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Guo C, Cui Y, Xia Z, Hu J, Xue Y, Huang X, Wan Y, Fang J, Zhang S. Association between health literacy, depressive symptoms, and suicide-related outcomes in adolescents: A longitudinal study. J Affect Disord 2023; 327:15-22. [PMID: 36707037 DOI: 10.1016/j.jad.2023.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Health literacy is associated with mental disorders in adolescents. This study aimed to examine the associations between health literacy, depressive symptoms, and suicide-related outcomes. METHODS In terms of participants, 937 middle school students in Shenyang City, China were enrolled between December 2018 and December 2019 to assess health literacy, depressive symptoms and suicide-related outcomes. Multiple logistic regression models were used to examine possible associations. RESULTS Adequate health literacy was negatively associated with 12-month follow-up depressive symptoms (RR = 0.115, 95 % CI: 0.032-0.411) and suicide-related outcomes (RR = 0.230, 95 % CI: 0.085-0.618) in females. Meanwhile, in females, interpersonal relationship, stress management, and self-actualization were negatively related to depressive symptoms, while physical activities, self-actualization, and health awareness are protective factors for suicide-related outcomes (P < 0.05 for each). LIMITATIONS Recall and reporting bias might be inevitable for self-reported data, and due to the small sample size, the predictive effect may not be very significant. CONCLUSIONS These findings suggest that adequate health literacy may serve as a critical and independent protective factor for poor long-term mental health outcomes and that the predictive effect is more pronounced in female students. Public health efforts to enhance health literacy levels are required to maintain and improve adolescents' mental health outcomes.
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Affiliation(s)
- Chunyu Guo
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yingying Cui
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Zhengmei Xia
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Jie Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yanni Xue
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xuexue Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Jun Fang
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan.
| | - Shichen Zhang
- School of Public Health and Health Management, Anhui Medical College, No 632 Furong Road, Hefei 230601, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China.
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Yager Z, Doley JR, McLean SA, Griffiths S. Goodform: A cluster randomised controlled trial of a school-based program to prevent body dissatisfaction and muscle building supplement use among adolescent boys. Body Image 2023; 44:24-35. [PMID: 36434957 DOI: 10.1016/j.bodyim.2022.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/27/2022]
Abstract
Although body dissatisfaction is common among adolescent boys, few intervention programs specifically developed for boys have been shown to be effective for reducing body dissatisfaction. Our study aim was to evaluate Goodform, a 4-session, teacher delivered intervention program specifically developed for boys to reduce body dissatisfaction and muscle building supplement use. The Goodform program was based on cognitive dissonance, social learning theory, and a social norms approach, and drew from two existing body image intervention programs that have shown promise among males: The Body Project- More than Muscles, and the Athletes Training and Learning to Avoid Steroids Program (ATLAS). A sample of 488 boys in grades 9 and 10 (Mage = 14.81, SDage = 0.51) at nine secondary schools in Australia were randomly assigned to Goodform (n = 244) or control (n = 244) at the school level. Self-reported body image, supplement use, anabolic androgenic steroid (AAS) use, and attitudes around using AAS and muscle building supplements were measured at baseline, post-intervention, and eight-week follow-up. Analyses with multi-level, mixed-effect regression models revealed no changes over time attributable to the intervention. Our results have implications for researchers in the body image and eating disorder prevention fields. Lessons learned in this study can inform future school-based efforts for reducing muscle building supplement use.
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Affiliation(s)
- Zali Yager
- Institute for Health and Sport, Victoria University, Footscray Park, Australia; Body Confident Collective, Australia.
| | - Jo R Doley
- Institute for Health and Sport, Victoria University, Footscray Park, Australia
| | - Siân A McLean
- The Bouverie Centre and Department of Psychology, Counselling, and Therapy, La Trobe University, Melbourne, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
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Doley JR, McLean SA, Griffiths S, Yager Z. Study protocol for Goodform - a classroom-based intervention to enhance body image and prevent doping and supplement use in adolescent boys. BMC Public Health 2020; 20:59. [PMID: 31937296 PMCID: PMC6961244 DOI: 10.1186/s12889-020-8166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Very few programs aimed at improving body image among adolescent boys have been effective, and there is still no clear evidence as to what will work for universal prevention of eating disorders and body dissatisfaction with this group. We combined two previously efficacious programs and used a design thinking framework to optimise program content alongside potential end-users including adolescent boys, teachers, parents, and experts. Goodform is a four-session universal program that aims to reduce body dissatisfaction and prevent the use of muscle-building supplements among 14-to-16 year old adolescent boys. METHODS/DESIGN Goodform will be trialled using a cluster randomised controlled trial (RCT) conducted in Australian schools, with Year 9 boys as participants. The intervention is teacher-delivered. Data will be collected at three time points: baseline, post-intervention, and follow-up (2 months). Three primary outcome constructs will be examined, including body dissatisfaction (Male Body Attitudes Scale-Revised) and attitudes towards appearance and performance enhancing substances (APES; Outcome Expectations for Steroid and Supplement Use, Intentions to use APES) and actual use of APES at each time point. Three secondary outcome constructs will be examined, which are social norms for APES (adapted Peer Norms Scale), negative body talk (Male Body Talk Scale), and internalisation of and pressure to attain appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised). Internalisation of appearance ideals will also be examined as a mediator of change in primary outcomes. Teachers will provide data on adherence to lessons, student engagement/enjoyment, and understanding of the content. DISCUSSION The GoodForm RCT will trial a novel, generalizable, and extensively developed program intended to improve boys' body image and reduce actual and intended APES use. We anticipate that it will provide a novel contribution to the field of boys' body dissatisfaction prevention. TRIAL REGISTRATION This trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry on May 14th 2019, registration number ACTRN12619000725167.
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Affiliation(s)
- Joanna Rachel Doley
- First Year College, Victoria University, Footscray Park, Footscray, Australia.
| | - Siân Alexandra McLean
- College of Arts and Education, Victoria University, Footscray Park, Footscray, Australia
| | - Scott Griffiths
- School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Zali Yager
- College of Arts and Education, Victoria University, Footscray Park, Footscray, Australia
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Abstract
This article reviews the 10 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2018. Two models frame this analysis. This first is the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment (recovery). The second parses the phases of prevention into rationale, theory, and methodology → clarification of risk factors, including very high risk, shading into warning signs → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. Collectively, the articles illustrate how complex and demanding the field of prevention is, with respect to, for example, phases of program development, the multidimensional ecology of interventions, and methodological requirements for demonstrating that a program deserves to be designated "evidence-based." A subset of the articles also illustrates how far the increasingly broad and dynamic field of prevention has advanced. Examples include models of eating disorder development in high-risk populations such as people with type 1 diabetes; prevention programming for young children; and after-school preventive interventions that combine dissonance-based lessons with empowering participation in community advocacy and activism.
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Affiliation(s)
- Michael P Levine
- a Department of Psychology , Kenyon College , Gambier , Ohio , USA
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