Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia

Nursing students' mental health literacy and resilience levels: A cross-sectional study

This study aimed to evaluate the relationship between nursing students' mental health literacy and resilience levels. This cross-sectional study included 676 nursing students who completed the Information Form, Mental Health Literacy Scale (MHLS), and Brief Resilience Scale (BRS). The total mean scores of the students' MHLS and BRS were 102.53 ± 11.49 and 18.19 ± 4.02 respectively. Correlation analysis revealed a very weak positive correlation between MHLS and BRS total scores. The nursing students' mental health literacy and resilience levels were moderate. Of them, those with high mental health literacy levels also had higher levels of resilience. This study may provide evidence that increasing societies' mental health literacy levels can also improve resilience levels.

Modifiable predictors of mental health literacy in the educational context: a systematic review and meta-analysis

Mental health literacy is vital for well-being in educational settings, extending beyond academics to include social and emotional development. It empowers individuals, allowing them to recognize and address their mental health needs and provide essential support to their peers. Despite the acknowledged importance of modifiable factors, there is a noticeable research gap in those amenable to change through educational interventions. Thus, this systematic review aims to identify potentially modifiable predictors of mental health literacy in the educational context. A systematic search was conducted for quantitative studies published between 2019 and October 2023 using several databases following PRISMA guidelines. Studies needed to focus on potentially modifiable predictors of mental health literacy in the educational context. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool). In total, 3747 titles and abstracts were screened, 60 articles were assessed in full-text screening, and 21 were included in the review. Significant correlations between mental health literacy and modifiable predictors, including stigma toward professional help, self-efficacy, attitudes toward help-seeking, social support, positive psychological states, receiving mental health training, and psychological distress, were identified. By addressing these factors, educational institutions can cultivate community's adept in mental health, fostering an environment marked by empathy, understanding, and proactive engagement in addressing mental health issues. The implications serve as a foundation for future research, policy development, and implementing of practical strategies to enhance mental health literacy in diverse educational settings.

The moderating role of stigma in the relationship between depression and resilience: results of a cross-sectional study in university students

Background/objective

Depression is a growing concern in university students and resilience has shown to play a protective role. The impact of stigma is still under-explored, with reference to its moderating role between depression and resilience. The present study investigate such a relationship among Italian university students.

Methods

A cross-sectional design was applied in a simple of 1,912 students to examine the interrelationships between depression (Patient Health Questionnaire-9), resilience (Nicholson McBride Resilience questionnaire), and stigma (Stigma-9). Correlation, predictor, and moderation analyses were applied in RStudio.

Results

A negative correlation was found between depressive symptoms and resilience (r = -0.455, p < 0.001). A positive correlation was found between depressive symptoms and stigma (r = 0.207, p < 0.001). Lower levels of resilience and higher levels of stigma were significant predictors of depressive symptoms [F(df, n) = 190.8(3, 1884), p < 0.001, R2 = 0.236]. The moderation analysis showed a weakening of resilience protective effect against depression as stigma levels increase [F(df,n) = 186.7(3,1908), p < 0.001, R2 = 0.226].

Conclusion

Stigma influences the relationship between depression and resilience. Anti-stigma interventions and programs empowering resilience, should be implemented in university settings to protect students from depression.

Mental health literacy in children and adolescents in low- and middle-income countries: a mixed studies systematic review and narrative synthesis

Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low- and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.

Factors associated with depression, anxiety, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients: A cross-sectional study

Depression and anxiety are prevalent mental health issues worldwide, especially among parental caregivers. By expanding the family stress model, this cross-sectional study investigated the relevant factors associated with depressive symptoms, anxiety symptoms, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients. Data were collected through questionnaires (N = 207) across five major public hospitals through convenience sampling. Participants answered questionnaires measuring financial strain, caregiver burden, relationship quality, belief in mental illness, perceived COVID-19 stress, satisfaction with health services, depressive symptoms, anxiety symptoms and life satisfaction. Findings revealed that relationship quality among spouses, COVID-19 stress and caregiver burden were significantly correlated with anxiety symptoms, depressive symptoms and satisfaction with life. The multiple regression model also suggested that depressive symptoms (β = .613, p < .001), anxiety symptoms (β= .657, p < .001) and relationship quality among spouses (β = .264, p < .001) were the most influential predictors of anxiety symptoms, depressive symptoms and satisfaction with life respectively. By addressing the mental health needs of parental caregivers, this study can contribute to improving the overall quality of care and support provided to adolescent patients and their caregivers in Malaysia and beyond.

Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review

BACKGROUND

The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups.

OBJECTIVE

In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature.

METHODS

A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis.

RESULTS

A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues.

CONCLUSIONS

Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted.

Self-stigmatization of high-school students seeking professional psychological help: the chain-mediating effect of perceived social support and optimism

Background

Research has shown that stigmatization of professional psychological help-seeking is an important factor influencing attitudes toward seeking professional psychological help (ATSPPH). However, how perceived social support (PSS) and optimism have a mediating role is not clear.

Objective

Examine the associations between ATSPPH, self-stigmatization of seeking help, PSS, and optimism in a cohort of Chinese high-school students (HSSs).

Methods

An offline survey was conducted in three high schools in Chongqing (China) from 20 February to 20 May 2023. Participants were HSSs recruited through their teachers. A total of 2,159 HSSs completed a survey on demographic information as well as the Self-Stigmatization of Seeking Help (SSOSH) score, ATSPPH, Perceived Social Support Scale (PASS), and Life Orientation Test (LOT). Mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of self-stigmatization of seeking psychological help on ATSPPH.

Results

Self-stigmatization of seeking psychological help was significantly and negatively related to ATSPPH among HSSs. Self-stigmatization of psychological help-seeking influenced ATSPPH through three pathways: (a) separate mediating effect of PSS (effect = -0.029); (b) separate mediating effect of optimism (effect = -0.069); (c) chain-mediating effect of PSS and optimism (effect = -0.017). These data suggested that self-stigmatization of psychological help-seeking could influence ATSPPH directly and indirectly through PSS and optimism.

Conclusion

PSS and optimism mediated the relationship between self-stigmatization of seeking help and ATSPPH. Improving the ability of HSSs to perceive social support and cultivating optimism could help improve the self-stigmatization of help-seeking and promote a positive attitude toward professional help-seeking.

Mental illness stigmatisation among Malaysian adults: a systematic review

BACKGROUND

Stigmatisation is considered a 'second illness' for people with a mental illness and is highly prevalent in Malaysia. Stigmatisation negatively impacts wellbeing, recovery and productivity. Addressing stigmatisation is integral towards people attaining a higher quality of life.

AIM

To explore mental illness stigmatisation in Malaysian adults.

METHOD

A systematic literature review was conducted using thematic analysis to synthesise and categorise evidence. Five key themes emerged, providing insight into mental health stigmatisation.

FINDINGS

Cultural beliefs, limited knowledge of mental health and lack of education on mental health were factors influencing stigmatisation. Stigmatisation significantly affected the wellbeing and functioning of people with a mental illness. Interventions such as contact-based education effectively reduce stigmatising attitudes manifested by healthcare providers.

CONCLUSION

Establishing mental health literacy, encouraging patient contact, promoting mental health awareness and strengthening mental health policies could reduce mental illness stigmatisation and its impact in Malaysia. Future research is warranted to investigate the impact on physical wellbeing and anti-stigmatising strategies targeting the general public.

Factors Influencing Delay in Seeking Care for Mental Illness Among a Sample of Adult Saudi Arabian Patients

BACKGROUND

 Treatment and prognosis of psychiatric disorders could be negatively affected by delay in seeking mental health care. The development of mental health services depends on understanding the reasons for delays in help-seeking and pathways to care and the duration of illness before treatment is initiated.

OBJECTIVES

The aim of the present study is to examine the reasons why patients with psychiatric symptoms delay their visits to psychiatry clinics in Saudi Arabia.

METHODS

This was a cross-sectional, observational, survey-based study that included 268 patients, of which 60.8% were males. Data were collected through a questionnaire (either online or distributed to patients who attend the outpatient psychiatric clinics) in Taif, Saudi Arabia.

RESULTS

Most patients were married males below 40 years old, with a university degree level, employed, and having average financial status. The most common symptom reported by responders was anxiety (41.8%). The most common reason in both age groups was the fear of side effects of medication (31.9% in those over 40 years and 18.4% below 40 years), followed by the patient belief that these are non-psychiatric symptoms and will disappear with time. The trial of folk medicine was the least common reason for both age groups (1.8% in patients below 40 years and 0% for patients above 40 years).

CONCLUSION

Fear of psychotropic drug adverse effects was the most frequent reason given for postponing mental health counseling. This could be due to some unpleasant or intolerable effects. Anxiety was the most common psychiatric symptom among patients delaying their first psychiatric consultation. These findings serve as a guide for the improvement of mental health services and psychoeducation in Saudi Arabia.

Suicidality in the Arab World: Results from an Online Screener

Suicide in the Arab World is grossly understudied. This study sought to understand suicidality among Arabic-speaking individuals visiting an online depression screener. A large sample (N = 23,201) from the Arab World was recruited online. 78.9% (n = 17,042) reported suicidality (thoughts of death or suicide, or a suicide attempt) and 12.4% reported a suicide attempt in the past 2 weeks. Binary logistic regressions indicated that women tended to report more suicidality, and that suicidality tended to decline with age (all ps < 0.001), across all levels of suicidality. Comparing countries with n ≥ 1000 (Algeria, Egypt, Jordan, Morocco, and Saudi Arabia), several 3-way (gender * age * country) and 2-way interactions indicated that some countries departed from the usual pattern of responses. For instance, in Algeria, neither gender nor age differences were observed in reported attempts. Women and younger adults in the Arab World may be at higher risk of suicidality. Differences between and within countries warrant further exploration.

Widening participation - recruitment methods in mental health randomised controlled trials: a qualitative study

BACKGROUND

Barriers to mental health research participation are well documented including distrust of services and research; and stigma surrounding mental health. They can contribute to a lack of diversity amongst participants in mental health research, which threatens the generalisability of knowledge. Given the recent widespread use of the internet in medical research, this study aimed to explore the perspectives of key partners on the use of online (e.g. social media) and offline (e.g. in-person) recruitment as an approach to improving diversity in mental health randomised controlled trials (RCTs).

METHODS

Face-to-face and online interviews/focus groups with researchers working in mental health and Patient and Public Involvement partners in the United Kingdom. Recordings were transcribed and analysed using a combination of inductive and deductive thematic analysis.

RESULTS

Three focus groups and three interviews were conducted with a total N = 23 participants. Four overarching themes were identified: (1) recruitment reach; (2) Demographic factors that affect selection of recruitment method; (3) safety of technology, and; (4) practical challenges. Five main factors were identified that affect the choice of recruitment method: age, complexity of mental health problem and stigma, cultural and ethnicity differences and digital divide. The use of online methods was considered more accessible to people who may feel stigmatised by their mental health condition and with a benefit of reaching a wider population. However, a common view amongst participants was that online methods require closer data monitoring for quality of responders, are not fully secure and less trustworthy compared to offline methods that enable participants to build relationships with health providers. Funding, staff time and experience, organisational support, and technical issues such as spam or phishing emails were highlighted as practical challenges facing online recruitment. All participants agreed that using a hybrid approach tailored to the population under study is paramount.

CONCLUSIONS

This study highlighted the importance of offering a flexible and multifaceted recruitment approach by integrating online with offline methods to support inclusivity and widening participation in mental health research. The findings will be used to develop considerations for researchers designing RCTs to improve recruitment in mental health research.

Buffering against exposure to mental health misinformation in online communities on Facebook: the interplay of depression literacy and expert moderation

BACKGROUND

The proliferation of health misinformation on social media is a growing public health concern. Online communities for mental health (OCMHs) are also considered an outlet for exposure to misinformation. This study explored the impact of the self-reported volume of exposure to mental health misinformation in misinformation agreement and the moderating effects of depression literacy and type of OCMHs participation (expert vs. peer-led).

METHODS

Participants (n = 403) were recruited in Italian-speaking OCMHs on Facebook. We conducted regression analyses using PROCESS macro (moderated moderation, Model 3). Measures included: the Depression Literacy Questionnaire (Griffiths et al., 2004), the self-reported misinformation exposure in the OCMHs (3 items), and misinformation agreement with the exposure items (3 items). Whether participants were members of expert or peer-led OCMHs was also investigated.

RESULTS

The final model explained the 12% variance in the agreement. There was a positive and significant relationship between misinformation exposure and misinformation agreement (β = 0.3221, p < .001), a significant two-way interaction between misinformation exposure and depression literacy (β = - 0.2179, p = .0014 ), and between self-reported misinformation exposure and type of OCMH (β = - 0.2322, p = .0254), such that at higher levels of depression literacy and in case of participation to expert-led OCMHs, the relationship misinformation exposure-misinformation agreement was weaker. Finally, a three-way interaction was found (β = 0.2497, p = .0144) that showed that depression literacy moderated the positive relationship between misinformation exposure and misinformation agreement such that the more misinformation participants were exposed to, the more they agreed with it unless they had higher levels of depression literacy; this, however, occurred only if they participated in peer-led groups.

CONCLUSIONS

Results provide evidence that the more members reported being exposed to mental health misinformation, the more they tended to agree with it, however this was only visible when participants had lower depression literacy and were participating in peer-led OCMHs. Results of this study suggest that both internal factors (i.e., high depression literacy) and external factors (the type of online community individuals were participating in) can buffer the negative effects of misinformation exposure. It also suggests that increasing depression literacy and expert community moderation could curb the negative consequences of misinformation exposure related to mental health. Results will guide interventions to mitigate the effects of misinformation in OCMHs, including encouraging health professionals in their administration and implementing health education programs.

South African university students' experiences of online group cognitive behavioural therapy: Implications for delivering digital mental health interventions to young people

Mental disorders are common among university students. In the face of a large treatment gap, resource constraints and low uptake of traditional in-person psychotherapy services by students, there has been interest in the role that digital mental health solutions could play in meeting students' mental health needs. This study is a cross-sectional, qualitative inquiry into university students' experiences of an online group cognitive behavioural therapy (GCBT) intervention. A total of 125 respondents who had participated in an online GCBT intervention completed a qualitative questionnaire, and 12 participated in in-depth interviews. The findings provide insights into how the context in which the intervention took place, students' need for and expectations about the intervention; and the online format impacted their engagement and perception of its utility. The findings of this study also suggest that, while online GCBT can capitalise on some of the strengths of both digital and in-person approaches to mental health programming, it also suffers from some of the weaknesses of both digital delivery and those associated with in-person therapies.

Examining factors that drive health-related students to seek help for psychological challenges

Objectives

This study aims to find the prevalence of mental health problems and the rates of seeking mental health care among health-related students, as well as identifying factors associated with seeking mental health care.

Methods

A cross-sectional online survey was conducted among students from the Faculty of Medicine at a university in the 2021 academic year. A total of 832 students voluntarily completed an online survey measuring mental health problems and factors influencing mental health care seeking. Descriptive and analytic statistics including t-test, Pearson's chi-square test, and binary logistic regression analysis, were used to analyze the data.

Results

Among the participants, 46.80% (n = 389) reported experiencing mental health problems, but only 16.97% (n = 66) of them sought mental health care. Binary logistic regression analysis revealed that female (OR = 2.63 (1.08 - 6.43)) and LGBTQ (OR = 4.26 (1.36 - 13.37)) students, and those with a positive attitude toward professionals (OR = 1.10 (1.02 - 0.19)), were more likely to seek formal mental health care than those who did not.

Conclusions

The study findings indicate that mental health problems are prevalent among health-related students, yet formal mental health care uptake is low. To address this issue, mental health screening programs, improved knowledge and attitudes about mental health care, and mental health training for academic staffs who work with health-related students are necessary. Future studies should explore interventions to increase the uptake of mental health services among health-related students.

An explorative cross-sectional analysis of mental health shame and help-seeking intentions in different lifestyles

To identify und support particular target groups for mental health prevention, we explore the links between shame and help-seeking intentions concerning mental health in different lifestyles (based on socioeconomic status as well as health-related behaviors). Lifestyles were operationalized by nine confirmatory, homogenous clusters of the sample. These clusters are based on individuals' similarities in sociodemographic aspects and health behavior. Analyses included t tests, Chi-square, ANOVA, regressions investigating in sociodemographic characteristics. Hierarchical linear models examining cross-sectional associations of shame and willingness to seek help for different lifestyles of participants of the Study of Health in Pomerania (SHIP-START-1 and SHIP-START-3, data collected 2002-2006 and 2014-2016; n = 1630). Hierarchical linear models showed small context effects for lifestyle-related associations of shame and willingness to seek help. For younger as well as male participants, lifestyles indicated different associations of shame and help-seeking intentions: Especially the lifestyles with unhealthy behaviors and high as well as low socioeconomic status resulted in higher shame being associated with low help-seeking intentions in case of mental illness. Lifestyle clusters might be a useful tool to identify marginalized groups with unhealthy behaviors, which should be addressed by interventions and prevention programs.

How communicative environments affect college students' mental health help-seeking during COVID-19: a cross-sectional study

Objective: This study explores how interpersonal communication environments (eg family, patient-provider, and online communication environments) affect college students' mental help-seeking during COVID-19. Methods: Based on Social Cognitive Theory, we conducted a cross-sectional survey assessing participants' mental help-seeking attitudes, self-stigma, self-efficacy, and readiness, as well as their communication experiences with their families, healthcare providers, and online environments. Four hundred fifty-six student participants were recruited. Structural equation modeling was used to explore relationships among the assessed variables. Results: About one-third of the participants (N = 137) had signs of mental distress, and most of them (N = 71) did not intend to seek help soon. Patient-centered communication experiences with healthcare providers were associated with reduced help-seeking stigma, whereas online and family communication predicted help-seeking readiness through changes in attitude, self-stigma, and self-efficacy. Conclusions: This study's results help identify risk factors of help-seeking reluctance. It suggests that communicative environments affect help-seeking by influencing individual predictors. This study may inform interventions targeting college students' use of mental health services during health crises like COVID-19.

Effectiveness of Psycho-Religious Sexuality Education upon Anger and Depression of Iranian Female Adolescents: The Relationship of Quality Family Relationships and Birth Order

Sexually active adolescents tend to have a wider range of psychosocial problems, including depression, anger, poor academic achievement, low self-esteem, and substance use. Developing a high-quality and curriculum-based comprehensive sexuality education (CSE) program is of great importance for adolescents following Iranian culture. Due to the lack of such an educational program, the purpose of this study was to investigate the effectiveness of psycho-religious CSE upon anger and depression of Iranian female adolescents, as well as the relationship of quality family relationships and birth order. The research design is quasi-experimental with pre-test and post-test with experimental and control groups. The statistical population of this study comprised all Iranian female adolescents aged 15 to 18 years in Mashhad who participated in this workshop voluntarily. For data collection, the Child and Adolescent Depression Inventory and Spielberger's State-Trait Anger Expression Inventory (STAXI) were used. SPSS 21 software and analysis of variance (ANOVA) and covariance (ANCOVA) were used for data analysis. The results showed that there was a significant difference in the mean difference between depression and anger in the control and experimental groups (p-Value < 0.05). The results also showed a significant relationship between birth order and the quality of family relationships on depression and anger. Psycho-religious-based SE can reduce depression and anger in female students. These findings can be used in planning educational interventions with a psycho-religious-based approach to reducing anger, depressive symptoms and dangerous sexual behaviors among adolescents.

Attitudes toward seeking professional psychological help among Chinese pregnant women: A cross-sectional study

BACKGROUND

There exists a gap between the high prevalence of mental health problems and negative attitudes toward seeking professional psychological help among Chinese pregnant women. This study aimed to investigate the attitudes and factors toward seeking professional psychological help among Chinese pregnant women to provide some suggestions for improving pregnant women's psychological help-seeking behaviors.

METHODS

A total of 1024 pregnant women were recruited. The Chinese version of the Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH) was used to assess the attitudes toward professional psychological help-seeking. Demographic and socio-psychological factors were collected by self-developed questionnaire, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Patient Health Questionnaire-9 Scale.

RESULTS

1006 pregnant women were included in the final analysis. Only 3.7 % of participants chose professionals as their first choice for psychological help-seeking. The attitudes toward seeking professional psychological help were relatively positive, with the highest score of stigma tolerance among four subscales in ATSPPH. Education level, perceived social support, and positive coping style had a positive predictive effect on the four subscales of ATSPPH. Women with prenatal depressive symptoms had a lower score in the subscales of recognition of need for psychotherapeutic help and confidence in mental health practitioner; women with higher scores of negative coping style had a lower score in the subscales of stigma tolerance and interpersonal openness. History of professional psychological help-seeking behaviors was only associated with the subscale of recognition of need for psychotherapeutic help; Maternal age was only associated with the subscale of interpersonal openness.

CONCLUSION

The attitudes toward seeking professional psychological help were relatively positive among Chinese pregnant women, and stigma tolerance was the significant barrier to professional psychological help-seeking. More attention should be paid to those women with older age, negative coping style, and women with prenatal depressive symptoms.

Review: Can digital mental health interventions bridge the 'digital divide' for socioeconomically and digitally marginalised youth? A systematic review

BACKGROUND

Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth.

METHOD

Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs.

RESULTS

Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations.

CONCLUSIONS

While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

Low depression literacy exacerbates the development and progression of depressive mood in Chinese adult social media users during COVID-19: A 3-month observational online questionnaire-based study with multiple cross-sectional analyses

Background

The main purpose of this study was to explore the relationship between depression literacy (D-Lit) and the development and progression of depressive mood.

Methods

This longitudinal study with multiple cross-sectional analyses used data from a nationwide online questionnaire administered via the Wen Juan Xing survey platform. Eligible participants were 18 years or older and had subjectively experienced mild depressive moods at the time of their initial enrollment in the study. The follow-up time was 3 months. Spearman's rank correlation test was used to analyze the predictive role of D-Lit on the later development of depressive mood.

Results

We included 488 individuals with mild depressive moods. No statistically significant correlation between D-Lit and Zung Self-rating Depression Scale (SDS) at baseline was observed (adjusted rho = 0.001, p = 0.974). However, after 1 month (adjusted rho = -0.449, p < 0.001) and after 3 months (adjusted rho = -0.759, p < 0.001), D-Lit was significantly and negatively correlated with SDS.

Limitations

The targeted subjects were limited to the Chinese adult social media users; meanwhile, China's current management policies for COVID-19 differ from most of the other countries, limiting the generalizability of this study.

Conclusion

Despite the limitations, our study provided novel evidence supporting that low depression literacy may be associated with exacerbated development and progression of depressive mood, which, if not appropriately and promptly controlled, may ultimately lead to depression. In the future, we encourage further research to explore the practical and efficient ways to enhance public depression literacy.

Factors Associated with Mental Health among Malaysian University Music Students: Roles of Fear of COVID-19, Nomophobia, Loneliness, Sleep Quality, and Socioeconomic Status

Previous mental health studies have shown higher levels of anxiety, stress, and depression symptoms among university music students. In general, some similar findings have been observed for Malaysian music university students. In diagnosing the complications of mental health, there is consensus that it is essential to develop and evaluate a model oriented toward mental health illness prevention and treatment. To date, a suitable pattern for estimating mental health in terms of anxiety, stress, and depression among music university students is lacking. To fill this gap, we collected the necessary data from 691 music and 871 general students who were students for one year. The introduced pattern includes socioeconomic status, fear of COVID-19, nomophobia, sleep quality, loneliness, and mental health. Our data analysis proved that the levels of anxiety, depression, and stress of music students were lower than those of general students. Unlike some previous studies, in this study, the fear of COVID-19 and nomophobia didn't have the most significant impact on mental health. The most significant impacts were related to sleep quality and loneliness. These findings have the potential to inform health promotion and services in the music education system.

College Students' Degree of Support for Online Learning during the COVID-19 Pandemic and Associated Factors: A Cross-Sectional Study

BACKGROUND

Educational institutions worldwide have experienced the suspension of offline teaching activities in favor of online teaching due to the outbreak of the COVID-19 pandemic. However, few studies have focused on the degree of support for online learning among college students in mainland China. Therefore, the aim of this study was to investigate the degree of support for online learning among Chinese college students during the epidemic and whether depression, loneliness, family communication, and social support were associated factors.

METHODS

A questionnaire was used to collect cross-sectional data from 9319 college students in mainland China, and a structural equation model was analyzed.

RESULTS

The results of the study showed high degrees of support for online learning among Chinese college students during the COVID-19 pandemic, with more than half expressing support. The SEM (Structural Equation Modeling) results showed that depression had a negative and significant effect on college students' support for online learning (β = -0.07; p < 0.001); family communication had a positive and significant effect on college students' support for online learning (β = 0.09; p < 0.001); social support had a positive and significant effect on college students' support for online learning (β = 0.11; p < 0.001).

CONCLUSIONS

Social support and family communication can alleviate the negative psychological status of college students, and depression plays a mediating role in the effect of social support and family communication on college students' degree of support for online learning. In addition, a significant chain-mediating effect was found of family communication, loneliness, and depression between social support and college students' degree of support for online learning. Government and education institutions must focus on college students' mental health issues and consider family interventions and general support that college students require.

Factors Affecting Willingness to Receive Online Counseling: The Mediating Role of Ethical Concerns

Since the outbreak of the COVID-19 pandemic, traditional face-to-face counseling has gradually given way to online counseling. To improve the application value of online counseling and change the current situation of college students' lack of willingness to receive online counseling, this study explored factors that influence Chinese college students' willingness to receive online counseling (WROC). Based on data gathered from surveying 823 Chinese college students using self-report questionnaires, we clarified the relationships between the self-stigma of seeking help, ethical concerns about online counseling (ECOC), online interpersonal trust (OIT), and the willingness to receive online counseling (WROC). The results indicated that (1) self-stigma of seeking help and OIT negatively and positively predicted the WROC, respectively; (2) ethical concerns negatively predicted the WROC; and (3) ethical concerns mediated the relationship between self-stigma and WROC and between OIT and WROC. The results suggest that reducing the self-stigma surrounding help-seeking, perfecting the ethical norms of online counseling, and enhancing interpersonal trust can improve willingness to receive online counseling.

Development of the Japanese version of the Depression Literacy Scale

BACKGROUND

Depression is a major social concern in Japan. It is therefore necessary to develop a scale in Japanese that can assess depression literacy.

AIMS

The present study aimed to develop the Japanese version of the Depression Literacy Scale (D-Lit-J), and examined its validity and reliability.

METHODS

Three groups were administered the D-Lit-J, including 117 first-year university English literature students, 112 first-year medical school students, and 53 psychiatrists. Among these, 112 (95.7%), 112 (100%), and 29 subjects (54.7%) returned completed questionnaires, respectively. The total D-Lit-J scores were compared between the three groups to assess known-group validity, and internal reliability was examined by calculating Cronbach's alpha coefficients. Medical students were asked to complete the questionnaire a second time, 3 weeks later (11 students did not respond), to assess the test-retest reliability using the intra-class correlation coefficient.

RESULTS

The total D-Lit-J scores (mean ± SD) were 7.61 ± 4.18, 9.51 ± 4.37, and 17.7 ± 3.15, for English literature students, medical students, and psychiatrists, respectively, and there were significant differences between the three groups (p < .05). The Cronbach's alpha coefficients ranged from .800 to .834 in all students, and was .764 in psychiatrists, revealing a good internal consistency. The intra-class correlation coefficient of the scale was .769.

CONCLUSIONS

The D-Lit-J showed a credible known-group validity, with good internal and test-retest reliabilities. Additional studies with a greater variety of subjects and that examine concurrent or discriminant validity will be necessary in the future.

Differences in psychosocial factors of mental health in an ethnically diverse Black adult population

We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.

Parent preferences for adolescent depression treatment: The role of past treatment experience and biological etiological beliefs

BACKGROUND

Parents play a crucial role in facilitating depression treatment for adolescents, yet parental preferences for adolescent treatments are ill-understood. Past treatment experience and belief in a biological model of depression may impact preferences, and warrant investigation.

METHODS

Parents (N = 143) of teens (12-18 years) completed a survey assessing preference for adolescent depression treatments, treatment knowledge, and beliefs about the biological etiology of depression. Details about parents' and adolescents' past mental health concerns and treatment were obtained. Parents indicated degree of preference from 0 (Not at all preferable) - 10 (Highly preferable) for six treatment options (counselling, antidepressant medication, repetitive transcranial magnetic stimulation, electroconvulsive therapy, exercise, no treatment) for three adolescents vignettes depicting varying depression severity (Mild/Moderate, Severe, and Treatment-Resistant).

RESULTS

Mean preference ratings across all vignette severities were high for counselling (range: 8.57-9.38) and exercise (range: 9.04-9.25). Multiple regression revealed parental past experience of psychopharmacological treatment was significantly associated with current preference for adolescent antidepressant medication, with increased helpfulness and milder/fewer adverse events associated with stronger preference. Greater perceived helpfulness of past teen psychopharmacological treatment was significantly associated with greater current parental preference for adolescent antidepressant medication. Strength of biological beliefs and counselling preference were significantly positively associated.

LIMITATIONS

Sample was highly educated, predominately female, and majority treatment-utilizing limiting the generalizability of findings.

CONCLUSIONS

Parents' own past medication experiences and degree of biological etiological beliefs appear to be associated with current teen depression treatment preferences. Counselling and exercise were highly preferred across depression severity.

The Stigmatizing Attitudes of Syrian University Students Toward Schizophrenia

Background: Stigma is frequently considered an obstacle to schizophrenia treatment and recovery. However, little is known regarding the stigma experienced by persons with schizophrenia among Syrian college students.

Methods: A total of 963 students from Syrian colleges and universities participated in this study, using a questionnaire with a case vignette illustrating schizophrenia. The questionnaire inquired about people's attitudes toward schizophrenia and their desire to avoid contact with people with schizophrenia. The current study investigated college students' stigma toward people with schizophrenia, desire for social distancing, gender (male and female), and major (medical and non-medical) differences.

Results: The people described in the vignette were deemed "dangerous" (28%) and "could snap out of the problem" (50.20%), according to the respondents. Female students were more likely than male students to agree that "schizophrenia is not really a medical disease" (4.40% vs. 8.9%, p ≤ 0.05). Compared with medical students, non-medical students were more likely to agree that "The problem is a reflection of personal weakness" (20% vs. 21.7%, p < 0.05). Many respondents said they would not "marry into the family of someone with schizophrenia" (95.6%) or "work closely with them" (77.6%). 

Conclusion: In this study, it was observed that a considerable percentage of Syrian college students exhibited stigma toward persons with schizophrenia and really wanted to avoid social interaction with them, with female and non-medical students having higher stigma toward people with schizophrenia in several subscale items. The findings imply that more anti-stigma interventions for Syrian college students should be implemented to help avoid or lessen the stigma toward people with schizophrenia.

Stigmatizing attitudes towards depression among university students in Syria

BACKGROUND

Depression is a prominent cause of mental disability globally, having a severe impact on mental and physical health. Depression rehabilitation and treatment, whether through psychiatric management or counseling therapy, is hampered by stigmatizing attitudes regarding psychiatric illness patients impacted by societal and cultural factors. However, little is known about the stigma toward people with depression among the students in Syria.

METHODOLOGY

A total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. A total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. The survey looked at attitudes toward depression, the desire to keep a safe distance from depressed people, stigma attitudes toward people with depression among college students, perceived beliefs about depressive people, gender (male and female), and the major section (medical and medical and non-medical) differences.

RESULTS

Four questionnaires have refused to finish the survey, out of 1259 issued. Around 47.80% of respondents, most of whom were females, felt that sad people might snap out of it. 14.60 percent believe depression isn't even an actual medical condition. Surprisingly, 2% of respondents with a medical background thought the same thing. Regarding more extreme stigmatization, 16.80% of respondents thought depressed persons were harmful. People with depression will be avoided by 19.50 percent of respondents, and people with medical backgrounds will be avoided by 5.20 percent of respondents. Nearly one-fifth of those polled said they would not tell anyone if they were depressed. Only a tiny percentage of respondents (6.90 percent) said they would not hire or vote for a politician who suffers from depression (8.40 percent).

CONCLUSION

According to the study, Syrian college students had a significant level of stigma and social distance toward mentally ill patients. Female students and non-medical students had a higher stigma in most subscale items for people with depression.

Exploration on the collaborative innovation path of college students' ideological education and psychological education

As a highly practical educational activity, mental health education must be guided by rich theories to maintain the steady development of mental health education. Ideological education plays a predictive role in college students' crisis management, which can improve college students' psychological crisis management ability. This paper proposes an early warning index system and applies it to the construction of an early warning mechanism, completes the qualitative and quantitative analysis of early warning information evaluation, and changes the situation that information evaluation only stays at the level of qualitative analysis in traditional methods. Quantitative analysis is more conducive to accurately predict the occurrence of psychological crisis. Through empirical research, this paper finds that there is a significant interaction between stressors and coping styles in the process of affecting mental health. The result of interaction is not only equal to the superposition of the influence of a single factor, but also greater or lesser than the superposition of the influence of a single factor. The study found that there was a significant correlation between stressors and mental health. It is one of the many factors that affect mental health, and it is also the main reason to induce college students' psychological crisis. Mature coping styles are significantly positively correlated with mental health, while immature coping styles are significantly negatively correlated with mental health. This paper tests students, which is more conducive to the timely warning of psychological crisis.

Psychosocial factors associated with mental health and quality of life during the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia

Background and aims

Mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms and quality of life among Malaysia’s multi-ethnic urban lower-income communities.

Methods

This is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age ≥18 years with a monthly household income ≤RM6960 (estimated $1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life, respectively. Multivariable logistic regression was performed for the final analysis.

Results

A total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy.

Conclusions

A high proportion of the sampled urban poor population reported mild to severe anxiety and depression symptoms. The psychosocial determinants should inform policymakers and shape future work within this underserved population.

Psychometric properties of Persian version of depression literacy (D-Lit) questionnaire among general population

Background

The prevalence of depression in society is increasing and there is a need for a suitable tool to assess the health literacy of people in this field. This study was conducted to evaluate the psychometric of the Iranian version of the depression literacy (D-Lit) questionnaire.

Methods

This cross-sectional study was conducted on 845 participants with a proportional stratified sampling method. First, the translation and cultural adaptation of questionnaire was performed. Then, the validity of D-Lit was assessed by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The reliability of D-Lit was assessed by the Cronbach’s alpha coefficient and McDonald omega coefficient.

Results

Based on the results of EFA, 5 factors emerged with eigenvalues of greater than 1, which accounted for 56.30% of the variance. Based on the results of CFA, one question was deleted and the results of goodness fit indexes confirmed the model. Cronbach’s alpha coefficient and McDonald omega coefficient for D-Lit questionnaire were 0.890 and 0.891, respectively. Finally, D-Lit questionnaire with 21 questions and 5 subscales of Knowledge of the psychological symptoms (5 items), Knowledge about the effectiveness of available treatment methods (4 items), Knowledge about cognitive-behavioral symptoms (6 items), Knowledge about taking medications and their side effects (4 items), and Knowledge of the severity of the disease (2 items) were confirmed.

Conclusion

The results of this psychometric evaluation confirmed the Persian version of D-Lit questionnaire with 21 questions and 5 subscales is an appropriate tool for measuring people's literacy about depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-022-00550-x.

Mental Health and Physical Activity of Female Higher Education Students during the COVID-19 Pandemic: A Comparative Cross-Sectional Study from Lithuania

During emerging adulthood (EA), higher education medical students undergo a higher risk of anxiety and depression compared to the general population. The aim of this comparative cross-sectional study was to compare the proportions of three mental disorders, namely anxiety, depression and somatisation in terms of their symptoms and self-reported physical activity (PA) levels across the cohorts of biomedical and non-biomedical female students as well as to assess the association between the mental health outcomes and PA use. Between September 2021 and January 2022, a total of 1231 female higher education students aged between 18 and 29 years old were recruited for the study. Severe symptoms of anxiety and depression, as well as unexplained somatic complaints, were suffered by 51.9%, 11% and 23% of female students, respectively. Non-biomedical female students, compared to medicine and health sciences students, were more vulnerable due to the increased prevalence of negative mental health outcomes. The relationship between increased sports activity as a potential trigger for mental well-being and decreased severity of depressive symptoms was identified in the cohorts of both biomedical (adjusted odd ratio (OR_adj) 0.4; 95% confidence interval (CI): 0.1-1.0) and non-biomedical (OR_adj 0.4; 95% CI: 0.2-0.9) female students. The current research highlights the importance of increasing sports activity by involving students in regular physical exercise of specific types for decreasing the severity of depressive symptoms in student-aged female populations.

Exploring psychopathological and cognitive factors associated with help-seeking intentions among Korean high school students: A cross-sectional study

Competitive college admissions and academic pressure have continuously increased the psychopathological burden of Korean high school students. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to explore the psychopathological and cognitive factors related to the help-seeking intentions of Korean high school students. This cross-sectional study was conducted between July and August 2020 using the General Help-Seeking Questionnaire, Symptom Checklist-90-R, and Mental Health Literacy Scale. Four hundred and twenty-one Korean high school students (275 males, 146 females; average age 17.44 years [standard deviation = 0.651]) completed self-report questionnaires. We performed analysis of variance, Spearman's correlation analysis, and stepwise regression analysis to explore the factors related to help-seeking intentions. The final model showed an explanatory power of 23.6% for the overall variance in help-seeking intentions. Somatization (β = -0.200; P = .001) and hostility (β = -0.203; P = .001) had a negative effect on help-seeking intentions. Further, knowledge of where to seek information (β = 0.230; P < .001) and attitudes promoting recognition and help-seeking behavior (β = 0.095; P = .030) had a positive effect. Students responded to society's negative awareness of mental illness by converting psychopathology into socially acceptable symptoms. Educational support can improve mental health literacy. This study is expected to help improve mental illness awareness and increase adolescents' access to public services.

Rasch Modeling and Differential Item Functioning of the Self-Stigma Scale-Short Version among People with Three Different Psychiatric Disorders

Self-stigma is prevalent in individuals with psychiatric disorders and can profoundly affect people. A unified assessment with sound psychometric properties is needed for evaluating self-stigma across psychiatric conditions. The aim of this study was to examine the psychometric properties of the Self-Stigma Scale-Short version (SSS-S) using Rasch modeling. Six-hundred and twelve participants with substance use disorders (n = 319), attention-deficit/hyperactivity disorder (n = 100), and schizophrenia (n = 193) completed the SSS-S. Rasch results confirmed the unidimensionality of the nine items of the SSS-S. The four-point Likert scale of the SSS-S reflected monotonical increases along the self-stigma continuum. No ceiling or floor effects were detected. Among the three subdomains of the SSS-S, cognitive items appeared to be the most robustly endorsed, and behavioral items were the least endorsed. Two items in the SSS-S displayed differential item functioning across the three diagnoses. Additionally, SSS-S scores showed weak to moderate correlation with depression, anxiety, and stress scale scores. The SSS-S had overall satisfactory psychometric properties. Healthcare professionals may use this assessment to assess self-stigma in multiple psychiatric groups, and information gained may facilitate improved care.

Chinese University Students' Perspectives on Help-Seeking and Mental Health Counseling

Psychological distress and mental illness have become increasingly pervasive among Chinese university students. However, many university students who need mental health treatment or psychological support do not actively seek help from professional counselors or service providers, which could lead to poor mental health outcomes. To promote help-seeking, we undertook a qualitative study to understand Chinese university students' perspectives on help-seeking and mental health counseling. We conducted 13 focus group interviews with students in six universities in Jinan, China, and altogether 91 (62%) female students, and 56 (38%) male students participated in the study. Our results indicate that students' misconception and distrust of on-campus counseling, stigma of mental illness, low mental health literacy, and hard-to-access mental health services are the major barriers that impede students help-seeking behaviors. Internal struggles and systematic and organizational barriers are identified to shed light on future work to promote mental health literacy among Chinese university students.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study

Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.

Mental health literacy: A systematic review of knowledge and beliefs about mental disorders in Malaysia

BACKGROUND

Mental health problems in Malaysia are on a rise. This study aimed at performing a systematic review of mental health literacy (MHL) in Malaysia.

METHODS

Medline, Embase, ERIC/Proquest, ScienceDirect, Pubmed, PsycINFO, CINAHL, Scopus, EBM Reviews - Cochrane Central Register of Controlled Trials, Ovid Emcare and reference lists of included studies were searched in February 2020. Studies that evaluated at least one of the main components of MHL, including (1) knowledge related to mental health issues, and (2) stigma, were included irrespective of study design. As secondary findings, the review also synthesized results related to facilitators and barriers to seeking mental health services. Depending on the research design, the quality of each study was assessed through checklists.

RESULTS

Forty six studies published between 1995 to 2019 were included. Most studies used cross-sectional designs to investigate MHL. Findings indicate that most Malaysians have stigmatizing attitudes towards mental health problems. Participants in the included studies endorsed multifactorial explanations of mental health issues with a dominance of supernatural and religious aetiologies. Likewise, the commonest barrier was considering sources other than professional sources of mental-health services. Presence of adequate knowledge and considering providers as competent facilitated help-seeking. Additionally, there was considerable heterogeneity in studies and a lack of standardized measures assessing MHL.

CONCLUSIONS

There is an increase in studies on MHL in Malaysia. A few of these studies, based on experimental design, have shown positive effects. Researchers, practitioners, and policymakers should develop standardized measures and interventional studies based on all the components of MHL.

Mental health of students amidst the COVID-19 pandemic: An empirical study

Purpose

Considering the severity of the global outbreak of coronavirus (COVID-19) on the whole of humanity, particularly in this case on the physical and mental health of students, this study strives to explore the role of financial worries, employment anxiety and COVID-19 knowledge on depression and mental health among students in Bangladesh.

Design/methodology/approach

In the study, a deductive reasoning approach was employed, together with a self-administered questionnaire survey. Questionnaires were sent to the respondents via different social media and by email by creating a Google form link. We finally received 387 responses students aged over 18 years who had internet access in order to complete the survey. To analyze the data, structural equation modeling via AMOS was used.

Findings

The results showed that employment anxiety, financial worry, and knowledge on COVID-19 positively influence depression, and finally depression negatively influences the mental health of the students. Thus, our findings supported all of the proposed hypotheses.

Originality/value

The research enriches the existing literature pool by contributing empirical substantiation on the role of employment anxiety, financial worries and knowledge of COVID-19 in depression, and the impact of depression on mental health.

Community mental health literacy in Tshwane region 1: A quantitative study

Background

Although mental health literacy is a major determining factor of mental health outcomes and functional capacity of individuals, there is dearth of research on the issue in South Africa.

Aim

To assess the literacy of three mental disorders, namely major depressive disorder (MDD), schizophrenia and generalised anxiety disorder (GAD) and to compare the resultant assumed literacy level between urban and townships participants.

Setting

Five clinics of region 1 in Tshwane, South Africa.

Method

A cross-sectional descriptive study was performed between November 2019 and January 2020. A total of 385 questionnaires were distributed equally in all five clinics. By means of questions about three fictive cases with clinical pictures indicative of MDD, schizophrenia and GAD the following were assessed: recognising a mental disorder, identifying the cause and knowledge about what would help best.

Results

The majority of participants (67.3%) recognised the clinical picture indicative of schizophrenia as a mental disorder, almost half of the participants (49.9%) recognised the clinical picture indicative of MDD as a mental disorder, whilst just more than one third (36.3%) of participants recognised the clinical picture GAD as a mental disorder. Concerning the causes for the clinical pictures, most participants indicated that stress was the cause for MDD and GAD (77.4% and 68.1%, respectively), whilst indicating that biological or psychological (59.5%) causes are relevant to the clinical picture indicative of schizophrenia symptoms. Fewer participants indicated supernatural causes for any of the clinical case (MDD: 2.6%; schizophrenia 15.3%; GAD 4.2%). Most participants chose professional help as the best option for all three cases (MDD 81.3%, schizophrenia 82.2%, GAD 66.1%). The indicators for health literacy in this study show that urban participants had better knowledge than township participants across all questions about the cases.

Conclusion

Overall, the study indicated a variable knowledge regarding the three mental disorders in region 1 of Tshwane and variable literacy levels in townships compared with urban settings. The results indicate that awareness campaigns should focus on the deficient areas.

Reducing depression-related stigma and increasing treatment seeking among adolescents: randomized controlled trial of a brief video intervention

BACKGROUND

Confronting stigma early in life could enhance receptivity to seeking treatment. We evaluated the efficacy of social contact interventions to reduce stigma toward depression and to enhance treatment-seeking intentions among adolescents. We hypothesized that the brief video-based interventions would be more effective than their matched controls.

METHOD

Using crowdsourcing, we recruited and randomly assigned 1,183 participants aged 14-18 to one of four video-based stimuli on a 4:4:1:1 ratio: (a) adolescent girl with depression; (b) adolescent boy with depression; (c) same girl, without depression; or (d) same boy, without depression. In each of the ~100-second-long videos, two simulated patients (SPs) depicted empowered presenters sharing their personal stories. In the depression conditions, SPs described how social support from family, friends, and professionals helped them overcome their symptoms and recover.

RESULTS

We found a significant effect for the Depression Stigma Scale (DSS) between active and control groups (F = 27.4, p < .001). We found a significant increase in treatment-seeking intentions, as measured by the General Help-Seeking Questionnaire (GHSQ; p < .001). Secondary analyses revealed that racial (but not gender) congruence between protagonists and participants resulted in greater stigma reduction and treatment seeking, as compared to racially incongruent pairings (t = 2.9, p = .004).

CONCLUSION

A brief video-based intervention effectively reduced stigma toward depression and increased treatment seeking among adolescents. Favorable changes were greater when race (but not gender) was congruent between protagonists and participants. Future studies should explore how to optimize brief contact-based interventions according to adolescents' race and ethnicity and how to scale such interventions to novel online platforms of dissemination.

Sociodemographic factors associated with treatment-seeking and treatment receipt: cross-sectional analysis of UK Biobank participants with lifetime generalised anxiety or major depressive disorder

Background

Anxiety and depressive disorders can be chronic and disabling. Although there are effective treatments, only a fraction of those impaired receive treatment. Predictors of treatment-seeking and treatment receipt could be informative for initiatives aiming to tackle the burden of untreated anxiety and depression.

Aims

To investigate sociodemographic characteristics associated with treatment-seeking and treatment receipt.

Method

Two binary retrospective reports of lifetime treatment-seeking (n = 44 810) and treatment receipt (n = 37 346) were regressed on sociodemographic factors (age, gender, UK ethnic minority background, educational attainment, household income, neighbourhood deprivation and social isolation) and alternative coping strategies (self-medication with alcohol/drugs and self-help) in UK Biobank participants with lifetime generalised anxiety or major depressive disorder. Analyses were also stratified by gender.

Results

Treatment access was more likely in those who reported use of self-help strategies, with university-level education and those from less economically advantaged circumstances (household income <£30 000 and greater neighbourhood deprivation). Treatment access was less likely in those who were male, from a UK ethnic minority background and with high household incomes (>£100 000). Men who self-medicated and/or had a vocational qualification were also less likely to seek treatment.

Conclusions

This work on retrospective reports of treatment-seeking and treatment receipt at any time of life replicates known associations with treatment-seeking and treatment receipt during time of treatment need. More work is required to understand whether improving rates of treatment-seeking improves prognostic outcomes for individuals with anxiety or depression.

Mental health literacy and quality of life in Iran: a cross-sectional study

BACKGROUND

Mental health is one of the effective factors in the quality of life of people. The aim of the present study was to determine the status of mental health literacy (MHL) and its relationship with the quality of life across the Iranian general population.

METHODS

In this cross-sectional study, a multi-stage sampling method was used to survey 1070 participants from the city of Gonabad (Iran). The data collection tools were demographics section, mental health literacy scale (MHLS), and quality of life (SF-12) questionnaires. The data was analyzed by SPSS software version 24 using Independent sample t- test, One- way ANOVA, Pearson correlation, and logistic regression.

RESULTS

The mean and standard deviation of the total scores of MHL and quality of life were 113.54 (10.34) and 35.26 (6.42), respectively. The results revealed that there was a significant positive correlation between MHL and the quality of life (p < 0.001). In this study, there was a significant relationship between variables of sex, level of education, plus received information about mental illness and MHL (p < 0.001). The quality of life was higher in participants whose family members did not have a mental illness, had a high-income level, and received information about mental illness (p < 0.001). Logistic regression indicated that there was a significant relationship between the ability to recognize mental disorders plus knowledge of where to seek information and obtaining information related to mental health (p < 0.001).

CONCLUSION

Based on the results of this study, there was a correlation between health literacy and quality of life, and more attention should be paid to MHL. Thus, appropriate programs should be designed and implemented to enhance the level of MHL.

Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India

Introduction

We evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems.

Methods

We conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India. The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents.

Results

Between 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ² (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66, p<0.001).

Conclusion

A single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India.

Trial registration number

NCT03633916.

The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: evidence from the APPROACH cross-sectional study in Vietnam

Background

There is very limited evidence on the existence of cancer-related perceived stigma and self-blame among patients with advanced cancer in Asia, and how they are associated with psychosocial outcomes. This study aimed to address the gap in the current literature by (1) assessing perceived stigma, behavioural self-blame and characterological self-blame among Vietnamese patients with advanced cancer, and (2) investigating the associations of perceived stigma and self-blame (behavioural and characterological) with depression, emotional well-being and social well-being.

Methods

This cross-sectional study involved 200 Vietnamese patients with stage IV solid cancer. Depression was measured using the Center for Epidemiologic Studies Depression (CES-D) Scale. Emotional well-being and social well-being were measured with the relevant domains of the Functional Assessment of Cancer Therapy-General (FACT-G) scale. Perceived stigma was assessed using the sense of stigma subscale of Kissane’s Shame and Stigma Scale. Behavioural self-blame and characterological self-blame were measured by the patients’ answers to the questions on whether their cancer was due to patient’s behaviour or character. Multivariable linear regressions were used to investigate the associations while controlling for patient characteristics.

Results

Approximately three-fourths (79.0%, n = 158) of the participants reported perceived stigma with an average score of 20.5 ± 18.0 (out of 100). More than half of the participants reported behavioural self-blame (56.3%, n = 112) or characterological self-blame (62.3%, n = 124). Higher perceived stigma was associated with lower emotional well-being (ß = -0.0; p = 0.024). Behavioural self-blame was not significantly associated with depressive symptoms, emotional well-being or social well-being. Patients who reported characterological self-blame reported greater depressive symptoms (ß = 3.0; p = 0.020) and lower emotional well-being (ß = -1.6; p = 0.038).

Conclusion

Perceived stigma and self-blame were common amongst Vietnamese advanced cancer patients. Perceived stigma was associated with lower emotional well-being while characterological self-blame were associated with greater depressive symptoms and lower emotional well-being. Interventions should address perceived stigma and self-blame among this population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00803-5.

Stigmatizing Attitudes Toward Depression Among Male and Female, Medical and Non-medical Major College Students

Background: Stigma is often reported to be a barrier to the treatment and rehabilitation of depression. However, little is known about stigma toward people with depression among college students in China.

Methods: Using a questionnaire with a case vignette describing depression, a total of 1,056 students from nine colleges/universities in Hunan Province of China were included in this study. The questionnaire addressed the attitudes toward depression and the desire for keeping a distance from depressed individuals. The current study explored the stigma attitudes of college students toward people with depression and the desire for social distancing, as well as the gender (male and female) and major (medical and non-medical) differences.

Results: Over half of the respondents agreed that people described in the vignette were “dangerous” (60.7%) and “could snap out of the problem” (58.7%). Compared with female students, males were more likely to agree that “If I had this problem, I would not tell anyone” (7.0 vs. 13.2%, p = 0.001); compared with non-medical students, medical students were more likely to agree that “The problem is a sign of personal weakness” (38.0 vs. 50.0%, p < 0.001). A lot of respondents would be unwilling to “marry into the family of people with depression” (71.1%) or “work closely with them” (45.1%). Compared with male students, females were more unwilling to “work closely with them” (40.3 vs. 47.5%, p = 0.026).

Conclusion: This study found that a high proportion of Chinese college students showed stigma toward and desire for social distancing from people with depression, male students and medical major students showed higher stigma in some subscale items toward people with depression. The present results suggest that more anti-stigma interventions should be applied for Chinese college students to help prevent or reduce stigma attitudes toward people with depression.

Associations between Health Literacy and Sociodemographic Factors: A Cross-Sectional Study in Malaysia Utilising the HLS-M-Q18

Health literacy is progressively seen as an indicator to describe a nation's health status. To improve health literacy, countries need to address health inequalities by examining different social demographic factors across the population. This assessment is crucial to identify and evaluate the strengths and limitations of a country in addressing health issues. By addressing these health inequalities, a country would be better informed to take necessary steps to improve the nation's health literacy. This study examines health literacy levels in Malaysia and analyses socio-demographic factors that are associated with health literacy. A cross-sectional survey was carried out using the HLS-M-Q18 instrument, which was validated for the Malaysian population. Multi-stage random sampling strategy was used in this study, utilising several sampling techniques including quota sampling, cluster sampling, and simple random sampling to allow random data collection. A total of 855 respondents were sampled. Our results showed that there were significant associations between health literacy and age, health status, and health problems. Our findings also suggest that lower health literacy levels were associated with the younger generation. This study's findings have provided baseline data on Malaysians' health literacy and provide evidence showing potential areas of intervention.

Career choice and influential factors among medical students majoring in psychiatry in China

BACKGROUND

The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors.

METHOD

This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career.

RESULTS

44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career.

CONCLUSION

More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.