Beliefs about appropriate first aid for young people with mental disorders: findings from an Australian national survey of youth and parents

Characteristics of mental health literacy measurement in youth: a scoping review of school-based surveys

Mental health literacy (MHL) was introduced 25 years ago as knowledge and beliefs about mental disorders which aid in their recognition, management, or prevention. This scoping review mapped the peer-reviewed literature to assess characteristics of secondary school-based surveys in school-attending youth and explore components of school-based programs for fostering MHL in this population. The search was performed following the method for scoping reviews by the Joanna Briggs Institute (JBI). Searches were conducted in four scientific databases with no time limit, although all sources had to be written in English. Primary studies (N = 44) provided insight into MHL surveys and programs for school-attending youth across 6 continents. Studies reported that most youth experience moderate or low MHL prior to program participation. School-based MHL programs are relatively unified in their definition and measures of MHL, using closed-ended scales, vignettes, or a combination of the two to measure youth MHL. However, before developing additional interventions, steps should be taken to address areas of weakness in current programming, such as the lack of a standardized tool for assessing MHL levels. Future research could assess the feasibility of developing and implementing a standard measurement protocol, with educator perspectives on integrating MHL efforts into the classroom. Identifying the base levels of MHL amongst school-attending youth promotes the development of targeted programs and reviewing the alignment with program components would allow researchers to build on what works, alter what does not, and come away with new ways to approach these complex challenges, ultimately advancing knowledge of MHL and improving levels of MHL.

Depression Literacy and Self-Reported Help-Giving Behaviour in Adolescents in Ireland

This questionnaire-based study aimed to explore depression literacy (DL) and help-giving experiences in 12-18-year-old adolescents (N = 535, Mage = 14.9 years, 51.8% male) in Ireland. In response to a vignette depicting a character displaying symptoms of depression, 46.7% labelled these symptoms 'depression', with increasing age and empathy associated with increased likelihood of labelling as such. Almost all (92.1%) believed the character needed help, but the perceived helpfulness of potential responses varied. Over one-third (38.2%) indicated they knew someone who had displayed similar symptoms in the past year, with 85.2% of these reporting having helped this person. Reported help-giving responses included comforting the person, encouraging professional help-seeking, and informing an adult. The findings suggest adolescent DL can be best supported by developmentally-sensitive interventions that encourage empathy and the importance of engaging adults' assistance.

Nomenclature for psychosis risk in Japan: Survey results from high-risk individuals, caregivers, and mental health professionals

BACKGROUND

Labeling terms for high-risk state for psychosis, such as 'ultra-high risk' (UHR), 'attenuated psychosis syndrome' (APS), and 'at-risk mental state' (ARMS), have been criticized for their potential to lead to stigma. Hence, mental health service users in Melbourne recently proposed new terms illustrating the at-risk concept ['pre-diagnosis stage' (PDS), 'potential of developing a mental illness' (PDMI), and 'disposition for developing a mental illness' (DDMI)]. We aimed at testing the suitability of these existing and new terms in the clinical settings of early psychiatric intervention in Japan.

METHODS

At two centers of early intervention (Toyama and Tokyo), a questionnaire on the understanding and opinion of high-risk terminology was administered to 62 high-risk patients, 44 caregivers, and 64 clinicians. The questionnaire contained the existing and new terms, where the term ARMS was translated into two different Japanese terms ARMS-psychosis and ARMS-kokoro. Participants' opinion on the disclosure of high-risk status was also obtained.

RESULTS

ARMS-kokoro was most preferred, least stigmatizing, and best explaining the patients' difficulties for all groups, while UHR and other terms including the Japanese word 'psychosis' (i.e., APS and ARMS-psychosis) were not preferred. New labeling terms were generally not well received. All groups preferred full disclosure of high-risk terms by the psychiatrist with or without the presence of family members.

CONCLUSION

The term ARMS-kokoro was commonly accepted as a favorable labeling term for the high-risk state for psychosis in Japan. However, another translation ARMS-psychosis was considered stigmatizing, demonstrating the importance of appropriate translation of high-risk terminology into local languages.

Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece

BACKGROUND

In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale.

METHODS

This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes.

RESULTS

A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified).

CONCLUSION

A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.

A survey of mental health literacy in parents and guardians of teenagers

Introduction

Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers.

Methods

Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors).

Results

The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively.

Conclusions

Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.

The use of diet for preventing and treating depression in young men: current evidence and existing challenges

Emerging evidence suggests that diet therapy (nutrients, foods and dietary patterns) could be effective as a potential adjunctive treatment option for major depressive disorder. Numerous mechanisms have been proposed, including the role inflammation, oxidative stress, brain-derived neurotrophic factor, the gastrointestinal tract microbiome and tryptophan/serotonin metabolism. Despite known differences in depression characteristics and treatment responses between males and females, there are limited sex-specific studies examining the role of diet in young men specifically. This is important as young men are often reluctant to seek mental health support, so finding treatment strategies which appeal to this demographic is crucial. This brief report provides an overview of the most recent advances in the use of diet for preventing and treating depression in young men, highlighting existing challenges and opportunities for future research. We recommend that clinicians discuss the role of diet with depressed young men, so that diet may be used alongside current treatment options.

Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial

BACKGROUND

Suicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools.

METHODS

We conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models.

RESULTS

A total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported.

CONCLUSIONS

These findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk.

TRIAL REGISTRATION

The study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls

Social anxiety can have an adverse effect on social connections, educational achievement, and wellbeing. However, the extent to which students stigmatize their peers with social anxiety disorder (SAD) in female educational settings remains unknown. This study investigated the relationship between SAD, peer-liking and stigma in a cohort of early adolescent girls. The sample was 103 sixth and seventh graders attending three girls' schools in Australia. The students, aged between 10- and 13-years, were randomly allocated to either a control (n = 52) or experimental (n = 51) group. Participants completed an online survey while at school to examine their responses to one of two age-and-gender matched vignettes: a hypothetical peer with SAD (experimental condition), or without SAD (control condition). Contrary to expectations, group comparisons revealed that students with the SAD vignette liked their peer more than students with the non-SAD vignette. Also, students endorsed higher levels of pity, lower levels of fear, but similar levels of anger when considering their SAD (versus non-SAD) peer. In the SAD group, higher levels of pity were associated with greater peer-liking. The opposite pattern was evident in response to the non-SAD peer. Importantly, students discriminated less (preferred less social distance) in response to their peer with SAD. This points to the potential benefit of adolescent peer programs that aim to promote positive peer-relationships as a protective factor for students with SAD. Future research may examine gender and socio-economically diverse students to increase the confidence with which findings can be generalized to other educational settings.

A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain

Objectives

Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions.

Design

This study employed a cross-sectional questionnaire design.

Methods

Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed.

Results

Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits.

Conclusion

Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.

Evaluation of the Conversations about Non-Suicidal Self-Injury Mental Health First Aid Course: Effects on Knowledge, Stigmatising Attitudes, Confidence and Helping Behaviour

BACKGROUND

Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage professional support. Mental Health First Aid® Australia's Conversations about Non-Suicidal Self-Injury course provides evidence-based training for the general public to support a person engaging in NSSI.

METHODS

This uncontrolled trial evaluated the effects of the Conversations about Non-Suicidal Self-Injury course on participants' knowledge, confidence, stigmatising attitudes, and intended and actual helping behaviours. Surveys were administered pre- and post-course, and at a six-month follow-up. A linear mixed-model analysis determined mean change over time, and effect sizes were estimated using Cohen's d. Course satisfaction was assessed using descriptive statistics and summative content analysis of qualitative data.

RESULTS

The pre-course survey was completed by 147 Australian participants (77.5% female, mean age 45.8 years), 137 (93.2%) at post-course and 72 (49%) at follow-up. Knowledge, confidence, quality of intended helping behaviours, and quality of actual helping behaviours increased significantly at both time points. Social distance decreased significantly at all time points and stigma decreased significantly at post-course. The course was perceived to be highly acceptable by participants.

CONCLUSIONS

There is initial evidence that the Conversations about Non-Suicidal Self-Injury course is effective and acceptable for members of the public who may support a person engaging in NSSI.

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up

OBJECTIVES

Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions.

DESIGN

Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17).

SETTING

Participants attended courses that were run in Queensland and Victorian communities and through one national organisation.

PARTICIPANTS

Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples.

INTERVENTION

The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI.

RESULTS

Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander.

CONCLUSIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.

Young people's help-giving actions towards a peer with a mental health problem: A systematic review and narrative synthesis

AIMS

Young people often seek help from their peers for mental health problems. However, little is known about young people's experiences of helping a peer with a mental health problem. The aim of this study was to systematically review the literature on young people's help-giving actions, highlight any gaps in the research and examine the evidence for interventions designed to increase and improve help-giving. The secondary aim was to compare findings between help-giving in face-to-face and online settings.

METHODS

Embase, SCOPUS, PsycINFO and MEDLINE electronic databases were searched for English studies published from 2003 onwards. Studies focusing on the help-giving actions of young people (aged 12-25 years) towards a peer with a mental health problem were included. Risk of bias was assessed using the Joanna Briggs Institute quality appraisal tools. Data were synthesized using thematic and narrative analysis.

RESULTS

Twenty-one studies (3440 participants) were included. The most frequently reported help-giving themes were encouraging professional and adult support and providing emotional support. Although limited studies reported on online help-giving, online settings allowed for immediate help to be provided despite time or location. Both positive and negative outcomes for helping were identified. Improvements in the quality of help-giving were found after training; however, help-giving for mental health crises was poor.

CONCLUSIONS

Further research regarding the young people's help-giving actions to peers online is required. Training programs need to consider how to further improve the quality of help-giving among young people and to increase the trainees' confidence in helping, particularly in a mental health crisis.

Promoting Mental Health Help-Seeking Behaviors by Mental Health Literacy Interventions in Secondary Education? Needs and Perspectives of Adolescents and Educational Professionals

Mental health literacy (MHL) interventions in secondary schools may help to improve competencies that adolescents require to stay mentally healthy and seek help if mental health problems arise. These MHL interventions should be tailored to the needs of adolescents and educational professionals (EPs) to reach sustainable implementation and long-term effectiveness. However, evidence is lacking on these needs. Thus, our aim was to explore their experiences with, and perspectives on, mental health help seeking and needs regarding MHL interventions. We performed online focus group discussions and interviews with adolescents (n = 21; 13-19 years) and EPs (n = 12) and analyzed the data using directed content analysis. We identified three themes related to mental health help seeking: (1) Limited MHL competencies of adolescents, (2) Limited competencies of EP to provide mental health support, and (3) Limited mental health promotion in the school environment. We further identified three themes regarding MHL interventions: (1) Addressing basic mental health knowledge and skills, (2) Interactive and easily accessible, and (3) Sustainable implementation. Improving the MHL competencies of adolescents and EPs, and creating a mental health-literate school environment can promote adolescents' mental health help seeking. Our findings highlight the importance of developing MHL interventions that are tailored to both adolescents' and EPs needs.

A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial

BACKGROUND

Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world.

OBJECTIVE

The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial.

METHODS

A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables.

RESULTS

Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t_179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t_174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%).

CONCLUSIONS

The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms.

TRIAL REGISTRATION

Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/11255.

An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol

BACKGROUND

Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting.

METHODS

In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained.

DISCUSSION

Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.

Mental health literacy among adolescents: Evidence from a community-based study in Delhi

BACKGROUND

Mental Health Literacy (MHL) is the ability to recognize mental disorders, along with knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Adequate MHL is linked to better health-seeking behavior and management of mental illness.

AIM

To assess the MHL related to depression and anxiety among adolescents of age 15 to 19 years residing in Delhi.

METHODS

A survey was conducted among adolescents in southeast Delhi. MHL was assessed using sex-matched vignettes of Common Mental Disorders (CMDs) like depression and anxiety. MHL was assessed under domains of identifications of disorders, help-seeking behavior, knowledge about prevention, and stigmatizing attitude toward the respective illness. Statistical analysis was done in STATA and percentage of participants with adequate MHL in various domains was calculated, and difference between various groups was examined using chi-square test.

RESULTS

A total of 491 adolescents participated (response rate of 87.2%) of whom a 50.3% were girls and 57.8% were 15 to 17 years of age. Only 50 (10.2%) participants identified depression vignette as that of depression and 51 (10.4%) identified vignette of anxiety disorder as the same. No statistically significant gender differential in MHL was seen (p value = .8). The stigmatizing attitude, assessed by asking a series of questions suggesting stigma toward the particular illness, was observed among almost all participants (depression -99.4%, and anxiety disorders -96.1%). 18.3% and 18.7% of participants reported correct knowledge about the prevention of depression and anxiety respectively. Four hundred and twenty-two (86%) identified the need to seek help for symptoms reported in vignettes. Of these, 234 (55%) preferred parents, and 62 (14.7%) look after friends for any help.

CONCLUSION

Adolescents residing in Delhi reported poor MHL for Common Mental Disorders. High stigma and poor help-seeking behavior was also observed among the participants toward CMDs.

The role of family structure in health literacy in children and adolescents: a narrative review

Childhood and adolescence are the periods in which children shape their character and behavior. This is also the period for children to adopt good health behaviors and to gain health knowledge- to gain health literacy (HL). Several factors play an important role in this. Among them are the person's characteristics, family and social environment, literacy in general, cultural influences, and technological advances. The present study reviews the recent scientific evidence on the role that the family structure plays in HL in children and adolescents. A literature search was performed, until July 2019, in PubMed and Scopus. Appropriate keywords, related to HL and family structure, were used. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. Ten studies were included in this literature review. Several aspects of family structure (e.g., marital status, members of family, parental educational level, etc.) seemed to play a positive role in children's HL status in the sense that children improve their HL when raised in families whose members have better HL. Although there is good evidence that HL positively affects children's and adolescents' health behavior, the role of family structure in children's HL has not been well studied and understood.

Mental health literacy survey among Cambodia’s urban and rural populations: Results from a vignette-based population survey

Background

Although there are effective methods for the treatment and management of various mental illnesses, some individuals still do not seek psychiatric treatment. Various factors could affect this reluctance toward treatment, one of which is the public’s lack of mental health literacy. This survey aimed to measure and compare mental health literacy in Cambodia’s urban and rural areas.

Method

Tours were held to hold seminars that provided information about mental health in the health centers around Phnom Penh (PP) and Siem Reap (SR), and a survey was conducted on mental health literacy for the participants before the seminar at each location. Anthony Jorm’s vignette of psychosis (young adult) and Angermeyer’s questionnaire were used. After the participants were classified into the “agree group” and “disagree group” for each item, the answers for each item given by the participants in PP and SR were compared using the chi-square test and the odds rate was calculated.

Results

The participants in SR were more likely to give reasons such as inherited causes, economic problems, stress at work, or family problems as the cause of schizophrenia. The percentage of these beliefs about schizophrenia was relatively lower in PP than in SR. Regarding attitudes toward schizophrenia, the participants in SR were more likely to have negative views and predict negative prognoses than the participants in PP. As for participants’ feelings about schizophrenia, the participants in SR reacted more strongly than those in PP. Even though the participants in SR reacted more negatively, they were sympathetic toward individuals with schizophrenia.

Conclusion

Overall, the participants in the SR group were more likely to have negative attitudes toward schizophrenia than those in the PP group. These results support our hypothesis that mental health literacy represents the maturity of community mental health in a targeted area.

Evaluation of beliefs and attitudes among caregivers of child labor about mental disorders first aid and stigma

BACKGROUND

The beliefs and attitudes of caregivers of working children about mental health issues and first aid and their attitudes about the stigma of mental health problems can affect their motivation to seek professional help for affected children. This study aimed to assess the mental health literacy among caregivers of child labor about first aid for mental health and their attitudes about the stigma of mental disorders.

METHODS

The Depression Health Literacy Questionnaire has been used in this cross-sectional study. All caregivers of working children who were willing to participate were included in the study. This group is covered by a Non-Governmental Organization (NGO) located in the 17th district of Tehran.

RESULTS

Questionnaires completed by 131 caregivers were analyzed. The average age of the participants was 32.6 (± 7.9) years. Of which 130 (99.2%) were mothers. Amongst, only 37 individuals (28.2%) were confident in their ability to help their children in case of depression symptoms. A majority of participants, 109 (83.2%), believed that asking a depressed child about suicidal ideation was harmful.

CONCLUSION

According to the findings of this study, the literacy among caregivers of child labor about mental health first aid in our study needs to be improved. There is also a need for educational and community-based programs to reduce the stigma about mental health disorders, including depression.

Adolescents’ Continuum and Categorical Beliefs, Help-seeking Intentions, and Stigma Towards People Experiencing Depression or Schizophrenia

The present study investigated the relationships between continuum and categorical beliefs, stigma, and help-seeking in response to vignettes depicting depression and schizophrenia. Participants were 193 adolescents aged 13-18 years. Results showed no relationships between continuum beliefs and stigma or help-seeking intentions for the depression vignette when controlling for other predictors. Stronger categorical beliefs were associated with greater social distance, and endorsement of dangerousness, avoidance, and fear. For the schizophrenia vignette, higher continuum beliefs predicted lower prognostic pessimism, social distance, and stigmatising attitudes. Surprisingly, continuum beliefs predicted greater intentions to not seek help. Categorical beliefs were associated with greater prognostic pessimism, social distance, and stigmatising attitudes. Future research is needed to explore the effect of continuum belief interventions on adolescent mental health stigma.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

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

Lower help-seeking intentions mediate subsequent depressive symptoms among adolescents with high autistic traits: a population-based cohort study

Adolescents with high autistic traits are at increased risk of depression. Despite the importance of seeking help for early intervention, evidence on help-seeking intentions amongst this population is scarce. Using a population-based cohort in Japan, we examined adolescents' help-seeking intentions and preferences by the level of autistic traits and tested its mediating role on the association between high autistic traits and depressive symptoms. At age 12, we measured parent-rated autistic traits using the short version of the Autism Spectrum Quotient and classified the adolescents into two groups (≥ 6 as AQhigh, < 6 as AQlow); help-seeking intentions and preferences were assessed through a depression vignette. At age 14, depressive symptoms were self-rated using the Short Mood and Feelings Questionnaire. Hypothesised associations between autistic traits and help-seeking intentions or depressive symptoms were tested applying multivariable regression modelling, while mediation was tested with structural equation modelling. Of the 2505 adolescent participants, 200 (8%) were classified as AQhigh. In both groups, the main source of help-seeking was their family; however, 40% of the AQhigh group reported having no help-seeking intentions compared to 27% in the AQlow. The AQhigh group was at increased risk of not having help-seeking intentions (OR 1.84, 95% CI 1.35-2.50) and higher depressive symptoms (b coefficient 1.06, 0.33-1.79). Help-seeking intentions mediated 18% of the association mentioned above. Interventions to promote help-seeking intentions among adolescents with high autistic traits could reduce their subsequent depressive symptoms. Ideally, such interventions should be provided prior to adolescence and with the involvement of their parents.

Adolescents' Empowerment for Mental Health Literacy in School: A Pilot Study on ProLiSMental Psychoeducational Intervention

Adolescence is a critical life phase for mental health and anxiety an emerging challenge for adolescents. Psychoeducational interventions to promote mental health literacy (MHL) on anxiety in adolescents are needed. This study aimed to test the primary outcome of a future full-scale trial: improvement of adolescents' anxiety MHL components on recognition, prevention strategies, and self-help strategies. A sample of 38 adolescents, 24 (63.2%) females and 14 (36.8%) males, with an average age of 14.50 years (SD = 0.89) participated in this study. Each class was allocated to the intervention group (IG, n = 21) or the waiting list control group (WLCG, n = 17) with single-blinded randomization. MHL was assessed using the QuALiSMental. The ProLiSMental psychoeducational intervention consists of four or eight weekly sessions of 90 or 45 min for adolescents, using different active pedagogical methods and techniques. There also are initial and final sessions with adolescents, legal guardians, and teachers. There was a significant improvement with a small to relatively strong effect size in many dimensions of anxiety MHL components. This study suggests the progression to the full-scale trial and values the important role of mental health and psychiatric nurses in the adolescents' empowerment for MHL in schools.

Recognition of anxiety disorder and depression and literacy of first-aid support: A cross-sectional study among undergraduate students in Ha Noi, Viet Nam 2018

This study is aimed at exploring undergraduate students’ abilities to recognize anxiety disorder and depression symptoms, and their literacy of mental first-aid supports for these problems. Using a mixed-method, cross-sectional design, data were collected from 724 undergraduate students in Hanoi. This used a questionnaire on literacy of anxiety disorder and depression, adapted from the Australian National Survey of Mental Health Literacy and Stigma. The prevalence of the respondents who could identify anxiety disorder and depression symptoms were 25.9% and 42.3%, respectively. Literacy of mental first-aid supports focused on: listening to the person in an understanding way, encouraging the person to be more active, seeking professional help, make appointment with the general doctor.

Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions

OBJECTIVE

Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course.

METHODS

We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person.

RESULTS

Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders.

IMPLICATIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

Stigmatizing attitudes of Swiss youth towards peers with mental disorders

Background

Previous research on public stigma towards people with mental disorders has mostly targeted adult samples and focused on depression, schizophrenia or mental disorders in general. Hence, the present study aimed to investigate predictors of stigmatizing attitudes towards different mental disorders (including less researched ones) in a representative sample of adolescents and young adults.

Methods

Data from the Swiss Youth Mental Health Literacy and Stigma Survey were used (analytical sample: n = 4,932). Each participant was randomly presented with one of five vignettes (depression; alcohol abuse; depression and alcohol abuse combined; schizophrenia; social anxiety). The structure of stigmatizing attitudes was assessed using confirmatory factor analysis. Regression models, implemented within a structural equation framework, were used to study predictors for the identified latent variables.

Results

A three-factor model for stigmatizing attitudes–consisting of ‘dangerous/unpredictable’, ‘weak-no-sick’, and ‘social distance’ factors–best fitted the data. Female gender was associated with less stigmatizing attitudes. Associations in opposite directions with different latent factors were found for educational and migration background. Exposure to mental disorders (being personally affected, personally having received professional help or knowing someone close who has received treatment for a mental disorder) was either not or was negatively associated with stigmatizing attitudes. In contrast, current mental health symptoms (heightened levels of psychological distress, problematic alcohol use) were generally not or were positively associated with stigmatizing attitudes. Even though the included predictors had some predictive value, the variance explained by the models was rather small (the adjusted R² varied between 0.03 and 0.26).

Conclusions

The current study indicates that contact with someone who has received treatment for a mental disorder might be an important component of programs aiming to decrease stigmatizing attitudes towards people with mental disorders, since this exposure variable predicted lower levels of stigmatizing attitudes. Furthermore, the findings suggest that target-group interventions for specific subgroups need to be considered, as the process leading to stigmatizing attitudes towards people with mental disorders appears to differ between specific sociodemographic subgroups.

Outcomes of reducing stigma towards alcohol misuse during adolescence: results of a randomized controlled trial of the MAKINGtheLINK intervention

BACKGROUND

While it is well-recognized that the stigma associated with alcohol use problems can prevent or delay help-seeking, there is limited research examining stigmatising attitudes towards alcohol misuse, or their consequences, during adolescence. The current study examined the results of a school-based intervention on adolescents' stigmatising attitudes towards alcohol misuse among their peers, and how changes in attitudes influenced intentions to encourage help-seeking, as well as participants' personal use and misuse of alcohol.

METHODS

Participants (n = 463) were a subset of a larger sample participating in a randomized controlled trial of the MAKINGtheLINK intervention. Of the included participants, 287 (62%) were allocated to the intervention group and 176 (38%) to the control group. Assessments were conducted at baseline and 6-weeks, 6-months, and 12-months post-baseline. At each assessment, participants were presented with a vignette describing a peer experiencing alcohol misuse and completed the General Help Seeking Questionnaire as well as a 10-item scale measuring stigmatising attitudes. Alcohol use was also assessed.

RESULTS

The intervention was associated with a greater reduction in 'weak-not-sick' attitudes over time, which in turn predicted stronger intentions to encourage help-seeking from family members and formal help sources at the 12-month follow-up. Perceptions of dangerousness did not change significantly as a result of the intervention, however overall perceptions of dangerousness demonstrated a trend towards encouraging help-seeking from formal sources. Changes in stigma were not associated with past-year alcohol use or problems.

CONCLUSIONS

School-based interventions such as MAKINGtheLINK can decrease some stigmatising attitudes towards alcohol misuse during adolescence, and increase adolescents' intentions to encourage help-seeking from both formal and informal help sources. However, results varied depending on both the dimension of stigma examined and the type of help source, highlighting a complex relationship between stigma, intentions, and sources of help that requires further investigation. Importantly, reducing stigma did not appear to result in negative effects due to greater acceptance of drinking (e.g., heavier alcohol use), supporting continued efforts to reduce alcohol-related stigma during adolescence.Trial registration: Registered with the Australia and New Zealand Clinical Trials Register (ANZCTR) on the 27th of February 2013 (ACTRN12613000235707).

“We need to slowly break down this barrier”: understanding the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK

Purpose

Undergraduates are highly susceptible to the development of mental health difficulties. Afro-Caribbean students are particularly vulnerable to the pressures of university yet are less likely than other ethnic groups to receive early intervention. This paper aims to understand the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK.

Design/methodology/approach

Critical Incident Technique was used as the qualitative method because it explores the critical factors that contribute to or detract from a specific experience. Seventeen Afro-Caribbean undergraduates participated in five focus groups. This involved engaging in a novel psychosocial activity that incorporated vignettes to encourage the identification of barriers and facilitators to service access. The data were analysed thematically to generate categories of critical incidents and wish-list items.

Findings

Analysis revealed rich data from a sub-group rarely researched within UK literature. Fifteen barriers, eleven facilitators and five wish-list items were identified. The importance of mental health literacy, social networks, cultural sensitivity and concerns surrounding services underpinned many categories.

Originality/value

Findings provide a new perspective on barriers reported in previous literature. Novel facilitators were highlighted where, although psychological and sociocultural factors were deemed valuable, structural changes were most desired. Recommended changes illustrate innovative interventions that could make services accessible for young adult Afro-Caribbean populations. Future research should explore the barriers and facilitators identified by Afro-Caribbean undergraduates across various universities who have successfully accessed and engaged with services. This could provide a holistic perspective on viable facilitators enabling access despite the presence of barriers.

A Systematic Review of Parent and Caregiver Mental Health Literacy

This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.

Parent perceptions of mental illness in Chinese American youth

BACKGROUND

Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth.

METHODS

Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking.

RESULTS

While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences.

DISCUSSION

These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.

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

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).

Adolescents' Views on Seeking Help for Emotional and Behavioral Problems: A Focus Group Study

This study aimed to get insight into adolescents’ views on help-seeking for emotional and behavioral problems. Fourteen focus groups were conducted. Two vignettes, depicting one healthy adolescent with few issues and one adolescent with severe psychosocial problems, were used to structure the focus groups. The focus groups were framed within a youth help-seeking model. Adolescents (mean age of 15.0 years) generally reported seeking help from friends or the internet for mild issues and from a person they trust like a parent or school mentor, for more severe problems. Adolescents correctly recognized the issues in vignette one as surmountable and the problems in vignette two as severe. A bond of trust with a help source was regarded as the main facilitator for the decision to seek help. Adolescents reported a preference for help sources who clearly displayed their expertise for the issue at hand and for informal help-sources, particularly friends.

Finding confidence and inner trust as a parent: experiences of group-based compassion-focused therapy for the parents of adolescents with mental health problems

Purpose: Compassion-focused therapy (CFT) can alleviate the stress and challenges faced by the parents of adolescents with mental health (MH) problems. Although CFT interventions have shown promising results, few studies have examined its effectiveness in adolescent psychiatric settings. Therefore, this study examined the participant experiences of group-based CFT for the parents of adolescents with MH problems.Methods: The reflective lifeworld research (RLR) approach was used to conduct in-depth interviews with eleven parents, focusing on participant experiences of group-based CFT. Meaning-oriented data analysis was undertaken.Results: The essential meaning of the phenomenon of participating in group-based CFT was understood as finding confidence and inner trust as a parent, characterized by an understanding of one's own needs, which provided parents with the confidence to support their children. The phenomenon is further explicated with its three constituents: (a) taking care of oneself and one's child; (b) being open and sharing experiences; and (c) acceptance and hope for the future.Conclusions: The CFT intervention enabled parents to find their agency and strengthened their relationships with their children. The findings underscore the need to acknowledge the supportive role parents play in the recovery of children who receive psychiatric care.

Interaction of Health Literacy and Problematic Mobile Phone Use and Their Impact on Non-Suicidal Self-Injury among Chinese Adolescents

Non-suicidal self-injury (NSSI) is prevalent among adolescents. Low health literacy (HL) and problematic mobile phone use (PMPU) are risk factors of NSSI. But so far, no study has examined the interactive role of HL and PMPU on NSSI. In this context, the present study aimed to examine the interactions of HL and PMPU and their impact on NSSI in a school-based sample of Chinese adolescents. A total of 22,628 junior and high school students (10,990 males and 11,638 females) were enrolled in this study. The outcomes were self-reported HL, PMPU and NSSI. Analyses were conducted with chi-square tests and logistic regression models. The prevalence of NSSI was 32.1%. Low HL and PMPU were significantly associated with NSSI independently (OR_{low HL} = 1.886, 95% CI = 1.723–2.065, OR_PMPU = 2.062, 95% CI = 1.934–2.199). Interaction analysis indicated that low HL and PMPU were interactively associated with increased risks of NSSI (OR = 2.617, 95% CI = 2.375–2.884). In all, our findings indicate that HL and PMPU are associated with NSSI independently and interactively. The intervention programs of NSSI should consider the adolescents HL levels and PMPU.

Stigmatising Attitudes Towards Depression and Alcohol Misuse in Young People: Relationships with Help-Seeking Intentions and Behavior

Background and Objective:

Adolescents experiencing mental health problems often approach their peers rather than seeking professional help. A better understanding of adolescents’ stigmatising attitudes towards mental illness will help inform interventions that aim to improve the quality of advice that young people provide to their peers. In particular, there is a need for research examining adolescents’ attitudes towards alcohol misuse, given it’s increase in prevalence during this period as well as the adverse outcomes that are associated with untreated early drinking problems.

Methods:

High-school students (n=2447) were recruited as part of an intervention focussed on overcoming barriers to accessing help for mental health and substance use problems. Participants were presented with two vignettes that described a peer experiencing depression and alcohol misuse, respectively, and completed the General Help-Seeking Questionnaire as well as a 10-item scale measuring stigmatising attitudes. Past helping behavior was also assessed.

Results:

Compared to depression, a peer experiencing alcohol misuse was more likely to be considered “weak” rather than sick, and was perceived as more dangerous and unpredictable. The “weak-not-sick” and “dangerousness” dimensions of stigma predicted weaker intentions to encourage help-seeking from informal sources, while ‘dangerousness’ predicted stronger intentions to encourage formal help-seeking. Both dimensions were associated with fewer instances of past helping behavior.

Conclusion:

Young people stigmatise alcohol misuse more severely than depression. Overall, stigma was associated with weaker intentions to encourage peers to seek help. While perceptions of ‘dangerousness’ were associated with stronger intentions to seek help from formal sources, this association may not translate into actual helping behavior.

A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial

Background

The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically.

Objective

Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up.

Methods

Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents.

Results

Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018.

Conclusions

If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression.

Trial Registration

Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855

International Registered Report Identifier (IRRID)

DERR1-10.2196/11255

Direct and moderating effects of personality on stigma towards mental illness

BACKGROUND

While many studies have explored the concept and correlates of stigma towards individuals with mental illness, few have investigated the role of personality in this process. In the current study, we firstly examined the relationship between personality and stigma towards mental illness; and then explored the moderating effects of personality traits on the relationship between contact experience/s and stigma.

METHODS

Participants were recruited from public medical (N = 502) and nursing schools (N = 500) from April to September 2016 in Singapore for this cross-sectional survey, and they were randomly assigned to a vignette describing one of the following mental disorders: major depressive disorder, obsessive compulsive disorder, alcohol abuse, schizophrenia, and dementia. Stigma was measured by the 'Personal and Perceived scales of the Depression Stigma Scale' and the 'Social Distance Scale'. These scales together had a 3-factor structure based on a previous national study in Singapore, namely 'weak-not-sick', 'dangerous/unpredictable' and 'social distance'. Personality was measured by the 20-item short form of the International Personality Item Pool-five factor model measure.

RESULTS

Regression suggested agreeableness and openness to experience were negatively associated with all three domains of stigma. 'Weak-not-sick' and extraversion were positively associated; and 'social distance' was positively associated with higher scores on conscientiousness and neuroticism. Both close- and non-close contact were associated with more positive attitudes towards mental illness among the participants. Openness to experience moderated the relationships of close contact experience with 'weak-not-sick' and 'dangerous/unpredictable', but in different directions. The association between close contact and 'social distance' were moderated by agreeableness.

CONCLUSIONS

Unlike non-close contact experience, close contact with people with mental illness worked differently on stigma for individuals with different personality traits. Future studies are needed to further explore the underlying mechanisms for such differences.

MAKINGtheLINK: A school-based intervention to improve help-seeking for substance use problems

BACKGROUND

Many young people are reluctant to seek professional help for alcohol and other substance use problems, preferring to rely on family and friends. MAKINGtheLINK is a school-based intervention that teaches adolescents how to help their peers overcome barriers to engaging with professional help. The current study examined the effect of the MAKINGtheLINK programme in a sample of 12- to 15-year-old students.

METHODS

Participants included 247 Grade 8 students (49% male, 51% female) recruited from 3 schools in Victoria, Australia. Participants completed questionnaires measuring barriers to professional help-seeking, help-seeking intentions and confidence to seek help at 3 time points (pre-intervention, post-intervention and 6-week follow-up). A non-controlled repeated measures design was used to assess the effect of the programme on help-seeking across time points.

RESULTS

The programme decreased barriers, increased intentions to seek help from formal sources, decreased intentions to seek help from family and increased confidence to seek help for a peer. The decrease in barriers was maintained at the 6-week follow-up, as were decreased intentions to seek help from family members, and increased intentions to seek help from school counsellors and alcohol and drug workers. The effects of the intervention did not differ substantially between males and females.

CONCLUSIONS

The MAKINGtheLINK is the first intervention to focus on overcoming barriers to help-seeking for substance use problems by helping adolescents develop skills to support their peers. The intervention has promise as a means of facilitating help-seeking during adolescence, although further research is needed to test its effectiveness in a more rigorous design.

Helping adolescents to better support their peers with a mental health problem: A cluster-randomised crossover trial of teen Mental Health First Aid

BACKGROUND

teen Mental Health First Aid (tMHFA) is a classroom-based training programme for students aged 15-18 years to improve supportive behaviours towards peers, increase mental health literacy and reduce stigma. This research evaluated tMHFA by comparing it to a matched emergency Physical First Aid (PFA) training programme.

METHODS

A cluster-randomised crossover trial matched four public schools in two pairs and then randomised each to first receive tMHFA or PFA for all Year 10 students. In the subsequent calendar year, the new Year 10 cohort received the opposite intervention, giving eight cohorts. Online surveys were administered at baseline and 1 week post-training, measuring quality of first aid intentions, mental health literacy, problem recognition and stigmatising beliefs, towards fictional adolescents with depression and suicidality (John) and social anxiety (Jeanie).

RESULTS

A total of 1942 students were randomised (979 received tMHFA, 948 received PFA), 1605 (84%) analysed for the John vignette at baseline and 1116 (69% of baseline) provided post-training data. The primary outcomes, 'helpful first aid intentions' towards John/Jeanie, showed significant group-by-time interactions with medium effect sizes favouring tMHFA ( ds = 0.50-0.58). Compared to PFA, tMHFA students also reported significantly greater improvements in confidence supporting a peer ( ds = 0.22-0.37) and number of adults rated as helpful ( ds = 0.45-0.46) and greater reductions in stigmatising beliefs ( ds = 0.12-0.40) and 'harmful first aid intentions' towards John/Jeanie ( ds = 0.15-0.41).

CONCLUSIONS

tMHFA is an effective and feasible programme for increasing supportive first aid intentions and mental health literacy in adolescents in the short term. tMHFA could be widely disseminated to positively impact on help seeking for adolescent mental illness.

Mental Health Literacy in Young Adults: Adaptation and Psychometric Properties of the Mental Health Literacy Questionnaire

Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12–14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness.

A pilot randomised controlled study of the mental health first aid eLearning course with UK medical students

BACKGROUND

Medical students face many barriers to seeking out professional help for their mental health, including stigma relating to mental illness, and often prefer to seek support and advice from fellow students. Improving medical students' mental health literacy and abilities to support someone experiencing a mental health problem could reduce barriers to help seeking and improve mental health in this population. Mental Health First Aid (MHFA) is an evidence-based intervention designed to improve mental health literacy and ability to respond to someone with a mental health problem. This pilot randomised controlled trial aims to evaluate the MHFA eLearning course in UK medical students.

METHODS

Fifty-five medical students were randomised to receive six weeks access to the MHFA eLearning course (n = 27) or to a no-access control group (n = 28). Both groups completed baseline (pre-randomisation) and follow-up (six weeks post-randomisation) online questionnaires measuring recognition of a mental health problem, mental health first aid intentions, confidence to help a friend experiencing a mental health problem, and stigmatising attitudes. Course feedback was gathered at follow-up.

RESULTS

More participants were lost follow-up in the MHFA group (51.9%) compared to control (21.4%). Both intention-to-treat (ITT) and non-ITT analyses showed that the MHFA intervention improved mental health first aid intentions (p = <.001) and decreased stigmatising attitudes towards people with mental health problems (p = .04). While ITT analysis found no significant Group x Time interaction for confidence to help a friend, the non-ITT analysis did show the intervention improved confidence to help a friend with mental health problems (p = <.001), and improved mental health knowledge (p = .003). Medical students in the intervention group reported a greater number of actual mental health first aid actions at follow-up (p = .006). Feedback about the MHFA course was generally positive, with participants stating it helped improve their knowledge and confidence to help someone.

CONCLUSION

This pilot study demonstrated the potential for the MHFA eLearning course to improve UK medical students' mental health first aid skills, confidence to help a friend and stigmatising attitudes. It could be useful in supporting their own and others' mental health while studying and in their future healthcare careers.

TRIAL REGISTRATION

Retrospectively registered ( ISRCTN11219848 ).

Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse

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.