview assessed mental health literacy, help seeking for mental health problems, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. Six campuses were randomised to intervention and three to control and all campuses were included in the analysis.

Findings

– There were no effects on depression and anxiety levels and alcohol use. Recall of intervention elements was greater in the intervention group at the end of the two-year assessment period. Staff in the intervention group showed better recognition of depression, greater knowledge of the National Health and Medical Research Council guidelines for safe levels of drinking and a greater intention to seek help for alcohol misuse from a general practitioner.

Originality/value

– Future interventions should involve more focused interventions that include consideration of working conditions and their influence on mental health, as well as addressing mental illness among employees, regardless of cause.