Actions that young people can take to prevent depression, anxiety and psychosis: beliefs of health professionals and young people

The impact of communicating personal mental ill-health risk: A randomized controlled non-inferiority trial

AIM

Risk algorithms predicting personal mental ill-health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill-health risk profiles on psychological distress.

METHODS

Australian participants using a mood-monitoring app were randomly allocated to receiving their current personal mental ill-health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non-inferiority trial design. The primary outcome was psychological distress at four-weeks as assessed on the Kessler Psychological Distress Scale.

RESULTS

There was high attrition in the trial with 64% of data missing at follow up. Per-protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: -2.59- 2.98) and achievable risk (m = -0.09, 95% CI: -2.84 to 2.66) groups were within the non-inferiority margin of the control group's mean at follow up. Supplementary intention-to-treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non-inferiority to the control group.

CONCLUSIONS

This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.

Patterns of Integrative Korean Medicine Practice for Anxiety Disorders: A Survey among Korean Medicine Doctors (KMDs) in Korea

Anxiety disorder is known as the most common disease among psychiatric disorders. However, many studies have not been conducted in the Korean medicine area. This study explores the current state of anxiety disorder treatments of Korean medicine through a survey research. The survey for Korean medicine doctors (KMDs) on Korean medicine (KM) diagnosis and treatments for anxiety disorder was conducted online from December 21, 2016, to December 29, 2016. The results were divided into two groups, KMDs and Korean medicine neuropsychiatric specialists (KMNPS), and comparatively analyzed. Self-evaluation and counseling were the most common in both diagnostic methods and evaluation of treatment effects, and KMNPS tended to make extensive use of objective indicators. There was no difference in the rate of psychiatric medication use among the patients between KMD and KMNPS. The main reason for patients wanting KM treatment was the tapering cessation of psychiatric medications. The most common treatments were acupuncture, herbal medicine, and moxibustion, in addition to dry cupping in KMD and psychotherapy in KMNPS. The most important factor for treatment was herbal medicine treatment, followed by rapport formation in KMD and patient's temperament in KMNPS. Opinions on various items were presented as treatment barriers, and KMNPS tended to think more importantly about the patient's family problems. For the items to be additionally trained in the future, KMD chose the diagnostic tools and KMNPS chose psychotherapies. This study is the first study to analyze the clinical patterns for anxiety disorder in KMDs. KMD and KMNPS showed similar patterns in the perception, diagnosis, and treatment of anxiety disorders, but KMNPS tended to use objective indicators and psychotherapy more actively. Further clinical studies for the development of clinical guidelines should be additionally required.

Assessment of Mental Health Literacy among Perinatal Hispanic Adolescents

According to the United States (U.S.) Census Bureau, Hispanics are the fastest growing ethnic minority in the U.S. As such, Hispanic females have the highest birth rate (35 per 1000) among adolescents between the ages of 15 and 19 years. Despite high fertility rates, there is limited mental health information among Hispanic adolescents during the perinatal period. Perinatal depression is a major concern as it poses health risks for both the mother and infant. Adverse outcomes such as preterm birth, low infant birth weight, and poor maternal-infant attachment may result from perinatal depression. However, less than half of Hispanic adolescent mothers who experience perinatal depression receive treatment. Previous research identified low mental health literacy (MHL) as one of the primary reasons for the limited use of mental health services among ethnic minorities. This study assessed the MHL of pregnant and postpartum Hispanic adolescents (n = 30) using a modified MHL scale. Implications for nursing practice are discussed to help improve mental health outcomes among pregnant and postpartum Hispanic adolescents.

Assessing the Mental Health Needs of Pregnant Adolescents: Health Literacy Frameworks to Guide Research and Practice

Background: Psychological distress negatively impacts fetal development and may result in complications such as preterm delivery, low infant birth weight, and poor maternal–infant attachment during the postpartum period. Female adolescents may be experiencing environmental and psychosocial stressors during the pre- and postnatal periods that may predispose them to psychological distress. Health literacy has been used to assess the needs of individuals who have chronic illnesses. Mental health literacy however has not been assessed as extensively, particularly among pregnant adolescents. Purpose: Analysis of 2 health literacy frameworks for assessment of relevancy for use among adolescents experiencing psychological distress. Methods: Systematic analyses of health literacy frameworks by Anthony Jorm and that of Paasche-Orlow and Wolf are provided in this article. Results: Paasche-Orlow and Wolf’s frameworks both provide useful approaches for assessing pregnant adolescent needs. A modified holistic health literacy conceptual model based on Paasche-Orlow and Wolf’s and Jorm’s framework is proposed. Implications for Practice: Assessing the mental health needs of pregnant adolescents requires a holistic approach. The modified conceptual model provides a basis for research and practice addressing health literacy and psychological distress among pregnant adolescents.

Mental health literacy about schizophrenia: a survey of Portuguese youth

AIM

Mental health literacy about psychotic disorders, specifically schizophrenia, may assist in appropriate help seeking and early intervention, preventing the exacerbation of symptoms and improving health outcomes in the medium and long term. The aim of this study was to characterize the level of mental health literacy of Portuguese youth concerning schizophrenia.

METHODS

A mental health literacy questionnaire was administered to a random sample of Portuguese youth aged 14-24 years. This questionnaire evaluated the following components: recognition of disorders, knowledge about professionals and treatments available, knowledge about the effectiveness of self-help strategies, knowledge and skills to support and provide first aid to others, and knowledge of how to prevent mental disorders.

RESULTS

There were 4938 adolescents and young adults who participated in the study. Schizophrenia or psychosis was recognized by 42.17% and 22.21%, respectively. Most young people recognized the potential helpfulness of family doctors, psychologists, psychiatrists and mental health services. There was also widespread belief in the potential helpfulness of family and friends, and lifestyle changes. However, teachers were not generally seen as a source of help. Appropriate mental health first-aid strategies were commonly endorsed, but there was a reluctance to ask about suicidal feelings and many endorsed speaking to the person firmly. Lifestyle factors were also commonly believed to be preventative.

CONCLUSIONS

Although many Portuguese youth have beliefs that may assist early intervention, there was a substantial minority who did not. Given the central role of teachers in the lives of young people, it is notable that they were not seen as a potential source of help. Mental health first-aid skills of young people also need improvement.

Self-care strategies for emotional distress among young adults in Catalonia: a qualitative study

BACKGROUND

Emotional distress is common in adolescence, and self-care strategies are frequently preferred to address it. The aim of this article is to analyze the self-care strategies among adolescents and young people diagnosed with depression or with self-perceived depressive distress in Catalonia using a qualitative design.

METHODS

We analyzed the self-care strategies of 105 young people (17-21 years of age) in Catalonia who had participated in a national survey on adolescents. The sample was divided into thirds, with 37 who had a previous diagnosis of depression, 33 who had self-perceived emotional distress, and 35 controls. The participants' narratives on self-care strategies for emotional distress were elicited through in-depth semi-structured interviews. The data were managed using ATLAS-Ti 6.5 software18. We applied hermeneutic theory and the ethnographic method to analyze the interviews.

RESULTS

The ten self-care strategies identified in the analysis were grouped into four areas covering the various pathways the young people followed according to whether they had a diagnosis of depression or their depressive distress was self-perceived. The young people feel responsible for their emotional distress and consider that they are capable of resolving it through their own resources. Their strategies ranged from their individuality to sociability expressed through their relationships with others, membership of groups or other self-care strategies (relaxation, meditation, naturopathy, etc.).

CONCLUSIONS

The study results highlight the importance of sensitivity in considering young people's self-care strategies as another option in the care of emotional distress.

Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies

BACKGROUND

Adolescence is a peak time for the onset of depression, but little is known about what adolescents can do to reduce their own level of risk. To fill this gap, a review was carried out to identify risk and protective factors for depression during adolescence that are modifiable by the young person.

METHODS

Employing the PRISMA method, we conducted a systematic review and meta-analysis of longitudinal studies to identify risk and protective factors during the adolescent period (aged 12-18 years) that are potentially modifiable by the young person without professional intervention or assistance. Stouffer׳s method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations.

RESULTS

We identified 113 publications which met the inclusion criteria. Putative risk factors implicated in the development of depression for which there is a sound evidence base, and which are potentially modifiable during adolescence without professional intervention, are: substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; negative coping strategies; and weight. Modifiable protective factors with a sound evidence base are healthy diet and sleep.

LIMITATIONS

Limitations include not systematically reviewing moderators and mediators, the lack of generalisability across cultures or to younger children or young adults, and the inability to conduct a meta-analysis on all included studies.

CONCLUSIONS

Findings from this review suggest that future health education campaigns or self-help prevention interventions targeting adolescent depression should aim to reduce substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; and negative coping strategies; and promote healthy weight; diet; and sleep patterns.

Patients' opinions about knowing their risk for depression and what to do about it. The predictD-qualitative study

BACKGROUND

The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based.

METHODS

A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities.

RESULTS

The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a "patient-centred" approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed.

CONCLUSIONS

Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.

Iranian adolescents' ability to recognize depression and beliefs about preventative strategies, treatments and causes of depression

BACKGROUND

Since depression often has its onset during adolescence, knowledge about adolescents' ability to recognize depression and their beliefs about preventative strategies, treatments, and causes of depression are of importance.

METHODS

A total of 1984 adolescents, aged 12-17 years, participated in this study. They were recruited from 16 urban and suburban schools in Ahvaz City, Iran by cluster sampling. Participants were presented with a vignette depicting depression that was developed by Jorm and colleagues.

RESULTS

About half of the adolescents were able to correctly recognize depression. In terms of dealing with the depression depicted by the character in the vignette, older compared to younger participants, thought it best to ignore the individual or keep him/her busy. Younger adolescents were more likely to believe that depression was the result of god's will and a physical illness, whereas older adolescents tended to consider depression as resulting from the way in which people were raised, and from the normal ups and downs of life. Older, compared to younger adolescents, tended to endorse the preventative value of "not using marijuana" and "never drinking alcohol in excess".

LIMITATIONS

Since a hypothetical vignette was used, the findings may not truly reflect the real life experience of depression. The sample was drawn from a single region in Iran.

CONCLUSIONS

Given adolescents' relatively limited knowledge about depression and their beliefs about the causes and preventative strategies, there is fertile ground for health promotion in Iran.

Young men's attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services

BACKGROUND

This mixed-methods study was designed to explore young Australian men's attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.

METHODS

National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).

RESULTS

Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.

CONCLUSIONS

The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men's views and everyday technology practices, and leverage the influence of peers.

Young people's beliefs about preventive strategies for mental disorders: findings from two Australian national surveys of youth

BACKGROUND

Political interest in prevention of mental illness has increased in recent years. However, relatively little is known about the public's beliefs about prevention, and the predictors of these beliefs. Since many disorders start in the first decades of life, a focus on young people is warranted.

METHODS

Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youths aged 12-25 years in 2006. A similar survey was repeated in 2011 with 3021 youths aged 15-25. In both surveys, respondents were presented with a vignette portraying depression, psychosis, social phobia, or depression with alcohol abuse in a young person. The 2011 survey also included depression with suicidal thoughts and post-traumatic stress disorder. Respondents rated the helpfulness of seven potential prevention strategies, and reported on any experience of mental health problems and treatment in the past year, exposure to beyondblue and mental health information at school or work.

RESULTS

Most respondents believed that regular contact with friends and family and regular physical activity would be helpful. Respondents who had recently experienced mental health problems, younger respondents, females, and those not exposed to beyondblue or mental health information were more likely to hold beliefs that differed from those of health professionals or available evidence. No significant changes were observed between surveys.

LIMITATIONS

Actual preventive actions and reasons behind respondents' beliefs were not assessed.

CONCLUSIONS

Future prevention efforts should target subgroups with beliefs that differ from professionals' and research evidence. Beyondblue and school and work settings may be promising avenues for these efforts.

Adolescent and parent experiences with a primary care/Internet-based depression prevention intervention (CATCH-IT)

This article describes a mixed-methods approach to understand the experience of adolescents involved in the Internet-based intervention for depression, Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training (CATCH-IT), as well as the experiences of their parents while they were involved. Qualitative analysis was done with grounded theory-based categorization of interview comments and typed program responses (adolescents only) into themes. Quantitative analysis was done with self-report surveys. The article describes the nine themes reflecting the adolescent experience and the three themes reflecting the parent experience. The article also describes the results of the quantitative surveys of helpfulness and attitudes change, which were favorable of the Internet-based intervention. Separate models explaining the psychological transformation of the adolescents and the experience of the parents are proposed. The positive experience of the adolescents and parents involved in CATCH-IT is discussed in the context of growing interest in how best to utilize Internet-based interventions for mental illness, and suggestions are made for future investigation.

Pharmacists' beliefs about treatments and outcomes of mental disorders: a mental health literacy survey

OBJECTIVES

To assess the beliefs of pharmacists about the helpfulness of interventions for schizophrenia and depression.

METHODS

A survey instrument containing a measure of mental health literacy was mailed to a random sample of 2000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Vignettes of a person with either depression or psychosis were presented, followed by questions related to the recognition of the disorder, the helpfulness of various interventions, prognosis with and without professional help, the person's long-term functioning in various social roles and the likelihood of the person being discriminated against.

RESULTS

A total of 391 responses were received (response rate 19.5%). The majority of pharmacists correctly identified depression (92%) with fewer recognizing schizophrenia (79%). Pharmacists rated medicine use highly for both schizophrenia and depression but were also positive about the use of psychological therapies and lifestyle interventions. Pharmacists had negative views about admission to a psychiatric ward and the use of electroconvulsive therapy (ECT). However, younger pharmacists had significantly more positive views on the use of ECT (p = 0.001). The majority of pharmacists (74%) thought discrimination by the community was highly likely and rated long-term prognosis as poor without appropriate professional help. Their views on the likelihood of specific negative outcomes were mixed, with many pharmacists not recognizing the risk of suicide in schizophrenia and depression. However, both female (p = 0.002) and younger pharmacists (p < 0.001) were significantly more inclined to rate the likelihood of suicide as more likely in a person with schizophrenia or depression.

CONCLUSIONS

The majority of pharmacists had a high degree of mental health literacy as indicated by the correct identification of, and support for evidence-based interventions for mental illnesses. Pharmacists should be aware that their attitudes and stigma towards mental illness may impact on the patient care they provide.