School-Based Curriculum to Improve Depression Literacy Among US Secondary School Students: A Randomized Effectiveness Trial

A Guide for Schools on Student-Directed Suicide Prevention Programs Eligible for Implementation under the STANDUP Act, a Rapid Review and Evidence Synthesis

This review evaluates the strength of evidence for school-based mental health and suicide prevention programs that meet the legal eligibility criteria of the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act of 2021 (STANDUP Act). Included studies were aggregated by program and a program's overall body of evidence was evaluated using the LEGEND system. Requirements for implementation were also documented. We identified 29 studies, which, when aggregated, encompassed 12 unique programs that meet the statute's evidence-based criteria. All four outcomes described in the statute were measured, with help-seeking being the most commonly measured. Two programs were assigned a high level of evidence in decreasing suicidal thoughts and behaviors. The findings serve as a resource for school officials in identifying evidence-based mental health and suicide prevention programs and understanding the resources needed for implementation.

The Promotion of Mental Health and Prevention of First-Episode Psychosis: A Pilot and Feasibility Non-Randomised Clinical Trial

BACKGROUND

Mental-health-related stigma prevents active help seeking and therefore early therapeutic approaches and the recovery of functionality. National and international agencies recommend the implementation of prevention and mental health promotion programs that support the elimination of stigma in the classroom, since most mental health problems usually start in the adolescent stage. In view of the evidence that teachers present stigmatizing attitudes towards mental health, it has been considered as convenient to carry out an anti-stigma program with the main objective of evaluating the impact of an intervention based on the education and promotion of mental health, aimed at teachers and counsellors of a secondary school. The specific objectives were to get to know which were the most stigmatising attitudes that prevailed in the sample before and after the intervention; to evaluate the knowledge of the teaching staff and counsellors on psychosis before the intervention; to analyse correlations between clinically relevant variables; and assess whether this programme was beneficial and feasible for alphabetising counsellors/teachers of educational centres on stigma and FEP.

METHODS

This was a non-randomised clinical trial in which a nursing intervention was performed.

TOOLS

a psychosis test (pre), Stigma Attribution Questionnaire (AQ-27) (pre-post), and satisfaction survey (post) were used. The inferential analysis included the Wilcoxon and the Pearson Correlation Test.

RESULTS

In the sample (n = 22), the predominant stigmatising attitude was "Help". The p-values obtained in the Wilcoxon Test were statistically significant, except for "Responsibility" and "Pity". The following constructs of interest were faced: "Fear"-"Age" and "Professional experience"; and "Help"-"Psychosis test".

CONCLUSIONS

Despite the scores obtained in "Responsibility" and "Pity", the intervention was useful for reducing stigma in the sample. Implications for the profession: There are adolescents who have suffered stigma from their teachers, and consequently have minimized their symptoms and not asked for help. For this reason, we implemented a nursing intervention based on the education and promotion of mental health, with the aim of expanding knowledge and reducing stigma. In fact, this intervention, which we carried out on high school teachers, managed to reduce the majority of stigmatizing attitudes measured on the stigma attribution scale.

Effectiveness of a Comprehensive Mental Health Literacy Educational Programme for Junior High School Students: A Randomised Controlled Trial Examining Changes in Their Knowledge, Attitudes, and Behaviour

Background: This study evaluated the effectiveness of a comprehensive mental health literacy (MHL) educational programme known as “Sanita” for improving junior high school students’ knowledge of mental illness, attitudes towards people with mental health problems, and help-seeking behaviour. Methods: A randomised controlled trial with a parallel-group design was conducted. A total of 125 students (51 in the intervention group and 74 in the control group) received three 50-min classes and completed self-report questionnaires (Mental Illness and Disorder Understanding Scale, MIDUS; Reported and Intended Behaviour Scale, RIBS-J; and an original questionnaire investigating help-seeking behaviour) before and after the programme and three months later. Results: Regarding MIDUS, the post-test and 3-month follow-up test results showed a significant main effect of time-by-group interactions in a linear mixed model. Regarding RIBS-J, the post-test results showed a significant main effect of time-by-group interactions; however, the 3-month follow-up test showed no significant effect. No significant effects of time-by-group interactions were seen in the post-test and 3-month follow-up test results for help-seeking behaviour in a logistic regression-mixed model. Conclusions: The Sanita MHL educational programme was longitudinally effective at improving junior high school students’ knowledge of mental illness, although improvements in attitudes and help-seeking behaviour were insufficient.

Risk and Protective Factors Associated with Suicidal Thoughts and Behaviors Among Maryland Middle School Students

The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to STB. Data from nearly 27,000 students who completed the 2018-19 Maryland Middle School Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) were used to identify independent risk and protective factors associated with STB among middle school students (grades 6–8; ages 11-14). Twenty-three percent of students reported lifetime suicidal ideation and nine percent reported lifetime attempt(s). Independent risk factors associated with STB include depression, substance abuse or misuse, violence involvement, bullying victimization at school or electronically, sexual activity, and sleep deprivation. Protective factors include having an adult outside of school to confide in and feeling that teachers care and provide encouragement. Interactive effects by gender and/or race/ethnicity were observed for some factors in relation to STB. These results suggest that evidence-based programs and policies at the universal and selective/indicated levels in school settings are needed and should be introduced earlier on to address the widespread prevalence of STB in young adolescents. Program planners should take into consideration social, cultural and language needs when implementing and developing intervention strategies.

School-based Interventions to Improve Adolescent Resilience: A Scoping Review

BACKGROUND: Resilience can help adolescents to have positive adaptations in dealing with difficulties, stress, and trauma, as well as preventing mental disorders. School-based resilience improvement programs have been implemented internationally. However, there has been no specific review to examine the effectiveness of the application of resilience programs in adolescents. AIM: This review aimed to analyze the effectiveness of school-based interventions to increase resilience in adolescents. METHODS: Search articles using three electronic databases, namely CINAHL Ebsco, PubMed, and ProQuest. The keywords used are “resilience or resilient” AND “adolescents or teenagers or young adults” AND “school-based intervention or classroom-based intervention or teacher implemented.” There are 1206 research articles from 2014 to 2020, but only nine randomized controlled trials (RCT) studies match the inclusion criteria for analysis. RESULTS: Findings show that five school-based intervention programs have a significant effect on adolescent resilience levels, namely: enhancing resiliency among students experiencing-stress-prosocial, mindfulness training with learning to BREATH (mindfulness-based programs stress reduction), resilience and coping intervention (RCI), and girls first resilience curriculum. The shortest program duration is RCI, 3 weeks, while the most extended time is Girls first for 5 months. The duration of the program had no significant effect on increasing resilience. CONCLUSION: These findings encourage further research and development of school-based intervention programs to increase resilience in adolescents, especially in developing countries such as Indonesia.

Review: School-based interventions to improve mental health literacy and reduce mental health stigma - a systematic review

BACKGROUND

The steadily increasing prevalence of mental disorders in children and adolescents presents itself as a public health challenge, especially given the health, social and economic burden of mental disorders. School-based interventions aimed at improving mental health literacy and reducing mental health stigma have the potential to prevent mental disorders and promote mental well-being, thus reducing the burden of mental disorders. This review identified and synthesised evidence on the effectiveness of school-based interventions designed to improve mental health literacy and reduce mental health stigma.

METHODS

Electronic bibliographic databases including MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Child Development and Adolescent Studies, British Education Index and Applied Social Sciences Index and Abstracts (ASSIA) were searched. Randomised controlled trials (RCTs) were included if they assessed the effectiveness or cost-effectiveness of school-based intervention aimed at improving mental health literacy and reducing mental health stigma for children and young people aged 4-18 years. Quality of studies was appraised using the EPHPP tool. A numerical summary and a narrative description of the findings in relation to the research questions were synthesised. This systematic review was registered with PROSPERO (CRD42020191265).

RESULTS

We identified 21 studies describing 20 unique school-based mental health interventions. Overall, there is moderate evidence suggesting that school-based mental health interventions can be effective in improving mental health literacy and reducing mental health stigma defined as attitudes and beliefs regarding mental disorders. However, there is less evidence for their long-term effectiveness, as most studies did not include follow-ups.

CONCLUSIONS

Despite exclusively including studies with randomised designs, intervention and methodological heterogeneity poses uncertainties to any conclusions made. Future research should focus on resolving methodological issues concerning how outcomes are assessed and include process evaluations to better inform the design of an intervention in term of its delivery and implementation.

The Long-Term Effectiveness of Interventions Addressing Mental Health Literacy and Stigma of Mental Illness in Children and Adolescents: Systematic Review and Meta-Analysis

Objectives: This study aims to provide a systematic review and meta-analysis of the literature on the long-term effects of interventions addressing children’s and adolescents’ mental health literacy and/or stigmatizing attitudes.

Methods: Articles in English or German published between January 1997 and May 2020 were retrieved from five databases, leading to a total of 4,375 original articles identified.

Results: 25 studies were included after applying exclusion criteria, 13 of which were eligible for meta-analysis. The overall average of the follow-up period was about 5 months. Long-term improvements were sustained for mental health literacy, d = 0.48, 95% CI = (0.34, 0.62), as well as for stigmatizing attitudes, d = 0.30, 95% CI = (0.24, 0.36), and social distance, d = 0.16, 95% CI = (0.03, 0.29). The combination of educational and contact components within interventions led to worse results for mental health literacy, but not stigmatizing attitudes or social distance.

Conclusion: Interventions targeting children and adolescents generally have a brief follow-up period of an average of 5 months. They show a stable improvement in mental health literacy, but are to a lesser degree able to destigmatize mental illness or improve social distance.

A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours

AIM

The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours.

METHODS

A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations.

RESULTS

One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion.

CONCLUSIONS

Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.

The effect of a culturally sensitive mental well-being module on Pakistani nursing students' knowledge and beliefs regarding their own mental health and illness

This study examined the effect of a mental well-being module on undergraduate nursing students' knowledge and beliefs regarding causes and treatment of mental health and illness, and explored the relationship between these variables and depression and anxiety. The one group design incorporated pre-intervention, intervention and post-intervention phases, in a consecutive sample of 246 students in a 4-year BScN programme in Pakistan. A culturally sensitive, interactive mental well-being module of four hours length was delivered to three groups of approximately 40 students per group. Repeated measures ANOVA was performed to assess the difference in the mean knowledge scores. Paired t-tests investigated between-group differences on the factor scores. A total of 112 students screened positive for anxiety and depression symptoms. Repeated measures ANOVA showed a significant difference in the mean knowledge scores regarding mental illness (P < 0.001). Factor analysis resulted in four factors for the aetiology items. Paired t-test showed significant differences (P < 0.001) between psycho-social and environmental factors, supernatural and religious beliefs, and neuro-genetics. For treatment, significant differences (P < 0.001) were found between all factors - Professional and Help from others, Religiosity and Socialization, and Alternative and Medical Treatment. There was a significant and positive change in students' mental health knowledge, beliefs and mental health-seeking behaviour and diminished stigmatized beliefs. Based on the findings, it is highly recommended to incorporate the mental well-being program in the curriculum.

A survey of mental health literacy in Japanese high school teachers

BACKGROUND

School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers.

METHODS

Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students.

RESULTS

The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%).

CONCLUSIONS

MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

Promotion of Mental Health Literacy in Adolescents: A Scoping Review

In recent years, there has been an important commitment to the development of programs to promote mental health literacy (MHL) among adolescents, due to the prevalence of mental health problems and the low level of MHL that affects this group. The aim of this study was to map the structure and context of programmes/interventions for promoting MHL among adolescents in school settings. A scoping review was conducted following the guidelines of The Joanna Briggs Institute. We searched for studies on programmes/interventions promoting at least one of the components of MHL of adolescents, written in Portuguese, English or Spanish, published from 2013 to 2020, in MEDLINE, CINAHL Plus with Full Text, SciELO, SCOPUS, OpenGrey, RCAAP and in the article reference lists. This review included 29 articles. The majority of programmes/interventions addressed one or more of the four components of MHL, with the knowledge of mental disorders and stigma reduction components being the most covered; were taught by adolescent's regular teachers; used face to face interventions; had a height variable duration; used non-validated instruments; were implemented in a classroom environment; and showed statistically significant improvements in adolescent's MHL levels. More research is needed to implement/construct programmes/interventions promoting adolescents' MHL concerning knowledge on how to obtain and maintain good mental health.

An International Review to Characterize the Role, Responsibilities, and Optimal Setting for Health Literacy Mediators

Health literacy is a critically important determinant of health and is influenced by access to supportive social networks and services. Global investment in education throughout the life course is required to support health literacy development. The aim of this review is to characterize the role, responsibilities, and the optimal setting for the emergent role of a Health Literacy Mediator (HLM). A scoping review of recent literature was conducted. The review revealed a lack of consensus on who should be teaching health literacy, and variability in confidence when teaching health literacy. Professionals reported facing barriers such as a lack of time, a lack of knowledge, and recognized that the health literacy needs of children worldwide are not being met. Further research into the role of HLM is required to determine who is best suited to this role and what their responsibilities will be to ensure consistent health literacy education.

School-Based Health Education Research: Charting the Course for the Future

SHAPE America has identified four goals as part of the 50 Million Strong by 2029 initiative; one of these goals is healthy behavior. School-based health education is uniquely positioned to be a primary route through which this goal can be achieved. Health education is an academic subject included in a well-rounded education, based on health behavior and learning theory, research-based and taught by licensed and trained health educators with adequate instructional time. Health education helps students acquire functional knowledge about a variety of topics and develop health-related skills resulting in personal competence and self-efficacy. The purpose of this paper is to provide an overview of the existing evidence examining school-based health education and to articulate future directions for research that will solidify school-based health education as a necessary and efficacious strategy for improving the health and wellness of youth.

Innovative approach to adolescent mental health in Japan: School-based education about mental health literacy

AIMS

Improving mental health literacy through school-based education may encourage mental health promotion, prevention and care and reduce stigma in adolescents. In Japan, instruction about mental illness has been formulated in a Course of Study that reflects governmental curriculum guidelines, which will be enforced from 2022 to promote an understanding of current issues of adolescent health. Educational resources available to schoolteachers have been developed. This article describes the development processes and contents of these resources.

METHODS

Our collaborating team, consisting of mental health professionals and schoolteachers, developed educational resources, based on feedback from high school students in general and young people who had experienced mental health problems.

RESULTS

The new Course of Study covers: (1) mechanisms of mental illness, prevalence, age at onset, risk factors and treatability; (2) typical symptoms of mental health problems and illnesses; (3) self-help strategies for prevention of and recovery from mental illness; (4) enhancing help-seeking and helping behaviour and (5) decreasing stigma associated with people with mental health problems. The educational strategy is targeted at high school students (grades 10-12) and is conducted by teachers of health and physical education. The educational resources include short story animated films, filmed social contact and educators' manuals, which are freely available through the internet and open to all concerned including schoolteachers in Japan.

CONCLUSIONS

Our efforts are expected to help implement mental health education of the public throughout Japan and other countries and promote the practice of early intervention and prevention of mental illnesses in adolescents.

The modules of mental health programs implemented in schools in low- and middle-income countries: findings from a systematic literature review

BACKGROUND

Secondary schools in low- and middle-income countries (LMICs) provide health promotion, preventive, and early intervention services. Nevertheless, literature indicates that the modules of these services are either adapted or modified from existing mental health programs in developed countries. The literature also highlights the provision of non-comprehensive services (mental health promotion, prevention, and early intervention), in LMICs. These findings inform the need for undertaking this systematic literature review. The aim of this review was thus to identify the modules of school-based mental health programs (SBMHP) that have been implemented in LMICs to guide the development of a culturally sensitive comprehensive mental health program for adolescents in a LMIC country.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was used to guide this review. The following databases were searched in September 2018, to identify the relevant literature: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and ERIC. The search was conducted by the first author and reviewed by the authors.

RESULTS

Following the screening process, a total of 11 papers were identified and reviewed for quality. The systematic review highlighted that the mental health programs provided in schools included: an introduction module, a communication and relationship module, a psychoeducation module, a cognitive skills module, a behavioral skills module, establishing social networks for recovery and help seeking behavioral activities and a summary/conclusion module.

CONCLUSION

This review sheds light on the characteristics of the programs in LMICs. Two programs were found to be universal in nature. Five programs were directed at key risk factors or at-risk groups, and four were early intervention programs. The review also revealed that only one program out of the 11 programs included modules for parents. The synthesis indicated that all the identified programs were adapted or modified from existing programs. The dearth of comprehensive programs in LMICs was also revealed. Lastly, the review revealed seven modules that can be useful for developing a SBMHP.

Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: a Systematic Review

This investigation reviews the effectiveness of anti-stigma interventions employed at educational institutes; to improve knowledge, attitude and beliefs regarding mental health disorders among students. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guidelines were followed and protocol was registered in PROSPERO (CRD42018114535). Forty four randomized controlled trials were considered eligible after screening of 104 full-text articles against inclusion and exclusion criteria.Several interventions have been employed to tackle stigma toward psychiatric illnesses, including education through lectures and case scenarios, contact-based interventions, and role-plays as strategies to address stigma towards mental illnesses. A high proportion of trials noted that there was a significant improvement for stigma (19/25, 76%), attitude (8/11, 72%), helping-seeking (8/11, 72%), knowledge of mental health including recognition of depression (11/14, 78%), and social distance (4/7, 57%). These interventions also helped in reducing both public and self-stigma. Majority of the studies showed that the anti-stigma interventions were successful in improving mental health literacy, attitude and beliefs towards mental health illnesses.

Improving mental health literacy in adolescents: systematic review of supporting intervention studies

OBJECTIVE

Mental health literacy (MHL) in adolescents is an important issue as it can lead to early detection and recognition of mental illness. The aim of this systematic review was to explore the effect of supporting interventions on improving MHL in adolescents.

METHODS

Systematic literature review by searching the ScienceDirect, Scopus, PubMed, Crochrane and CINAHL databases. Seven of 1107 papers were included in the final review.

RESULTS

Supporting interventions for improving MHL in adolescents could be categorised into school-based and community-based. Both types used an education stand-alone strategy or an education plus contact-based group in their programmes. To provide knowledge of mental illness to adolescents, teaching methods should be interactive and use various media such as group discussion, videos and movies.

CONCLUSIONS

School-based and community-based interventions were likely to improve MHL among adolescents. However, further research with objective tool measures is needed to confirm the findings.

The Youth Aware of Mental Health Intervention: Impact on Help Seeking, Mental Health Knowledge, and Stigma in U.S. Adolescents

PURPOSE

Suicide is a leading cause of death among U.S. youth aged 12-18 years. Youth Aware of Mental Health (YAM), a promising, universal, school-based mental health promotion/suicide primary prevention intervention for adolescents, has been evaluated in Europe but not in the U.S. The present study used an uncontrolled, pretest/post-test design to document the potential for YAM to reduce suicidal ideation, attempt, and suicide. A demonstration that help seeking behaviors, mental health literacy, and mental health stigmatizing attitudes improve after the intervention would suggest that the program is promising in the U.S., as well as in Europe, and that further investigation is merited.

METHODS

YAM was delivered to 1,878 students in 11 schools as part of regular school curricula. A subset of these students (n = 436) completed surveys before and 3 months postdelivery. Surveys included five questions about help seeking behaviors, a measure of intent to seek help (General Help Seeking Questionnaire), two mental health literacy scales, and two mental illness stigma scales (Reported and Intended Behavior Scale and Personal Stigma and Social Distance Scale). Both McNemar's test and repeated measures linear models were used to determine whether the survey outcomes changed after YAM delivery.

RESULTS

Among the 436 adolescents (286 and 150 in Montana and Texas, respectively), significant increases were found pre- to post-intervention in three of five help seeking behaviors, along with improved mental health literacy and decreased mental health-related stigma. Intent to seek help was unchanged.

CONCLUSIONS

Several help seeking behavioral factors, mental health knowledge, and stigma improved post-YAM intervention. All three domains are likely protective against suicide. A randomized controlled trial testing the efficacy of YAM in preventing suicidal behaviors is warranted.

A quasi-cluster randomized controlled trial of a classroom-based mental health literacy educational intervention to promote knowledge and help-seeking/helping behavior in adolescents

INTRODUCTION

School-based education is a potentially effective approach for improving mental health literacy (MHL) in adolescents. This study evaluated the effects of the "Short MHL Program (SMHLP)", a brief (50 min), school teacher-led program, on MHL in adolescents in a quasi-cluster randomized controlled trial.

METHODS

A total of 975 high school first graders (age 15-16) in Japan were allocated to classes such that gender and academic achievement ratios were almost equivalent at the time of admission to the high school. They were assigned at the class level to the SMHLP (n = 364 from 10 classes) or a control group (n = 611 from 17 classes). The program consisted of a 50-minute session and was delivered by a school teacher. The students completed a self-report questionnaire at 3 time points: pre-, (immediately) post- and 2-month follow-up. Outcomes included "Knowledge about mental health/illnesses", "Recognition of the necessity to seek help", "Intention to seek help", and "Intention of helping peers". Mixed effects modeling was employed for analyses.

RESULTS

Scores of all outcomes were significantly improved in the intervention group compared to the control group post-intervention (p < .001). These improvements were maintained at 2-months follow-up for all outcomes (p < .001-.05). Questionnaire scores did not differ between groups at baseline.

CONCLUSIONS

The effect of the SMHLP was confirmed in grade 10 students. Brief, yet effective programs can be a viable option to promote understanding of mental health problems and have the potential to be incorporated into regular school curriculum. ".

Feasibility and Acceptability of the Youth Aware of Mental Health (YAM) Intervention in US Adolescents

Suicide is the second leading cause of death among US adolescents, and rates of suicide among youth have been increasing for the past decade. This study assessed the feasibility and acceptability of the universal, school-based Youth Aware of Mental Health (YAM) program, a promising mental health promotion and suicide primary prevention intervention, in US youth. Using an uncontrolled design, the feasibility and acceptability of delivering and studying YAM were assessed in Montana and Texas schools. Thirteen of 16 (81.3%) schools agreed to support YAM delivery, and five Montana and 6 Texas schools were included in analyses. Facilitators delivered YAM in 78 classes (1,878 students) as regular high school curriculum. Of the total number of students who received YAM, 519 (27.6%) provided parental consent and assent. 436 (84.0%) consented students participated in pre- and post-surveys. Students, parents, and school staff found YAM highly acceptable based on satisfaction surveys. In summary, this study found YAM feasible to implement in US schools. Results also suggest students, parents, and school staff supported school-based programs and were highly satisfied with the YAM program. A randomized controlled trial is warranted to test the efficacy of YAM in promoting mental health and preventing suicidal thoughts and behaviors in US adolescents.

Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors

BACKGROUND

Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent.  The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings.

METHOD

Data are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments.

RESULTS

Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization.  These students have low levels of externalizing risk behaviors making them difficult to detect.  The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance.  Many of these students have low English fluency, and identify as sexual minority.

LIMITATIONS

Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey.

CONCLUSION

Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.

Identifying the prerequisites, facilitators, and barriers in improving adolescents' mental health literacy interventions: A systematic review

The present study aimed at identifying the prerequisites, facilitators, and barriers to adolescent mental health literacy interventions. To that end, databases PsycINFO, Science Direct, Scopus, Emerald, PubMed, Web of Science, and Google Scholar were systematically searched, out of which 39 articles that had the inclusion criteria were analyzed by the content analysis. Databases searched from September 30, 2018, to October 10, 2018, with the keywords "health literacy," "mental health literacy," "mental disorders," adolescents, students, and more. Seven themes were identified as the prerequisites for interventions to improve adolescents' mental health literacy including education at the school level, parents' education, training of trainers and providers, cooperation and participation among providers, intervention assessment and monitoring, provision of educational content, consideration of the cultural and linguistic issues. Five themes were identified as facilitators: using interactive learning and teaching methods, supplying diverse and stimulating educational content, employing trainers with different backgrounds, having direct contact with people with mental illness, and utilizing technological advancements in education. Finally, short-time intervention, the collaboration between school administrators and researchers, lack of valid information sources were identified as barriers.

Teacher Mental Health Literacy is Associated with Student Literacy in the Adolescent Depression Awareness Program

The Adolescent Depression Awareness Program, developed by psychiatrists and psychiatric nurses at the Johns Hopkins University School of Medicine, is a depression literacy program delivered to high school students by teachers. This mode of delivery represents an effective and sustainable way to increase awareness of mental health, reduce stigma, improve early detection, and facilitate help-seeking behavior among adolescents. The present study explores the depression literacy and stigma of teachers and their students. Survey responses of 66 teachers and 6679 high school students about depression literacy and stigma pre- and post-education intervention were analyzed using a multilevel model fit in Mplus. Teacher depression literacy was significantly associated with student depression literacy [β = 0.199, SE = 0.095, p = 0.035, 95% CI (0.044, 0.355)] at the post-assessment, but was not associated with student stigma. Teacher stigma was not significantly related to student depression literacy or stigma in the post-assessment. These findings highlight the importance of optimizing teacher depression literacy in order to maximize student depression literacy while also diminishing concerns about the transmission of stigmatized beliefs from teachers to students.

Gender Differences in Depression Literacy and Stigma After a Randomized Controlled Evaluation of a Universal Depression Education Program

PURPOSE

Depression is a debilitating illness with frequent onset during adolescence. Depression affects women more often than men; men are more likely to complete suicide and less likely to seek treatment. The Adolescent Depression Awareness Program (ADAP) is a school-based depression intervention that educates adolescents about depression symptoms and addresses accompanying stigma. The study aims examined gender differences in the ADAP's impact on depression literacy and stigma.

METHODS

Data came from a randomized trial (2012-2015). Six thousand six hundred seventy-nine students from 54 schools in several states were matched into pairs and randomized to the intervention or wait-list control. Teachers delivered the ADAP as part of the health curriculum. Depression literacy and stigma outcomes were measured before intervention, 6 weeks later, and at 4 months. Multilevel models evaluated whether gender moderated the effect of ADAP on depression literacy and stigma.

RESULTS

At 4 months, there was a main effect of the ADAP on depression literacy (odds ratio [OR] = 3.3, p = .001) with intervention students achieving depression literacy at higher rates than controls. Gender exhibited a main effect, with women showing greater rates of depression literacy than men (OR = 1.51, p = .001). There was no significant intervention × gender interaction. The ADAP did not exhibit a significant main effect on stigma. There was a main effect for gender, with women demonstrating less stigma than men (OR = .65, p = .001). There was no significant interaction between the intervention and gender on stigma.

CONCLUSIONS

The ADAP demonstrates effectiveness for increasing rates of depression literacy among high school students. In this study, gender was not associated with ADAP's effectiveness.

Teaching mental health first aid in the school setting: a novel approach to improving outcomes for common adolescent mental disorders

PURPOSE OF REVIEW

Common adolescent mental disorders, such as depression, often go untreated and severely impact health and educational outcomes. The purpose of this review is to describe what is currently known about school-based mental health interventions and to describe a new intervention, Mental Health First Aid training.

RECENT FINDINGS

Universal and selective prevention and treatment programmes have been widely evaluated, though population-level dissemination remains elusive. A novel approach is to train adolescents in how to recognise early signs of mental disorder onset, decrease stigmatising beliefs and barriers to help-seeking, and to use appropriate first aid strategies for assisting peers in mental health crisis, such as those with depression and suicidal ideation.

SUMMARY

Teaching adolescents the skills necessary to recognise and respond to mental health problems and mental health crises may provide life-long skills that prompt lower stigmatising beliefs, greater support of peers and appropriate, timely help-seeking.