Men's Mental Health Promotion Interventions: A Scoping Review

Enhancing Men's Awareness of Testicular Diseases (E-MAT) using virtual reality: A randomised pilot feasibility study and mixed method process evaluation

INTRODUCTION

Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men's awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men's Awareness of Testicular Diseases using Virtual Reality intervention (E-MATVR) compared to the Enhancing Men's Awareness of Testicular Diseases using Electric information control (E-MATE). The study protocol is registered on ClinicalTrials.gov (NCT05146466).

METHODS

Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via FacebookTM, XTM (formerly TwitterTM), and posters. Participants were individually randomised to either E-MATVR or E-MATE. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers.

RESULTS

Data were collected from 74 participants. Of those, 66 were retained. All E-MATVR participants and most E-MATE participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MATVR participants (n = 34, 91.9%) and all E-MATE participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MATVR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MATVR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0-1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MATVR participants and 29/32 E-MATE participants (90.6%) reported purposefully examining their testes within the past three months.

CONCLUSION

Findings are promising, highlighting the feasibility of using VR to promote young athletes' awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.

Shop Talk: A Qualitative Study to Understand Peer Health-related Communication Among Black Men at the Barbershop

BACKGROUND

While successful health promotion efforts among Black men have been implemented at barbershops, the focus has largely been on outcomes as opposed to the processes by which outcomes are produced. An understanding of processes can be leveraged in the design and implementation of future efforts to improve the health of Black men.

PURPOSE

The objectives of the present study were to: (i) understand peer-derived sources of health-related support at the barbershop and (ii) understand the role of the barbershop in promoting health among Black men.

METHODS

Seven focus groups were conducted at barbershops used predominately by Black men. Each focus group lasted between 45 and 60 min. Using a thematic approach, each focus group was independently coded by two coders using a codebook derived from an inductive and deductive approach. The results were confirmed with members of the community advisory board.

RESULTS

Three themes emerged: (i) dynamic and candid exchange of health-related support at the barbershop; (ii) tailored forms of health-related and judgment-free communication that provide encouragement and increase motivation; and (iii) characteristics of a supportive environment at the barbershop that facilitate health-related communication.

CONCLUSIONS

The findings of the present study offer a potential pathway for public health efforts seeking to improve health among Black men. Those interested in designing and implementing these efforts can create tailored programs for Black men by recognizing and leveraging the unique dynamics of health-related conversations at the barbershop.

Workplace Interventions Targeting Mental Health Literacy, Stigma, Help-Seeking, and Help-Offering in Male-Dominated Industries: A Systematic Review

Mental ill-health and suicide represent a significant proportion of the burden of global disease among men. Connell's relational theory of masculinities provides a useful framework to explore how mental health literacy, mental health stigma, and delayed help-seeking and help-offering behaviors are associated with mental ill-health among men, particularly within male-dominated industries. To address the high incidences of mental ill-health in male-dominated industries, several workplace interventions targeting these outcomes have been implemented. No review to date has examined the current state of evidence for these interventions or identified the behavior change techniques used. This review was restricted to empirical, quantitative research reporting on psychosocial interventions targeting mental health literacy, stigma, and help-seeking and help-offering behaviors in male-dominated industries. Quality appraisal was completed using the Effective Public Health Practice Project and a narrative synthesis was conducted. Twelve articles were included for review which reported on four distinct interventions. The methodological quality of two articles was strong, three moderate and seven weak. The strongest evidence of intervention effects related to mental health literacy and help-seeking intentions. There was less evidence relating to help-offering and help-seeking behaviors and mental health stigma. Sixteen behavior change techniques were identified across interventions that are discussed in relation to the wider men's health literature. The evidence on psychosocial interventions in male-dominated industries is limited due to methodological and conceptual issues. Recommendations for future research include standardized reporting of intervention descriptions, the use of theory to guide intervention development, and utilizing validated and reliable outcome measures.

Facilitators of, barriers to, and preferences for e-mental health interventions for depression and anxiety in men: Metasynthesis and recommendations

BACKGROUND

Little is known about men's use of online mental health (eMH) interventions and factors that promote their engagement or attrition. We aimed to synthesise the qualitative literature on men's preferences for, attitudes towards, and experiences of using eMH interventions for depression and anxiety, and develop recommendations from the findings.

METHOD

Systematic searches were conducted (Jan 2000-Oct 2020) in six databases; study quality was assessed using Qualsyst with a minimum total of 0.55 required for inclusion. Extracted data were synthesised using meta-aggregation.

RESULTS

Eight studies met inclusion criteria and three synthesised findings were generated. (1) Facilitators of men's eMH use: finding apps and technology motivating and convenient, support and encouragement from important others, and interventions allowing men to take action, gain control over their mental health, and resulting in positive outcomes; (2) Barriers to men's eMH use: lack of free time, predicted or experienced lack of benefit from use, and technical difficulties; (3) What men want in eMH: personalised, tailored, relevant interventions that are bright and easy to use, with information presented in multiple formats, psychoeducation, exercises, self-monitoring, information on further resources, and the option of clinician involvement, without any repetitive questioning, boring tools, or negative feedback.

LIMITATIONS

All included studies were conducted in high income, 'Western' countries; most data related to experiences of using an existing eMH intervention within a trial, rather than in 'real world' settings where eMH acceptability is generally lower and experiences may differ.

CONCLUSIONS

Practice, research, and policy recommendations are presented.

Intersecting identities, diverse masculinities, and collaborative development: Considerations in creating online mental health interventions that work for men

Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations. Keywords: men, male, mental health, e-mental health, digital health, online interventions.

The male-focused marital relationship enrichment and sexual well-being interventions: A scoping review

Background

There is an increasing need for sexual well-being and health promotion strategies that effectively engage men. Researchers have evaluated the efficacy of sexual and reproductive health-related and marital enhancement interventions in male-dominated societies. However, few have focused on culturally appropriate and gender-specific program effects.

Objective

This review aims to evaluate evidence of existing interventions aimed at enriching marital relationships and sexual well-being in adult men.

Materials and Methods

This scoping review was conducted by searching various databases (CINAHL, PsycINFO, EMBASE, Google Scholar, PubMed, Scopus, SID, and Noormags), and other available resources in both English and Persian languages. We located all publications up to January 2023 with no time restriction. Inclusion criteria were studies targeting men in the enrichment of marital and sexual relationships, which focus on marital/sexual enrichment, sexual and reproductive health (SRH) program, passionate relationship, or sexual satisfaction as the main outcomes. PRISMA guidelines were utilized in this review.

Results

Of records 34,405 retrieved by searching, after removing duplicate articles, 8 articles were included based on the inclusion criteria. SRH program was the main focus of 6 articles. Marital and sexual enhancement were common areas of focus in 2 studies. Research methods included 2 semi-experimental, 3 clinical trials, 1 systematic review, 1 content analysis, and a mixed method. According to the assessment result, 4 articles were moderate and 4 were of high quality.

Conclusion

Our findings reveal that a small number of interventions specifically offering SRH or marital and sexual enhancement programs to men should be conducted. As the majority were heterosexual couples, we recommend male-focused programs recognizing men's sexuality.

Outcome assessment of a complex mental health intervention in the workplace. Results from the MENTUPP pilot study

OBJECTIVE

Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT).

METHODS

The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up.

RESULTS

In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p < 0.05): mental wellbeing, symptoms of anxiety, and personal stigmatising attitudes towards depression and anxiety.

CONCLUSIONS

The results of this outcome evaluation suggest that MENTUPP has the potential to strengthen employees' wellbeing and decrease anxiety symptoms and stigmatising attitudes. Additionally, this study demonstrates the utility of conducting pilot workplace interventions to assess whether appropriate measures and indicators have been selected. Based on the results, the intervention and the evaluation strategy have been optimised.

Working with men in the context of distressed and disrupted intimate partner relationships: A qualitative study

OBJECTIVE

To describe key considerations for working with men experiencing distressed and disrupted intimate partner relationships.

METHODS

Individual Zoom interviews were conducted with help-seeking men (n = 25) who had experienced an intimate partnership break-up, and health service providers (n = 30) working with men in the relationships space. Interpretive Description methodology was used to generate considerations for working with men in distressed and disrupted relationships.

RESULTS

Three thematic findings were inductively derived; 1) A whole life approach for deconstructing relationships, wherein men engaged in discussions about their broader experiences and circumstances within the context of intimate partnerships; 2) Affirming men's relationship emotions and vulnerabilities as normative and changeable, comprising coaching for embodying transformative masculinities; and 3) Tangible 'to do's' in and after a relationship, outlining men's present and prospective self-work with action-oriented strategies.

CONCLUSION

Strategies tailored to men's receptivity and needs can increase connection with professional services and providers to bolster the mental health of men in and after disrupted intimate partner relationships.

PRACTICE IMPLICATIONS

With men increasingly accessing professional mental health services, the present study offers key considerations and recommendations regarding assessment, communication, and treatment for health service providers working with men in the relationships space.

Mental health promotion practice in Aotearoa New Zealand: findings from a qualitative study

Mental health promotion (MHP) is integral to improving the overall health and well being of individuals, communities, and populations. However, knowledge and reporting about MHP which occurs throughout Aotearoa New Zealand (NZ) is limited. This article reports findings from a qualitative study that sought to understand NZ health promotion practitioners' (HPPs) MHP practice. Semi-structured interviews were undertaken with 15 HPPs employed at various health promotion organizations. Thematic analysis of interview transcripts identified three key themes. Two themes (planning and evaluation) related to practice directly and included various subthemes: needs assessment; principles/approaches/frameworks; operationalizing equity and te Tiriti o Waitangi; collaborative approaches; planning for evaluation; process evaluation domination; and evaluation challenges. The third theme related to the context of practice and encompassed various system influences restricting HPPs from practising as they wished. These were represented in four subthemes: contractual agreements; field fragmentation; in the shadows of mental ill-health and workforce capacity. Study findings highlight several opportunities to improve MHP practice in NZ. Most pertinently, the need for system-level action to address the factors restricting HPPs' practice.

Effectiveness of behavior change interventions for smoking cessation among expectant and new fathers: findings from a systematic review

BACKGROUND

Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn.

METHODS

We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet.

RESULTS

We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes.

CONCLUSIONS

This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.

Promotive and preventive interventions for mental health and well-being in adult populations: a systematic umbrella review

Introduction

Mental health disorders are increasing worldwide, leading to significant personal, economic, and social consequences. Mental health promotion and prevention have been the subject of many systematic reviews. Thus, decision makers likely face the problem of going through literature to find and utilize the best available evidence. Therefore, this systematic umbrella review aims to evaluate the effectiveness of interventions for promoting mental health and mental well-being, as well as for the primary prevention of mental health disorders.

Methods

Literature searches were performed in APA PsycInfo, Medline, and Proquest Social Science databases from January 2000 to December 2021. The search results were screened for eligibility using pre-defined criteria. The methodological quality of the included reviews was evaluated using the AMSTAR 2 tool. The key findings of the included reviews were narratively synthesized and reported with an emphasis on reviews achieving higher methodological quality.

Results

Out of the 240 articles found, 16 systematic reviews and four systematic umbrella reviews were included. The methodological quality of included reviews was low or critically low.

Discussion

This review suggests that interventions using cognitive-behavioral therapy and those developing resilience, mindfulness, or healthy lifestyles can be effective in the promotion of mental health and well-being in adult populations. Motivational interviewing may reduce alcohol consumption in young adults. Indicated or selective prevention is likely to be cost-effective compared to universal prevention. Parenting interventions and workplace interventions may be cost-effective in terms of promoting mental health. Due to the low methodological quality of the included reviews and substantial heterogeneity among the reported results, the findings from the reviews we summarized should be interpreted with caution. There is a need for further rigorous, high-quality systematic reviews.

Lonely but not alone: Examining correlates of loneliness among Canadian post-secondary students

Objective: Loneliness is increasingly acknowledged as a public health concern due to its association with morbidity and mortality. The prevalence of loneliness is highest in the post-secondary population. Understanding the correlates of loneliness may assist in developing policy and program interventions. Participants and Methods: Post-secondary students (n = 28,975) from the Winter 2022 Canadian Campus Wellbeing Survey (CCWS) cycle. A multi-level logistic regression controlling for the institution was built to determine how demographic, health behaviors, mental health and institutional level factors are associated with loneliness. Results: The prevalence of loneliness was 31% in our sample. Demographic (e.g., gender, sexual orientation, social economic status), health behaviors (e.g., physical activity and substance use), mental health (e.g., mental distress and social support) and institutional factors (e.g., college or university institution) impacted the odds of reporting loneliness (p < 0.05). Conclusion: Our findings suggest loneliness might require greater attention by institutional staff and administrators.

Promoting employee wellbeing and preventing non-clinical mental health problems in the workplace: a preparatory consultation survey

BACKGROUND

Small and medium-sized enterprises (SMEs) face major financial losses due to mental health issues affecting employees at all levels but seldom apply programs to promote wellbeing and prevent mental health issues among employees. To support the development of a multi-country workplace-based mental health intervention for SMEs (MENTUPP), a multinational consultation study was conducted. The study aimed to examine the experiences and needs of SMEs concerning the promotion of employee wellbeing, and the prevention and management of non-clinical mental health problems in workplaces.

METHODS

A survey consisting of open and closed questions was designed to assess key informants' opinion about the acceptability, the use, and the implementation of interventions to promote wellbeing and prevent mental health issues in the workplace. Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations across the nine MENTUPP intervention countries (eight European countries and Australia) were invited to complete the survey. Data were collected via the online platform Qualtrics. Sixty-five of 146 informants responded, representing a 44.5% response rate. Descriptive statistics were used to analyse the quantitative data and qualitative data were analysed through thematic analysis.

RESULTS

Measures to create mentally healthy workplaces were most used in SMEs, while more specific mental health interventions, such as training staff on how to promote wellbeing, were hardly used. Managers lack resources to implement mental health interventions and are concerned about employees spending too much time on these interventions during working hours. Receiving information about the economic benefits of mental health interventions and hearing successful testimonials from other SMEs can persuade managers otherwise. Employees have concerns about confidentiality, discrimination and stigma, and career opportunities when using such interventions.

CONCLUSIONS

The study identifies a variety of challenges, needs and possibilities related to implementing mental health interventions in SMEs. Employers need to be convinced that investing in mental health in the workplace is worth their time and money. This requires more studies on the (cost-)effectiveness of mental health interventions. Once employers are engaged, their knowledge and competencies about how to implement such interventions should be increased and privacy concerns of employees to participate in them should be addressed.

Men's mental health and the arts: perceived benefits and dynamics of engagement

Arts engagement is gaining recognition as a non-clinical approach to promote mental health and well-being. However, the perceived utility of the arts to promote mental health among men with low socioeconomic status (SES) and how to best engage them is underexplored. This study explores the lived experiences of men with low SES who engage with the arts in Northern Ireland (n = 41). Data collected via focus groups (n = 5) and interviews (n = 11) were analysed using reflexive thematic analysis to inductively derive four themes. Theme 1 highlights how the arts facilitated friendship, a collective identity, peer support and a reason to socialize. Themes 2 and 3 explore how the arts enhanced self-esteem and emotional regulation by developing a routine, purpose, sense of mastery, a sense of catharsis through immersion in a soothing endeavour and an alternative outlet for self-expression. Theme 4 covers strategies that facilitate male engagement in the arts such as using a familiar space, delivering to an existing male group, framing the programme around male interests not health or creativity, building on existing strengths and capacities, enabling ownership, using tangible action-orientated activities, and being non-authoritative and flexible with delivery. This is one of the first studies to highlight the gendered dimensions in which men with low SES engage with and experience mental health benefits through arts engagement. This study points towards relevant theories to further understand the pathways between the arts and improved mental health among men which can inform development of tailored arts programmes for men.

Sex differences in functional outcome after hospitalisation: A systematic review and meta-analysis

The aims of this review were to determine: i) how many studies have examined global functioning outcomes from a psychiatric inpatient stay disaggregated by sex; and ii) if women have worse global functioning outcomes than men following an admission. A systematic review following PRISMA guidance and meta-analysis were conducted. Thirty-six studies met eligibility criteria for inclusion in the review. Of these, eleven papers provided sufficient data to conduct a meta-analysis of global functioning outcomes comparing men and women. Overall, differences between men and women were small. The meta-analysis revealed either no difference or a small significant difference in global functioning outcomes in favour of women, contrary to expectations. As many as 93% of otherwise eligible studies had to be excluded for not disaggregating data by sex. Women may have slightly superior functioning outcomes than men suggesting that inpatient services should be more heavily focused on applying principles of gender-informed care for men as well as women. The finding that so many potential studies had to be excluded for not reporting sex differences is consistent with other mental health literature and highlights a need for better reporting practices in relation to sex differences.

Relationship between objective cognitive functioning and work performance among Japanese workers

OBJECTIVES

We aimed to explore the relationship between objective cognitive functioning and work performance among Japanese workers.

METHODS

From February to November 2019, this cross-sectional study enrolled workers aged 18-65 years from 10 companies located in a metropolitan area of Japan. We emailed invitations to participate to employees of companies that had agreed to cooperate with the study. We measured work performance with the question, "How would you rate your performance (compared with your optimum performance) over the past 4 weeks?" Responses were made via a visual analog scale (range: 0-100). Cognitive functioning was assessed using the THINC-integrated tool (THINC-it®). THINC-it® is a brief, objective computerized cognitive assessment battery. Associations between work performance and cognitive functioning tests were examined using logistic regression analysis.

RESULTS

In total, 353 individuals provided e-consent to participate, of whom 276 were included in the analysis (after omitting those with missing values). The median work performance was used to divide participants into high- (scoring ≥ 80%) and low- (scoring < 80%) performing groups. The P-values for trends indicated that association between cognitive domains, such as attention, executive functioning and working memory was significant (P < .05). Work performance was significantly associated with cognitive function for the two tests that assess attention, executive functioning, and working memory in general workers.

CONCLUSIONS

Our results suggest that objective cognitive functioning may be related to work performance. Longitudinal investigations may allow for the establishment of causality.

Gender differences in psychosocial factors related to severe stress in a construction company in Japan

BACKGROUND

In Japan, women's participation in the workforce has been increasing. However, there are few studies about gender differences in stress factors in the workplace.

OBJECTIVES

We aimed to clarify gender differences in psychosocial factors in the workplace related to severe stress.

METHODS

In total, 930 male and 339 female employees working in a construction company in Japan participated in this study. We used individual responses to the Brief Job Stress Questionnaire (BJSQ) conducted by their company for the most recent year between 2016 and 2019. Data were categorized by gender, and we extracted the factors contributing to severe stress using logistic regression.

RESULTS

We identified 142 men and 32 women who had severe stress. Logistic regression analysis showed that six factors ("Qualitative job overload", "Job control", "Interpersonal conflict", "Poor physical environment", "Supervisor's support", and "Job satisfaction and life satisfaction") were significantly associated with the presence of severe stress in men. In women, five factors ("Qualitative job overload", "Job control", "Interpersonal conflict", "Suitable work", and "Job satisfaction and life satisfaction") showed a significant association with severe stress.

CONCLUSION

Factors associated with severe stress were "Poor physical environment" and "Supervisor's support" in men, and "Suitable work" in women.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

Efficacy of the Mental Health App "Intellect" to Improve Body Image and Self-compassion in Young Adults: A Randomized Controlled Trial With a 4-Week Follow-up

BACKGROUND

Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults.

OBJECTIVE

In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students.

METHODS

Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up.

RESULTS

The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76).

CONCLUSIONS

This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973.

Suicide among transport industry workers: A systematic review and meta-analysis

OBJECTIVES

Working in high-stress and male-dominated occupations is associated with an elevated risk of suicide. The current study sought to conduct the first systematic literature review and meta-analysis aimed at determining suicide risk across the diverse, high pressure and male-dominated transport industry (commercial aviation, merchant seafaring, transit/driving) as compared to the general/employed population.

METHODS

Searches of PubMed/Medline, Scopus and PsycINFO databases were conducted without date restriction until March 2021. Studies were included if they were written in English, were peer reviewed, and presented primary observational research data. Studies referring exclusively to suicidal ideation, suicide attempts, self-harm, and/or accidents were excluded.

RESULTS

Following deletion of duplicates and non-English titles, a total of 4201 titles/abstracts were screened and 92 full-texts were read against inclusion/exclusion criteria. The final included sample consisted of 23 articles (16 used for meta-analysis). Results from the meta-analysis indicated that transport workers had a significantly elevated risk for suicide as compared to the general/employed population. Results were consistent across sensitivity analyses, and there was some variation across subgroup analyses.

CONCLUSIONS

Overall, we found transport workers had a significantly higher risk for suicide than the general/employed population, and this appeared to be driven by the association for those working in merchant seafaring/maritime occupations. The findings are discussed in relation to an identified need for the development, implementation, and evaluation of tailored workplace suicide prevention strategies for transport industry workers.

Barbershops as a setting for supporting men's mental health during the COVID-19 pandemic: a qualitative study from the UK

BACKGROUND

Previous research has highlighted the need to promote help-seeking by men with mental health problems.

AIMS

To investigate barbers' views about offering mental health support for men in barbershops, with a specific focus on the psychosocial impacts of the COVID-19 pandemic.

METHOD

We used a sequential mixed-methods qualitative design with online data collection. In Phase 1, 30 barbers in Southern England completed surveys exploring perceptions of their clients' mental health during the COVID-19 pandemic, experiences of informal supportive roles and scope for providing formal mental health support in barbershops. Phase 2 involved member validation interviews and explored practice implications with three Phase 1 respondents.

RESULTS

Thematic analysis identified three overarching themes: 'more than a haircut' (describing how the physical and relational contexts of barbershops can offer a supportive environment for clients); 'impacts of COVID-19' (describing stressors related to the pandemic and implications for clients' mental health and barber-client relationships); and 'formal mental health strategies' (describing opportunities for, and potential barriers to, formalising mental health support in barbershops).

CONCLUSIONS

Barbers were aware of their clients' worsening mental health during the COVID-19 pandemic. Barbershops were generally considered to be a suitable setting in which to promote good mental health, monitor for signs of mental ill health and provide information about local mental health services. Future work is needed to co-produce and evaluate formal mental health promotion and prevention strategies in barbershops. Particular attention should be given to service innovations that preserve the credibility and trust that are fundamental to the barbershop experience for many males.

"People say men don't talk, well that's bullshit": A focus group study exploring challenges and opportunities for men's mental health promotion

Men’s mental health promotion presents unique challenges including gender-related barriers and stigmas, which demand novel approaches to prevention, treatment, and management. The aim of this study was to explore men’s perceptions of mental health and preferences for mental health promotion. Seven focus groups (N = 59) were conducted in Sydney, Australia, including 5 groups of men (M = 50.65, SD = 13.75 years) and 2 groups of stakeholders who had frontline experience working with men (e.g., men’s groups, health clubs, mental health advocates). Data were analysed using thematic analysis and interpreted using a gender relations approach to explore connections between gender roles, relations and identities, and men’s mental health. Three overarching themes were identified; (1) Roles, identities, and the conceptualisation and concealment of mental health challenges, revealing challenges to mental health promotion related to perceptions of men’s restrictive emotionality and emotional awareness as well as difficulties with conceptualising the internalised experiences of mental health, (2) Constraining social contexts of stigma and gender relations, identifying how social context and the policing of gender roles often obscured opportunities for discussing mental health and help-seeking behaviour, (3) Anchoring mental health promotion to acceptable lifestyle practices, highlighting potential remedies included leveraging men’s social practices related to reciprocity, normalising mental health promotion relative to other behaviours, and embedding mental health promotion within acceptable masculine practices. Discussed are directions for men’s community-based mental health promotion and opportunities for how masculinities may be negotiated and expanded to embody mental health promoting values.

Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial

BACKGROUND

The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect.

METHODS

The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS.

RESULTS

Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness.

LIMITATIONS

The study was a secondary analysis with power to detect moderate-to-large mediation effects only.

CONCLUSION

To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.

Gender-Oriented Mental Health Prevention: A Reappraisal

Many studies have investigated the impact of gender on mental health, but only a few have addressed gender differences in mental health risk and prevention. We conducted a narrative review to assess the current state of knowledge on gender-specific mental health preventive interventions, along with an analysis of gender-based risk factors and available screening strategies. Out of 1598 articles screened using a comprehensive electronic search of the PubMed, Web-of-Science, Scopus, and Cochrane databases, 53 were included for review. Among risk factors for mental health problems, there are individual, familiar, social, and healthcare factors. Individual factors include childhood adversities, which show gender differences in distribution rates. However, current childhood abuse prevention programs are not gender-specific. Familiar factors for mental health problems include maternity issues and intimate partner violence, and for both, some gender-specific preventive interventions are available. Social risk factors for mental health problems are related to education, employment, discrimination, and relationships. They all display gender differences, but these differences are rarely taken into account in mental health prevention programs. Lastly, despite gender differences in mental health service use being widely known, mental health services appear to be slow in developing strategies that guarantee equal access to care for all individuals.

Behavioral and Cognitive Outcomes of an Online Weight Loss Program for Men With Low Mood: A Randomized Controlled Trial

BACKGROUND

Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms.

PURPOSE

To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood.

METHODS

Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 ≥ 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d).

RESULTS

At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up.

CONCLUSIONS

This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).

The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study

BACKGROUND

The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood.

OBJECTIVE

The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting.

METHODS

This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the "mental health" and "vitality" subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program.

RESULTS

On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures.

CONCLUSIONS

Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.

Masculinities and mental distress: from personal care to fight against male sexism?

Mental health problems have great international health relevance. From a multifactorial nature, the health conditions considered here as suffering are influenced by social elements such as the construction of masculinity, notwithstanding the evident increasing criticisms and struggles against male sexism. Given this setting, the paper addresses male mental distress and its care, based on a literature review, according to BVS research, and considering the 2010-2020 period. Twenty-two papers were selected from the research. The results of the study were organized into these categories: Characteristics/Particularities of men's mental distress; Access/Way of seeking help by men in distress and approach/Care of men in mental distress. We can conclude that there is a need for more visibility for the relationship between masculinity and suffering and their care specificities, considering the existence of an apparent silent crisis, the right of men (as people) to care, and the possible contribution, albeit indirect and modest, of addressing men's distress to the fight against machismo.

Integrative Community Therapy - interventive strategies in the reduction of depression symptoms in adolescents: A quasi-experimental study

This study aimed to evaluate the effects of Integrative Community Therapy on depression symptoms in adolescents in the school context. This is a quantitative, quasi-experimental, pre-, and post-test study that compared depression scores before and after the Integrative Community Therapy intervention was applied, conducted with 56 adolescent students. The guidelines recommended by the Standards for Quality Improvement Reporting Excellence were used to present this study. The instruments used for data collection were the following: Participants' characterization, Economic Classification, and the Children's Depression Inventory. This depression inventory was applied before and after the intervention was carried out. Most of the participants presented depressive symptoms (53.6%). Girls presented higher depression scores and were more likely to develop depression; to be working proved to be a protective factor for depression and adolescents with depression symptoms presented a higher proportion of suicidal ideation. The analysis of the depression variable indicated a reduction of the scores in the post-intervention period; however, in the gender analysis, there was a reduction in the depression scores only for the girls. The Integrative Community Therapy was an effective intervention in reducing depression scores, being a relevant strategy for healthcare services and schools in assisting adolescents to deal with their emotions, mitigate psycho-emotional suffering, and contribute as a support tool in the context of vulnerabilities inherent to the process of becoming an adolescent.

Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour

In the face of ongoing attempts to achieve gender equality, there is increasing focus on the need to address outdated and detrimental gendered stereotypes and norms, to support societal and cultural change through individual attitudinal and behaviour change. This article systematically reviews interventions aiming to address gendered stereotypes and norms across several outcomes of gender inequality such as violence against women and sexual and reproductive health, to draw out common theory and practice and identify success factors. Three databases were searched; ProQuest Central, PsycINFO and Web of Science. Articles were included if they used established public health interventions types (direct participation programs, community mobilisation or strengthening, organisational or workforce development, communications, social marketing and social media, advocacy, legislative or policy reform) to shift attitudes and/or behaviour in relation to rigid gender stereotypes and norms. A total of 71 studies were included addressing norms and/or stereotypes across a range of intervention types and gender inequality outcomes, 55 of which reported statistically significant or mixed outcomes. The implicit theory of change in most studies was to change participants' attitudes by increasing their knowledge/awareness of gendered stereotypes or norms. Five additional strategies were identified that appear to strengthen intervention impact; peer engagement, addressing multiple levels of the ecological framework, developing agents of change, modelling/role models and co-design of interventions with participants or target populations. Consideration of cohort sex, length of intervention (multi-session vs single-session) and need for follow up data collection were all identified as factors influencing success. When it comes to engaging men and boys in particular, interventions with greater success include interactive learning, co-design and peer leadership. Several recommendations are made for program design, including that practitioners need to be cognisant of breaking down stereotypes amongst men (not just between genders) and the avoidance of reinforcing outdated stereotypes and norms inadvertently.

The acceptability, effectiveness and gender responsiveness of participatory arts interventions in promoting mental health and Wellbeing: a systematic review

Background:This mixed methods review synthesizes the evidence of acceptability, effectiveness and gender-responsiveness of participatory arts interventions (PAIs) in promoting mental health and wellbeing among adults. Methods: The search was restricted to empirical studies of PAIs that reported on outcomes relating to common mental health problems and wellbeing among adults aged ≥18 years old. The mixed methods appraisal tool was used for quality appraisal. A narrative synthesis was conducted. Results:Thirty-two studies were included (1,058 participants). Typical PAI features are discussed. The evidence for effectiveness is limited by methodological issues. PAIs are perceived to benefit mental health via improved connectedness; emotional regulation; meaning-making & re-defining identity; and personal growth & empowerment. Conclusion: The review highlights the dearth of studies focused on men. Research standards to establish the evidence of effectiveness and the need to expand the evidence of acceptability beyond the "perceived effectiveness" domain are discussed.

Impact of male-only lifestyle interventions on men's mental health: A systematic review and meta-analysis

Despite rising mental health problems worldwide, engaging men to seek mental health support is challenging. Male-only lifestyle interventions have shown promise for improving men's physical health, but the overall impact of these programs on psychological outcomes is unclear. This review aimed to evaluate the impact of male-only lifestyle interventions on men's mental health and to identify if any study or intervention features were associated with effectiveness. A systematic literature search with no date restrictions was conducted across four databases and returned 15 946 citations. Nine studies were eligible for inclusion, representing 1427 participants. Risk of bias was generally low across studies, although none were specifically powered to detect changes in mental health. Overall, significant group-by-time effects were reported for 26% of mental health outcomes examined. In the fixed-effects meta-analyses, small-to-medium intervention effects were observed for mental health-related quality of life (SMD = 0.24), self-esteem (SMD = 0.51), and positive affect (SMD = 0.58). Insights into effective study or intervention features were limited because of the low number of heterogeneous studies. Although male-only lifestyle interventions have improved men's mental health in some circumstances, studies that are specifically powered to detect long-term changes are urgently required, particularly in groups with pre-existing mental health concerns.

Men's Work-Related Stress and Mental Health: Illustrating the Workings of Masculine Role Norms

Although a strong relationship between employment and men’s mental health has been identified, theoretical linkages between masculinity, employment, and mental health are not well developed and mental health supports that account for gender and employment are correspondingly inadequate. The purpose of this study is to contribute to theoretical understandings of men’s employment-related mental health experience and raise possibilities for gender-responsive employer supports for men’s mental health. Specifically, this study is a secondary analysis of narrative accounts from 18 men employed in male-dominated occupations about their employment-related mental health. Results of this study present evidence of processes by which theoretical concepts of masculine role norms influence work-related stress and mental health including: (a) injunctive norms, which operate through an internal sense of the cultural “shoulds” and “should nots”; (b) descriptive norms, which are communicated through the behaviors that a man sees other men enacting in his immediate environment; and (c) cohesive norms, which exert influence through observations of how men who are leaders, behave. Men’s insights into the complexity of employment-related stress and mental health according to masculine role norms related to work demands and leadership modeling and messaging are discussed. This study concludes with potential ways forward for employer support for men’s mental health.

Men's health clinics: a real need or a marketing strategy

Globally, the life expectancy for men is 5.1 years less than for women. This gender gap in mortality is intrinsically linked to a higher proportion of premature male mortality and is a significant economic, social and healthcare issue. We explore the main causes for premature male death and also discuss the need for a dedicated men's health clinic, especially in the context of potential commercial exploitation.

Evaluating a Tool to Support the Integration of Gender in Programs to Promote Men's Health

Men's disproportionate rate of suicide and substance use has been linked to problematic conformity to traditional masculine ideals. Mental health promotion interventions directed toward men should address the gender-specific needs of men; yet, no tools exist to provide such guidance. To address this need, the Check-Mate tool was developed as part of a global evaluation of the Movember Foundation's Social Innovators Challenge (SIC). The tool provides an initial set of evidence-based guidelines for incorporating gender-related influences in men's mental health promotion programs. This article describes the development of Check-Mate and an evaluation of its usability and usefulness. Using a qualitative descriptive approach, semistructured interviews were conducted with the leads for eight of the SIC projects; they used the tool for these. Data were analyzed using conventional content analysis. Overall, project leads found the tool user-friendly. Identified strengths of Check-Mate included its practicality, adaptability, usefulness for priming thinking on gender sensitization, and value in guiding program planning and implementation. With respect to limitations, project leads explained that the complexity of men's mental health promotion programming may limit applicability of some or all approaches included in Check-Mate. They also expressed concern about how using Check-Mate might reinforce hegemonic masculine ideals. It was suggested that examples illustrating the use of Check-Mate would be a helpful accompaniment to the tool. Findings indicate that Check-Mate is a useful guide in men's mental health promotion programming. In addition to future testing of the tool in different settings, links between the tool's approaches and program outcomes should be explored.

The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up

We examined the effects of the Healthy Body Image (HBI) intervention on positive embodiment and health-related quality of life among Norwegian high school students. The intervention comprised three interactive workshops, with body image, media literacy, and lifestyle as main themes. In total, 2,446 12^th grade boys (43%) and girls (mean age 16.8 years) from 30 high schools participated in a cluster-randomized controlled study with the HBI intervention and a control condition as the study arms. Data were collected at baseline, post-intervention, 3- and 12-months follow-up, and analysed using linear mixed regression models. The HBI intervention caused a favourable immediate change in positive embodiment and health-related quality of life among intervention girls, which was maintained at follow-up. Among intervention boys, however, weak post-intervention effects on embodiment and health-related quality of life vanished at the follow-ups. Future studies should address steps to make the HBI intervention more relevant for boys as well as determine whether the number of workshops or themes may be shortened to ease implementation and to enhance intervention effects.

Developing young men's wellbeing through community and school-based programs: A systematic review

Boys and young men have unique health-related needs that may be poorly met by existing programs and initiatives. The mismatch between the needs of boys and young men and current service offerings-driven largely by social determinants of health such as masculinity-may stymie health status. This is evidenced through high rates of self-stigma, accidental death or suicide, and low rates of help seeking and health literacy among populations of boys and young men. With growing interest in improving wellbeing and educational outcomes for all young people (including boys and young men), this systematic review aimed to evaluate community and school-based programs with specific focus on program features and outcomes directly relevant to young males aged 12-25 years. Five data-bases were searched; Medline, EMBASE, PsycInfo, ERIC, and ERAD. Articles were included if they evaluated an intervention or program with a general or at-risk sample of young men, and measured a psychological, psychosocial, masculinity, or educational outcome. The majority of the 40 included studies had high quality reporting (62.5%). Synthesised data included theoretical frameworks, intervention characteristics, outcomes, and key results. Of the included studies, 14 were male-focussed programs, with masculinity approaches directed towards program aims and content information. The emergent trend indicated that male-targeted interventions may be more beneficial for young men than gender-neutral programs, however, none of these studies incorporated masculine-specific theory as an overarching framework. Furthermore, only three studies measured masculine-specific variables. Studies were limited by a lack of replication and program refinement approaches. It is concluded that there is significant scope for further development of community and school-based health promotion programs that target young men through incorporation of frameworks that consider the impact of gendered social and environmental determinants of health. Evaluation of these programs will provide researchers and practitioners with the capacity for translating beneficial outcomes into best-practice policy.

The treatment gap for mental disorders and associated factors in the Czech Republic

OBJECTIVES

To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care.

METHODS

Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied.

RESULTS

The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02-1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97-5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12-3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03-1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist.

CONCLUSIONS

The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.

Engaging Australian men in masculinity and suicide - A concept test of social media materials and a website

ISSUE ADDRESSED

Men dominate the suicide statistics and are less likely than women to seek help for emotional problems, and this has been linked to aspects of stoic masculinity. Promoting help-seeking and challenging stoic thinking may help to address this problem, but it is unclear what works in engaging men in these topics.

METHODS

We developed a multimedia intervention called Man Up - including a documentary and digital campaign. We tested promotional materials and the website by interviewing 17 men from different ages and backgrounds about their perceptions, and asked them whether the materials generated interest in the topics of the documentary.

RESULTS

Participants preferred visual materials that were relatable to them and included active and direct language. This helped them to understand and identify with the messages being imparted. Participants had mixed views on talking about masculinity and the use of the term "man up," with some expressing interest and others being deterred by it. Sharing content about mental health and suicide was seen by some as a risk to personal reputation and their relationships with others.

CONCLUSIONS

Our findings informed the design of targeted materials for the national Man Up campaign and website which were then used in a multilevel national health promotion intervention in Australia. SO WHAT?: Our study provided valuable insights beyond Man Up for those seeking to design and deliver health promotion interventions targeting Australian men and engage in sensitive and stigmatised male health issues. Using active and empowering language was especially important when addressing men which contrasts with many promotional materials currently available.

Treatment seeking by employment characteristics among Australian males: a longitudinal study from the Ten to Men study

OBJECTIVES

Men are less likely to seek treatment for mental health problems than women; however, the structural employment-related factors influencing this relationship are unknown.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Using the Australian Ten to Men cohort (N = 6447), we examined the relationship between being in a male-dominated occupation and treatment seeking from a mental health professional compared to being in a gender-equal occupation. Models were fit using logistic regression.

RESULTS

There was some evidence of a stepwise gradient between male-dominated occupations and treatment seeking for mental health problems. However, results were only significant for the most male-dominated occupations after adjustment (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52 to 0.94, P = 0.017). We also found evidence that individuals who more strongly adhered to masculine norms had a lower likelihood of treatment seeking (OR = 0.97, 95% CI 0.95 to 0.99, P = 0.004).

CONCLUSIONS

This supports the idea that occupational-related factors influence male treatment seeking for mental health problems.

Impacts of a Documentary about Masculinity and Men's Health

As part of a larger study, we developed a three-part documentary called Man Up that explored the relationship between masculinity, mental health, and suicide. In this study, we examine in detail the qualitative feedback provided by those who viewed Man Up, in order to gain a more in-depth understanding of its impact on them. A total of 169 participants provided qualitative feedback via an online survey 4 weeks after viewing Man Up. We examined their opinions about the show and whether they reported any changes in their attitudes and/or behaviors as a result of watching it. All the men who provided feedback on Man Up were overwhelmingly positive about it. The majority reported significant and profound impacts of viewing the documentary. They reported being more aware of others, more willing to help others, and more open about their emotions and problems, as well as demonstrating associated behavioral changes related to helping others and being more emotionally expressive. The data presented here demonstrate the potential for men's health outcomes to be positively impacted by novel, media-based public health interventions.

Looking Beyond Distress: A Call for Spanning the Continuum of Mental Health Care

Background

Despite mental health’s definition as a state of well-being, mental health research and practice has often narrowly focused on pathology and distress. The identification, treatment, and rehabilitation of mental illness are the primary activities pertaining to the role of mental health professionals, but only focusing on these primary activities carries the risk of neglecting other legitimate responsibilities related to prevention of illness and promotion of wellness. Therefore, it becomes important to highlight the potential utility of separately examining levels of distress, alongside levels of well-being in community samples. The goal of this study was to determine the extent to which low levels of distress or a lack of significant distress co-occurs with high levels of well-being in a sample of urban Indian adults.

Methods

Standardized measures of psychological distress, along with measures of emotional, psychological, and social well-being, were used in a sample of 300 adults aged 20 to 60 years. The participation of community-dwelling adults who could respond to the questionnaires in English or Hindi (the most widely spoken and official language in India) was solicited through posting announcements on various platforms in a metropolitan city in Southern India. The participants had the option to respond to the questionnaires via a paper-pencil version or through an online Google survey. Psychological distress was assessed using the Kessler Psychological Distress scale (K-10) on which a score over 19 indicated significant distress. We used the 25th and 75th percentile points on the respective distributions of scores to determine high, low, and moderate ranges on the three measures of well-being.

Results

Both men and women were well represented in the sample (47% and 53%, respectively). Approximately 41% were young adults, nearly 30% were in the 36 to 45-year age group, and 30% were in the 46 to 60-year age group. Approximately 48% of the overall sample (N = 143) exhibited an absence of significant distress. Patterns of well-being were examined in this group of low-distress participants. Only 13% of low-distress participants exhibited high emotional well-being (i.e., had a high positivity ratio) and high psychosocial functioning (i.e., had high psychological and social well-being). As many as 37.8% exhibited low well-being on at least one of the three measures of well-being, despite being low on distress. In other words, low well-being scores were fairly common in conjunction with non-significant levels of distress.

Conclusion

Reliance on low distress for operationalization of mental health may mask lower levels of emotional well-being and psychosocial functioning in a given population. The findings underscore the need to span the entire continuum of mental health care by routinely including preventive and promotive aspects in research and practice.

Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.