An interactive video increasing French students' mental health literacy: a mixed-methods randomized controlled pilot study

Mental health literacy (MHL) is a determinant of psychological well-being in young people. A randomized controlled design was used to evaluate the appreciation and effectiveness of an interactive video on French University students' MHL (knowledge about depression and suicidal behavior, mental health help-seeking behaviors, stigma and misconceptions about mental health). At the baseline, all participants (n = 101) completed a questionnaire including several scales on MHL. One month after, participants were randomly assigned to two homogeneous groups (intervention, n = 50 or control, n = 51) and again completed the questionnaire on MHL. Through a mixed-methods approach, semi-structured interviews were also conducted with the intervention group to collect information on the appreciation of the interactive video. Quantitative data indicated that MHL scores increased or remained stable in the intervention group. Comparison with the control group and multivariate logistic regression models did not show statistically significant differences, due to the small sample of the study. According to qualitative data, users appreciated the content and the format of the intervention. It was suggested that the video could be disseminated in other University campuses in France and internationally to promote MHL among students.

Scaling up community-delivered mental health support and care: A landscape analysis

Introduction

The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up.

Methods

A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features.

Results

The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies.

Discussion

This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.

The program evaluation of 'Go-To Educator Training' on educators' knowledge about and stigma toward mental illness in six Canadian provinces

AIM

Schools are well positioned to promote mental health literacy and assist in the early identification of students who may have a mental disorder. However, many educators are unprepared to effectively address these issues. Enhancing this capacity may improve mental health outcomes for students. This report describes the application of a gatekeeper-type program, the 'Go-To Educator Training' (GTET), targeting educators whom students naturally gravitate toward for support, designed to improve educators' mental health knowledge and early identification skills and decrease stigma.

METHODS

GTET was conducted in six Canadian provinces (Ontario, Nova Scotia, New Brunswick, Newfoundland, Alberta and Manitoba) (2012-2015), with 949 secondary school educators involved. Pre- and postintervention mental health knowledge and stigma surveys were completed. Paired t-tests assessed change in knowledge and stigma. ANCOVA compared knowledge and stigma change across subgroups. Correlation measured the relationship between knowledge and stigma.

RESULTS

Knowledge significantly improved (t[919] = 58.40, P < .001, d = 2.12) and stigma significantly decreased (t[872] = 4.52, P < .001, d = 0.14). Similar results were identified within each province/region. Knowledge and stigma were correlated before (N = 922, r = .18, P < .01) and after the training (N = 888, r = .22, P < .01).

CONCLUSIONS

These results suggest GTET may be an effective school-based mental health related intervention. Further study is needed to measure its long-term impact and its role in addressing youth mental health care referrals.

Qualitative Process Evaluation of Rural Schools: Uptake of Change Processes and Contextual Factors Influencing Implementation Within a Primary Prevention Program for Youth

Sexual violence (SV), homophobic name-calling, and bullying commonly occur in school settings. As such, comprehensive school-based violence prevention strategies are needed. Recent calls in prevention science argue that investigations of preventive interventions must move beyond simply testing if programs work; rather, they must also examine how interventions work. The purpose of this study was to explore the differential uptake of salient change mechanisms of a school-based primary prevention program, Sources of Strength (Sources) in rural schools, and examine contextual factors that may influence implementation outcomes in rural contexts. As a supplement to a randomized controlled trial of Sources in 20 high schools in Colorado, the present project utilized a rigorous qualitative design to conduct staff focus groups and student interviews within four schools (two intervention and two waitlist schools) that participated in the RCT. Results suggest variability in uptake of Sources key processes (expansion of networks to build connections, school-wide activities, and staff support) in intervention schools. While these were indicated as non-formalized processes in waitlist schools, there was also variability in these reports. Furthermore, results revealed specific contextual factors including cultural norms, degree of rurality, and school-level buy-in/investment that impacted implementation outcomes for intervention and waitlist schools (e.g., pre-implementation readiness). Implications are discussed around alignment of a school's policies, procedures, and values with the preventative intervention in effort to support strong implementation.

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

OBJECTIVE

This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma.

METHOD

A total of 24 high schools and 534 students in the regional area of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 "Healthy Living" courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes.

RESULTS

For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001).

CONCLUSION

This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted. Clinical trial registration information-Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780.

Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy

OBJECTIVE

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

METHOD

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students' knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

RESULTS

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students' knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52).

CONCLUSIONS

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.

Mental health literacy in secondary schools: a Canadian approach

"Mental health literacy is an integral component of health literacy and has been gaining increasing attention as an important focus globally for mental health interventions. In Canada, youth mental health is increasingly recognized as a key national health concern and has received more focused attention than ever before within our health system. This article outlines 2 unique homegrown initiatives to address youth mental health literacy within Canadian secondary schools."

Improving Malawian teachers' mental health knowledge and attitudes: an integrated school mental health literacy approach

BACKGROUND

Mental health literacy is foundational for mental health promotion, prevention, stigma reduction and care. Integrated school mental health literacy interventions may offer an effective and sustainable approach to enhancing mental health literacy for educators and students globally.

METHODS

Through a Grand Challenges Canada funded initiative called 'An Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania', we culturally adapted a previously demonstrated effective Canadian school mental health curriculum resource (the Guide) for use in Malawi, the African Guide: Malawi version (AGMv), and evaluated its impact on enhancing mental health literacy for educators (teachers and youth club leaders) in 35 schools and 15 out-of-school youth clubs in the central region of Malawi. The pre- and post-test study designs were used to assess mental health literacy - knowledge and attitudes - of 218 educators before and immediately following completion of a 3-day training programme on the use of the AGMv.

RESULTS

Results demonstrated a highly significant and substantial improvement in knowledge (p < 0.0001, d = 1.16) and attitudes (p < 0.0001, d = 0.79) pertaining to mental health literacy in study participants. There were no significant differences in outcomes related to sex or location.

CONCLUSIONS

These positive results suggest that an approach that integrates mental health literacy into the existing school curriculum may be an effective, significant and sustainable method of enhancing mental health literacy for educators in Malawi. If these results are further found to be sustained over time, and demonstrated to be effective when extended to students, then this model may be a useful and widely applicable method for improving mental health literacy among both educators and students across Africa.

Sustained improvements in students' mental health literacy with use of a mental health curriculum in Canadian schools

BACKGROUND

Enhancement of mental health literacy for youth is a focus of increasing interest for mental health professionals and educators alike. Schools are an ideal site for addressing mental health literacy in young people. Currently, there is limited evidence regarding the impact of curriculum-based interventions within high school settings. We examined the effect of a high-school mental health curriculum (The Guide) in enhancing mental health literacy in Canadian schools.

METHODS

We conducted a secondary analysis on surveys of students who participated in a classroom mental health course taught by their usual teachers. Evaluation of students' mental health literacy (knowledge/attitudes) was completed before and after classroom implementation and at 2-month follow-up. We used paired-samples t-tests and Cohen's d value to determine the significance and impact of change.

RESULTS

There were 265 students who completed all surveys. Students' knowledge significantly improved between pre- and post-tests (p < 0.001; d = 0.90) and was maintained at follow-up (p < 0.001; d = 0.73). Similarly, attitude significantly improved between pre- and post-tests (p < 0.001; d = 0.25) and was significantly higher at follow-up than base-line (p < 0.007; d = 0.18) CONCLUSIONS: The Guide, applied by usual teachers in usual classroom curriculum, may help improve student knowledge and attitudes regarding mental health. This is the first study to demonstrate the positive impact of a curriculum-based mental health literacy program in a Canadian high school population.

Exploring the Relative Contributions of the Strength and Distress Components of Dual-Factor Complete Mental Health Screening

Early school-based mental health screeners were informed by a deficit paradigm that aimed to identify psychological distress symptoms. In comparison, following a whole-child perspective, a dual-factor approach has been proposed that assesses complete mental health using both positive dispositions and distress symptoms. Applying the dual-factor approach, the current study involved 118 students from 10th grade and examined how strongly subjective well-being (SWB) was associated with measures of positive psychological dispositions (Social Emotional Health Survey [SEHS]) and psychological distress (Behavioral and Emotional Screening System [BESS]). Results indicated that the strength-based SEHS explained 32% of the variance in the students’ global SWB with the deficit-based BESS adding an additional 8% of explained variance. Implications for school-based mental health screening are discussed.

Children First

Although the importance of healthy mental development in children and youth is not disputed, the mental health needs of far too many Canadian children are being ignored. Within the context of recent federal and provincial calls for systemic reform of the mental health care systems for children and youth, we underscore the necessity for ongoing innovation, development, education, and evaluation. This article describes our aims to establish demonstration and research sites focused on promising frameworks that draw from systems of care, public health, and resiliency approaches.