1
|
Probst C, Elton-Marshall T, Imtiaz S, Patte KA, Rehm J, Sornpaisarn B, Leatherdale ST. A supportive school environment may reduce the risk of non-medical prescription opioid use due to impaired mental health among students. Eur Child Adolesc Psychiatry 2021; 30:293-301. [PMID: 32215733 DOI: 10.1007/s00787-020-01518-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/16/2020] [Indexed: 02/08/2023]
Abstract
Canada is in the midst of an ongoing, escalating opioid crisis, with significant impacts on adolescents and young adults. Accordingly, mental health impairment was examined as a risk factor for non-medical prescription opioid use (NMPOU) among high school students. In addition, the moderating effects of the school environment, in terms of the availability of mental health services and substance use policies, were characterized. Self-reported, cross-sectional data were obtained from the COMPASS study, including 61,239 students (grades 9-12) in 121 secondary schools across Canada. Current and lifetime NMPOU were ascertained. Categorical indicators of mental health impairment and school environment were derived. The main analytical strategy encompassed hierarchal multilevel logistic regression, including the addition of interaction terms to characterize the moderation effects. Current and lifetime NMPOU were reported by 5.8% and 7.2% of the students, respectively. After adjusting for confounders, students in the highest quintile of mental health impairment had odds ratios (OR) of 2.60 (95% confidence interval [CI] 2.29-2.95) and 2.96 (95% CI 2.64-3.33) for current and lifetime NMPOU, respectively when compared to students in the lowest quintile of mental health impairment. A significant interaction between mental health impairment and school environment indicated relatively lower risks of NMPOU in students from schools that provide more mental health services and have stricter substance use policies. Mental health impairment increased the risk of NMPOU, but the associations were moderated by the school environment. These findings underscore the importance of mental health services and substance use regulations in schools.
Collapse
Affiliation(s)
- Charlotte Probst
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada. .,Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, 69120, Heidelberg, Germany.
| | - Tara Elton-Marshall
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada
| | - Karen A Patte
- Department of Health Sciences, Brock University, St. Catharines, ON, L2S 3A1, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, 119992
| | - Bundit Sornpaisarn
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
2
|
Lubman DI, Cheetham A, Sandral E, Wolfe R, Martin C, Blee F, Berridge BJ, Jorm AF, Wilson C, Allen NB, McKay-Brown L, Proimos J. Twelve-month outcomes of MAKINGtheLINK: A cluster randomized controlled trial of a school-based program to facilitate help-seeking for substance use and mental health problems. EClinicalMedicine 2020; 18:100225. [PMID: 31922118 PMCID: PMC6948229 DOI: 10.1016/j.eclinm.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Young people experiencing mental health problems are often reluctant to seek help, particularly from professionals (i.e., doctors or mental health workers). MAKINGtheLINK is a school-based intervention that aims to help adolescents overcome barriers to seeking professional help for mental health and substance use problems. METHODS A cluster randomised controlled trial was conducted to evaluate the 12-month outcomes of MAKINGtheLINK among 2447 participants (Mean age=14.9 years, SD=0.5 years, 50% male). Randomisation resulted in 1130 students from 11 schools allocated to receive the intervention, and 1317 students from 10 schools allocated to the wait-list control group. After the baseline assessment, follow-ups were conducted at 6-weeks (n = 2045), 6-months (n = 1874), and 12-months (n = 1827). The primary outcome measure was help-seeking behaviour, from both formal (e.g., health professionals) and informal (e.g., friends, family members) sources. The trial was registered with the Australia and New Zealand Clinical Trials Register (ANZCTR) on the 27th of February 2013 (registration number ACTRN12613000235707). FINDINGS The intervention was not associated with overall help-seeking at the 12-month follow-up (p = 0.99, odds ratio [OR]=1.00, 95% CI for OR = 0.70-1.42), or help-seeking for depression (p = 0.28, OR = 1.21, 95%CI =0.86-1.69), stress and anxiety (p = 0.73, OR = 1.04, 95%CI = 0.74-1.47), or alcohol/other drugs (p = 0.84, OR=1.12, CI=0.37-3.37). However, the intervention was associated with increased help-seeking from formal sources (compared to informal sources) both overall (p = 0.005, OR = 1.81, 95%CI = 1.19-2.75), as well as for depression (p = 0.01, OR=2.09, 95%CI=1.19-3.67), and stress and anxiety (p < 0.006, OR = 1.72, 95%CI = 1.17-2.54). INTERPRETATION Rates of help-seeking remained unchanged following the intervention. However, MAKINGtheLINK effectively improved the quality of adolescent help-seeking behaviour by increasing help-seeking from formal sources. As prompt treatment is essential in reducing the long-term impact of early onset mental health problems, MAKINGtheLINK has the potential to make a significant contribution to existing early intervention and prevention efforts. FUNDING National Health and Medical Research Council (APP1047492).
Collapse
Affiliation(s)
- Dan I Lubman
- Turning Point, Eastern Health, Richmond, Victoria 3121, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
- Corresponding author at: Turning Point, 100 Church St, Richmond, Victoria 3121, Australia.
| | - Ali Cheetham
- Turning Point, Eastern Health, Richmond, Victoria 3121, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
| | - Emma Sandral
- Turning Point, Eastern Health, Richmond, Victoria 3121, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Fiona Blee
- Turning Point, Eastern Health, Richmond, Victoria 3121, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
| | - Bonita J Berridge
- Turning Point, Eastern Health, Richmond, Victoria 3121, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
| | - Anthony F. Jorm
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Coralie Wilson
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
- Graduate Medicine, School of Medicine University of Wollongong, Wollongong, NSW 2522, Australia
- Centre for Personal and Professional Development (CPPD), Wollongong 2517, Australia
| | - Nicholas B. Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
- Department of Psychology, University of Oregon, Eugene 6200, United States
| | - Lisa McKay-Brown
- Travancore School, Victorian Department of Education and Training, Travancore, Victoria 6200, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Victoria 6200, Australia
| | - Jenny Proimos
- Victorian Department of Education and Training, Melbourne, Victoria 6200, Australia
| |
Collapse
|
3
|
Lubman DI, Cheetham A, Jorm AF, Berridge BJ, Wilson C, Blee F, Mckay-Brown L, Allen N, Proimos J. Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse. BMC Public Health 2017; 17:658. [PMID: 28814325 PMCID: PMC5559792 DOI: 10.1186/s12889-017-4655-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 07/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources. METHOD The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help. RESULTS Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends. CONCLUSIONS While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.
Collapse
Affiliation(s)
- D. I. Lubman
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - A. Cheetham
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - A. F. Jorm
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC Australia
| | - B. J. Berridge
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - C. Wilson
- Illawarra Health and Medical Research Institute, Wollongong, NSW Australia
- School of Medicine, University of Wollongong, Wollongong, NSW Australia
| | - F. Blee
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - L. Mckay-Brown
- Travancore School, Victorian Department of Education and Training, Travancore, VIC Australia
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, VIC Australia
| | - N. Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC Australia
- Department of Psychology, University of Oregon, Eugene, OR USA
| | - J. Proimos
- Victorian Department of Education and Training, Melbourne, VIC Australia
| |
Collapse
|