A Systematic Review of Parent and Caregiver Mental Health Literacy

Assessing mental health literacy in Jordan: a factor analysis and Rasch analysis study

Background

Mental health literacy (MHL) research in Jordan is sparse and validated MHL measures are lacking. The present study validated a Jordanian version of the Mental Health Literacy Scale (MHLS) and examined Jordanian individuals' MHL.

Method

A Google Forms survey was designed, and the link was shared through various Jordanian social media platforms. Factor analysis and Rasch analysis were performed to validate the Jordanian version of the MHLS. Binary logistic regression was performed to assess variables associated with MHL.

Results

The Jordanian MHLS was administered to 974 participants (74.4% females; median age 27 years). The mean MHL score of the participants was 71.1% indicating average literacy levels. The factor analysis indicated that 27 items distributed across four factors had the best model fit. The Rasch analysis confirmed item separation reliability and person reliability. The regression showed a correlation between educational attainment, income, marital status and MHL level. These findings emphasize the role of educational attainment in MHL, pointing to the necessity of integrating mental health education into formal curricula to enhance MHL across all societal levels. Stigma and limited-service availability act as barriers to mental health service and access, which compound the challenge of improving MHL. Targeted educational interventions and policy reforms may help improve MHL, thereby contributing to improving mental health outcomes in Jordan and potentially other similar settings.

Experiences of Help-Seeking for Severe Mental Health Problems in Young Pakistani Women: A Preliminary Qualitative Study

Almost three quarters of mental illnesses start by the age of 25, yet youth (18-25-year-olds) are often underrepresented in U.K. services. This is particularly true for those of ethnic minorities. In this study, we aimed to understand how young Pakistani women and their parents make decisions to seek help for severe mental health problems, and the barriers and facilitators to accessing professional help. Young Pakistani women with experience of severe mental health problems and their parents were recruited from a community sample. Semi-structured interviews were conducted with six young people and two parents. Data were analyzed using reflexive thematic analysis. Pakistani culture and its interplay with British culture strongly influenced the decisions and ability of young Pakistani women and their parents to help-seek, largely through the role of stigma. Low mental health literacy, stigma, and a lack of culturally informed services were identified as the most common barriers to accessing care. These barriers fed into the internalized stigma these young women experienced which, through fear of damaged reputation and personal prejudices, posed further barriers to seeking help. Participants highlighted recommendations for both individual-level (e.g., increased education and awareness) and service-level (e.g., greater choice over care) change to facilitate accessibility of professional help. Young Pakistani women face multiple culturally related challenges to accessing care for severe mental health problems at both the individual- and service-level. Novel suggestions to address these challenges, such as including youth peer support workers in services, may facilitate more inclusive and accessible services.

Continuity of mental disorders in children with chronic physical illness

Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.

Intergenerational Transmission of Mental Health Literacy and Its Mechanism: The Mediating Effect of Parent-Child Relationship and the Moderating Effect of School Mental Health Service

Background

Adolescents' mental health literacy is a topic of growing interest and studies have begun to explore the factors that influence adolescents' mental health literacy. This study investigated the relationship between parents' mental health literacy and adolescents' mental health literacy, as well as the mediating roles of parent-child relationship, and the moderating roles of school mental health service.

Methods

Questionnaires were distributed to adolescents and their parents at two time points with an interval of one month. In the first survey, 835 parents completed a mental health literacy scale and a parent-child relationship scale. In the second, 841 adolescents completed a school mental health service questionnaire and an adolescent mental health literacy assessment questionnaire. A total of 617 paired data points were matched (parents' age: M = 40.47, SD = 5.10; adolescents' age: M = 13.34, SD = 0.99).

Results

Bootstrapping results showed that parents' mental health literacy was positively associated with adolescents' mental health literacy. In addition, parent-child intimacy mediated the relationship between parents' mental health literacy and adolescents' mental health literacy. School mental health service moderated the relationship between parents' mental health literacy and parent-child intimacy and adolescents' mental health literacy.

Conclusion

Intergenerational transmission of mental health literacy from parents to adolescents and its conditions were revealed. These findings provide new insights for the intervention of adolescents' mental health literacy, and may lead future research to investigate the role of parents within the family context, as well as the influence of home-school cooperation on adolescents' mental health literacy.

Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning

Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.

Mental health needs and accessing specialised healthcare in Mexican children with mental disorders: gender- and diagnosis-dependent differences

BACKGROUND

Access describes factors that influence the initial contact or use of services, emphasising both the characteristics of patients and the health resources that influence the use of health services.

AIMS

To compare Mexican boys and girls with mental disorders, with respect to primary diagnosis, symptom onset, and seeking and accessing specialised mental health services (SMHS).

METHOD

Longitudinal data were collected from primary caregiver-reported assessments of 397 child-caretaker dyads (child mean age 12.17 years, range 5-18 years, 63% male) that were obtained in two psychiatric hospitals specialising in child mental healthcare. Student t-tests and χ2-tests were applied to compare boys and girls regarding their diagnosis and variables associated with the seeking of and access to SMHS.

RESULTS

Hyperkinetic disorder was the most prevalent diagnosis in boys, whereas depressive disorder and anxiety disorder were most prevalent in girls. The mean age at symptom onset for boys was 7 years, compared with 10 years for girls. Hyperkinetic disorder had the earliest symptom onset (mean 5.9 years), followed by depressive disorder (mean 9.8 years) and anxiety disorder (mean 12 years). Delayed access to SMHS was associated with initially seeking care from a psychologist, whereas quicker access was associated with affiliation with the (now defunct) Popular Insurance, a programme that served low-income and uninsured individuals.

CONCLUSIONS

Programmes aimed at children's mental health education and early intervention should consider gender- and diagnosis-related differences in symptom onset and trajectory. Access to SMHS might be improved by rapid identification by parents, educators, primary-care physicians and psychologists.

Consumers' longitudinal health information needs and seeking: a scoping review

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

Mediated depictions of mental health, chronic care and literacy: a narrative analysis of Randall's mental health journey in the television series, This is Us

Introduction

Mental health and delivery of care is a global issue, that was only magnified by COVID-19. Over the past 3 years, people's time spent watching television increased, while the way that mental health care was delivered changed. Audiences can gain insight into mental health issues through positive or negative mediated depictions on television. We argue that mental health is a chronic condition and the importance of literacy through different domains is critical for how the characters in media content and audience viewers make sense of mental health.

Method

The current study uses qualitative narrative analysis to examine the narrative probability and fidelity at the intersection of mental health depictions, the chronic care model, and different types of literacy in the award-winning series, This is Us.

Results

Findings reveal that Randall's experiences with mental health (N = 38 episodes) depict moments of narrative coherence and fidelity to varying degrees. We see Randall's experiences align most with the self-management support and community elements of the CCM, but the overall depiction is unbalanced. Randall's literacy level is high, but if inspected on a deeper level, analysis points to differing levels of health and mental health literacy, thus enabling and constraining positive and realistic portrayals of mental health.

Discussion

Implications for mental health as a chronic issue and care delivery through CCM are discussed along with the importance of different types of literacy for audience members who may be struggling with a mental health disorder or trying to navigate the health care system. We offer recommendations for using Randall's narrative as a teaching tool, integrating CCM into clinical visits to help guide delivery of care and understand literacy levels, and finally future work should continue this line of work from an Entertainment-Education perspective.

Mental Health Literacy for Supporting Children: A Systematic Review of Teacher and Parent/Carer Knowledge and Recognition of Mental Health Problems in Childhood

The level of mental health literacy (MHL) in adults who work with or care for children is likely to influence the timeliness and adequacy of support that children receive for mental health problems. The aim of this study was to systematically review the literature on mental health literacy for supporting children (MHLSC, recognition/knowledge) among parents and teachers of school aged children (5 to 12 years old). A systematic search was conducted for quantitative studies published between 2000 and June 2021 using three databases (MEDLINE, PsycINFO and ERIC) and relevant citations reviewed in Scopus. To be included, studies needed to measure at least either 'mental health knowledge' or 'recognition'. Synthesis proceeded according to study design, adult population, child MHP, then MHL outcome. Study quality was assessed using AXIS. 3322 documents were screened, 39 studies met inclusion criteria. 49% of studies examined teachers' knowledge or recognition of ADHD; only five studies reported on parent samples. Synthesis found a nascent field that was disparate in definitions, methods and measures. Little research focussed on knowledge and recognition for internalizing problems, or on parents. Methods used for measuring knowledge/recognition (vignette vs screening) were associated with different outcomes and the quality of studies was most often low to moderate. Adults appear to have good recognition of childhood ADHD but their knowledge of internalizing disorders is less clear. Further research is required to develop standard definitions and validated measures so gaps in MHLSC can be better identified across populations who have a role in supporting children with their mental health.

Polygenic risk, familial liability and stress reactivity in psychosis: an experience sampling study

BACKGROUND

There is evidence for a polygenic contribution to psychosis. One targetable mechanism through which polygenic variation may impact on individuals and interact with the social environment is stress sensitization, characterized by elevated reactivity to minor stressors in daily life. The current study aimed to investigate whether stress reactivity is modified by polygenic risk score for schizophrenia (PRS) in cases with enduring non-affective psychotic disorder, first-degree relatives of cases, and controls.

METHODS

We used the experience sampling method to assess minor stressors, negative affect, positive affect and psychotic experiences in 96 cases, 79 first-degree relatives, i.e. siblings, and 73 controls at wave 3 of the Dutch Genetic Risk and Outcome of Psychosis (GROUP) study. Genome-wide data were collected at baseline to calculate PRS.

RESULTS

We found that associations of momentary stress with psychotic experiences, but not with negative and positive affect, were modified by PRS and group (all pFWE<0.001). In contrast to our hypotheses, siblings with high PRS reported less intense psychotic experiences in response to momentary stress compared to siblings with low PRS. No differences in magnitude of these associations were observed in cases with high v. low level of PRS. By contrast, controls with high PRS showed more intense psychotic experiences in response to stress compared to those with low PRS.

CONCLUSIONS

This tentatively suggests that polygenic risk may operate in different ways than previously assumed and amplify reactivity to stress in unaffected individuals but operate as a resilience factor in relatives by attenuating their stress reactivity.

Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study

Background

The care and treatment management of people with mental health problems has become a prominent global concern in recent years that requires consistent attention. However, the literature suggests that only a small percentage of individuals with mental health problems in Indonesia receive the necessary mental health care. Therefore, it is crucial to explore this gap.

Objective

This study aimed to explore barriers and facilitators that affect access to mental health services among people with mental health disorders in Indonesia.

Methods

The study employed a qualitative descriptive design and focused on individuals with depression, anxiety, or bipolar disorder. Data were collected through in-depth interviews conducted via WhatsApp chat with 90 participants aged 18-32, who were purposively selected from Sumatra, Java, Kalimantan, and Papua Islands in Indonesia between January and June 2022. Thematic analysis was used to analyze the data.

Results

The barriers to accessing mental health services included: 1) uneasy access to mental healthcare facilities, 2) stigma, lack of social support, and delay in receiving proper treatment, and 3) expensive treatment costs without national health insurance membership. Importantly, the facilitators to access mental health services included: 1) national health insurance membership, 2) support from spouse, family, and closest friends and its association with mental health literacy, and 3) self-help.

Conclusion

The widespread distribution of mental health knowledge is recommended among healthcare providers, including public health practitioners and primary care nurses, to enhance their mental health literacy and competencies while rendering services to individuals with mental disorders. Additionally, efforts should be made to educate and promote awareness among caregivers and communities to reduce the stigma faced by those with mental disorders.

An online intervention to promote mental health literacy for psychosis amongst parents of adolescents: A pilot randomized controlled trial

AIM

This study evaluated an online mental health literacy intervention to improve help-seeking for psychosis amongst parents of adolescents.

METHODS

A total of 2496 parents of first-grade junior high school students, recruited from a Japan-based survey company, participated in a randomized controlled trial in July 2016; participants were randomly allocated to the intervention (n = 1248) or control group (n = 1248). They were assessed at baseline and one-week post intervention. The intervention group received a 30-minute online educational programme that included a narrative of the mother of an adolescent with psychosis.

RESULTS

There were no between-group differences in changes in the rate of 'no help-seeking' in any hypothetical situations of a child's psychosis and prodromal symptoms.

CONCLUSIONS

The intervention might have been suboptimal to improve mental health literacy for psychosis amongst parents of adolescents. A narrative message from a service user may be helpful to encourage parents in help-seeking.

Predictors of Mental Health Literacy among Parents, Guardians, and Teachers of Adolescents in West Malaysia

Parents, guardians, and teachers are the informal sources of mental health support that adolescents rely on. Nevertheless, limited mental health knowledge limits their ability and confidence in providing appropriate assistance. This study aims to (1) evaluate the relationship between the roles of parents/guardians and teachers and their responses to discover the common misconceptions on mental health among those providing informal support to adolescents and (2) determine which demographic factors would act as the strongest predictor influencing their mental health literacy (MHL) status. The cross-sectional study recruited 867 parents, guardians, and teachers of adolescents from 24 government secondary schools' parent-teacher associations via multistage stratified random sampling. Parents, guardians, and teachers' MHL were evaluated using the Mental Health Knowledge Schedule-Malay Version (MAKS-M). The collected data were analyzed using Pearson's Chi-squared test to investigate the association between the respondents' roles and responses. Multiple Regression analysis was used to determine the predictors of MHL. The score of MAKS-M for the current study sample is 73.03% (M = 43.82, SD = 4.07). Most respondents responded incorrectly on Items 1 (employment), 6 (help-seeking), 8 (stress), and 12 (grief). Teachers provided more favorable responses on several items than parents and guardians. Finally, younger age, higher income, knowing someone with mental disorders, and having experience of attending formal training on mental health first aid were the significant predictors of MHL. MHL interventions in Malaysia should cater to older adults of lower socioeconomic status and lesser experience in mental health, specifically highlighting the stigmas on mental health help-seeking behaviors, treatment, and employment concerns, plus the recognition of various mental health diagnoses.

Parental Stressors in Sports Influenced by Attributes of Parents and Their Children

(1) Background: Although parental behavior is known to be an important source of influence, relatively few studies have examined the factors possibly contributing parental stressors as being directly related to their children’s sport socialization. The present study explored the relative importance of related parental stressors and the associations between these stressors and various types of parental involvement. (2) Method: A total of 1260 parents completed an online form including demographic questions, questions on their children’s sport participation, and three self-report measures (PSSS, PISQ, and PASSES). (3) Results: The results revealed that the multiple linear regression models for overall parental stress were statistically significant. The significant predictors were the parent’s educational level, the child’s current stage of sports participation, and the child’s sport injury (or the lack thereof). Furthermore, the stressors perceived by parents were positively associated with parental direct behavior and pressure. (4) Conclusions: Parents are under more stress as their child’s stages of sport development increases, if their child has already had a sports injury, and the parents’ directive behavior and experienced stress were significantly associated. The obtained results expand the existing knowledge of the complexity of parents’ importance in children’s sports careers.

The Effect of Digital Health Interventions on Parents' Mental Health Literacy and Help Seeking for Their Child's Mental Health Problem: Systematic Review

Background

Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear.

Objective

This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes.

Methods

Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction.

Results

Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature.

Conclusions

There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074

Caregiver Perceptions of Mental Health and Barriers to and Facilitators of Their Child's Treatment

OBJECTIVES

Nearly 1 million children visit emergency departments (EDs) annually for mental health crises. Caregivers play a critical role in the outcome of mental illness in their children, yet there is limited research on effective means to engage caregivers in the ED and provide the support they need. Our aim was to determine caregivers' perceptions about mental illness in their children, specifically regarding suicidality and depression, the impact of the children's mental health on the caregiver, and barriers to and facilitators of treatment.

METHODS

Guided by qualitative descriptive methodology, we conducted semistructured, open-ended interviews with a purposive sample of English-speaking primary caregivers of children 6 to 17 years old who presented with suicidal ideations or behaviors to 1 urban pediatric ED. Interviews were recorded and transcribed verbatim, and conventional content analysis was performed.

RESULTS

The participants (n = 20) were largely single ethnic-racial minority mothers. Content analysis identified 6 categories: caregivers' definitions of mental health, depression, and suicidality; perceived causes of mental illness; difficulty in identification of mental illness; the influence of the mental illness on caregivers; a complex network of communication among involved parties that resulted in the child's ED visit, as well as barriers to and facilitators of treatment.

CONCLUSIONS

We identified several categories that encapsulate caregivers' perceptions of mental health and mental illness in their children and its effect on them. Future research should explore how inner-city EDs might partner with schools and trusted community-based organizations to enhance caregiver knowledge, reduce obstacles to care, increase screening for at-risk youth and implement strategies to optimize outcomes for children with depression and suicidal ideations.

Family Conundrums with Psychiatric Medication: An Inquiry into Experiences, Beliefs, and Desires

Research with families of people with serious mental illness consistently shows that the concerns and conundrums about their loved one's medication are among those most centrally voiced. The inquiry here relied on an anonymous cross-sectional survey of attitudes, beliefs, and experiences of family members (N = 339) specifically related to psychiatric medication use. A latent profile analysis yielded two categories of respondents: those "skeptical of the medical model," which represented 43% of the survey respondents, and those "supportive of the medical model," which represented 57% of the survey respondents. Data from open-ended questions suggests families crave inclusion and wish providers would more radically embrace both collaboration and balance in their approach to medication maintenance. The hope of this research is to help mental health providers be more responsive and compassionate in their work with families of people with serious mental illness, especially as it relates to psychiatric medication.

Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review

INTRODUCTION

Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents.

METHODS

PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies.

RESULTS

Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others.

CONCLUSIONS

A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.

A Systematic Review of Help-Seeking Interventions for Parents of Adolescents

PURPOSE

Parents do not always seek timely help for adolescents when the need arises. Although interventions to increase parental help-seeking have been evaluated and published, no systematic review of these interventions has been conducted. The aim of this systematic review is to collate, synthesise, and evaluate research on help-seeking interventions for parents of adolescents.

METHODS

Six electronic databases were searched from inception to May 2020 using terms related to the concepts of "parent" and "help-seeking" and focusing on parents of adolescents (aged 10-19 years). Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies; the Behavioural Change Taxonomy was used to code behavioral change techniques, and "promising interventions" were identified using pre-established criteria.

RESULTS

Eighteen studies met inclusion criteria, with six rated strong for design and methodology. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as "promising" because of strong methodology, significant positive outcomes, and strong evidence-base.

CONCLUSIONS

More high-quality, theory-driven parental help-seeking interventions using common outcome measures are needed to advance the literature in this area. Future research should replicate the promising interventions identified to develop best practice guidelines.

Do Parental Education-Related Inequality Matter in Child and Adolescent Utilization of Mental Health Services: Results From a Norwegian Register Linkage Study

Equitable access to health care point to equal access to care for those with equal needs, but pro-rich and pro-educated inequities have been documented in specialized mental health care utilization. This study aimed to investigate equity in Norwegian adolescents’ use of child and adolescent mental health services (CAMHS) with regards to parental education levels, using a survey of 10 257 Norwegian 16- to 19-year-olds subsequently linked to CAMHS data from the Norwegian Patient Registry (n = 970 had been in contact with CAMHS). Analyses using concentration indices (C) suggested adolescents with parents with lower education levels had more mental health problems (ie, larger need; C = −0.032, P < .001) and were more in contact with CAMHS (C = −0.025, P < .001). Regression analysis suggested that CAMHS contact, and number of unique admissions was largely distributed according to need, but participants whose parents had basic education levels were in contact with CAMHS for slightly longer than predicted from their self-reported mental health problems, age, and sex. Results from this study suggested that contact with CAMHS was largely equitable and mostly influenced by need. There was little evidence of parental education-related inequity in access to, and use of, specialized mental health services.

Mental Health Literacy: a Critical Target for Narrowing Racial Disparities in Behavioral Health

One of the most persistent and troubling health disparities is the underutilization of mental health services, particularly for depression and anxiety, commonly occurring behavioral health concerns. The gap between individuals who need mental health care and those who receive care is large, and identified barriers to treatment include poor mental health and insurance literacy, as well as stigmatizing attitudes toward mental health disorders. The present study presents the results of an inquiry into the mental health literacy, insurance literacy, internalized stigma, and mental health symptoms. Results suggest that mental health literacy is poor and associated with higher rates of depression, anxiety, stress, internalized stigma, and caregiver burden. Implications of poor mental health literacy, as well as demographic disparities in literacy, are discussed.

Mental Health Literacy in Zurich: A First Measurement Attempt Using the General HLS-EU-Q47

Background: Mental health literacy (MHL) promises to be an important factor for public health by enabling people to take responsibility for their own mental health. To date, there is no measurement tool that allows the assessment of a comprehensive understanding of MHL as part of health literacy (HL). Nonetheless, the widely used Health Literacy Survey European Questionnaire 47 (HLS-EU-Q47) includes items assessing at least some MHL-aspects in the context of HL. The present study aimed at investigating how these MHL-aspects are related to HL, health behavior and health outcome and how they differ between sociodemographic groups.

Methods: Data from the Health Literacy Survey Zurich 2018, collected by an adapted version of the HLS-EU-Q47, served to investigate these relationships.

Results: MHL-aspects were related to HL, health behavior and health outcome. Nearly half of all respondents (45%; N = 904) showed low MHL levels, particularly those with higher age and higher financial deprivation.

Conclusions: Relations of MHL-aspects with HL, health behavior, and health outcome indicate their potential importance for future interventions in public health, addressing mental health and MHL. A specific MHL tool is needed to comprehensively investigate these relations, which could be developed by extending the present measurement approach.

The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial

Background

Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments.

Method

Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT.

Discussion

This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments.

Trial registration

This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00213-x.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.

eMental Health Literacy and Knowledge of Common Child Mental Health Disorders among Parents of Preschoolers

The purpose of the study was to assess the eMental health literacy of parents of preschool children and explore the relationships between their eMental health literacy skills and their knowledge of common child mental health disorders and their child difficulties. Online survey data were collected using Mechanical Turk (MTurk). Parents of preschool children completed questionnaires related to internet-based mental health information seeking behavior, knowledge of common child mental health disorders using case vignettes, and child difficulties. Data were analyzed using descriptive statistical methods. eMental health literacy of parents was high but knowledge of the child mental health disorders was low. Only 14% of parents correctly identified all three disorders; 41.1% identified attention deficit hyperactivity disorder (ADHD), 64.9% recognized autism spectrum disorder (ASD), and 19.1% identified separation anxiety disorder (SAD). Parents with high eMental health literacy (≥30) were more likely to endorse professional help and seek information on how to manage problem behaviors for all three disorders. Parents with low eMental health literacy (<30) were more likely to have a child with a high risk of a mental health disorder. The findings will be used to inform educational initiatives on the use of online resources and recognition of child mental health disorders to promote early intervention and appropriate help seeking.