Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial

Effectiveness of a mental health literacy module on stigma related mental health knowledge and behaviour among youth in two educational settings in Chennai, South India: A quasi-experimental study

BACKGROUND

Improving mental health literacy (MHL) can reduce stigma towards mental illness, decreasing delays in help-seeking for mental disorders such as psychosis. We aimed to develop and assess the impact of an interactive MHL intervention on stigma related mental health knowledge and behaviour (SRMHKB) among youth in two urban colleges in South India.

METHODS

Incorporating input from stakeholders (students, teachers, and mental health professionals), we developed a mental health literacy module to address SRMHKB. The module was delivered as an interactive session lasting 90 min. We recruited 600 (300 males; 300 females; mean age 19.6) participants from two city colleges in Chennai from Jan-Dec 2019 to test the MHL module. We assessed SRMHKB before the delivery of the MHL intervention, immediately after, and at 3 and 6 months after the intervention using the Mental Health Knowledge Schedule (MAKS) and Reported and Intended Behaviour Scale (RIBS). We used generalised estimating equations (GEE) to assess the impact of the intervention over time.

RESULTS

Compared to baseline, there was a statistically significant increase in stigma related knowledge and behaviour immediately after the intervention (coefficient=3.8; 95% CI: 3.5,4.1) and during the 3-month (coefficient=3.4; 95% CI: 3.0,3.7) and 6-month (coefficient=2.4; 95% CI: 2.0,2.7) follow-up.

CONCLUSION

Preliminary findings suggest that a single 90-minute MHL interactive session could lead to improvements in SRMHKB among youth in India. Future research might utilise randomised controlled trials to corroborate findings, and explore how improvements can be sustained over the longer-term.

A Pilot Evaluation of the Respect You Curriculum

BACKGROUND

The objective of this study is to evaluate the Respect YOU program's impact on students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. A total of 444 (intervention cohort n = 348, control cohort n = 96) underclassmen enrolled in health or physical education courses from 7 high schools in the Midwest participated in the study.

METHODS

A repeated measure research design was utilized to assess students' eating expectancies, body image satisfaction levels, self-efficacy, and knowledge. More specifically, paired t-tests were conducted to compare outcome measurements to evaluate the efficacy of the intervention.

RESULTS

Among the students who received the intervention (n = 348), there was a statistically significant change in scores for eating expectancies (Z = -14.403, p < .001), body image satisfaction levels (Z = -14.114, p < .001), social media self-efficacy (Z = 14.868, p < .001), and knowledge scales (Z = -16.100, p < .001) at post-intervention and compared to the control group.

CONCLUSIONS

Results indicate that the Respect YOU program was effective in improving body image scores, eating expectancies, self-esteem, and knowledge-related outcomes among students post-intervention. These results can be used to further develop educational programming to address body image concerns and disordered eating among adolescents.

Qualitative Evaluation of the Impact of a School Mental Health Literacy Curriculum on Student-Teacher Relationships

Mental health literacy (MHL) programs, which aim to improve knowledge, reduce stigma and promote help-seeking behavior, are a promising approach to meeting the growing mental and behavioral health needs of youth. This study aimed to understand the relational impacts of a MHL curriculum on students and teachers. A MHL curriculum was delivered in middle school classrooms across 11 schools in two diverse school districts in the Mid-Atlantic and Southeast regions. Fifteen teachers and counselors who delivered the MHL curriculum participated in focus groups to describe their experiences using the curriculum and perceptions of its impact. Qualitative focus group data were analyzed via team-based inductive thematic analysis following a grounded theory approach. Findings indicate that educators perceived the universal school MHL program to have a positive impact on relationships amongst students and between students and teachers. Participants reported that the MHL curriculum helped to open conversations about mental health and related topics by developing common language and providing an opportunity to model vulnerability. Having these conversations improved classroom rapport and helped teachers develop deeper connections with students. As a result, teachers and students achieved greater empathy and students advocated more for themselves and their peers. Implications for integrating MHL programs into multi-tiered frameworks in schools to expand access to mental health supports are discussed.

The predictors of mental health literacy among adolescents students

AIM

This study aimed to examine levels of mental health literacy (MHL) and associated factors among adolescents.

METHODS

A descriptive, cross-sectional, analytical study was conducted with a total of 650 students aged 11-18 years in three middle and three high schools. Data were collected using the Child and Adolescent Mental Health Literacy Scale and evaluated using descriptive statistics and regression analysis to determine whether age, gender, and grade are predictive factors of MHL.

RESULTS

The mean age of the participants in the study was 16.8 ± 1.35 years, 55 % of the students were girls, and the mean MHL score was 3.96 ± 1.2, indicating moderate MHL. Multiple regression analysis indicated that the variables of age, gender, and grade explained 5.5 % of the variance in MHL score. When these variables were examined individually, gender and grade had no significant effect (p > 0.05), while older age was associated with higher MHL score (p < 0.05).

CONCLUSION

The results of this study showed that MHL improved with age. MHL promotion is important in mental health resilience. Collaboration between school nurses, school counselors, and psychiatric nurses to provide mental health educational interventions may help reduce stigma and increase help-seeking behaviors.

Assessing the efficacy of the 'Bicho De 7 Cabeças' B-learning school-based program in enhancing mental health literacy and reducing stigma

The prevalence of mental disorders in adolescents has a considerable impact on daily life, restricting tasks and diminishing overall quality of life while potentially leading to stigmatization. This study aims to measure the impact of a mental health literacy intervention program, called "Bicho de 7 Cabeças" project, in b-learning format, on the increase of knowledge and the decrease of stigma in young people from Póvoa de Varzim, in Portugal. A quasi-experimental study was conducted, from November 2022 to May 2023, involving an experimental group ("Bicho de 7 Cabeças" protocol) and an active control group (informational brochures), utilizing a pre-test/post-test design. Mental Health Literacy Measure-MHLM, Mental Health Promoting Knowledge Scale-MHPK-10, Mental Illness Knowledge Schedule-MAKS, Reported and Intended Behaviour Scale-RIBS, and Community Attitudes toward People with Mental Illness-CAMI were used. A total of 504 young students from the 9th grade enroll in this study, with a mean age around 14 years old. There is a significant difference between stigma (p <.001) and knowledge (p <.001) scores at baseline and follow-up. The results of this study shows that interventions aimed at young people for the promotion of mental health literacy and stigma reduction are needed and more initiatives should be implemented in schools to address these problems.

'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom

PURPOSE

This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK).

METHODS

Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions.

RESULTS

The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group.

CONCLUSION

By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

The Role of Interpersonal Communication in Mental Health Literacy Interventions for Young People: A Theoretical Review

School-based mental health literacy (MHL) programs can increase knowledge, reduce stigma, and encourage help-seeking behaviors in school-aged children. Yet, MHL intervention effects are inconsistent and unsustainable over time, and scholars have called for more theoretical work to address these limitations. The purpose of this theoretical review is to investigate how theory is utilized in MHL interventions, explore the interpersonal communication processes integrated in MHL interventions, and uncover the theoretical assumptions made in MHL interventions about interpersonal communication. We identified 27 articles for inclusion and utilized both content and interpretive analyses. Findings suggest that very few MHL interventions are based in theory; interpersonal communication is a central component within MHL programming; and numerous assumptions are made about interpersonal communication within MHL interventions that need to be addressed theoretically and empirically. Accordingly, we recommend that MHL intervention content and delivery practices are grounded in interpersonal communication theory related to disclosure and social support (seeking and provision). Additionally, teaching disclosure and social support skills may be a productive way for MHL interventions to help students build self-efficacy in communication about mental health for themselves and others.

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

Mental health, study skills, social support, and barriers to seeking psychological help among university students: a call for mental health support in higher education

Introduction

Poor mental health among youths is a complex worldwide issue. Many countries with medium-to-low levels of development, particularly those in Southern Europe, have not introduced appropriate mental health and educational strategies to identify the key factors influencing wellbeing, promote psychological wellbeing, and prevent poor mental health among youths. In response to these trends, we sought to uncover insights for developing interventions for youth mental wellbeing. We assessed mental health, study skills, barriers to seeking psychological help, and perceived social support among Kosovar university students, and investigated their experiences with professional mental health services and their needs and perceptions regarding the importance of professional mental health services on campus.

Methods

The study used a parallel mixed-methods design. Participants included 234 university students. Quantitative data were gathered through validated questionnaires, including the Depression, Anxiety, and Stress Scale, Multidimensional Scale of Perceived Social Support, Academic Anxiety Scale, Study Skills Assessment Questionnaire, and the Barriers to Seeking Psychological Help Scale. Qualitative data on the students' experiences with mental health services and their perceptions regarding the importance of professional university mental health services were explored through open-ended questions.

Results

Most students experienced anxiety and depression, more than half were stressed, and most reported poor or moderate study skills. Lack of trust in mental health professionals was a major barrier to seeking psychological help, followed by difficulties in self-disclosure. Perceived social support and academic anxiety were significant predictors of barriers to seeking psychological help. The participants believed that mental health and academic support from the university would help improve their mental wellbeing, study skills, self-esteem, self-perception, and attitudes toward social support; raise awareness regarding mental health; and help them overcome personal and academic challenges.

Discussion

Our findings highlight the need for more comprehensive and accessible mental health services on campuses. By providing adequate support and resources to address various personal and academic factors that contribute to mental health issues in university students, universities can enhance students' academic success and personal growth.

Evaluating the effect of an adapted mental health literacy intervention on mental health related stigma among secondary students in Germany: results of a pre-post evaluation study

BACKGROUND

Most mental health problems develop during youth, with about three quarter emerging before age 25. In adolescence, stigmatizing attitudes related to mental illness become more nuanced and consolidate into one's belief system. As the stigma of mental illness is still one of the leading barriers to help-seeking, intervention measures should explicitly address it before it becomes entrenched over time. Preventive measures, for example, based on promoting mental health literacy (MHL), can be used to address and tackle stigmatizing attitudes. The Canadian MHL-based intervention "the Guide" was translated and adapted for the use in German schools. The present study evaluates the effect of the German version of the Guide on attitudes towards mental illness among students in Germany.

METHODS

The first-time application of the Guide (German version) was evaluated with a pre-post-evaluation study with an intervention and a control group. The evaluation data of 188 students (intervention group n = 106, control group n = 82) were statistically analyzed focusing on the outcomes social stigma, social distance, and self-stigma.

RESULTS

The analysis showed that participants do not tend to hold stigmatizing attitudes even before the intervention. Nevertheless, the intervention was effective in reducing social stigma, but not in reducing social distance and self-stigma. Neither gender, pre-existing experience with mental illness, nor the delivery modality of the contact element within the intervention (speaker vs. video) seemed to influence the outcomes.

CONCLUSIONS

The German version of the MHL-based intervention, the Guide, seems to be a suitable intervention to improve attitudes towards mental illness among students in Germany. More extensive research is necessary to confirm the findings and further explore factors that influence the program's effects on attitudes short- and long-term.

Effectiveness of an online mental health strengthening module to build resilience and overcome stress for transitional aged medical students

Introduction

Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience.

Methods

A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week.

Results

Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference (P < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups.

Conclusion

The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability.

Mental illness stigma in Bangladesh: Findings from a cross-sectional survey

Background

Mental illness stigma is universally prevalent and a significant barrier to achieving global mental health goals. Mental illness stigma in Bangladesh has gained little attention despite its widespread impact on seeking mental health care in rural and urban areas. This study aimed to investigate mental illness stigma and the associated factors in rural and urban areas of Bangladesh.

Methods

The study areas were divided into several clusters from which 325 participants (≥18 years) were recruited with systematic random sampling. The Bangla version of the Days' Mental Illness Stigma Scale was used to collect data. Independent-samples t-test, ANOVA, and multiple regression were performed.

Results

Results suggest that gender, age, geographical location, socioeconomic status, and occupation significantly differed across subscales of stigma. Age, gender, seeking treatment of mental illness, having knowledge on mental health, and socioeconomic status were predictive factors of mental illness stigma. The results also showed a high treatment gap in both rural and urban areas.

Conclusion

This study supports that mental illness stigma is prevalent in Bangladesh, requiring coordinated efforts. Results can inform the development of contextually tailored mental health strategies to reduce stigma and contribute to the promotion of mental health of individuals and communities across Bangladesh.

Child and youth mental health and wellbeing before and after returning to in-person learning in secondary schools in the context of COVID-19

Background

As children reintegrate with in-person classroom learning after COVID-19, health and education institutions should remain mindful of students' mental health. There is a paucity of data on changes in students' mental health before, during and after their return to in-person classroom learning.

Methods

We collected and analyzed data on self-reported wellbeing, general mental health, perceived stress, and help-seeking attitudes from grade 7-12 students in a Catholic school division in Canada (n = 258 at baseline; n = 132 at follow-up). Outcomes were compared according to demographic differences such as gender, grade level, experience accessing mental health services, and presence of support staff between baseline and follow-up. Effects of time points and each demographic variable on each outcome and on the prediction of students' mental health were also analyzed.

Results

No significant differences were apparent for outcomes between baseline and follow-up. However, specific subgroups: junior high students, male students, students who had not accessed mental health services, and students who had access to support-staff had better outcomes than their counterparts. From baseline to follow-up, male students reported mental health decline [Mean = 11.79, SD = 6.14; Mean = 16.29, SD = 7.47, F(1, 333) = 8.36, p < 0.01]; students who had not accessed mental health services demonstrated greater stress [Mean = 20.89, SD = 4.09; Mean = 22.28, SD = 2.24, F(1, 352) = 6.20, p < 0.05]; students who did not specify a binary gender reported improved general mental health [Mean = 19.87, SD = 5.89; Mean = 13.00, SD = 7.40, F(1, 333) = 8.70, p < 0.01], and students who did not have access to support-staff improved help-seeking attitudes [Mean = 22.32, SD = 4.62; Mean = 24.76, SD = 4.81; F(1, 346) = 5.80, p < 0.05]. At each time point, students indicated parents, guardians, and close friends as their most-preferred help-seeking sources. High stress predicted lower wellbeing at baseline, but higher wellbeing at follow-up.

Conclusion

Students presented stable mental health. Subgroups with decreased mental health may benefit from extra mental health support through building capacity among teachers and health care professionals to support students following public health emergencies.

The effects of an adapted mental health literacy curriculum for secondary school students in Germany on mental health knowledge and help-seeking efficacy: results of a quasi-experimental pre-post evaluation study

Background

Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention's effects on mental health knowledge and help-seeking efficacy among 10th grade students in Germany.

Methods

10th grade students (aged 14-17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention's effects.

Results

Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574, p < 0.001, partial η2 = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311, p < 0.001, partial η2 = 0.09).

Conclusion

The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.

The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: A systematic review and meta-analysis

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people's help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10-19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions.

Mental health knowledge and classroom experiences of school teachers in Aragon, Spain

Background

Research shows that many mental disorders begin in childhood but are sometimes not diagnosed until later years. School-age children spend much of their time in schools and have daily interactions with school teachers.

Aim

Examine school teachers' experiences of mental disorders in school going children and adolescents and their associated mental health training needs.

Method and sample

A descriptive cross-sectional study was carried out with teachers in Infant-Primary and Secondary Education-Baccalaureate schools.

Results

A convenience sample of 685 teachers responded to the online survey. Participants worked in both urban and rural areas and in Infant-Primary and Secondary Education-Baccalaureate schools. Over half of participants reported classroom experiences of learner mental disorders such as ADHD, anxiety, conduct disorders or autism. Most participants acknowledged a training need, both in recognition of symptoms of mental disorders and in care resources and processes. However, 80% of respondents reported having not received any training in this regard. Participant preferences for training included face-to-face or hybrid - combined online learning. Participants also considered the management of their own mental health to be deficient, therefore any training should incorporate personal mental health awareness and self-help strategies.

Conclusion

In Aragón (Spain), teachers of children and adolescents with mental disorders, recognize a need for training in the identification of symptoms and other aspects of mental healthcare, such as availability and access to services. Protocols for early identification and referral would promote mentally healthy school environments and reduce stigma which could be a barrier to timely intervention. In addition, any training should include mental health self-care for teachers.

A randomised controlled trial evaluating the Guide Cymru mental health literacy intervention programme in year 9 (age 13-14) school pupils in Wales

BACKGROUND

Adolescent mental health has become a public health concern as 10-20% of adolescents have experiences with mental health problems. Improving mental health education is critical to reducing stigma and improving access to appropriate care when needed. Here we examine the impact of a mental health literacy programme (Guide Cymru) in young adolescents in the UK. A randomised controlled trial assessed the effectiveness of the Guide Cymru intervention.

METHOD

A total of 1,926 pupils (860 males and 1066 females) aged 13-14 (year 9) took part in the study. The secondary schools were randomised into the active and control arms of the study. Teachers in the active arm of the study were trained on the Guide Cymru and then delivered the intervention to their pupils. Pupils in the active groups received six modules of mental health literacy (the Guide Cymru), and control schools received teaching as usual. Mental health literacy across several domains (e.g., knowledge, stigma, help-seeking intentions) were assessed both before and after the intervention. Data collection for the randomised controlled trial ran from September 2019 to March 2020. Multi-level modelling analysis was conducted to account for the clustered nature of the design.

RESULTS

All aspects of mental health literacy, including mental health knowledge (g = 0.32), good mental health behaviours (g = 0.22), mental health stigmas (g = 0.16), intentions to seek help (g = 0.15), and avoidant coping (g = 0.14) improved after completing the Guide Cymru programme (ps < .001).

DISCUSSION

The current study presents evidence for the Guide Cymru's effectiveness in improving secondary school pupils' mental health literacy. We demonstrate that providing teachers with appropriate resources and training to deliver the Guide Cymru programme within their classrooms can improve the mental health literacy of pupils. These findings have important implications for the beneficial impacts the secondary school system can have on reducing the burden of mental health problems at a critical point in a young person's life.

TRIAL REGISTRATION

ISRCTN15462041. Registered 03/10/2019.

Just-word beliefs and community-level abortion stigma: An exploratory survey

OBJECTIVES

This study aimed to evaluate whether belief in a just world is associated with community-level abortion stigma.

STUDY DESIGN

From December 2020 to June 2021, we conducted a national U.S. survey of 911 adults using Amazon Mechanical Turk. Survey respondents completed both the Community-Level Abortion Stigma Scale and Global Belief in a Just World Scale. We used linear regression to evaluate the association between just-world beliefs, demographic characteristics, and community-level abortion stigma.

RESULTS

The mean Global Belief in a Just World Scale score was 25.8. The mean Community-Level Abortion Stigma Scale score was 2.6. The strength of just-world beliefs (β = 0.7), male gender (β = 4.1), a history of a previous pregnancy (β = 3.1), post college education (β = 2.8), and strength of religious beliefs (β = 0.3) were associated with higher community-level abortion stigma. Asian race was associated with lower community-level abortion stigma (β = -7.2).

CONCLUSIONS

After controlling for demographic characteristics, strong just-world beliefs were associated with higher community-level abortion stigma.

IMPLICATIONS

Understanding just-world beliefs may provide a potential target for stigma-reduction strategies.

A vignette study of mental health literacy for binge-eating disorder in a self-selected community sample

BACKGROUND

Mental health literacy has implications for mental disorder recognition, help-seeking, and stigma reduction. Research on binge-eating disorder mental health literacy (BED MHL) is limited. To address this gap, our study examined BED MHL in a community sample.

METHOD

Two hundred and thirty-five participants completed an online survey. Participants read a vignette depicting a female character with BED then completed a questionnaire to assess five components of BED MHL (problem recognition, perceived causes, beliefs about treatment, expected helpfulness of interventions, and expected prognosis).

RESULTS

About half of participants correctly identified BED as the character's main problem (58.7%). The most frequently selected cause of the problem was psychological factors (46.8%) and a majority indicated that the character should seek professional help (91.9%). When provided a list of possible interventions, participants endorsed psychologist the most (77.9%).

CONCLUSIONS

Compared to previous studies, our findings suggest that current BED MHL among members of the public is better, but further improvements are needed. Initiatives to increase knowledge and awareness about the symptoms, causes, and treatments for BED may improve symptom recognition, help-seeking, and reduce stigma.

Developmentally appropriate mental health literacy content for school-aged children and adolescents

Although improving the mental health of children and adolescents has become a global priority, resources outlining developmentally appropriate content for improving mental health literacy (MHL) across school-aged children are scarce. A comprehensive, life-course approach to building MHL is needed to address the evolving competencies, needs, capacities, and risk factors for mental health, especially to establish school-based interventions that can be equitably and sustainably implemented. We conducted a theoretical review highlighting the relation of research and practice in building MHL through developmentally appropriate knowledge and competencies for children and adolescents. A two-pronged review of the literature was conducted to provide an overview of (1) research with a focus on neurobiological, psychological, cognitive, and social developmental milestones of school-aged children relevant for building MHL and (2) evidence-based and theory-driven content for the development of universal MHL interventions for children and adolescents considering the four components of MHL. A map of relevant key milestones highlights the range of development that occurs and ample opportunity for increasing universal MHL during these sensitive years primed for learning. We reflect on current understandings and global considerations for MHL interventions with an emphasis on applying developmental science to the future strengthening of intervention development, uptake, adaptation, implementation, evaluation, and scale-up.

Research on the Effect of Evidence-Based Intervention on Improving Students' Mental Health Literacy Led by Ordinary Teachers: A Meta-Analysis

BACKGROUND

the purpose of this study was to systematically review the effects of intervention experiments led by ordinary teachers to improve students' mental health literacy and to provide evidence-based research and new ideas for improving students' mental health literacy.

METHODS

A systematic search using 5 English (Web of Science, PubMed, ProQuest, EBSCO, Springer Link) and 3 Chinese (CNKI, WanFang, and VIP) databases was initiated to identify controlled trials assessing the immediate effect and delay effect of the intervention experiment led by ordinary teachers on improving students' mental health knowledge, anti-stigma, willingness, or behavior to seek-help.

RESULTS

a total of 14 experiments with 7873 subjects were included. The results showed that the immediate effect of the intervention on promoting students' mental health knowledge [g = 0.622, 95% CI (0.395, 0.849)] and anti-stigma [g = 0.262, 95% CI (0.170, 0.354)] was significant, but the amount of delay effect is not significant.

CONCLUSIONS

the results of this review show that ordinary classroom teachers can effectively participate in projects to improve students' mental health literacy, significantly improve students' mental health knowledge and attitudes towards psychological problems, and make up for the shortage of full-time mental health teachers in schools. In future, more attention should be paid to students' mental health literacy, and evidence-based intervention research should be strengthened. Furthermore, we can improve students' mental health literacy and avoid poor mental health by addressing delays in early intervention, as well as improve experimental design, prolong the intervention time, and improve the effectiveness of the intervention.

Assessment of health sciences academic advisors' mental health literacy and their experiences with students facing mental health problems

BACKGROUND

Owing to everyday educational activities, academic advisors often have to deal with mental health problems among students. Therefore, their mental health literacy must be assessed to determine whether they can detect mental health problems when working with the students.

OBJECTIVE

This study aimed to assess health sciences academic advisors' mental health literacy and their experiences dealing with university students facing mental health challenges.

METHODS

A cross-sectional descriptive study was undertaken among a convenience sample of 133 health sciences academic advisors at the medical campus of a public university in Jeddah, Saudi Arabia. An electronic self-administered questionnaire using the Mental Health Literacy Scale (MHLS) was used to appraise participants' recognition, knowledge, and attitudes toward ways to solve mental health difficulties. Data collection was completed from November 2020 to February 2021. Descriptive statistics, Student's t-test for independent samples, One-Way Analysis of Variance (ANOVA), and Tukey's test were selected for data analysis.

RESULTS

Academic advisors were found to be highly literate about matters of mental health. The mean mental health literacy score was statistically significantly higher in those advisors who were lecturers, assistant professors, associate professors, and professors (p <0.001). Additionally, the mean scores were significantly higher among advisors with a teaching role of lecturer rather than those who did not have the teaching role of a clinical supervisor (t = -2.331; p = 0.021).

CONCLUSIONS

The academic advisors had an elevated level of mental health literacy, and the highly experienced academic advisors could deal better with students having mental health problems. Hence, it is essential to continue to provide educational programs and training on mental health literacy to academic advisors, as it helps them identify the signs of mental health complications. Furthermore, it improves their skills and confidence when they offer student support in coping with mental health issues.

The effectiveness of a "EspaiJove.net"- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial

BACKGROUND

The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention "EspaiJove.net" in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity.  METHODS: A clustered school-based randomised controlled trial (cRCT) design.

SUBJECTS

1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018.

INTERVENTION

Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list.

OUTCOME MEASURES

1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ.

ANALYSIS

The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling.

RESULTS

One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p < 0.005).

CONCLUSIONS

The three interventions of the EspaiJove.net programme (SP, MHL and MHL + SR) seem not to be effective in terms MHL, Stigma and help-seeking behaviours. The contact with a person who has experimented mental illness first-hand did not reduce stigma attitudes. Further research should deal with the heterogeneity of MHL interventions (concept, duration and measures) and identify which components of stigma interventions are effective.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03215654 (registration date 12 July 2017).

The effectiveness of psychoeducation in improving attitudes towards psychological disorders and internalized stigma in the family members of bipolar patients: A quasi‐experimental study

Family members of bipolar patients experience stigma following being labeled by others, which can disrupt their routine lives and result in social isolation. This study aims to evaluate the effectiveness of psychoeducation in improving the attitudes of bipolar patients' family members towards psychological disorders and internalized stigma. The present study is a quasi-experimental study with a pre- and post-test follow-up design, in which 74 individuals were selected by convenience sampling among families who had a member with a bipolar disorder who was referred to the largest psychiatric hospital in Iran in 2021. The participants were randomly divided into the experimental and control groups (n = 37 per group). The members of the experimental group then underwent eight 90-min sessions of psychoeducation. The control group also received psychoeducation at the end of the study. The results of analysis of covariance showed that psychoeducation reduced internalized stigma in the family members of bipolar patients and increased their positive attitudes towards psychological disorders compared with the control group (p < .01). On this basis, psychoeducation can be useful to reduce the internalized stigma of family members of bipolar patients and to increase their positive attitudes towards psychological disorders.

School-based mental health literacy training shifts the quantity and quality of referrals to tertiary child and adolescent mental health services: A Western Canada regional study

BACKGROUND

We aimed to improve mental health referral quality of young people by helping educators build capacity for early identification of youth at risk of mental illness and facilitate referrals between the education and health systems.

METHODS

We applied the Go-To Educator mental health literacy training for early identification, triage and support in 208 schools in Calgary, Alberta between 2013 and 2016. Students presenting to mental health services during this time were compared on a number of clinical, system, and demographic variables, based on the training status of the school (untrained schools; before and after training schools), using retrospective cohort design. Based on clinical and system data, bivariate and multivariable logistic regression analysis were employed to compare the three school status domains.

RESULTS

After training, referrals differed significantly from control and pre-training schools. Students presenting to services from these schools were younger, from single parent families; were referred more because of adjustment and learning/attention problems; had complex social/family issues; thought disturbances, and harmful behavior/thoughts towards others. While they waited longer to be admitted they stayed longer in services; had more provisional comorbid diagnoses and demonstrated positive treatment outcomes.

CONCLUSIONS

The Go-To Educator training may be an effective intervention helping educators identify students at risk of mental disorders and in substantial need of mental health services, demonstrating improved linkages between education and health sectors.

Review: School-based mental health literacy interventions to promote help-seeking - a systematic review

BACKGROUND

School-based mental health literacy interventions aim to prevent mental disorders and promote mental wellbeing through improving the knowledge and understanding of mental health, mental disorders, and reducing stigma. Evidence suggests that good mental health literacy helps young people recognise mental health difficulties in themselves and in others, and seek help for mental health problems. Improved help-seeking can allow for early intervention, which prevents the progression of mental disorders and ultimately reduces the burden of mental disorders. The aim of this review is to identify and synthesise evidence on the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes.

METHODS

We searched MEDLINE, Embase, PsycINFO, ERIC, Child Development and Adolescent Studies, British Education Index and ASSIA (June 2020). Additional searches were conducted a year later to identify any new publications (June 2021). We included randomised controlled trials (RCTs) assessing the effectiveness or cost-effectiveness of school-based interventions to improve help-seeking outcomes for children and young people aged 4-18 years. Included studies were critically appraised.

RESULTS

We identified 11 studies investigating help-seeking outcomes of school-based mental health literacy interventions including a total of 7066 participants from 66 secondary schools. Overall, there is no strong evidence for the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes, including general attitudes towards help-seeking, personal intentions to seek help, knowledge of when and how to seek help for mental disorders, confidence to seek help, and actual help-seeking behaviours. None of the studies investigated the cost-effectiveness of the interventions.

CONCLUSION

The lack of standardised measures with established reliability and validity for help-seeking outcomes, and the incomprehensive consideration of the multi-faceted concepts of MH literacy and MH stigma have contributed to the scarcity of evidence for the effectiveness. Future research should focus on developing standardised measurement tools and including economic evaluations to understand pragmatic and financial aspects of school-based mental health literacy interventions.

Predictors of Mental Health Literacy and Information Seeking Behavior Toward Mental Health Among University Students in Resource-Limited Settings

BACKGROUND

This paper investigated mental health literacy level and information seeking behavior, and mental health-related information sources in limited-resource settings, in the case of Ethiopian university students.

METHODS

A cross-sectional, self-administered web-based survey was conducted among Dilla University students, from 1 January to 29 February 2022, with a total of 780 respondents. We presented descriptive statistics using mean, standard deviations, and proportions. Bivariate and multivariate logistic regression were employed to identify factors associated with mental health literacy and information seeking behavior of students. Further, path analysis was also employed.

RESULTS

The result showed 71 (9.1%) respondents had a diagnosed history of mental illness. Overall, 397 (50.9%) respondents were identified as having adequate mental health literacy and 420 (53.8%) sought mental health information. In multivariate analysis, mental health literacy was significantly associated with: being female (AOR = 2.8; 95% CI (1.5-5.4)), higher digital health literacy (AOR=2.8; 95% CI (1.5-5.4), seeking mental health-related information (AOR=1.6; 95% CI: (1.1-2.5)), having family with mental illness, and students in health-related programs (AOR = 2.1; 95% CI (1.0-4.2)). Furthermore, health-related programs, level of mental health literacy, exposure to mental health problems in the family, and were associated with information seeking behavior regarding mental health. Further, path analysis revealed significant positive associations of information seeking behavior and digital health literacy with mental health literacy.

CONCLUSION

The result indicated the status of university students' mental health literacy level and information seeking behavior were low and inadequate. This study suggests the need to improve students' digital health competencies by designing mental health literacy programs by collaboration of different stakeholders, and mental health literacy programs need to optimize access to internet and online resources in the university settings.

Attitudes and perceptions of teachers toward mental health literacy: A case of Odzi High School, Mutare District, Zimbabwe

In dealing with adolescent mental health, teachers and school institutions have a critical role in minimizing the challenges of mental health. However, the success of such a measure is dependent on teachers' attitudes and perceptions of mental health literacy. Adolescent mental health disorders have become a major global concern with heightened increases and prevalence in secondary schools. In Zimbabwe, a dearth of knowledge exists in understanding the perceptions and attitudes of teachers in maximizing student mental health and positive educational outcomes. The aim of the research was to understand the attitudes and perceptions of teachers toward mental health literacy. Using a qualitative approach to understanding attitudes and perceptions, a case study was carried out at Odzi High School. A total of 12 teachers were purposively sampled for data generation on knowledge, attitudes, perceptions, and strategies that can be used to inform adolescent mental health. Data were collected using semi-structured interview(s). Emergent themes of the study were knowledge, stigma, training, and development. Using thematic analysis, the data showed that there was generalized knowledge of mental health and there were disparities in effective and efficient responses to gender sensitivity issues. Additionally, this knowledge was not put into practice because of attitudes and perceptions toward mental health. Recommendations from the study include developing of mental health training for teachers, equipping teachers with skills in psychosocial support in schools' mental health, and enabling teachers to be able to link adolescents to appropriate care within the school and community-based settings. Teachers have the responsibility of promoting the wellbeing of the students, thus minimizing the adverse effects. Outcomes for positive mental health may be the result of teachers' informed perceptions and positive attitudes on mental health literacy.

Long-term impact of a mental health literacy resource applied by regular classroom teachers in a Canadian school cohort

Application of evidence-based mental health literacy (MHL) curriculum resources by classroom teachers has been demonstrated to significantly improve knowledge and decrease stigma in the short term.

AIMS

To report results that extend these positive findings for a period of one year.

METHOD

In a naturalistic cohort study, 332 grade 9 students (ages 14-15) in a Canadian school district learned from an evidence-based curriculum resource (the Guide) applied by classroom teachers who trained in its use. Evaluations of knowledge and stigma were conducted before the Guide, immediately following the Guide delivery and at one-year follow-up.

RESULTS

Students showed significant (p < .001) and substantial (d = 0.68 and 0.67) short-term and significant (p < .001) and substantial (d = 0.44 and 0.58) long-term improvements in knowledge and reductions in stigma. Significant stigma reduction was found among female students than male students, but no gender differences on knowledge were found at long-term follow-up. Educators showed significant and substantial short-term improvements in knowledge (p < .001; d = 1.03) and reductions in stigma (p < .05; d = 0.35).

CONCLUSIONS

The Guide resource delivered by trained classroom teachers may have value in enhancing MHL outcomes for young people.

Effectiveness of a Comprehensive Mental Health Literacy Educational Programme for Junior High School Students: A Randomised Controlled Trial Examining Changes in Their Knowledge, Attitudes, and Behaviour

Background: This study evaluated the effectiveness of a comprehensive mental health literacy (MHL) educational programme known as “Sanita” for improving junior high school students’ knowledge of mental illness, attitudes towards people with mental health problems, and help-seeking behaviour. Methods: A randomised controlled trial with a parallel-group design was conducted. A total of 125 students (51 in the intervention group and 74 in the control group) received three 50-min classes and completed self-report questionnaires (Mental Illness and Disorder Understanding Scale, MIDUS; Reported and Intended Behaviour Scale, RIBS-J; and an original questionnaire investigating help-seeking behaviour) before and after the programme and three months later. Results: Regarding MIDUS, the post-test and 3-month follow-up test results showed a significant main effect of time-by-group interactions in a linear mixed model. Regarding RIBS-J, the post-test results showed a significant main effect of time-by-group interactions; however, the 3-month follow-up test showed no significant effect. No significant effects of time-by-group interactions were seen in the post-test and 3-month follow-up test results for help-seeking behaviour in a logistic regression-mixed model. Conclusions: The Sanita MHL educational programme was longitudinally effective at improving junior high school students’ knowledge of mental illness, although improvements in attitudes and help-seeking behaviour were insufficient.

Providers as Stakeholders in Addressing Implementation Barriers to Youth Mental Healthcare

Research has shown that youth with mental health disorders often do not receive adequate care. School- and community-based mental health organizations are integral to implementing evidence-based mental healthcare to the vast majority of youth. It is therefore important to understand the perspectives of this stakeholder group, to determine how to improve access to high-quality care. A series of three focus groups with community mental health providers and three school counselors and social workers focus groups were conducted to get their perspective on existing barriers that prevent youth who need mental health services from being treated. A grounded theory inductive qualitative analysis revealed six major themes (Lack of Services, Lack of Knowledge, Stigma, Logistics, Poor Past Experiences with Mental Health, and Poor Coordination of Services). Each of these themes are discussed and implications are framed within the context of implementation science.

Adolescents' lived experience of panic disorder: an interpretative phenomenological analysis

Background

Panic disorder is a debilitating anxiety disorder that has a serious impact on adolescents’ social and academic functioning and general wellbeing. Panic disorder is experienced by around 1 to 3% of the adolescent population. The aim of this study was to examine adolescents’ experiences of having panic disorder.

Methods

Semi-structured interviews were conducted with eight adolescents with a primary diagnosis of panic disorder. Interpretative Phenomenological Analysis was used to gain an understanding of adolescents’ lived experience of panic disorder.

Results

Two superordinate themes were identified: (1) Drowning in sensations, and (2) An unacceptable self. The findings show that adolescents experience panic disorder as extremely overwhelming and unpleasant, with debilitating feelings of drowning in sensations. Adolescents’ experiences largely fit with the cognitive model of panic, in which catastrophic misinterpretation of bodily sensations is associated with anxiety, avoidance, and safety behaviours, creating a vicious cycle. Attempts to avoid or prevent the attacks appear to inadvertently make them worse. Social worries, feeling broadly misunderstood, and unhelpful responses from others, contributed to feelings of being different or abnormal and were connected to a negative self-concept. Negative social interactions with teachers and peers in the school environment were particularly damaging.

Conclusions

These findings offer new insight into these adolescents’ lived experience of panic disorder and highlight the need for adolescents to access timely, evidence-based treatment, as well as the need for increased awareness and understanding of panic disorder in schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00849-x.

The Impact of Transitions, a Mental Health Literacy Intervention With Embedded Life Skills for Postsecondary Students: Preliminary Findings From a Naturalistic Cohort Study

OBJECTIVE

Mental illness is a common medical condition to onset during adolescence. Young people who leave for postsecondary life are at an especially challenging period of lifetime when many will leave home and familiar environments for prolonged periods of time. These new circumstances may put young people at risk of developing mental health problems or disorders or exacerbate existing mental disorders. Alternatively, some young people may misinterpret the normal negative emotional states occurring as a result of these new challenges as a mental disorder requiring professional intervention. We conducted a quasiexperimental cohort study to investigate the effectiveness of a mental health literacy intervention Transitions with blended life skills to address these challenges for first-year postsecondary students.

METHODS

Students (n = 2,397) from five Canadian postsecondary institutions were assigned to the intervention or the control group and were administered a survey at baseline, postintervention, and at 2-month follow-up (September 2017 to February 2018). We applied generalized linear mixed effects (PROC Mixed procedure) to test the between-group difference in the post-pre/follow-up-pre and to determine the predicted least-square mean values.

RESULTS

The findings showed that students who were exposed to the Transitions intervention significantly improved their mental health knowledge, decreased stigma against mental illness, improved help-seeking attitudes and behaviours, and decreased perceived stress when compared to students who had not been exposed to the intervention. However, we did not identify significant changes in general health. This may be due to the relatively short follow-up time (2 months) to determine participants' general health status.

CONCLUSIONS

Transitions delivered to first-year postsecondary students may be a beneficial intervention to help young people adjust to their new postsecondary life and improve their mental health.

Mental Health of Czech University Psychology Students: Negative Mental Health Attitudes, Mental Health Shame and Self-Compassion

High rates of mental health problems are a growing concern in Czech higher education, negatively impacting students’ performance and wellbeing. Despite the serious nature of poor mental health, students often do not seek help because of negative attitudes and shame over mental health problems. Recent mental health research reports self-compassion is strongly associated with better mental health and reduced shame. However, relationships between those constructs remain to be evaluated among Czech students. This study aims to appraise the relationships between mental health problems, negative mental health attitudes, mental health shame, and self-compassion in this population. An opportunity sample of 119 psychology students from a Czech university completed questionnaires regarding these constructs. Correlation, regression, and path analyses were conducted. Mental health problems were positively associated with negative mental health attitudes and shame, and negatively associated with self-compassion. Self-compassion negatively predicted mental health problems, while negative attitudes and shame did not. Last, self-compassion fully mediated the negative attitudes-mental health problems relationship, and partially mediated the shame-mental health problems relationship. Findings suggest self-compassion is essential for mental health in Czech students and associated with negative mental health attitudes and mental health shame. Czech universities can benefit from incorporating self-compassion training into their curricula to protect students’ mental health.

Effectiveness of Mental Health Literacy Programs in Primary and Secondary Schools: A Systematic Review with Meta-Analysis

In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, from 2013 to the present, on mental health knowledge, stigma, and help-seeking is conducted. Of the 795 identified references, 15 studies met the inclusion criteria. Mental health knowledge increased after the interventions (standardized mean difference: SMD = 0.61; 95% CI (0.05, 0.74)), at two months (SMD = 0.60; 95% CI (0.4, 1.07)) and six months (SMD = 0.39; 95% CI (0.27, 0.51)). No significant differences were observed between stigma and improving help-seeking. Mental health literacy interventions are effective in augmenting mental health knowledge, but not in reducing stigma or improving help-seeking behavior.

What do Teachers do to Show They Care? Learning From the Voices of Early Adolescents

This mixed methods study examined how middle school students (ages 11–13) in middle-class neighborhoods in Western Canada characterized a caring teacher. Specifically, qualitative content analysis was conducted on 199 sixth and seventh grade students’ written responses to the question “What are three things that teachers do to show they care?” Guided by recent work in the area of mindfulness in teaching, we identified 19 themes: one was categorized as General Teaching (e.g., “They teach”), and 18 that were grouped into one of three thematic categories associated with mindful teaching: Calm (e.g., calm/not reactive), Clear (e.g., democratic communication), and Kind (e.g., empathy). In their descriptions of caring teachers, almost all students (97.5%) used Kind themes, while many used Clear themes (41%); with fewer students using Calm (13.6%) or General Teaching (10.6%) themes. Chi square analyses revealed that girls were more likely to mention Clear themes compared to boys, while boys were more likely to use the specific themes of nurturance and helpfulness. Additional demographic differences were also explored. This research adds to the growing body of studies aimed at elucidating the role of mindful teaching in caring student-teacher relationships, particularly from the perspectives of early adolescents.

Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review

BACKGROUND

Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier.

METHODS

Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review.

RESULTS

Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns.

CONCLUSIONS

The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

Review: School-based interventions to improve mental health literacy and reduce mental health stigma - a systematic review

BACKGROUND

The steadily increasing prevalence of mental disorders in children and adolescents presents itself as a public health challenge, especially given the health, social and economic burden of mental disorders. School-based interventions aimed at improving mental health literacy and reducing mental health stigma have the potential to prevent mental disorders and promote mental well-being, thus reducing the burden of mental disorders. This review identified and synthesised evidence on the effectiveness of school-based interventions designed to improve mental health literacy and reduce mental health stigma.

METHODS

Electronic bibliographic databases including MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Child Development and Adolescent Studies, British Education Index and Applied Social Sciences Index and Abstracts (ASSIA) were searched. Randomised controlled trials (RCTs) were included if they assessed the effectiveness or cost-effectiveness of school-based intervention aimed at improving mental health literacy and reducing mental health stigma for children and young people aged 4-18 years. Quality of studies was appraised using the EPHPP tool. A numerical summary and a narrative description of the findings in relation to the research questions were synthesised. This systematic review was registered with PROSPERO (CRD42020191265).

RESULTS

We identified 21 studies describing 20 unique school-based mental health interventions. Overall, there is moderate evidence suggesting that school-based mental health interventions can be effective in improving mental health literacy and reducing mental health stigma defined as attitudes and beliefs regarding mental disorders. However, there is less evidence for their long-term effectiveness, as most studies did not include follow-ups.

CONCLUSIONS

Despite exclusively including studies with randomised designs, intervention and methodological heterogeneity poses uncertainties to any conclusions made. Future research should focus on resolving methodological issues concerning how outcomes are assessed and include process evaluations to better inform the design of an intervention in term of its delivery and implementation.

Perception of radiography lecturers towards the proposed doctor of radiography program

Background

Radiography as a profession has undergone significant changes in recent times with the introduction of new imaging modalities, increase in the ranges of radiological investigations, and a diversification in the role of radiographers. As a result of these, there is a need to step up the radiography program to meet up with these changes. This study aims at ascertaining the perception of radiography lecturers in Nigeria towards the proposed doctor of radiography program. A cross-sectional study of radiography lecturers in Nigeria was conducted from February to July 2020. Subjects were recruited through a convenient sampling technique. Validated questionnaires were sent online to all the lecturers. The questionnaire contained 32 questions divided into 3 sections. Section A captured the demographic data of the lecturers. Section B captured information on the ability of the doctor of radiography program to produce graduates with a broad orientation in all specialties of radiography. Section C elicited information on the ability of the doctor of radiography program to produce high-quality radiographers.

Results

A total of 62 lecturers comprising 51 males (82.3%) and 11 females (17.7%) participated in the study. The grand mean of all the items in sections B and C were 3.03 and 3.25 respectively which show that the respondents are confident that the proposed program will produce high-quality and versatile radiographers.

Conclusion

The lecturers showed a positive perception towards the doctor of radiography program. Hence, they strongly believe that the proposed program will produce more versatile radiographers than the bachelor’s program.

"I wouldn't even know what to do," Adolescent and Parent Perspectives on Identifying, Understanding, and Seeking Help for Adolescent Depression

Within the context of a randomized clinical trial (RCT) of school-based depression screening, the study objective was to understand parent and adolescent perspectives on school-based depression screening and barriers to help-seeking for adolescent depression. From May-Nov. 2019, separate focus groups were held with adolescents (8 groups, n = 52) and parents (6 groups, n = 36). Two coders individually coded 20% of transcripts to establish interrater reliability (adolescent k = 0.76 and parent k = 0.80). Remaining transcripts were then separately coded and reviewed to develop three themes: (1) Both recognized depression as a serious issue that needed to be addressed in schools, but had confidentiality and communication concerns; (2) Both parents and adolescents believed the majority of adolescents would seek help with depression from friends more than any other source; and (3) Neither adolescents nor parents could clearly describe steps to take if their peers (adolescents) or adolescents (parents) were depressed. We intend to address identified barriers and concerns in the context of the larger RCT.

A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours

AIM

The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours.

METHODS

A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations.

RESULTS

One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion.

CONCLUSIONS

Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.

What matters to patients: Parental and caregiver opinions on International Consortium for Health Outcomes Measurements overall health outcomes for children in Singapore

Background:

Health in children is multifaceted. More than just the absence of disease, good child health also comprises psychological well-being and social functioning. In paediatrics, optimal health care is a partnership between caregivers and doctors. Value-based medicine strengthens this partnership. Monitoring and tracking these patient-reported outcomes using validated measurement tools in a life-course manner helps us to understand and ultimately improve overall child health better.

Objectives:

This study aimed to assess parental opinions in Singapore on recommended outcome measures and approach recommended by the International Consortium for Health Outcomes Measurements (ICHOM) Overall Pediatric Health (OPH) working group.

Methods:

An international working group comprising 25 experts in paediatric health was formed under the auspices of ICHOM. Through a series of literature reviews, patient focus groups and open review periods, a set of health outcomes and case-mix variables was proposed, with the aim of improving paediatric care globally. Parents and caregivers were invited to participate in this survey from around the world, including from the USA, UK, Colombia and Singapore. The survey covered domains that were included in the ICHOM OPH Standard Set. An international anonymised online patient validation survey tool online survey was initiated to evaluate caregiver opinions of these proposed ICHOM OPH outcomes, and this was conducted from November 2019 to January 2020. Singapore participated in this caregiver survey on overall paediatric health outcomes. Of the 270 respondents in this ICHOM OPH consumer international open review online survey, 160 were from Singapore. We report here a cross-sectional study with data from the Singapore group of respondents.

Results:

Of the 160 responses from Singapore, 73.8% had no more than two children, and 38.8% of caregivers had children between 0 and 5 years old. In general, 76.9% of caregivers were satisfied with the health care that they received, and 60% of caregivers had had between one and four health-care appointments in the last 12 months. Assessment was done on a scale of 1 to 9, with importance defined as a score of ⩾7. All outcome measures were ranked to be important, with an overall mean score of 7.9 on a scale ranging from 1 to 9. Development was assessed as being the most important ( M=8.34±0.93), and sexual health was assessed as being the least important ( M=7.09±1.71). Almost all respondents felt that the list of ICHOM-recommended outcomes proposed was complete. Parents and caregivers in Singapore placed development and mental health as the most important across all age groups surveyed. They felt that the framework provided by the ICHOM OPH working group was adequate in addressing their concerns. Most parents and caregivers were satisfied with the health care they had received.

Conclusion:

Child health is a continuum that requires longitudinal attention from both the family and the clinician, and should take a life-course approach, utilising validated measurement tools to monitor and track key parameters. Parents and caregivers in Singapore place high importance on their child’s development and mental functioning. While there has been much community effort on development and mental functioning in children, more can be done in these two areas and to increase the emphasis and awareness on sex education both within the home and in schools. A framework for evaluating children during follow-up clinic visits would be helpful in continuing longitudinal care of children to provide holistic care and to improve adult health in the long term, guided by the framework set down by the ICHOM OPH standard set. As we recognise and embrace the importance not just of health care but the health of the next generation, we will need to use validated measurement tools to monitor and track these importance parameters in the journey of our children, so that we can identify and improve these outcomes in a timely manner.

Development and psychometric properties of the Knowledge and Attitudes to Mental Health Scales (KAMHS): a psychometric measure of mental health literacy in children and adolescents

BACKGROUND

Adolescence is a crucial period for the acquisition of good mental health behaviours, which are the foundation for health and wellbeing in later life. Improved knowledge about mental health and improved help-seeking behaviours have been shown to lead to better mental health outcomes. Mental health literacy (MHL) is multifaceted (e.g., knowledge about symptoms, the stigma around mental health, good mental health practices, etc.). Measures are needed that can assess these different aspects of MHL. Measurement of mental health literacy is currently limited due to a lack of reported psychometric instruments with known psychometric properties. Given that most mental health problems start in early adolescence, a scale is needed that is reliable and valid in this age group.

METHODS

The development and validation of the psychometric instrument (termed the Knowledge and Attitudes to Mental Health Scales: KAMHS) entailed two phases: 1) item generation based on an evidence-based intervention programme: The Guide; and 2) item reduction through exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) for factor structure and psychometric assessment. Participants were 559 Year 9 pupils in secondary schools across Wales aged between 13 and 14 years.

RESULTS

Results from the CFA indicated an acceptable fit of the model to the data. The KAMHS showed good internal constancy and moderate test-retest validity (.40-.64).

CONCLUSIONS

The final version of the KAMHS contains 50 items that are appropriate for use in children and adolescents. These results suggest that the KAMHS can be used over time to assess the efficacy of interventions aimed at increasing the mental health literacy of adolescent populations.

Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study

BACKGROUND

Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities.

METHODOLOGY

This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation.

RESULTS

The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (P<.001), but these changes were not maintained at the two-month follow up. The stigma of mental illness did not change during the study (P=.13).

CONCLUSIONS

The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic.

TRIAL REGISTRATION

The trial was registered at the ISRCTN registry (26 May 2021), registration number 10.1186/ ISRCTN10565335 ).

Adaptation of a school-based mental health literacy curriculum: from Canadian to English classrooms

BACKGROUND

School-based mental health literacy (MHL) interventions are increasingly trialled outside of the country in which they were developed. However, there is a lack of published studies that qualitatively explore their cultural adaptation. This study investigated the reasons for adaptations made and suggested to a Canadian MHL curriculum (The Guide) within the English school context.

METHOD

Semi-structured interviews were conducted with 11 school staff responsible for the planning and/or implementation of The Guide across three schools in the South East of England, as part of the Education for Wellbeing (EfW) feasibility study. Transcripts were analysed using a hybrid, deductive-inductive thematic analysis.

RESULTS

Adaptations made and suggested included dropping and emphasising content, and adapting language, examples and references. Most adaptations were proactive and related to The Guide's implementation methods, including developing more interactive and student-led approaches. Staff Capacity and Expertise, Timetabling, and Accessibility of Resources were identified as logistical reasons for adaptations. Philosophical reasons included Consistency of Messages, Student Characteristics, Reducing Stigma and Empowering Students, National and Local Context, and Appropriate Pedagogic Practices.

CONCLUSION

Overall, recommendations were for immediately implementable lesson plans informed by teachers' knowledge about best pedagogic practices in England. Adequate training, attended by both senior leadership and those implementing, was also emphasised. While ensuring that the core components are clear, MHL interventions should be developed with a necessary level of flexibility to accommodate contextual characteristics. Future research should ensure that adaptations are captured through process and implementation evaluations conducted alongside efficacy trials.

A survey of mental health literacy in Japanese high school teachers

BACKGROUND

School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers.

METHODS

Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students.

RESULTS

The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%).

CONCLUSIONS

MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

Promotion of Mental Health Literacy in Adolescents: A Scoping Review

In recent years, there has been an important commitment to the development of programs to promote mental health literacy (MHL) among adolescents, due to the prevalence of mental health problems and the low level of MHL that affects this group. The aim of this study was to map the structure and context of programmes/interventions for promoting MHL among adolescents in school settings. A scoping review was conducted following the guidelines of The Joanna Briggs Institute. We searched for studies on programmes/interventions promoting at least one of the components of MHL of adolescents, written in Portuguese, English or Spanish, published from 2013 to 2020, in MEDLINE, CINAHL Plus with Full Text, SciELO, SCOPUS, OpenGrey, RCAAP and in the article reference lists. This review included 29 articles. The majority of programmes/interventions addressed one or more of the four components of MHL, with the knowledge of mental disorders and stigma reduction components being the most covered; were taught by adolescent's regular teachers; used face to face interventions; had a height variable duration; used non-validated instruments; were implemented in a classroom environment; and showed statistically significant improvements in adolescent's MHL levels. More research is needed to implement/construct programmes/interventions promoting adolescents' MHL concerning knowledge on how to obtain and maintain good mental health.

COVID-19-related stigma and its influencing factors: a nationwide cross-sectional study during the early stage of the pandemic in China

OBJECTIVES

To describe the situation of COVID-19-related stigma towards patients with COVID-19 and people from the city of Wuhan in China and to assess the associations between COVID-19-related stigma, health literacy and sociodemographic characteristics during March 2020, the early stage of the pandemic.

DESIGN

A cross-sectional online survey.

SETTING

The study surveyed 31 provinces in China.

PARTICIPANTS

This study surveyed 5039 respondents in China.

OUTCOME MEASURES

Public stigma towards both patients with COVID-19 and Wuhan residents was measured. Binary logistic regression was used to identify the factors associated with public COVID-19-related stigma.

RESULTS

Among the participants, 122 (2.4%) reported themselves and 254 (5.0%) reported the communities they lived in as holding a stigmatising attitude towards patients with COVID-19, respectively. Additionally, 114 (2.5%) and 475 (10.3%) reported that themselves and the communities they lived in, respectively, held a stigma against people from Wuhan, which was the most severely affected area in China. People aged over 40, lived in areas with severe epidemics (adjusted OR (aOR)=2.03, 95% CI (1.05 to 3.92)) and who felt it difficult to find and understand information about COVID-19 (aOR=1.91, 95% CI (1.08 to 3.37); aOR=1.88, 95% CI (1.08 to 3.29)) were more likely to stigmatise patients with COVID-19. People who were male, aged 41-50 and had difficulty understanding information (aOR=2.08, 95% CI (1.17 to 3.69)) were more likely to stigmatise people from Wuhan.

CONCLUSIONS

Patients with COVID-19 and Wuhan residents suffered stigma at both the individual and the community levels. Those who had low health literacy, who lived in areas with a large number of COVID-19 cases and who were of ethnic minorities were more likely to stigmatise others. Tailored interventions are encouraged to improve health literacy and consequently to reduce public COVID-19-related stigma.