Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents

Characteristics of mental health literacy measurement in youth: a scoping review of school-based surveys

Mental health literacy (MHL) was introduced 25 years ago as knowledge and beliefs about mental disorders which aid in their recognition, management, or prevention. This scoping review mapped the peer-reviewed literature to assess characteristics of secondary school-based surveys in school-attending youth and explore components of school-based programs for fostering MHL in this population. The search was performed following the method for scoping reviews by the Joanna Briggs Institute (JBI). Searches were conducted in four scientific databases with no time limit, although all sources had to be written in English. Primary studies (N = 44) provided insight into MHL surveys and programs for school-attending youth across 6 continents. Studies reported that most youth experience moderate or low MHL prior to program participation. School-based MHL programs are relatively unified in their definition and measures of MHL, using closed-ended scales, vignettes, or a combination of the two to measure youth MHL. However, before developing additional interventions, steps should be taken to address areas of weakness in current programming, such as the lack of a standardized tool for assessing MHL levels. Future research could assess the feasibility of developing and implementing a standard measurement protocol, with educator perspectives on integrating MHL efforts into the classroom. Identifying the base levels of MHL amongst school-attending youth promotes the development of targeted programs and reviewing the alignment with program components would allow researchers to build on what works, alter what does not, and come away with new ways to approach these complex challenges, ultimately advancing knowledge of MHL and improving levels of MHL.

New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey

In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.

Public perception of psychiatry, psychology and mental health professionals: a 15-year analysis

Background

X (previously known as "Twitter") serves as a platform for open discussions on mental health, providing an avenue for scrutinizing public perspectives regarding psychiatry, psychology and their associated professionals.

Objective

To analyze the conversations happening on X about psychiatrists, psychologists, and their respective disciplines to understand how the public perception of these professionals and specialties has evolved over the last 15 years.

Methods

We collected and analyzed all tweets posted in English or Spanish between 2007 and 2023 referring to psychiatry, psychology, neurology, mental health, psychiatrist, psychologist, or neurologist using advance topic modelling and sentiment analysis.

Results

A total of 403,767 tweets were analyzed, 155,217 (38%) were in English and 248,550 (62%) in Spanish. Tweets about mental health and mental health professionals and disciplines showed a consistent volume between 2011 and 2016, followed by a gradual increase from 2016 through 2022. The proportion of tweets discussing mental health doubled from 2016 to 2022, increasing from 20% to 67% in Spanish and from 15% to 45% in English. Several differences were observed on the volume of tweets overtime depending on the language they were written. Users associated each term with varied topics, such as seeking for help and recommendation for therapy, self-help resources, medication and side effects, suicide prevention, mental health in times of crisis, among others. The number of tweets mentioning these topics increased by 5-10% from 2016 to 2022, indicating a growing interest among the population. Emotional analysis showed most of the topics were associated with fear and anger.

Conclusion

The increasing trend in discussions about mental health and the related professionals and disciplines over time may signify an elevated collective awareness of mental health. Gaining insights into the topics around these matters and user's corresponding emotions towards them presents an opportunity to combat the stigma surrounding mental health more effectively.

Mental health literacy for social phobia in Ghana: Investigation of gender stereotypes and previous experience for recognition rates and prejudice

BACKGROUND

Mental health literacy (MHL) research has been of substantial interest internationally. Nevertheless, the interplay between beliefs, attitudes, previous experience with mental disorders, and knowledge of Ghanaians on specific mental disorders remains to be understood. The present study explored the interconnectedness between gender stereotypes, prejudice, previous experience with social phobia, and MHL among the general population in Ghana.

METHOD

Six hundred and one Ghanaians were recruited for an online experimental study design using a survey approach for data gathering. Respondents were randomly assigned to one of the two conditions (i.e., male and female vignettes) depicting symptoms of social phobia for a hypothetical person. Participants further completed self-reported measures including gender stereotypes (based on Ambivalent Sexism Inventory) and prejudice.

RESULTS

Results revealed a 15.5% recognition rate for social phobia. Recognition rates of social phobia did not differ by the experimental condition or by the gender of participants. However, personal experience of social phobia was positively related to an increased likelihood of correctly labeling social phobia among men in the female vignette condition, whereas correct recognition of social phobia was negatively related to prejudice among women in the male vignette condition. In the male vignette condition, men with more hostile sexism attitudes toward men exhibited more prejudice toward their hypothetical male counterpart. In contrast, women with hostile sexism attitudes toward men exhibited less prejudice, but greater benevolent sexism attitudes toward men was associated with more prejudice toward the hypothetical male in the vignette.

CONCLUSION

Findings from the current study emphasize the role of the cultural milieu in shaping effective mental health interventions. The results also have implications for promoting MHL to reduce prejudice in Ghana and other developing countries in the region.

Pathways to professional mental care in the Swiss young adult community: a case-control study

Treatment success for mental health (MH) problems depends, among others, on the timeliness of help-seeking. Therefore, we studied the effect of symptoms and reasons for help-seeking on the point-of-contact and the most intensive professional treatment in a community sample. Participants were recruited as part of the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community persons of the Swiss canton Bern. Of the 2,683 participants, 615 (22.9%) reported at least one instance of help-seeking for MH problems and were selected for the presented analyses. Help-seeking behavior was assessed by a modified version of the 'WHO pathway-to-care questionnaire', from which the outcome 'most intensive MH professional contact' was generated. The effect of symptoms and reasons for help-seeking were analyzed in separate models using path analyses. Most help-seeking persons sought MH professional help (n = 405; 65.9%) with a high number of medical pre-contacts (n = 233; 37.9%). The 'most intensive MH professional contact' was provided after an average of 1.47 contacts. Both models showed negative associations between non-MH professional pre-contacts and the most intensive, likely most adequate MH treatment. In the symptom model, 'substance misuse' and 'central-vegetative problems' increased the general likelihood of MH professional contact. Our findings highlight the importance of the first point-of-contact in pathways to adequate MH care and, when seeking help from non-MH professional, of quick referrals to MH professionals. Awareness campaigns or training of health professionals, such as general practitioners, may support timely contact with MH professionals to improve diagnosis, prognosis, and outcome.

A survey of mental health literacy in parents and guardians of teenagers

Introduction

Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers.

Methods

Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors).

Results

The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively.

Conclusions

Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.

Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives

The worldwide prevalence of anxiety disorders among college students is high, which negatively affects countries, schools, families, and individual students to varying degrees. This paper reviews the relevant literature regarding risk factors and digital interventions for anxiety disorders among college students from the perspectives of different stakeholders. Risk factors at the national and societal levels include class differences and the coronavirus disease 2019 pandemic. College-level risk factors include the indoor environment design of the college environment, peer relationships, student satisfaction with college culture, and school functional levels. Family-level risk factors include parenting style, family relationship, and parental level of education. Individual-level risk factors include biological factors, lifestyle, and personality. Among the intervention options for college students' anxiety disorders, in addition to traditional cognitive behavioral therapy, mindfulness-based interventions, psychological counseling, and group counseling, digital mental health interventions are increasingly popular due to their low cost, positive effect, and convenient diagnostics and treatment. To better apply digital intervention to the prevention and treatment of college students' anxiety, this paper suggests that the different stakeholders form a synergy among themselves. The nation and society should provide necessary policy guarantees, financial support, and moral and ethical supervision for the prevention and treatment of college students' anxiety disorders. Colleges should actively participate in the screening and intervention of college students' anxiety disorders. Families should increase their awareness of college students' anxiety disorders and take the initiative to study and understand various digital intervention methods. College students with anxiety disorders should actively seek psychological assistance and actively accept and participate in digital intervention projects and services. We believe that in the future, the application of methods such as big data and artificial intelligence to improve digital interventions and provide individualized treatment plans will become the primary means of preventing and treating anxiety disorders among college students.

Informative value of referral letters from general practice for child and adolescent mental healthcare

Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.

Employees' support strategies for mental wellbeing during and beyond the COVID-19 pandemic: Recommendations for employers in the UK workforce

Throughout the COVID-19 pandemic, and beyond for many businesses, employees have had to adapt to new ways of working due to disruptions in traditional practices. It is therefore crucial to understand the new challenges that employees are facing when it comes to taking care of their mental wellbeing at work. To that end, we distributed a survey to full-time UK employees (N = 451) to explore how supported they felt throughout the pandemic, and to identify whether there are any additional types of support they would like to receive. We also compared employees' intentions to seek help before versus during the COVID-19 pandemic, and assessed their current attitudes toward mental health. Based on direct employee feedback, our results show remote workers felt more supported throughout the pandemic compared to hybrid workers. We also found that employees who had previously experienced an episode of anxiety or depression were significantly more likely to want extra support at work compared to those who had not. Furthermore, employees were significantly more likely to seek help for their mental health during the pandemic compared to before. Interestingly, the largest increase in intentions to seek help during the pandemic compared to before was with digital health solutions. Finally, we found that the strategies managers have adopted to better support their employees, an employee's mental health history, and their attitude to mental health all contributed to significantly increasing the likelihood that an employee would disclose a mental health concern to their line manager. We provide recommendations that encourage organisations to make changes to better support their employees, and we highlight the importance of mental health awareness training for both managers and employees. This work is of particular interest to organisations who are looking to tailor their current employee wellbeing offer to a post-pandemic world.

Assessing the Utility of Mental Health First Aid Training for Physician Assistant Students

INTRODUCTION

Physician assistant (PA) students are at increased risk for anxiety and depression compared with the general population. The demands of studying medicine can contribute to a decline in mental health, which may impede a student's ability to progress in his or her PA program. Mental Health First Aid (MHFA) is one strategy that can be used to increase mental health literacy, promote help-seeking behavior, reduce stigma, and improve confidence in providing help to individuals showing signs of a mental health disorder. The aim of this outcomes assessment was to assess PA students' satisfaction with the MHFA course and their posttraining confidence in using the skills learned.

METHODS

Participants were PA students (N = 435) across 9 PA programs in their didactic year of training who had completed an MHFA course through the PA Foundation's Mental Health Outreach Fellowship. MHFA postcourse evaluations, completed by the PA students, were analyzed to determine PA students' satisfaction with the course and their posttraining confidence in using the skills learned to help both themselves as well as the general population.

RESULTS

The mean of the MHFA course evaluation items corresponding to satisfaction with the course was 4.82 (maximum score of 5), and the mean of the items corresponding to posttraining confidence in using the skills learned was 4.74 (maximum score of 5). When asked, "Would you recommend this course to others?" 99.3% of the PA students trained in MHFA answered "yes," indicating a high level of satisfaction with the training they had received.

DISCUSSION

PA students who received MHFA training from the PA Foundation's Mental Health Outreach fellows showed high levels of satisfaction with the MHFA course and posttraining confidence in using the skills learned.

Public perception of social workers as a source for providing help during the COVID-19 pandemic

Summary

The current study examined the contribution of select demographic and psychosocial variables, as well as prior experience with social workers (SWs), to explaining the likelihood of seeking their help by the general public in Israel during the COVID-19 pandemic. For the purpose of the study, an online questionnaire was administered to a sample of 582 respondents older than 20.

Findings

The findings show that the respondents reported a fairly low likelihood of seeking help from SWs. Women, those not in a significant relationship, people who had prior experience with SWs, and those reporting higher levels of loneliness, had a higher likelihood of seeking help from SWs. At the same time, no association was found between age, employment status, depression, and anxiety, and the likelihood of seeking help from SWs.

Applications

When dealing with the mental, health, and social consequences of the COVID-19 crisis, it is important to identify groups with a lower likelihood of seeking help from SWs and to actively offer them help. Furthermore, it is important to develop a policy aimed at promoting knowledge of SW roles and reducing barriers to seeking SW help, while attending to the unique needs of diverse population groups.

A prospective observational study exploring the association of comorbid chronic health conditions with total healthcare expenditure in people with mental health conditions in an Asian setting

BACKGROUND

It is pertinent to focus on chronic medical condition (CMC) comorbidity with mental health conditions (MHC) as their co-occurrence has significant cost and health implications. However, current evidence on co-occurrence of MHC with CMC is mixed and mostly from Western settings. Therefore, our study aimed to (i) describe the association between MHC and total healthcare expenditure, (ii) examine the association between CMC and total healthcare expenditure and (iii) examine determinants of total and different types of healthcare expenditure in respondents with and without MHC in an Asian setting.

METHODS

The data from Singapore Mental Health Study (SMHS) 2016, a nationwide epidemiological survey, were linked with the National claims record (from 2017 to 2019). Multivariable Generalized Linear Models (GLM) were used to examine the association between MHC and total and different types of healthcare expenditure.

RESULTS

A total of 3077 survey respondents were included in current analysis. Respondents with MHC had a lower mean age of 38.6 years as compared to those without MHC (47.1 years). MHC was associated with increased total healthcare expenditure after adjusting for covariates (b = 0.508, p < 0.05). In respondents with MHC, presence of CMC increased the total healthcare expenditure by 35% as compared to 40% increase in those without MHC. Interestingly, 35-49 years age group with MHC had almost 3 times higher total healthcare expenditure and 7.5 times higher inpatient expenditure as compared to the 18-34 years age group.

CONCLUSION

Our study highlights variations in association of CMC and age with total healthcare expenditure in those with versus without MHC in an Asian setting. Practical recommendations include appropriate planning and resource allocation for early diagnosis and management of MHC, proactive screening for CMC in those with MHC and addressing the dual issues of treatment gap and stigma to facilitate early help seeking and prevent episodic, costly healthcare utilization.

Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review

INTRODUCTION

Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents.

METHODS

PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies.

RESULTS

Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others.

CONCLUSIONS

A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.

Feasibility of a serious game coupled with a contact-based session led by lived experience workers for depression prevention in high-school students

BACKGROUND

Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained.

METHODS

Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed.

RESULTS

Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers' stories and shared their own experiences with depression.

CONCLUSIONS

Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms.

TRIAL REGISTRATION

The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).

Views on Adolescents' Mental Health in Sweden-A Qualitative Study among Different Professionals Working with Adolescents

Professionals who meet and work with adolescents hold important information and perspectives on adolescents' mental health that, in addition to the adolescents' voices, can shed light on complex issues. The aim was to explore professionals' views on what challenges they face and how they can strengthen today's adolescents' mental health. This study involves four group interviews, conducted in March and October of 2020, including professionals with different working backgrounds. Data were analyzed with a qualitative content analysis. Two categories emerged: navigating life arenas and support for mental health. The first category included the demanding aspects of school, the challenges of social media, and the professionals' thoughts on which pieces of mental health knowledge adolescents are lacking. The second category included what the professionals thought today's parents need to develop and do to best support their children. Moreover, self-critical views were expressed on which aspects the professionals could do better to improve adolescents' mental health. In conclusion, listening to professionals working with adolescents talk about adolescents' mental health gives important insights. According to the professionals, both adolescents and their parents need improved life skills, including a strengthened and empowered self-esteem as well as improved mental health literacy.

Knowledge, attitude and behaviours toward mental illness and help-seeking in a large nonclinical Tunisian student sample

BACKGROUND

Mental disorders are widespread among students. However, mental health help-seeking remains low. Several reviews and meta-analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help-seeking intentions and comfort with disclosing a mental illness.

METHOD

The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9).

RESULTS

We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help-seeking intentions (p < .001) and knowledge of mental illness (p = .019). Students' age negatively correlated with knowledge (p < .001, r = -.147). Pearson correlations indicated that help-seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p < .001, r = .103) and greater mental health knowledge (p < .001, r = .163); and that comfort with disclosing significantly and negatively correlated with attitudes (p < .001, r = -.125).

CONCLUSION

To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group.

Child mental health literacy training programmes for professionals in contact with children: A systematic review

AIMS

There has been a surge in child mental health literacy training programmes for non-mental health professionals. No previous review has examined the effectiveness of child mental literacy training on all professionals in contact with children.

METHODS

Studies were identified through a systematic literature search of the Cochrane, EMBASE, Medline, and PsycINFO databases in February 2019. The review included studies that delivered training to professionals who have regular contact with young people aged 0 to 19 in the context of their role and at least one component of mental health literacy; (a) knowledge, (b) attitudes, (c) confidence in helping, (d) intention to help and (e) actual helping behaviour. The quality of papers was reviewed using the Cochrane revised Risk of Bias Tool for randomized controlled trials (RCTs) and the Integrated Quality Criteria for the Review of Multiple Study Designs for non RCTs.

RESULTS

Twenty-one studies met eligibility criteria (n = 3243). There was some evidence that global and specific child mental health literacy training improved professionals' knowledge and stigma-related attitudes towards mental health. Few studies investigated the impact of training on actual helping behaviour.

CONCLUSION

There may be value in providing child mental health literacy training to professionals in contact with children, however there is a need for studies to evaluate the long-term impact of such training, particularly on subsequent access to appropriate support. Findings raise concerns about the quality of the studies reported in the systematic review and recommendations are made for future studies.

Help-Seeking Preferences to Informal and Formal Source of Care for Depression: A Community-Based Study in Northwest Ethiopia

BACKGROUND

Globally, 350 million people are suffering from depression. Many people suffering from depression use different sources of help for their problems. People with different mental health problems seek help from formal and/or informal sources. This gives crucial information on community beliefs and perception regarding their preference for help. This study helps to guide effective planning and provision of mental health services, and health policy of the country to explore the community's preference to different sources of help.

OBJECTIVE

The aim was to contrast patterns of formal and informal help-seeking preferences for depression among residents of Aykel town, Northwest Ethiopia.

METHODS

This cross-sectional population-based study included 832 participants. We used a major depressive disorder case vignette and general help-seeking questionnaire (GHSQ) to assess preference to seek help. Study participants were selected by multistage cluster sampling technique. An independent sample t-test and analysis of variance test (ANOVA) was performed.

RESULTS

A total of 656 subjects (78.8%) showed high propensity to intimate partner, and 655 (78.7%) of the study subjects had high propensity to mental health professional. The mean score of the residents' preference to seek help from informal sources was 3.41±0.60. The mean score of preference to seek help from formal sources was 3.18±0.75. A total of 276 (33.2%) subjects showed high propensity to both informal and formal sources of help. The results also showed there was a mean score difference in preference for informal help between subjects with strong social support and low and moderate social support (P<0.001).

CONCLUSION

The result suggests that the majority of the residents had a higher preference to seek help from informal sources than formal sources of care. Providing and strengthening both formal and informal sources of help in conjunction are crucial to get a more qualified and effective care for depressed patients.

Long-term effects of Youth Mental Health First Aid training: randomized controlled trial with 3-year follow-up

BACKGROUND

Mental Health First Aid (MHFA) training teaches community members how to provide initial support to someone with a mental health problem. Key gaps in the evidence base supporting the training are the longevity of effects beyond 6 months, effects on mental health first aid behavior, and the impact of support on the recipient of aid. This study aimed to evaluate the effect of the Youth MHFA course 3 years after training.

METHODS

384 Australian parents of an adolescent aged 12-15 were randomized to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. This paper reports outcomes at baseline and 3 years later. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about youth mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems. Data were analyzed with mixed-effects models with group by measurement occasion interactions.

RESULTS

3-year follow-up data was obtained from 149 parents and 118 adolescents, who were aged 16.5 years on average. Between baseline and 3-year follow-up, there was a non-significant reduction in adolescent cases of mental health problems relative to the control group (odds ratios (OR) 0.16-0.17), a non-significant improvement in parental support reported by adolescents with a mental health problem (OR 2.80-4.31), and a non-significant improvement in the quality of support that parents reported providing to their adolescents with a mental health problem (d = 0.38). Secondary outcomes that showed significant improvements relative to the control group were parental knowledge about youth mental health problems (d = 0.31) and adolescent perceptions of general social support from their parents (d = 0.35).

CONCLUSIONS

This paper reports on the longest follow-up of Mental Health First Aid training in a controlled trial. Three years after training, participants had maintained their improved knowledge about mental health problems. There were some indications of other positive effects, but the study was underpowered to clearly show benefits to mental health first aid skills and recipients of aid.

TRIAL REGISTRATION

ACTRN 12612000390886 , registered retrospectively 5/4/2012, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347502.

Barriers to mental health care for Australian children and adolescents in 1998 and 2013-2014

OBJECTIVE

To assess changes in barriers to mental health care for children and adolescents over 16 years.

METHODS

We used data from two nationally representative surveys of Australian children and adolescents (4-17 years old), conducted in 1998 (N = 4509) and 2013-2014 (N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013-2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped.

RESULTS

Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013-2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013-2014. Top three parent-endorsed barriers ('self-reliance', 'unsure where to get help', and 'cost') were the same at both time points; 'self-reliance' decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers ('self-reliance' and 'concerned what others might think') were the same at both time points, the third differed, but none of them decreased.

CONCLUSION

Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013-2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.

A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service

Background

Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking.

Objective

The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables.

Methods

Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study.

Results

Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables.

Conclusions

MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.

Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore

OBJECTIVES

A considerable proportion of those who suffer from mental illnesses in Singapore do not seek any form of professional help. The reluctance to seek professional help could be due to misconceptions about the causes of mental illnesses. Research has shown that help-seeking attitudes can predict actual service use. As young adults are most at risk of developing mental illnesses, this study aims to elucidate the impact of causal beliefs about mental illness on help-seeking attitudes among university students in Singapore.

DESIGN

Prior to attending an anti-stigma intervention, data on the Causal Beliefs about Mental Illness, Inventory of Attitudes towards Seeking Mental Health services and questions pertaining to sociodemographic background were collected from participants using a self-administered questionnaire. Multiple linear regressions were performed to examine the relationship between causal beliefs and help-seeking, as well as their sociodemographic correlates.

SETTINGS

A university in Singapore.

PARTICIPANTS

390 students who were studying in a University in Singapore.

RESULTS

Younger age was associated with higher scores on psychosocial attribution, while prior social contact with individuals with mental illness was significantly associated with lower scores on personality attribution. With regard to help-seeking attitudes; being a male and personality attribution were significantly associated with lower scores on 'Psychological Openness' and 'Indifference to Stigma', while psychosocial attribution was significantly associated with higher scores on 'Help-seeking Propensity'. Having prior social contact also predicted higher 'Psychological Openness', while being in Year 2 and 3 predicted lower scores on 'Indifference to Stigma'.

CONCLUSION

Findings from this study suggest that help-seeking attitudes might be influenced by causal beliefs, with personality attribution being the most impairing. Hence, to reduce the wide treatment gap in Singapore, anti-stigma interventions targeting young people could focus on addressing beliefs that attribute mental illness to the personality of the individual.

Exploring perceived costs and benefits of first aid for youth with depression: a qualitative study of Japanese undergraduates

BACKGROUND

Early interventions for depression among youth are greatly needed. Although Youth Mental Health First Aid (YMHFA) program has been developed to teach the public how to help young people with mental disorders, including depression, it has assumed human altruism and overlooked the possibility that participants would experience conflict between the costs and benefits of helping behaviors. The present qualitative study, therefore, initially explored content of the costs and benefits perceived by youth in terms of helping their peers with depression.

METHODS

A total of 56 Japanese undergraduates (32 female, 24 male; M age  = 20.20, SD = 1.09) participated in the face-to-face survey. They were provided with basic knowledge about helping behaviors and were presented with a vignette describing an undergraduate with depression. Then, they left free descriptive comments on their views of the costs/benefits of helping/not helping the person in the vignette. As supplemental quantitative analyses, we statistically compared numbers of labels (n = 624), which were obtained from participants' comments, across two (costs/benefits) × two (helping/not helping) domains. Finally, we conducted a qualitative content analysis that combined inductive and deductive methods to categorize these labels.

RESULTS

The supplemental quantitative analyses (i.e., ANOVA and post hoc analyses) on the numbers of labels highlighted that the participants perceived suppressors (i.e., costs of helping, benefits of not helping) as well as motivators (i.e., costs of not helping) in making decision to help peers with depression. The qualitative content analysis mainly showed that: (i) the categories in each domain covered multiple facets of costs and benefits, including negative/positive effects on the participants themselves, the person in the vignette, and interpersonal relationships; and that (ii) the participants perceived the conflicts of costs and benefits regardless of whether they help their peers with depression.

CONCLUSIONS

These results provide evidence for how young people experience the conflicts between the costs and benefits of helping behaviors toward their peers with depression and reveal specific content of these costs and benefits. These findings could serve as a basis for extending YMHFA programs and designing educational content to promote public helping behaviors in realistic situations.

A Systematic Review of Parent and Caregiver Mental Health Literacy

This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.

Twelve-month outcomes of MAKINGtheLINK: A cluster randomized controlled trial of a school-based program to facilitate help-seeking for substance use and mental health problems

BACKGROUND

Young people experiencing mental health problems are often reluctant to seek help, particularly from professionals (i.e., doctors or mental health workers). MAKINGtheLINK is a school-based intervention that aims to help adolescents overcome barriers to seeking professional help for mental health and substance use problems.

METHODS

A cluster randomised controlled trial was conducted to evaluate the 12-month outcomes of MAKINGtheLINK among 2447 participants (Mean age=14.9 years, SD=0.5 years, 50% male). Randomisation resulted in 1130 students from 11 schools allocated to receive the intervention, and 1317 students from 10 schools allocated to the wait-list control group. After the baseline assessment, follow-ups were conducted at 6-weeks (n = 2045), 6-months (n = 1874), and 12-months (n = 1827). The primary outcome measure was help-seeking behaviour, from both formal (e.g., health professionals) and informal (e.g., friends, family members) sources. The trial was registered with the Australia and New Zealand Clinical Trials Register (ANZCTR) on the 27th of February 2013 (registration number ACTRN12613000235707).

FINDINGS

The intervention was not associated with overall help-seeking at the 12-month follow-up (p = 0.99, odds ratio [OR]=1.00, 95% CI for OR = 0.70-1.42), or help-seeking for depression (p = 0.28, OR = 1.21, 95%CI =0.86-1.69), stress and anxiety (p = 0.73, OR = 1.04, 95%CI = 0.74-1.47), or alcohol/other drugs (p = 0.84, OR=1.12, CI=0.37-3.37). However, the intervention was associated with increased help-seeking from formal sources (compared to informal sources) both overall (p = 0.005, OR = 1.81, 95%CI = 1.19-2.75), as well as for depression (p = 0.01, OR=2.09, 95%CI=1.19-3.67), and stress and anxiety (p < 0.006, OR = 1.72, 95%CI = 1.17-2.54).

INTERPRETATION

Rates of help-seeking remained unchanged following the intervention. However, MAKINGtheLINK effectively improved the quality of adolescent help-seeking behaviour by increasing help-seeking from formal sources. As prompt treatment is essential in reducing the long-term impact of early onset mental health problems, MAKINGtheLINK has the potential to make a significant contribution to existing early intervention and prevention efforts.

FUNDING

National Health and Medical Research Council (APP1047492).

A Randomized Controlled Trial Evaluating the Effectiveness of Face-to-Face and Digital Training in Improving Child Mental Health Literacy Rates in Frontline Pediatric Hospital Staff

Background: Children with chronic physical health conditions are up to six times more likely to develop a mental health condition than their physically well peers. Frontline pediatric hospital staff are in a good position to identify mental health problems and facilitate appropriate support for patients. To date, no evaluation of mental health literacy training has taken place with this professional group to enable early identification of difficulties. It is also not known whether face-to-face or digital training is more effective or preferable in this setting. To improve the skills of frontline hospital staff, a face-to-face and digital mental health literacy training course was delivered using MindEd content and evaluated in a randomized controlled trial. Method: Two-hundred and three frontline staff across different professions from a tertiary pediatric hospital were randomized to a face-to-face (n = 64), digital (n = 71), or waitlist control group (n = 68). Face-to-face training was two and a half hours and digital training took ~1 h. The effects of training were evaluated pre- and post-training and at two-week follow-up. Questionnaires assessed mental health knowledge, stigma, confidence in recognizing concerns and knowing what to do, actual helping behavior, as well as training delivery preference, completion rate, and satisfaction. Results: Both face-to-face and digital training increased mental health knowledge, confidence in recognizing mental health problems and knowing what to do compared to waitlist controls. Digital training increased actual helping behavior relative to the waitlist controls and stigma decreased across all groups. Staff were satisfied with both delivery methods but preferred face-to-face training. Conclusions: The results provide promising findings that digital content is an effective way of improving mental health literacy in frontline pediatric hospital staff. Providing digital training could be a time-efficient way of upskilling non-mental health professionals to identify mental health needs in a pediatric population and facilitate access to appropriate care.

Effect of a School-Based Anxiety Prevention Program among Primary School Children

Anxiety is one of the most common mental health disorders in childhood, and children with anxiety have an increased risk of psychiatric disorders during adulthood. This study aimed to evaluate the effectiveness of a school-based anxiety prevention program for reducing anxiety among primary school students relative to a school-as-usual control group. Secondary to this, the current study aimed to examine the effect of a school-based prevention program on worry coping skills and self-esteem. A two-group parallel cluster randomized controlled trial of a single-blinded study was conducted to evaluate the effectiveness of the program, with schools as the unit of allocation and individual participants as the unit of analysis. The intervention program was conducted between May 2016 and December 2017. The primary outcome was anxiety, whereas the secondary outcomes were worry coping skills and self-esteem measured at three months post-intervention. Data were analyzed by using a generalized linear mixed model, accounting for the clustering effect. Subgroup analyses were performed for children with anxiety. A total of 461 students participated in this study. At baseline, there was no significant difference between groups for anxiety score, worry coping skills score, and self-esteem score (p > 0.05). The intervention was effective in reducing anxiety for the whole sample (p = 0.001) and the anxiety subgroup (p = 0.001). However, it was not effective in improving worry coping skills and self-esteem. These findings suggest that the program could be effective for reducing symptoms of anxiety when delivered in schools and provide some support for delivering this type of program in primary school settings.

An evaluation of the teen and Youth Mental Health First Aid training with a CALD focus: an uncontrolled pilot study with adolescents and adults in Australia

BACKGROUND

Australia is an ethnically diverse nation with one of the largest refugee resettlement programs worldwide. Evidence suggests that although the risk of developing mental disorders in culturally linguistically diverse (CALD) adolescents may be elevated, professional help-seeking in CALD youth is low. This study sought to evaluate the face-to-face teen (tMHFA) and Youth Mental Health First Aid (YMHFA) training with a CALD focus, which aimed at improving mental health literacy (MHL) and skills in youth and adults assisting adolescents with mental health problems.

METHODS

An uncontrolled pre-, post-, and follow-up design was used to measure improvement in MHL measures in year 10 students and adults.

RESULTS

A total of 372 year 10 students from 2 high schools were trained. 308 responded to the pre-training questionnaire, 220 responded to the post-training questionnaire, and 256 completed the 3-month follow-up questionnaire. A total of 34 adults were trained, 32 responded to the pre-questionnaire and 31 responded to the post-training questionnaire and 20 completed the 3-month follow-up questionnaire. Following training, students were more likely to endorse 'helpful' adults as valid sources of help (p < 0.001) and these gains were maintained at follow-up (p < 0.01). Significantly higher levels of concordant (helpful) helping intentions were found after training (p < 0.01), and this was maintained at follow-up (p < 0.05). Significant lower levels of discordant (harmful) helping intentions were found after training (p < 0.001), and this was maintained at follow-up (p < 0.01). A significant improvement in adults' knowledge of youth mental health problems and Youth Mental Health First Aid was noted from pre- to post-training (p < 0.01) and was maintained at follow-up (p < 0.01). Confidence when helping a young person with mental health problems increased significantly after training (p < 0.001) and this was maintained at follow-up (p < 0.05).

CONCLUSION

Our findings indicated the training led to an improvement in a number of measures of MHL and helpful intentions of both the adolescents and adults evaluated. These results indicate that CALD tMHFA and YMHFA are a recommended way of upskilling those trained and thereby leading to the improvement youth mental health in areas with high proportion of ethnically diverse groups.

Potential of social media in promoting mental health in adolescents

The growing prevalence of adolescent mental disorders poses significant challenges for education and healthcare systems globally. Providers are therefore keen to identify effective ways of promoting positive mental health. This aim of this qualitative study was to explore perceptions that social media might be leveraged for the purposes of mental health promotion amongst adolescents aged between 11 and 18 years. Utilizing focus groups conducted with adolescents (N = 54), educational professionals (N = 16) and mental health practitioners (N = 8). We explored their views about the value of social media for this purpose. Three themes were identified. First, social media appears to have potential to promote positive mental health. Second, adolescents frequently utilize social media and the internet to seek information about mental health. Finally, there are benefits and challenges to using social media in this way. We conclude that despite challenges of using social media and the risks, social media does offer a useful way of educating and reaching adolescents to promote mental wellbeing.

Perceived need and barriers to adolescent mental health care: agreement between adolescents and their parents

AIMS

Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care.

METHODS

A nationally representative sample of Australian adolescents aged 13-17 and their parents (N = 2310), recruited between 2013-2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement.

RESULTS

Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = -0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19-3.04) to RRR = 4.69 (95% CI = 2.38-9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46-5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30-0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = -0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)).

CONCLUSIONS

There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.

Barriers to Mental Health Help-Seeking Amongst Refugee Men

Rates of help-seeking for mental health problems are low amongst refugee communities, despite the high prevalence of PTSD reported amongst these individuals. Research suggests that the key barriers to seeking help for psychological problems include structural barriers (e.g., unstable housing), cultural barriers (e.g., mental health stigma), and barriers specific to refugees and asylum seekers (e.g., visa status). This study examined the effect of structural, cultural and refugee specific barriers on the relationship between PTSD symptom severity and intentions to seek help from professional, social, and community sources. Data was collected from 103 male refugees and asylum seekers with an Arabic-, Farsi-, or Tamil-speaking background. Participants completed measures indexing demographics, trauma exposure, PTSD symptoms, mental health stigma, and help-seeking intentions. Path analyses indicated that PTSD severity was associated with lower help-seeking intentions indirectly via mental health stigma (self-stigma for seeking help and self-stigma for PTSD) and visa security. PTSD severity was also associated with greater help-seeking intentions from community members indirectly via structural barriers. These findings are important to consider when identifying key barriers to mental health help-seeking and developing interventions designed to increase help-seeking for psychological problems, within this group.

Experiential peer support and its effects on desistance from delinquent behavior: protocol paper for a systematic realist literature review

BACKGROUND

Experiential peers are increasingly involved in the development and delivery of interventions for individuals who are engaged in delinquent behavior. Experiential peer support, which is the provision of support to an individual engaged in delinquent behavior by someone who has previously also practiced such behavior, is one such application. Little is known, however, about its effects on desistance, or the mechanisms that explain these effects. On the basis of theoretical papers, program descriptions, and interviews with experts, we developed an initial program theory. We propose seven mechanisms that might play a role in the (potential) effects of support by experiential peers: (1) empathy and acceptance, (2) social learning, (3) social bonding, (4) social control, (5) narrative and identity formation, (6) hope and perspective, and (7) translation and connection. In addition, in this protocol paper, we describe the methods of a systematic realist literature review that will be conducted in order to investigate the evidence base for this program theory.

METHODS

The study described in this protocol paper is a realist review, which is a suitable approach to study complex interventions and fits the explanatory purpose of the study. We outline the steps to be taken for the systematic realist review, including the selection and assessment of studies and the methods for synthesizing the findings.

DISCUSSION

Investigating the effects and the underlying mechanisms of support by experiential peers for individuals with delinquent behavior is relevant because the forensic setting has some unique features, and the involvement of service users might create even more tension than in other settings due to stigma and perceived risks. The findings that will be reported in the realist review will contribute to the knowledge of the effects of support by experiential peers and will provide insight into which aspects remain to be studied. It might also provide formal care institutions with guidance on whether to involve experiential peers in the delivery of their services and the conditions under which these interventions are likely to lead to positive results.

Does Mental Health First Aid training improve the mental health of aid recipients? The training for parents of teenagers randomised controlled trial

BACKGROUND

There is well-established evidence that Mental Health First Aid (MHFA) training improves knowledge about how to support someone developing a mental health problem, but less evidence that this support improves the mental health of the recipient of aid. This randomised controlled trial aimed to assess the long-term effects of MHFA training of parents on the mental health of their adolescent children.

METHODS

384 Australian parents of an adolescent aged 12-15 were randomised to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. Outcomes were assessed at baseline, 1-year, and 2-year follow-up in both parents and adolescents. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems.

RESULTS

Parent and adolescent reports showed no significant difference between training groups in the proportion of cases of adolescents with a mental health problem over time (ps > .05). There was also no significant difference between training groups in the quality of parental support provided to their adolescent at 1- or 2-year follow-up (ps > .05). In contrast, some secondary outcomes showed benefits from the Youth MHFA training relative to the control, with increased parental knowledge about mental health problems at 1-year (d = 0.43) and 2-year follow-up (d = 0.26), and increased confidence to help a young person (d = 0.26) and intentions to provide effective support (d = 0.22) at 1-year follow-up.

CONCLUSIONS

The study showed some improvements in mental health literacy in training recipients, but could not detect changes in the mental health of adolescents and the support provided to them by their parents if they had a mental health problem. However, there was a lack of power to detect primary outcome effects and therefore the question of whether MHFA training leads to better outcomes in the recipients of aid remains to be further explored.

TRIAL REGISTRATION

ACTRN12612000390886 , registered retrospectively 5/4/2012.

Intention to seek help for depression and associated factors among residents of Aykel town, Northwest Ethiopia: cross-sectional study

Background

Depression is the leading cause of disability at a population level and globally 350 million people are suffering from depression. Despite a high prevalence and serious consequences, people with depression are reluctant to seek help and a large proportion remains untreated. The aim of this study was to assess intention to seek help for depression and associated factors among residents of Aykel town, Northwest Ethiopia.

Methods

This cross-sectional population based study included 832 participants. We used a major depressive disorder case vignette and general help-seeking questionnaire (GHSQ) to assess intention. Study participants selected by multistage cluster sampling technique. Face-to-face interview used to collect data. We performed adjusted multiple linear regression analyses to identify factors for intention to seek help.

Results

The mean score on intention to seek help from any health professionals was 3.72 (SD = 1.23) with a range of (1 “very unlikely” to 5 “very likely”). Majority of the respondents had an intention to visit health professionals to get a remedy for their illness depicted in the vignette. The proportion of those who had an intention to seek help from any health professionals if they were having depression was 71.2%. Favorable attitude towards seeking professional help for depression positively associated with an intention to seek help with (unstandardized β = 0.03, 95% CI (0.01, 0.05), p-value < 0.001). Other factors positively associated with an intention to seek help for depression were age (β = 0.02, CI (0.01, 0.03) p < 0.001), and perceived need of treatment for depression (β = 0.19, CI (0.01, 0.38), p < 0.05). Poor social support was negatively associated with an intention to seek help for depression (β = − 0.39 CI − 0.68, − 0.10, p < 0.05).

Conclusions

The results suggest that over two-third of the respondents reported that they were likely or very likely to seek help from health professionals if they were having depression. Increased age, favorable attitude to depression, and perceived need for treatment were factors for intention to seek help. Interventions focusing on awareness creation and attitude change towards depression are necessary.

Early intervention for depression in young people: a blind spot in mental health care

Depression is a major contributor to disability across the lifespan. As a disorder that commonly has its onset in adolescence and early adulthood, and high recurrence and persistence, it is a prime candidate for early intervention. Most of the early intervention focus, however, has been confined to indicated prevention efforts. In this Personal View, we argue that early intervention for depression must expand beyond this narrow focus to include young people (aged 12-25 years old) who present with early episodes of full-threshold major depressive disorder. We discuss the development of enhanced primary care services for youth mental health, which allow young people improved access to evidence-based care. We argue that young people with severe and complex depression require particular attention: they are at high risk of lifelong disabling illness and need support to alleviate the early effects of their illnesses on their functional trajectories.

Mental health literacy among Nigerian teachers

INTRODUCTION

Teachers are frontline professionals who have daily contact with children and are therefore most likely to have the biggest impact on their students. Findings in this study should inform the development of teacher training programs, and more broadly, assist in the success of a strategic plan addressing mental health in classrooms. This study aims to assess mental health literacy among teachers with focus on their knowledge of depression.

METHODS

The study was a cross-sectional descriptive survey conducted among teachers in five secondary schools (high school) in southeast Nigeria. All consenting teachers were recruited, making a total of 120 participants. The participants were presented with a questionnaire designed to elicit the participants' recognition of the disorder depicted in two vignettes and their recommendation about the appropriate source of help seeking. One vignette was of a clinically depressed case while the other vignette was about a girl undergoing normal life crisis.

RESULTS

Out of the 120 teachers recruited into the study, 104 questionnaires were adequately completed indicating a response rate of 86.7%. A total of 16.3% (n = 17) participants correctly identified and labeled the depression vignette. Only 14 teachers (13.5%) recommended professional help from a psychiatrist or psychologist. Diminished ability to concentrate was the most identified symptom of distress for depression (30.8%). Counsellors were the most recommended source of help.

DISCUSSION

Mental health literacy was poor among the teachers surveyed. There is an urgent need to improve mental health literacy among teachers in Nigeria.

Suicide, mental, and physical health condition stigma in medical students

The current study aimed to compare the personal stigma of suicide with the personal stigma for other mental and physical health conditions. 116 Australian medical students (58% women), aged between 20 and 41 years (M = 25.02, SD = 3.80), completed an online survey. Suicide was more highly stigmatized than most of the other mental and physical health conditions in both attitudes toward suicide and willingness to disclose. The current study highlights the need for further medical student education in suicide, as ongoing negative attitudes could negatively affect patient care and disclosure.

A Web- and Mobile-Based Map of Mental Health Resources for Postsecondary Students (Thought Spot): Protocol for an Economic Evaluation

Background

Youth demonstrate a low propensity to seek help for mental health issues and exhibit low use of health services despite the high prevalence of mental health challenges in this population. Research has found that delivering interventions via the internet and mobile devices is an effective way to reach youth. Thought Spot, a Web- and mobile-based map, was developed to help transition-aged youth in postsecondary settings overcome barriers to help-seeking, thereby reducing the economic burden associated with untreated mental health issues.

Objective

This paper presents the protocol for an economic evaluation that will be conducted in conjunction with a randomized controlled trial (RCT) to evaluate the effectiveness and cost of Thought Spot compared with usual care in terms of self-efficacy for mental health help-seeking among postsecondary students.

Methods

A partially blinded RCT will be conducted to assess the impact of Thought Spot on the self-efficacy of students for mental health help-seeking. Students from 3 postsecondary institutions in Ontario, Canada will be randomly allocated to 1 of 2 intervention groups (resource pamphlet or Thought Spot) for 6 months. The economic evaluation will focus on the perspective of postsecondary institutions or other organizations interested in using Thought Spot. Costs and resources for operating and maintaining the platform will be reported and compared with the costs and resource needs associated with usual care. The primary outcome will be change in help-seeking intentions, measured using the General Help-Seeking Questionnaire. The cost-effectiveness of the intervention will be determined by calculating the incremental cost-effectiveness ratio, which will then be compared with willingness to pay.

Results

The RCT is scheduled to begin in February 2018 and will run for 6 months, after which the economic evaluation will be completed.

Conclusions

We expect to demonstrate that Thought Spot is a cost-effective way to improve help-seeking intentions and encourage help-seeking behavior among postsecondary students. The findings of this study will help inform postsecondary institutions when they are allocating resources for mental health initiatives.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 (Archived at WebCite at http://www.webcitation.org/6xy5lWpnZ)

Ahead of the game protocol: a multi-component, community sport-based program targeting prevention, promotion and early intervention for mental health among adolescent males

BACKGROUND

There is a recognised need for targeted community-wide mental health strategies and interventions aimed specifically at prevention and early intervention in promoting mental health. Young males are a high need group who hold particularly negative attitudes towards mental health services, and these views are detrimental for early intervention and help-seeking. Organised sports provide a promising context to deliver community-wide mental health strategies and interventions to adolescent males. The aim of the Ahead of the Game program is to test the effectiveness of a multi-component, community-sport based program targeting prevention, promotion and early intervention for mental health among adolescent males.

METHODS

The Ahead of the Game program will be implemented within a sample drawn from community sporting clubs and evaluated using a sample drawn from a matched control community. Four programs are proposed, including two targeting adolescents, one for parents, and one for sports coaches. One adolescent program aims to increase mental health literacy, intentions to seek and/or provide help for mental health, and to decrease stigmatising attitudes. The second adolescent program aims to increase resilience. The goal of the parent program is to increase parental mental health literacy and confidence to provide help. The coach program is intended to increase coaches' supportive behaviours (e.g., autonomy supportive behaviours), and in turn facilitate high-quality motivation and wellbeing among adolescents. Programs will be complemented by a messaging campaign aimed at adolescents to enhance mental health literacy. The effects of the program on adolescent males' psychological distress and wellbeing will also be explored.

DISCUSSION

Organised sports represent a potentially engaging avenue to promote mental health and prevent the onset of mental health problems among adolescent males. The community-based design, with samples drawn from an intervention and a matched control community, enables evaluation of adolescent males' incremental mental health literacy, help-seeking intentions, stigmatising attitudes, motivation, and resilience impacts from the multi-level, multi-component Ahead of the Game program. Notable risks to the study include self-selection bias, the non-randomised design, and the translational nature of the program. However, strengths include extensive community input, as well as the multi-level and multi-component design.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000709347 . Date registered 17 May 2017. Retrospectively registered.

A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice

BACKGROUND

The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response.

OBJECTIVE

This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community.

METHODS

Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit's acceptability, relevance, and appeal.

RESULTS

Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were "to get information for myself" (185/451, 41.0%) and "to find out how to help a friend or a family member" (136/451, 30.2%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a "low prevalence of use, yet high impact" message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website.

CONCLUSIONS

The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities.

Mental health literacy: what do Nigerian adolescents know about depression?

BACKGROUND

Depression is a leading cause of disability and has been projected to become the 2nd most burdensome disease by the year 2020; depression has also been found to be the strongest single risk factor for attempted or completed suicides. Adolescent-onset mood disorders are frequently unrecognized or misdiagnosed and often go untreated. While there is a growing literature on the mental health literacy of adults, there has not been a parallel interest in the mental health literacy of young people in Nigeria.

METHODS

The study was a cross-sectional descriptive survey conducted among students of a Federal Government College (high school) in south-east Nigeria. All consenting students in the senior secondary classes (grades 10-12) were recruited, making a total of 285 participants. The participants were presented with the 'friend in need' questionnaire designed to elicit the participants' recognition of the disorder depicted in two vignettes and their recommendation about the appropriate source of help-seeking. One vignette was of a clinically depressed case while the other vignette was about a girl undergoing normal life crisis.

RESULTS

Out of the 285 students recruited into the study, 277 questionnaires were adequately completed indicating a response rate of 97.2%. A total of 4.8% (n = 13) participants correctly identified and labelled the depression vignette. Only four respondents (1.5%) recommended professional help from a Psychiatrist or Psychologist. Insomnia was the most identified symptom of distress for depression (17.1%). Females demonstrated higher mental health literacy, in terms of their ability to correctly label the depression vignettes, their expression of greater concern over a depressed peer than males, their expectation that depression requires a longer recovery than normal teenage problems and in their ability to identify individual symptoms of depression. Family and friends were the most recommended source of help.

CONCLUSION

Mental health literacy was abysmally low amongst the adolescents surveyed. There's an urgent need to increase mental health awareness in Nigeria.

Mental disorders in Australian 4- to 17- year olds: Parent-reported need for help

OBJECTIVE

To describe the extent to which parents report that 4- to 17-year-olds with symptoms meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for mental disorders need help, the types of help needed, the extent to which this need is being met and factors associated with a need for help.

METHOD

During 2013-2014, a national household survey of the mental health of Australia's young people (Young Minds Matter) was conducted, involving 6310 parents (and carers) of 4- to 17-year-olds. The survey identified 12-month mental disorders using the Diagnostic Interview Schedule for Children - Version IV ( n = 870) and asked parents about the need for four types of help - information, medication, counselling and life skills.

RESULTS

Parents of 79% of 4- to 17-year-olds with mental disorders reported that their child needed help, and of these, only 35% had their needs fully met. The greatest need for help was for those with major depressive disorder (95%) and conduct disorder (93%). Among these, 39% of those with major depressive disorder but only 19% of those with conduct disorder had their needs fully met. Counselling was the type of help most commonly identified as being needed (68%). In multivariate models, need for counselling was higher when children had autism or an intellectual disability, in blended families, when parents were distressed, and in the most advantaged socioeconomic areas.

CONCLUSIONS

Many children and adolescents meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for mental disorders have a completely unmet need for help, especially those with conduct disorders. Even with mild disorders, lack of clinical assessment represents an important missed opportunity for early intervention and treatment.

Evaluation of an mHealth App (DeStressify) on University Students' Mental Health: Pilot Trial

BACKGROUND

One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy.

OBJECTIVE

The aim of this study was to evaluate a mindfulness-based app's ("DeStressify") efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students.

METHODS

Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL.

RESULTS

A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05).

CONCLUSIONS

Mindfulness-based apps may provide an effective alternative support for university students' mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty.

Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents' mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents' needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse

BACKGROUND

Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources.

METHOD

The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help.

RESULTS

Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends.

CONCLUSIONS

While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.