Mental health promotion works: a review

Assessing the impact of a community-based psychodrama intervention on mental health promotion of adolescents and young adults in Mozambique: A mixed-methods study

Background

While mental health is an emerging issue in low-income countries, its promotion remains poor, with little context-oriented evidence available. Here we aimed to assess the impact and acceptability/feasibility of a community-based psychodrama intervention involving both adolescents and young adults (AYA) living with HIV (AYALHIV) and without HIV (AYAHIV-).

Methods

We used a mixed-methods approach, where the quantitative part was based on pre/post questionnaires and the qualitative one on content analysis of semi-structured interviews. Trained community health care workers delivered psychodrama sessions involving AYAs aged 15-24 years once a week between July and August 2023 in Beira, Mozambique. The baseline assessment involved a sociodemographic and three mental health questionnaires: the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward People with Mental Illness (CAMI27), and the Toronto Alexithymia Scale (TAS). We repeated all questionnaires after the intervention and conducted semi-structured interviews.

Results

We enrolled 354 AYAs (50.8% female, 45.5% AYALHIV) at baseline; 315 (89.0%) attended the sessions, with a mean participation rate of 94.4%. Overall, 281 (89.2%) completed the post-intervention assessment. MAKS score improved from 44.5 (95% confidence interval (CI) = 44.0-45.0) to 47.1 (95% CI = 46.4-47.7, P < 0.001). Total CAMI27 score showed no significant variation (P = 0.855). Total TAS score decreased from 57.3 (95% CI = 56.1-58.5) to 54.3 (95% CI = 53.0-55.6, P < 0.001). We found no statistically significant interactions between time and sex, age, or HIV serostatus in all questionnaires. For the qualitative part of the study, we analysed 37 semi-structured interviews (43.2% with females, 40.5% with AYALHIV). We identified four areas of intervention impact: peer-to-peer support (30.3%), social empowerment (24.7%), resilience (23.0%), and emotional skills (21.9%). Regarding acceptability/feasibility, perceived scalability (37.2%) and affective attitude (34.5%) were the sub-areas most frequently retrieved in the SSIs.

Conclusions

The community-based psychodrama intervention proved to be an effective tool in AYAs' mental health promotion, increasing knowledge and improving emotional awareness through group experience and interpersonal learning. The intervention also showed good acceptability and feasibility in the context of our study.

Association between participation in the Northern Finland Birth Cohort 1966 study and use of psychiatric care services

AIMS

In most population-based epidemiological follow-up studies the aim is not to intervene in the life of the participants. Although the idea is not to intervene, being a member of the longitudinal follow-up study and studies conducted during follow-up may affect the target population. A population-based study including mental health enquiries might reduce the unmet need for psychiatric treatment by motivating people to seek treatment for their psychiatric ill-health. We examined the use of psychiatric care services in the population born in the year 1966 in Northern Finland, of whom 96.3% are participants in the prospective Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

As a study cohort we used people born in 1966 in Northern Finland (n = 11 447). The comparison cohort included all the people born in the years 1965 and 1967 in the same geographical area (n = 23 339). The follow-up period was from age 10 to 50 years. The outcome measure was the use of psychiatric care services, which was analysed using Cox Proportional Hazard regression and Zero-Truncated Negative Binomial Regression.

RESULTS

People born in 1966 in Northern Finland did not differ from those born in 1965 and 1967 in terms of the outcome measure.

CONCLUSIONS

We found no association between participation in an epidemiological follow-up study and the use of psychiatric care services. The NFBC1966 may be regarded as a representative at the population level in terms of psychiatric outcomes despite the personal follow-up of the birth cohort. The associations of participation in epidemiological follow-up studies have previously been under-examined, and the results need to be replicated.

Emotional response patterns, mental health, and structural vulnerability during the COVID-19 pandemic in Canada: a latent class analysis

BACKGROUND

The COVID-19 pandemic has contributed to increases in negative emotions such as fear, worry, and loneliness, as well as changes in positive emotions, including calmness and hopefulness. Alongside these complex emotional changes has been an inequitable worsening of population mental health, with many people experiencing suicidal ideation and using substances to cope. This study examines how patterns of co-occurring positive and negative emotions relate to structural vulnerability and mental health amid the pandemic.

METHODS

Data are drawn from a cross-sectional monitoring survey (January 22-28, 2021) on the mental health of adults in Canada during the pandemic. Latent class analysis was used to group participants (N = 3009) by emotional response pattern types. Descriptive statistics, bivariate cross-tabulations, and multivariable logistic regression were used to characterize each class while quantifying associations with suicidal ideation and increased use of substances to cope.

RESULTS

A four-class model was identified as the best fit in this latent class analysis. This included the most at-risk Class 1 (15.6%; high negative emotions, low positive emotions), the mixed-risk Class 2 (7.1%; high negative emotions, high positive emotions), the norm/reference Class 3 (50.5%; moderate negative emotions, low positive emotions), and the most protected Class 4 (26.8% low negative emotions, high positive emotions). The most at-risk class disproportionately included people who were younger, with lower incomes, and with pre-existing mental health conditions. They were most likely to report not coping well (48.5%), deteriorated mental health (84.2%), suicidal ideation (21.5%), and increased use of substances to cope (27.2%). Compared to the norm/reference class, being in the most at-risk class was associated with suicidal ideation (OR = 2.84; 95% CI = 2.12, 3.80) and increased use of substances to cope (OR = 4.64; 95% CI = 3.19, 6.75).

CONCLUSIONS

This study identified that adults experiencing structural vulnerabilities were disproportionately represented in a latent class characterized by high negative emotions and low positive emotions amid the COVID-19 pandemic in Canada. Membership in this class was associated with higher risk for adverse mental health outcomes, including suicidal ideation and increased use of substances to cope. Tailored population-level responses are needed to promote positive coping and redress mental health inequities throughout the pandemic and beyond.

The Key Role of Psychosocial Competencies in Evidence-Based Youth Mental Health Promotion: Academic Support in Consolidating a National Strategy in France

Psychosocial competencies, also known as psychosocial skills or life skills, are essential for the prevention and promotion of mental health. Since the beginning of this century, psychosocial competencies have been defined as the ability to develop positive mental health. Most individual or social mental health protection programs are related to psychosocial competencies. A majority of evidence-based programs that develop mental health explicitly aim at developing psychosocial competencies, either exclusively or with complementary approaches. Many of these programs have demonstrated their effectiveness, with lasting effects on reduced anxiety and depression symptoms, violent and risky behaviors, and improved well-being and academic success. Based on international meta-analyses and on 20 years of French national and local experiences, a national strategy to develop psychosocial competencies was launched in France in 2021 for all children from 3 to 25 years old. Two reports on evidence-based psychosocial competence development were published in 2022 by the national agency for public health-Santé publique France (Public Health France)-to support this deployment strategy and develop a common evidence-based culture in health and education. This article presents the French national strategy as an example of a means of increasing evidence-based mental health promotion while discussing the importance of cultural adaptation of such programs.

Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis

BACKGROUND

Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement.

OBJECTIVE

We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated.

METHODS

In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria.

RESULTS

Three PRAM factors emerged ("Acceptability of Parenting Resources," "Interest in Learning Parenting Strategies," and "Acceptability of Parenting Websites"), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited.

CONCLUSIONS

The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement.

Finding the right words: Articulating the value of mental health promotion. A focus group study

The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 participants. Resulting data were thematically analysed to articulate how the initiative supports mental wellbeing in different ways. Mental health benefits were categorized into three themes; mental health value, civil values and common values which were comprised of nine subthemes; paradigm shift, social inclusion, personal meaning, regeneration, ambience, stigma, sustainability, democracy and environment. Mental health promotion emphasises the impact of daily environments in which people live their lives. Results from this study support the use of broad based actions which promote different components of mental wellbeing simultaneously. Psychiatric hospitals may offer historically meaningful sites for such actions.

Introducing the QACP: development and preliminary validation of an instrument to measure psychotherapist's core competencies

The movement towards the conceptualization, description and evaluation of psychotherapists' competencies has been widely developed in the last years and has relevant implications for psychotherapy, training, and continuous education. In Italy, this movement has been supported by the Committee for Psychotherapists' Competencies established in 2010 by FIAP (Italian Federation of Psychotherapy's Associations) and CNSP (National Association of Psychotherapy's Training Institutes) and has involved more than 1000 psychotherapists from different approaches, by means of conferences, expert meetings, workshops, and focus groups. One of the outcomes of this process has been the development of a new self-assessment tool for core competencies (i.e., those that are shared by therapists from all modalities): the QACP (Questionario per l'Autovalutazione delle Competenze dello Psicoterapeuta). The present study aims to present the process of development and the preliminary proofs of the validity of this tool. Construct and knowngroup validity of the questionnaire were examined, and reliability was estimated by computing the internal consistency reliability coefficients for both the overall and the subscale scores. Overall, the instrument showed satisfactory psychometric characteristics. The limitations of the study and the results are discussed and directions for further research are proposed.

Mental Health Prevention and Promotion-A Narrative Review

Extant literature has established the effectiveness of various mental health promotion and prevention strategies, including novel interventions. However, comprehensive literature encompassing all these aspects and challenges and opportunities in implementing such interventions in different settings is still lacking. Therefore, in the current review, we aimed to synthesize existing literature on various mental health promotion and prevention interventions and their effectiveness. Additionally, we intend to highlight various novel approaches to mental health care and their implications across different resource settings and provide future directions. The review highlights the (1) concept of preventive psychiatry, including various mental health promotions and prevention approaches, (2) current level of evidence of various mental health preventive interventions, including the novel interventions, and (3) challenges and opportunities in implementing concepts of preventive psychiatry and related interventions across the settings. Although preventive psychiatry is a well-known concept, it is a poorly utilized public health strategy to address the population's mental health needs. It has wide-ranging implications for the wellbeing of society and individuals, including those suffering from chronic medical problems. The researchers and policymakers are increasingly realizing the potential of preventive psychiatry; however, its implementation is poor in low-resource settings. Utilizing novel interventions, such as mobile-and-internet-based interventions and blended and stepped-care models of care can address the vast mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. Furthermore, employing decision support systems/algorithms for patient management and personalized care and utilizing the digital platform for the non-specialists' training in mental health care are valuable additions to the existing mental health support system. However, more research concerning this is required worldwide, especially in the low-and-middle-income countries.

Promoting Mental Health During the COVID-19 Pandemic: A Hybrid, Innovative Approach in Malaysia

Background: The COVID-19 pandemic has had monumental effects on the mental health of populations worldwide. Previous research indicated that programs and interventions using social networks can play a positive role in promoting mental health. Nevertheless, current evidence is largely derived from high-income regions, reflecting an urgent need for more studies in low- and middle-income settings.

Objectives: This paper aims to (a) describe the potential value of a hybrid health carnival in promoting mental health and increasing access to screening services; (b) assess the level of community engagement with the digital platform.

Methods: A mental health carnival was conducted with the theme of “Mind Your Mental Health” (Cakna Kesihatan Mental) in conjunction with the World Mental Health Day in Malaysia. This was a hybrid carnival that combined elements of face-to-face interactions and virtual learning. Free online therapy sessions were offered to high-risk groups identified during the screening process. Social media metrics were utilized to report the levels of community engagement and participants completed pre-and post-assessments to measure the program's impact on their knowledge.

Results: The carnival was attended by 515 participants (78.8% virtual participants). Social media metrics reported more than 5,585 reaches on Facebook for all the activities held throughout the event. Results from pre-and post-assessments showed significant improvement in the mean knowledge scores (p < 0.05).

Conclusion: This digital approach will continue to evolve by releasing new features and tools as a new frontier for high-risk populations and all individuals seeking mental health support and treatment.

PROTOCOL: Social interventions to improve well-being of people with mental disorders: Global evidence and gap map

Introduction: Mental illnesses play a role in poor health outcomes. Mental health is just as vital as physical health for an individual's total well-being. Alterations in mental health can have a significant impact on all aspects of life, including school or work performance, relationships with family and friends, and community participation. As a result, we would like to provide an overview of psychosocial interventions that are available to improve the well-being of people with mental health conditions and map available studies on the effectiveness of interventions provided in framework. Methods: This Evidence Gap Map will feature systematic reviews of the effects of interventions and effectiveness studies that used either: (a) randomised experimental design, or (b) rigorous quasi-experimental design, (c) natural experiments, (d) regression discontinuity, (e) propensity score matching, (f) difference in difference, (g) instrumental variables, (h) and other matching design, (I) Single subject design. We will include qualitative studies, relevant working papers will also be included. Also, language restricted to english from any country will be reviewed for inclusion. Electronic Search will be conducted with the help of a relevant databases in our area of study. Outcomes: Will be focused mainly on the basis of community-based Rehabilitation matrix adapted from the comprehensive mental health action plan, 2013-2020.

Feasibility study on the mhGAP-IG as a tool to enhance parental awareness of symptoms of mental disorders in lower primary (6-10 year old) school-going children: Towards inclusive child mental health services in a Kenyan setting

AIMS

(1) To determine the feasibility of involving parents as key partners in school mental health activities; (2) to determine whether educating parents on mental health treatment Gap Intervention Guideline (mhGAP-IG) section on children leads to enhanced parent perception of mental health symptoms in their children; and (3) to determine context appropriate social demographic predictors of the parental awareness following the psychoeducation using the mhGAP-IG children version.

METHODS

Consenting parents completed the Child Behaviour Checklist (CBCL) and the Brief Problem Monitor for Parents (BPM-P) about their children at baseline and at 6 months post-baseline respectively. Immediately after post-baseline, they received psychoeducation on the importance of mental well-being in children and how to recognize symptoms of mental disorders, using the mhGAP-IG section on children. This psychoeducation was the intervention between baseline and 6 months post-baseline. We analysed means of mental disorder symptoms and prevalence of the various mental syndromes/problems on the CBCL/BPM-P scores to determine the statistical significance of the changes between baseline and 6 months.

RESULTS

Overall, there was significant increase (P < 0.05) in the symptoms mean scores and prevalence of syndromes/problems between baseline and 6 months post-psychoeducation. However, there were some differences between urban and rural settings and in some parents and children socio-demographics and gender that should be considered in individual cases.

CONCLUSION

It is feasible to include parents in school mental health programmes as key stakeholders. The mhGAP-IG section on children is a good tool for psychoeducation. However, there are predictors of outcomes that need further research.

H-WORK Project: Multilevel Interventions to Promote Mental Health in SMEs and Public Workplaces

The paper describes the study design, research questions and methods of a large, international intervention project aimed at improving employee mental health and well-being in SMEs and public organisations. The study is innovative in multiple ways. First, it goes beyond the current debate on whether individual- or organisational-level interventions are most effective in improving employee health and well-being and tests the cumulative effects of multilevel interventions, that is, interventions addressing individual, group, leader and organisational levels. Second, it tailors its interventions to address the aftermaths of the Covid-19 pandemic and develop suitable multilevel interventions for dealing with new ways of working. Third, it uses realist evaluation to explore and identify the working ingredients of and the conditions required for each level of intervention, and their outcomes. Finally, an economic evaluation will assess both the cost-effectiveness analysis and the affordability of the interventions from the employer perspective. The study integrates the training transfer and the organisational process evaluation literature to develop toolkits helping end-users to promote mental health and well-being in the workplace.

Equipping youth for meaningful policy engagement: an environmental scan

To better address the mental health and substance use crises facing youth globally, a comprehensive approach, inclusive of mental health promotion is needed. A key component of mental health promotion is policy intervention to address the social and structural determinants of health. Importantly, youth should be engaged in these efforts to maximize relevancy and impact. Yet, while there is growing interest in the inclusion of youth in the policymaking process, there is a paucity of guidance on how to do this well. This environmental scan reports findings from a comprehensive search of academic and grey literature that was conducted using the electronic databases: CINAHL, ERIC, MEDLINE, PsycINFO, Google Scholar, and Google. Search terms included variations of 'youth*', 'educat*', 'engage*', 'policy' and 'policy training'. Thirteen English language training programmes met inclusion criteria. Analysis identified marked differences in programme philosophy and focus by geographic region and highlights the need for enhanced evaluation and impact measurement moving forward. This paper makes a needed contribution to the evidence-base guiding this key mental health promotion strategy, which holds the potential to address critical gaps in approaches to youth mental health and substance use.

State of Mind Ireland-Higher Education: A Mixed-Methods Longitudinal Evaluation of a Positive Mental Health Intervention

Objective: This study evaluates the impact of the State of Mind Ireland-Higher Education (SOMI-HE) Mental Fitness intervention on student wellbeing, resilience, and physical activity (PA) participation. Design: A mixed-methods research design, comprising of a self-report questionnaire, and semi-structured focus group interviews at pre, post and follow-up phases were employed. Participants were a sample of 134 higher education students (29% male: 71% female; mean age range 18 to 25 years old). The quantitative outcome measures of wellbeing, resilience and PA data were analysed using SPSS version 26.0, (IBM, Armonk, NY, USA) with appropriate statistical analysis. Qualitative data were analysed using thematic analysis to capture the long-term outcomes and impact of the intervention. Results: The results indicate a significant intervention effect on participants’ wellbeing (t (120) = −4.27, p < 0.001), PA levels (t (126) = 3.91, p < 0.001) and motivational readiness for exercise change (χ2 (1, n = 131) = 6.9, p < 0.009 (2–sided). Qualitative findings suggest a sustained long-term increase in PA and resilience skills for positive mental health, and reduced stigma and barriers to positive mental health. Conclusion: The findings demonstrate the effectiveness of the SOMI-HE evidence-based intervention, and beneficial outcomes of a salutary approach to higher education student mental health.

Assessing the impacts of the Agenda Gap intervention for youth mental health promotion through policy engagement: a study protocol

BACKGROUND

Mental health challenges are a leading health concern for youth globally, requiring a comprehensive approach incorporating promotion, prevention and treatment within a healthy public policy framework. However, the broad enactment of this vision has yet to be realized. Further, mental health promotion evidence specific to youth is still emerging and has not yet focused at a policy level. This is a critical gap, as policy is a key mental health promotion lever that can alter the social and structural conditions that contribute to shaping youth mental health outcomes for all youth, across the full spectrum of need. Responsive to this research and intervention priority, our prototype study intervention-the Agenda Gap-is comprised of an innovative, multi-media engagement intervention, developed in collaboration with youth. This intervention aims to equip youth and build capacity for them to lead meaningful policy change reflective of the mental health needs of diverse communities of youth, including those who experience structural vulnerability and who would not typically have had their voice represented in policymaking processes.

METHODS

This study will use a multiple case study design and mixed methods grounded in a realist approach and will be conducted in three sites across two Canadian provinces (British Columbia and Alberta). In an earlier phase of this research, we collaboratively designed the prototype intervention with youth, community and policy partners. In this phase of the study, the intervention will be implemented and further tested with new groups of youth collaborators (n = 10-15/site). Outcome data will be collected through realist qualitative interviews, validated questionnaires [i.e., Child and Youth Resilience Measure (CYRM-12), General Self-Efficacy (GSE) Scale, and the Critical Consiousness Scale (CCS)] and additional survey items developed by our study team. Analysis will focus on identification of key context-mechanism-outcome configurations to provide comprehensive insights into how this intervention works, for whom, and in what context.

DISCUSSION

This study is unique in its "upstream" focus on youth-engaged policymaking as a tool for improving the social and structural conditions that influence youth mental health across socioecological levels. Through the implementation and testing of the Agenda Gap intervention with diverse youth, this study will contribute to the evidence base on youth-engaged policymaking as a novel and innovative, mental health promotion strategy.

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

BACKGROUND

Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence.

METHODS

We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health.

RESULTS

Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0-25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories.

CONCLUSIONS

Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.

Understanding the relationships between mental disorders, self-reported health outcomes and positive mental health: findings from a national survey

BACKGROUND

The link between mental illness and mental health is gaining focus in research and practice. This study aimed to investigate the association of mental disorders with positive mental health (PMH), overall health and quality of life. In addition, the role of PMH in mediating the relationships between mental disorders and health outcomes was assessed.

METHODS

The study sample comprised 2270 residents aged 18 years and above who participated in a nationally representative, cross-sectional survey estimating the lifetime prevalence of mood, anxiety and alcohol use disorders, and health outcomes (self-reported overall health, quality of life and PMH) in Singapore. The Positive Mental Health Instrument was used to estimate the level of Total PMH among the respondents with and without mental disorders. Associations between mental disorders and health outcomes were assessed through regression models. Path analyses were conducted to investigate mediating role of PMH.

RESULTS

Total PMH (Mean ± SD) was significantly lower among individuals having any of the studied lifetime mental disorders (4.23 ± 0.64 versus 4.50 ± 0.67 among those without these disorders). Although having a mood or anxiety disorder was associated with significantly lower Total PMH even after controlling for socio-demographic characteristics, similar relationship was not observed for alcohol use disorders. History of any mental disorders was also associated with lower overall health and quality of life. Total PMH mediated the relationships between mental disorders and overall health and quality of life by reducing the effect sizes for the associations between mental disorders and these health outcomes.

CONCLUSIONS

Mental disorders were associated with poor health outcomes in affected individuals. This study showed that PMH can mediate the relationships between mental disorders and health outcomes, and act as an underlying mechanism to improve overall health and quality of life in individuals with mental disorders. Findings thus highlight the significance of incorporating mental health promotion and interventions in clinical populations.

Factors affecting the implementation of a whole school mindfulness program: a qualitative study using the consolidated framework for implementation research

BACKGROUND

Preventing the onset of poor mental health in adolescence is an international public health priority. Universal, whole school preventative approaches are valued for their reach, and anti-stigmatising and resilience building principles. Mindfulness approaches to well-being have the potential to be effective when delivered as a whole school approach for both young people and staff. However, despite growing demand, there is little understanding of possible and optimal ways to implement a mindfulness, whole school approach (M-WSA) to well-being. This study aimed to identify the determinants of early implementation success of a M-WSA. We tested the capacity of the Consolidated Framework for Implementation Research (CFIR), to capture the determinants of the implementation of a mental health intervention in a school setting.

METHODS

Key members of school staff (n = 15) from five UK secondary schools attempting to implement a M-WSA were interviewed at two-time points, 6 months apart, generating a total of 30 interviews. Interviews explored participants' attitudes, beliefs and experiences around implementing a M-WSA. Interview data were coded as CFIR constructs or other (non CFIR) factors affecting implementation. We also mapped school-reported implementation activity and perceived success over 30 months.

RESULTS

The CFIR captured the implementation activities and challenges well, with 74% of CFIR constructs identifiable in the dataset. Of the 38 CFIR constructs, 11 appeared to distinguish between high and low implementation schools. The most essential construct was school leadership. It strongly distinguished between high and low implementation schools and appeared inter-related with many other distinguishing constructs. Other strongly distinguishing constructs included relative priority, networks and communications, formally appointed implementation leaders, knowledge and beliefs about the intervention, and executing.

CONCLUSIONS

Our findings suggest key implementation constructs that schools, commissioners and policy makers should focus on to promote successful early implementation of mental health programs. School leadership is a key construct to target at the outset. The CFIR appears useful for assessing the implementation of mental health programs in UK secondary schools.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

A qualitative investigation of mental health promotion among aging gay men

Background: Gay men, particularly middle aged and older men (over 40 years of age) experience a disproportionate burden of mental health issues compared to heterosexual men. Despite ample evidence that chronic exposure to structural and interpersonal discrimination negatively affect their mental health, little is known from gay men's perspectives how they understand mental health or their strategies to address their mental health concerns.Aim: This study's aim was to investigate how middle aged and older gay men experience their mental health and the mitigation strategies used to promote mental health.Method: Semi-structured interviews were conducted with 25 men who self-identified as gay. Data were analyzed using an interpretive descriptive approach.Results: Three overarching themes that best illustrate how men perceived their mental health and manage their mental health concerns were identified: gaining perspective, engaging with health services, and promoting and maintaining mental health.Conclusions: This study provides insight into how gay men come to acknowledge the validity of their mental health concerns, engage with health services, and their participation in other activities deemed essential for mental health promotion. These findings are ideally poised to inform development of health resources to promote and protect the mental health of aging gay men.

Looking Ahead

Abstract. Across many domains of health and welfare, there have been remarkable advances in prevention where public-health models have had a significant impact. Psychology has much to offer in building on these successes and we describe some excellent examples, but in general, it has not been fully engaged with prevention science and implementation. We set out some of the key challenges and opportunities for psychology and prevention science in contemporary practice, recognizing that often the rhetoric from governments to support prevention interventions do not match up to making the necessary resources available. We argue that psychology must prioritize this area of practice as there is evidence that the gains of recent decades may be under threat without concerted efforts.

Identifying key targets for interventions to improve psychological wellbeing: replicable results from four UK cohorts

BACKGROUND

An increasing importance is being placed on mental health and wellbeing at individual and population levels. While there are several interventions that have been proposed to improve wellbeing, more evidence is needed to understand which aspects of wellbeing are most influential. This study aimed to identify key items that signal improvement of mental health and wellbeing.

METHODS

Using network analysis, we identified the most central items in the graph network estimated from the well-established Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Results were compared across four major UK cohorts comprising a total of 47,578 individuals: the Neuroscience in Psychiatry Network, the Scottish Schools Adolescent Lifestyle and Substance Use Survey, the Northern Ireland Health Survey, and the National Child Development Study.

RESULTS

Regardless of gender, the three items most central in the network were related to positive self-perception and mood: 'I have been feeling good about myself'; 'I have been feeling confident'; and 'I have been feeling cheerful'. Results were consistent across all four cohorts.

CONCLUSIONS

Positive self-perception and positive mood are central to psychological wellbeing. Psychotherapeutic and public mental health interventions might best promote psychological wellbeing by prioritising the improvement of self-esteem, self-confidence and cheerfulness. However, empirical testing of interventions using these key targets is needed.

Improving mental health literacy among young people aged 11-15 years in Java, Indonesia: co-development and feasibility testing of a culturally-appropriate, user-centred resource (IMPeTUs) - a study protocol

BACKGROUND

Depression and anxiety are two of the leading causes of disease burden in low-to-middle income coutnries. The World Health Organisation has engaged in a programme of scaling-up mental health services, but significant challenges remain. Improving mental health literacy in children and young people, a core part of recent, global health strategies has the potential to address some of these challenges. The study aims to co-develop and feasibility test, a culturally-appropriate toolkit to promote depression and anxiety focused mental health literacy and self-management skills in Indonesia, for children aged 11-15 years.

METHODS

A mixed methods study comprising four phases. Through a systematic review of existing evidence, phase 1 will review approaches to improve mental health literacy and self-management in South East Asia and critically review current evidence regarding intervention effect. Phase 2 will explore stakeholders' views on depression, anxiety and mental health more broadly and identify priorities for the intervention through the use of semi-structured interviews and/or focus groups with policy makers, clinicians, teachers, adolescent service users, carers and young people aged 11-15. Phase 3 will comprise iterative workshops with local stakeholders to present our findings and co-produce a testable, culturally appropriate toolkit to promote mental health literacy and depression/anxiety focused self-management in 11-15 year olds in Java, Indonesia. Phase 4 comprises feasibility evaluation of our developed intervention via nine in-depth case studies (Jakarta, Bogor and Magelang). We will examine the impact, acceptability and feasibility of our prototype intervention and produce evidence-based guidelines for wider implementation.

DISCUSSION

Tools to support mental health literacy and self-management are a low cost way in which mental health services in LMICs can attempt to address the burden of anxiety and depression amongst children and young people. However, this is an underexplored area in Indonesia. Working closely with local stakeholders, this study will design and undertake feasibility evaluation of co-produced mental health literacy and anxiety and depression focussed interactive self-management tools. This abstract has also been published on the funders website (UK Research and Innovation. Improving Mental Health Literacy Among Young People aged 12-15 years in Indonesia 2019).

Social and emotional competence as key element to improve healthy lifestyles in children: A randomized controlled trial

AIM

To show the results of an exploratory trial based on social and emotional learning to promote healthy lifestyles in 5-6 aged children.

DESIGN

A randomized controlled trial.

METHOD

The study was conducted from 2015-2016. Thirty-seven children were allocated to the intervention group (N = 19) and control group (N = 18). A multi-method and multi-component evaluation approach was used to capture the preliminary efficacy, acceptability, and feasibility of the programme. Repeat measures ANOVA followed by an ANCOVA tests were applied for the inferential analysis and for qualitative data, a content analysis was used.

RESULTS

Positive effects on emotional perception and resilience were found in children's intervention group. Children and families showed high programme's acceptability and a wide range of barriers and facilitators were identified during the implementation process.

CONCLUSION

Predicted mechanisms to improve healthy lifestyles in children throughout social and emotional competence seem to be supported by some of the study's results. However more research is needed to replicate such results and confirm these mechanisms. ClinicalTrials.gov Identifier: NCT02975544.

Evaluating PsychEd: a mental health and well-being educational programme for secondary schools

BACKGROUND

Young people's mental health and well-being is an important concern in the UK. Provision of education and support to schools has been highlighted as an area for improvement; however, evidence-based programmes are scarce and costly.

AIMS

To provide an acceptable education programme to improve pupils' confidence and knowledge of mental health and well-being. It covered the mental and emotional well-being outcomes set by the Scottish Government in their schools' curriculum.

METHOD

Lessons were designed by A.P. and delivered by volunteer doctors and medical students, and supervised by a psychiatrist. Outcomes were measured using questionnaires before and after lessons with optional comments.

RESULTS

PsychEd was piloted in 2016 in six schools to pupils between the ages of 11 and 18. There was a statistically significant improvement in pupil confidence and knowledge after the lessons (P < 0.001). Of the pupils 84% felt that having lessons on mental health was useful. Qualitative feedback was also collected and coded into positive, constructive and negative comments. In total, 72% of pupil comments were positive.

CONCLUSIONS

PsychEd showed promising results. Future areas of development include reaching a greater number of local authority schools, longer training for volunteers and provision of teaching materials to teachers for their own use.

DECLARATION OF INTEREST

None.

Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents

Background

Mental health among adolescents is an important public health challenge. School health services perform central public health functions in Norwegian municipalities, where school nurses are uniquely positioned to educate and promote mental health among adolescents. MEST (MEST is not an acronym; MEST is a short version of the Norwegian word for coping) is a newly developed universal working strategy for school health services that aims to promote positive mental health literacy (MHL) and mental wellbeing in the adolescent population. The aim of this study was to investigate the potential outcome mean differences in positive MHL and mental wellbeing between adolescents who participated and those who did not participate in MEST over a school year.

Methods

This study is based on cohort data collected from 357 adolescents (aged 15–21 years) in five Norwegian upper secondary schools at the beginning and end of the 2016/2017 school year. The data were analyzed by describing mean scores and estimating the average treatment effect (ATE) of MEST on positive MHL and mental wellbeing.

Results

Positive MHL increased significantly more among the MEST participants compared to the non-MEST participants (p = .02). No significant change in mental wellbeing was found between MEST and non-MEST participants (p = .98). Estimating the ATE of MEST on positive MHL, the MEST participants showed a significant 2.1% increase (p = .04) in the potential outcome mean of positive MHL compared to the nonparticipants. Estimating the ATE of MEST on mental wellbeing, the girls who attended MEST exhibited a significant 9.7% increase (p = .03) in the potential outcome mean of mental wellbeing compared with the girls who did not attend MEST, while no significant change (p = .99) was detected among boys or the entire sample of both genders combined (p = .12).

Conclusion

This study found a significant ATE of MEST on positive MHL and on mental wellbeing among girls. The results support further investments in studying MEST as a promising work strategy for school health services to promote adolescent mental health. This initial study of MEST may be used as a foundation for investing in future evaluations of MEST.

Pilot towards developing a school mental health service: Experiences and lessons learnt in implementing Kenya integrated intervention model for dialogue and screening to promote children's mental well-being

AIM

This paper aims at documenting the process of implementing "Kenya Integrated intervention model for Dialogue and Screening to promote children's mental wellbeing (KIDS)", with emphasis on activities, experiences, challenges and lessons learnt through the process that can inform improvement in Kenya and other social-economically and culturally similar settings.

METHODS

KIDS aimed at providing early and integrated culturally acceptable intervention to promote child mental health in 6 to 13 year olds, targeting 5429 children in 24 schools. It was a pilot study conducted in 2 administrative counties in Kenya (Machakos and Makueni). The main goal of this study was to test the efficacy and feasibility of the proposed model that incorporated several significant stakeholders.

RESULTS

The implementation of KIDS was grouped into 6 stepwise and 2 ongoing processes: (1) Stakeholder engagement and collaboration; (2) Selecting, adapting, translating, piloting and adopting the study tools; (3) Conducting Participatory Theory of Change (ToC); (4) Building the capacity of the key implementing partners; (5) Community awareness and psycho-education, (6) Using school-based life skills and peer clubs counselling to provide psychosocial support; (7) Ongoing monitoring, supervision and quality assurance and (8) Ongoing knowledge exchange and dissemination. Specific logistical challenges and possible solutions for future school mental health services are also stated in this article.

CONCLUSION

KIDS is a feasible model for school mental health service programme in Kenya but there are challenges which provide innovative opportunities for better designed school mental health services programme.

Using Computerized Mental Health Programs in Alternative Education: Understanding the Requirements of Students and Staff

Computerized cognitive behavioral therapy (cCBT) programs have been shown to be both acceptable and effective with youth. However, their use with more vulnerable youth, such as early school leavers, remains relatively unstudied. This study explored student and staff attitudes toward the use of cCBT in an alternative education setting.

METHODS

Student and staff needs were assessed using the Requirements development approach (Van Velsen, Wentzel, & Van Gemert-Pijnen, 2013). An online staff survey (n = 16) was conducted to provide information on the context of delivery, and stakeholder requirements were further explored in four student workshops (n = 32) and staff group discussions (n = 12).

RESULTS

Students' requirements in relation to program look and feel were reflective of issues with literacy and concentration. Activity- rather than text-based programs were considered easier to learn from, whereas attractive design with features such as connecting with others were thought necessary to keep young people engaged. Students wanted to learn practical skills on improving their mental health and well-being, using content that is positive, encouraging, and credible and that can be tailored to individual needs. Anonymity and voluntary participation were considered essential when delivering cCBT in the context of alternative education, as well as additional access from home to ensure timeliness of support. Staff required both flexibility and careful planning and timetabling in order to deliver cCBT in the alternative education setting and to support student engagement.

CONCLUSION

The findings provide novel insight into the needs and preferences of vulnerable youth, with important implications for the implementation of computerized mental health programs in alternative education settings. A better understanding of user needs and preferences is critical for improving the uptake and impact of e-mental health resources.

Family-based youth mental health interventions delivered by nonspecialist providers in low- and middle-income countries: A systematic review

INTRODUCTION

Youth in low- and middle-income countries (LMICs) are at increased risk for poor mental health due to economic and social disadvantage. Interventions that strengthen families may equip children and adolescents with the supports and resources to fulfill their potential and buffer them from future stressors and adversity. Due to human resource constraints, task-sharing-delivery of interventions by nonspecialists-may be an effective strategy to facilitate the dissemination of mental health interventions in low resource contexts. To this end, we conducted a systematic review of the literature on family-based interventions delivered in LMICs by nonspecialist providers (NSPs) targeting youth mental health and family related outcomes.

METHOD

Cochrane and PRISMA procedures guided this review. Searches were conducted in PsychInfo, PubMed, and Web of Science, with additional articles pulled from reference lists.

RESULTS

This search yielded 10 studies. Four studies were developed specifically for the delivery context using formative qualitative research; the remaining interventions underwent adaptation for use in the context. All interventions employed a period of structured training; nine studies additionally provided ongoing supervision to counselors. Interventions noted widespread acceptance of program material and delivery by NSPs. They also noted the need for ongoing supervision of NSPs to increase treatment fidelity.

DISCUSSION

Usage of NSPs is quite consistently proving feasible, acceptable, and efficacious and is almost certainly a valuable component within approaches to scaling up mental health programs. A clear next step is to establish and evaluate sustainable models of training and supervision to further inform scalability. (PsycINFO Database Record

GoodYarn: building mental health literacy in New Zealand’s rural workforce

Purpose

“GoodYarn” is a skills-based workshop that focusses on building mental health literacy in rural communities, members of which are known to experience geographic, attitudinal and service configuration barriers to accessing mental health services. The purpose of this paper is to evaluate the impact of the GoodYarn project on raising mental health literacy in the rural community.

Design/methodology/approach

GoodYarn is primarily for farmers, their families and farm workers, as well as the “farmer facing” workforce. The focus on mental health literacy aligns with the mental health promotion approach of using methods that foster supportive environments. By raising the mental health literacy of those not directly needing help, but in positions to help those that do – such as employers, rural professionals and rural support industries who are well placed to perceive stressors in farmers – GoodYarn builds a community with the knowledge and skills to identify and approach those experiencing mental distress or illness, and direct them to appropriate support and services. All participants in the GoodYarn workshops (n=430) were invited to complete a questionnaire at the end of the workshop. All participants answered the questionnaire, with over 80 per cent answering all questions.

Findings

Participant feedback affirmed the utility of GoodYarn as an effective vehicle to facilitate the discussion of mental illness in rural farming communities of New Zealand. GoodYarn had a significant positive impact on the three immediate workshop indicators of awareness, confidence and knowledge (p<0.001 for all three indicators). Further, the high level of concordance in workshop outcomes across various organisations’ delivery indicates programme consistency and quality has been maintained throughout the upscaling of the programme.

Originality/value

The uptake of the GoodYarn programme by rural organisations and communities at a national level, and the positive evaluation results, provide encouragement that building mental health literacy in the rural workforce is a promising mental health promotion strategy.

Mental Health Literacy Content for Children of Parents with a Mental Illness: Thematic Analysis of a Literature Review

Millions of children have a parent with a mental illness (COPMI). These children are at higher risk of acquiring behavioural, developmental and emotional difficulties. Most children, including COPMI, have low levels of mental health literacy (MHL), meaning they do not have accurate, non-stigmatized information. There is limited knowledge about what kind of MHL content should be delivered to children. The aim of this exploratory study is to identify the knowledge content needed for general population children and COPMI to increase their MHL. A second aim is to explore content for emerging children's MHL scales. Researchers created and analyzed a literature review database. Thematic analysis yielded five main mental health knowledge themes for children: (1) attaining an overview of mental illness and recovery; (2) reducing mental health stigma; (3) building developmental resiliencies; (4) increasing help-seeking capacities; and (5) identifying risk factors for mental illness. COPMI appeared to need the same kind of MHL knowledge content, but with extra family-contextual content such as dealing with stigma experiences, managing stress, and communicating about parental mental illness. There is a need for MHL programs, validated scales, and research on what works for prevention and early intervention with COPMI children.

Psychosocial Correlates of Jordanian Adolescents' Help-Seeking Intentions for Depression: Findings From a Nationally Representative School Survey

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents' helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents' willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12-17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

An exploratory trial of a health education programme to promote healthy lifestyles through social and emotional competence in young children: Study protocol

AIM

To implement and evaluate a health education programme based on the development of social and emotional competence in young children.

BACKGROUND

Children's social and emotional skills play a key role in the adoption and maintenance of their lifestyles. Currently, a more comprehensive perspective dealing with these aspects is needed to promote healthy habits in children and develop effective health education programmes.

DESIGN

An exploratory randomized controlled trial.

METHODS

A convenience sample of 30 children (5 and 6 years old) will be recruited from a public school in Spain, with 15 participants in the experimental group and 15 in the control group. Participants in the experimental group will receive the first unit of the programme, consisting of developing emotional knowledge skills around daily health habits (eating, hygiene, sleep and physical exercise) using different game-based dynamics and an emotional diary, while those in the control group will continue with their usual school routine. Outcome measures include emotional knowledge ability, basic social skills and children's health profile. The perceived impact of the intervention by parents, acceptability (by parents and children) and feasibility of the programme will be also assessed. Data will be collected at baseline, postintervention and at 7-month follow-up.

DISCUSSION

This study offers an innovative intervention aimed at improving children's healthy lifestyles from a holistic perspective by addressing social and emotional competence as one of the most influential aspects of children's development. This exploratory trial is an essential step to explore crucial aspects of the full-scale clinical trial.

Mental health promotion: a narrative review of emerging trends

PURPOSE OF REVIEW

The current review aims to provide an update on the recent work in mental health promotion with a special emphasis on emerging evidence and innovations in the field.

RECENT FINDINGS

Studies reviewed across settings like the home, school, workplace, communities, and internet-based platforms, have indicated a growing evidence base for effective mental health promotion strategies that are holistic, multicomponent, and targeted at both, specific vulnerable groups and whole populations. Innovative approaches involving online delivery platforms, sports and exercise, positive psychology and lifestyle interventions, mobilizing community networks, and mental health first aid, are some exciting and upcoming areas for future research.

SUMMARY

Mental health promotion interventions are applicable to individuals, groups, and whole populations and can be delivered in many ways, including media and communication technology. They can be applied in low-resource settings by mobilizing existing community resources like opinion leaders, health workers, and peer educators, thereby increasing cost-efficiency, cultural acceptability, and local capacity. There needs to be a greater focus on study designs and variable measures that examine process-factors affecting well being outcomes. Early interventions through intersectorial collaborations may result in improved long-term positive mental health outcomes for individuals, families, and communities.

Efficacité des interventions en prévention et en promotion de la santé mentale dans les établissements d’enseignement postsecondaire

Le développement d’un problème de santé mentale affecte les étudiants de niveau postsecondaire sur tous les plans et peut mettre leur santé, voire leur survie, en péril. Les problèmes vécus pourraient être atténués, ou même évités dans certains cas, en intervenant plus tôt. Les stratégies en prévention et en promotion de la santé mentale mises de l’avant dans les établissements d’enseignement postsecondaire offrent les plus belles possibilités de rejoindre un grand nombre de jeunes adultes. Cependant, malgré l’intérêt grandissant pour de telles initiatives en milieu scolaire, les méta-analyses et les revues des écrits scientifiques recensés mettent en lumière les difficultés reliées à l’évaluation des stratégies utilisées et aux possibilités de répliquer les interventions, particulièrement en ce qui a trait à la promotion. Les stratégies les plus efficaces sur le plan de l’amélioration de la santé mentale semblent être associées à la supervision d’exercices en lien avec l’intervention telles que les exercices de pleine conscience (mindfulness), les techniques cognitives-comportementales, la relaxation et le développement d’habiletés sociales. Par ailleurs, même si elles présentent une plus grande hétérogénéité, les études impliquant une aide technologique (Web, ordinateur, etc.) démontrent des résultats favorables lorsqu’elles utilisent l’approche cognitive comportementale.

Effects of optimism on recovery and mental health after a tornado outbreak

OBJECTIVE

Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being.

DESIGN

Data for this study come from the Centers for Disease Control and Prevention's Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama.

MAIN OUTCOME MEASURES

This study assesses the effect of dispositional optimism on post-disaster recovery and mental health.

RESULTS

Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage.

CONCLUSIONS

The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.

The position of Ghana on the progressive map of positive mental health: A critical perspective

According to the World Health Organisation (WHO), mental health is a state of well-being and not just the absence of diseases. With this definition, there has been a surge of mental health research, albeit still predominantly in Western countries, which is reflected in contemporary theories on positive mental health that include 'flourishing mental health', 'salutogenesis', and 'fortigenesis'. However, in low- and middle-income countries (LMICs), mental health research is slowly receiving scholarly attention. The aim of this paper was twofold: Firstly, to highlight progress that had been made in some LMICs, giving consideration to research across different settings and populations as a basis to argue for more research on positive mental health in the Ghanaian context. Secondly, to present a critical perspective on the current mental health research trends in Ghana, thus discussing important recommendations for future research.

EPA guidance on mental health and economic crises in Europe

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

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.

Advancing Research to Action in Global Child Mental Health

Most mental and substance use disorders begin during childhood and adolescence and are the leading cause of disability in this population. Prenatal and postnatal genetic, familial, social, and environmental exposures interact to influence risk for mental disorders and trajectories of cognitive development. Efforts to advance prevention and implement early interventions to reduce the burden of mental disorders require a global research workforce, intersectoral cooperation, attention to environmental contexts, and the development and testing of evidence-based interventions. The authors describe challenges and resources for building mental health research capacity that stands to influence children's mental health outcomes around the globe.

A Universal Mental Health Promotion Programme for Young People in Italy

In Italy, the Mental Health Unit of the National Institute of Public Health has developed a school-based mental health programme based on a structured handbook. The aim of this programme is to promote self-efficacy, psychological well-being, and life satisfaction. In this study, we evaluated the effectiveness of this programme. We used data from 308 students who participated in a study in 9 Italian high schools during the 2011-2012 school year. In order to analyse the school intervention programme, we set up a pre-post test design study involving 18 classrooms (8 of which acting as a control). The schools were selected via a snowball technique, and then the classrooms that agreed to participate were randomly assigned to intervention and control groups. The programme was performed during regular school hours in one-hour a week sessions for a total of 20 hours of classroom time. Assessments before and 2 months after the programme were performed using Regulatory Emotional Self-Efficacy, Satisfaction With Life, and Ryff's Psychological Well-Being Scales. The results showed an improvement in self-efficacy in regulating negative affect, overall psychological well-being, and satisfaction with life. These results demonstrate that the programme produced significant positive effects on the mental health status of participating students.

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.