Beliefs of young people and their parents about the effectiveness of interventions for mental disorders

Stigmatising attitudes towards people with mental disorders: results from a survey of Japanese high school students

The aim of the current study was to assess the stigmatising attitudes of Japanese high school students towards people with depression, social phobia and psychosis/schizophrenia. In 2011, 311 students aged 15-18 years filled out an anonymous self-report questionnaire, which included a case vignette describing either depression, schizophrenia or social phobia and two questionnaires to assess stigmatising attitudes towards people with these disorders. Exploratory Structural Equation Modelling (ESEM) was used to determine the dimensionality and loading pattern of the stigma items in the two scales, to establish dimensions of stigma and to compare levels on these dimensions between genders. Stigmatising attitudes towards people with mental disorders in young Japanese people are substantial. ESEM revealed that the structure of stigmatising attitudes in young Japanese people is comparable in personal and perceived attitude stigma, with each forming distinct dimensions and each comprising 'weak not sick' and 'dangerous/unpredictable' components. The social distance dimension of stigma was separate from other components. Stigmatising attitudes relating to dangerousness/unpredictability were the lowest for social phobia and highest for schizophrenia. Females had lower stigmatising attitudes than males. These findings echo those of Australian studies and extend them by demonstrating a similar structure of stigma in another cultural group, namely young Japanese people.

Improving eating disorders mental health literacy: a preliminary evaluation of the "Should I say something?" workshop

A repeated measures, uncontrolled, preliminary evaluation of a single 3-hour workshop-"Should I Say Something?"-aimed at improving eating disorders mental health literacy, was conducted in a sample of 177 university undergraduates. Following participation in the workshop, significant increases in eating disorder recognition and knowledge, and significant decreases in stigmatizing attitudes, were reported by participants. Moreover, 85% of participants reported that they provided assistance to someone whom they suspected had a mental health condition, including an eating disorder, during the 3-month follow-up period. This study provides preliminary evidence that "Should I Say Something?" may be effective in improving the mental health literacy of young people.

Literacia em saude mental de adolescentes e jovens portugueses sobre abuso de alcool

OBJETIVO: Caracterizar a literacia em saúde mental de adolescentes e jovens relativamente ao consumo abusivo de álcool, nas diversas componentes do conceito de literacia. MÉTODOS: Estudo descritivo-exploratório, em que foi aplicado o QuALiSMental a uma amostra representativa de 4.938 adolescentes e jovens, com idades compreendidas entre os 14 e os 24 anos, que frequentam escolas do 3º ciclo do ensino básico e do ensino secundário da região centro de Portugal. RESULTADOS: O reconhecimento da vinheta do consumo abusivo de álcool pelos participantes é elevado (72,4%), ainda que seja também identificado como alcoolismo (70,3%), o que no entanto indica a percepção do problema como grave. Os participantes apresentam níveis modestos de literacia nas restantes componentes, preferindo as fontes informais de ajuda. CONCLUSÃO: Conclui-se que há necessidade de implementação de programas nas escolas que promovam a literacia em saúde mental, para adoção de comportamentos saudáveis nos jovens, que os transferem para a idade adulta.

Iranian adolescents' ability to recognize depression and beliefs about preventative strategies, treatments and causes of depression

BACKGROUND

Since depression often has its onset during adolescence, knowledge about adolescents' ability to recognize depression and their beliefs about preventative strategies, treatments, and causes of depression are of importance.

METHODS

A total of 1984 adolescents, aged 12-17 years, participated in this study. They were recruited from 16 urban and suburban schools in Ahvaz City, Iran by cluster sampling. Participants were presented with a vignette depicting depression that was developed by Jorm and colleagues.

RESULTS

About half of the adolescents were able to correctly recognize depression. In terms of dealing with the depression depicted by the character in the vignette, older compared to younger participants, thought it best to ignore the individual or keep him/her busy. Younger adolescents were more likely to believe that depression was the result of god's will and a physical illness, whereas older adolescents tended to consider depression as resulting from the way in which people were raised, and from the normal ups and downs of life. Older, compared to younger adolescents, tended to endorse the preventative value of "not using marijuana" and "never drinking alcohol in excess".

LIMITATIONS

Since a hypothetical vignette was used, the findings may not truly reflect the real life experience of depression. The sample was drawn from a single region in Iran.

CONCLUSIONS

Given adolescents' relatively limited knowledge about depression and their beliefs about the causes and preventative strategies, there is fertile ground for health promotion in Iran.

Mental health literacy about depression and schizophrenia among adolescents in Sweden

BACKGROUND

Mental health literacy (MHL) refers to an individual's knowledge of mental disorders, including the ability to recognize psychopathology and being aware of help options. Most studies of MHL have focused on adults.

OBJECTIVE

The purpose of this study was to examine levels of MHL among adolescents.

METHODS

MHL was examined using two pre-established vignettes that presented an adolescent with symptoms of either depression or schizophrenia. The respondents were 426 adolescents (age mean=16). Vignette data were analyzed both qualitatively and quantitatively.

RESULTS

The data showed that 42.7% and 34.7% of the respondents identified depression and schizophrenia, respectively. Depression was recognized more often by females than males. Professional help was suggested by a minority of the respondents for managing symptoms of depression (22.5%) or schizophrenia (32.6%). Altruistic behaviors, examined through the willingness to help an acquaintance with mental illness symptoms, were apparent among 58.2% of the respondents and to a greater extent in females than males. Answers following the schizophrenia vignette also revealed stigmatizing attitudes in 11.5% of the participants.

CONCLUSIONS

There are relatively low levels of MHL among teenagers in Sweden. Awareness campaigns and the implementation of psychoeducation in the school curriculum could increase MHL in this group.

The Australian public's beliefs about the harmfulness of antipsychotics: associated factors and change over 16 years

Negative views of psychiatric medications are common in many countries. Relatively little is known about beliefs about antipsychotic medications. A 2011 national survey of 2024 Australian adults assessed beliefs about their helpfulness or harmfulness for a person with either early or chronic schizophrenia and the associations with sociodemographic characteristics, exposure to schizophrenia, recognition of schizophrenia, and beliefs about other interventions, long-term outcomes, causes, and stigmatising attitudes. Changes since previous surveys (conducted in 1995 and 2003/4) were also assessed. Results showed that 19% of Australian adults believe that antipsychotics would be harmful for a person with early schizophrenia and 14% for chronic schizophrenia. This group was more likely to be male, born overseas, have less exposure to schizophrenia, show poorer schizophrenia recognition, have less positive views about other standard interventions, be less pessimistic about long-term outcomes and have greater stigmatising attitudes. Comparison with previous surveys showed that overall belief in the harmfulness of antipsychotics for schizophrenia decreased between 1995 and 2003/4 and between 1995 and 2011. The higher proportions of males and those from non-English speaking backgrounds believing in harmfulness suggest that education about the role of antipsychotics in the treatment of schizophrenia should focus on these groups.

Young men's attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services

BACKGROUND

This mixed-methods study was designed to explore young Australian men's attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.

METHODS

National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).

RESULTS

Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.

CONCLUSIONS

The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men's views and everyday technology practices, and leverage the influence of peers.

Associations between awareness of beyondblue and mental health literacy in Australian youth: Results from a national survey

OBJECTIVES

The aim of this paper is to examine whether Australian young people's awareness of beyondblue is associated with better recognition of depression and anxiety disorders, and better quality of beliefs about possible interventions and first-aid actions for these problems.

METHOD

In 2011, a telephone interview was conducted with a national sample of 3021 Australians aged between 15 and 25 years. Participants were presented with a vignette portraying depression, depression with suicidal thoughts, social phobia, post-traumatic stress disorder or psychosis in a young person. They were then asked about recognition of the disorder portrayed, their beliefs about the helpfulness or harmfulness of various interventions and first-aid actions, and their awareness of beyondblue. The quality of youths' beliefs was scored against health professionals' ratings of the same list of interventions and first-aid actions.

RESULTS

Beyondblue awareness was associated with more accurate recognition of the disorder portrayed in all vignettes except social phobia. It was also associated with beliefs about the helpfulness of first-aid actions that were more closely aligned with professional ratings for the depression, psychosis and social phobia vignettes. However, it was associated with beliefs about interventions for the psychosis vignette only.

CONCLUSIONS

Overall, the associations of beyondblue awareness with better mental health literacy were not specific to depression and anxiety disorders, which are their main focus. Beyondblue awareness is mostly unrelated to treatment beliefs, but seems to have non-specific associations with recognition of disorders and first-aid beliefs.

Actions taken to deal with mental health problems in Australian higher education students

AIMS

With approximately 50% of young people aged 18-24 in tertiary education, these are potential settings for programmes to improve mental health literacy. A survey was carried out with students and staff of a tertiary education institution to investigate psychological distress, actions to deal with mental health problems and first-aid behaviours.

METHODS

Telephone interviews were carried out with 774 students of an Australian metropolitan university (with 422 staff as a comparison group). They answered questions relating to psychological distress, actions to deal with mental health problems and first-aid behaviours.

RESULTS

Students were more likely to be psychologically distressed than staff (21% vs. 13%) and 27% reported experiencing a problem similar to that described in a depression vignette. The most common actions taken were talking to a close friend, physical activity and talking to close family. Over 72% of students with a problem had sought professional help, most often from a general practitioner or counsellor. Only 10% reported seeking help from a student counsellor. Helpful first-aid behaviours were common and were seen in over 90% of students who had a family member or close friend with a similar problem.

CONCLUSIONS

There is a need for further investigation of levels and factors associated with psychological distress in higher education students along with an exploration of barriers to and enablers of use of student counselling services. High levels of help seeking from friends and first-aid behaviours provided point to the need for effective peer-to-peer education.

Young people's mental health first aid intentions and beliefs prospectively predict their actions: findings from an Australian National Survey of Youth

Little is known about whether mental health first aid knowledge and beliefs of young people actually translate into actual behavior. This study examined whether young people's first aid intentions and beliefs predicted the actions they later took to help a close friend or family member with a mental health problem. Participants in a 2006 national survey of Australian youth (aged 12-25 years) reported on their first aid intentions and beliefs based on one of four vignettes: depression, depression with alcohol misuse, psychosis, and social phobia. At a two-year follow-up interview, they reported on actions they had taken to help any family member or close friend with a problem similar to the vignette character since the initial interview. Of the 2005 participants interviewed at follow-up, 608 reported knowing someone with a similar problem. Overall, young people's first aid intentions and beliefs about the helpfulness of particular first aid actions predicted the actions they actually took to assist a close other. However, the belief in and intention to encourage professional help did not predict subsequent action. Findings suggest that young people's mental health first aid intentions and beliefs may be valid indicators of their subsequent actions.

Intentions and helpfulness beliefs about first aid responses for young people with mental disorders: findings from two Australian national surveys of youth

BACKGROUND

Youths are important sources of first aid for people close to them who are experiencing mental health problems, but their skills are not optimal. A better understanding of predictors of young people's first aid intentions and beliefs will facilitate future efforts to improve their mental health first aid skills.

METHODS

Young people's first aid intentions and beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12-25 years in 2006. A similar survey was repeated in 2011 with 3021 youths aged 15-25 years. In both surveys, youths were presented with a vignette portraying depression, psychosis, social phobia, or depression with alcohol misuse in a young person. The 2011 survey also included depression with suicidal thoughts and post-traumatic stress disorder. Respondents reported on any past-year experience of mental health problems and treatment, exposure to beyondblue and mental health information at school or work.

RESULTS

The potential value of encouraging professional treatment was not universally recognized, although young people were mostly aware of and reported the intention to take supportive actions. Respondent age, sex, experience of mental health problems, type of mental disorder, and exposure to mental health information at school, work, or beyondblue all predicted some intentions and beliefs. Some improvements in beliefs were observed between surveys.

LIMITATIONS

Actual first aid actions and their helpfulness were not measured.

CONCLUSIONS

Future efforts should target adolescents, males and those with recent mental health problems who had not received help. Beyondblue and school and work settings may be promising avenues for these efforts.

Mental health literacy in higher education students

AIM

With approximately 50% of young people aged 18-24 in tertiary education, these are potential settings for programmes to improve mental health literacy. A survey was carried out with students and staff of a tertiary education institution to investigate recognition of depression, help-seeking intentions, beliefs about interventions and stigmatizing attitudes.

METHODS

Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. They answered questions relating to mental health literacy.

RESULTS

Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. Over 70% of students and staff were able to recognize depression in a vignette, with greater likelihood of recognition in students associated with older age, female gender, being born in Australia and a higher level of education. Over 80% of respondents said they would seek help if they had a problem similar to that of the vignette. However, rates of specific help-seeking intentions for students were relatively low, with only 26% nominating a general practitioner and only 10% nominating a student counsellor. Factors associated with stigmatizing attitudes included male gender, younger age, lower level of education, being born outside Australia and lack of recognition of depression.

CONCLUSIONS

There is a need for mental health literacy interventions targeted at students, particularly those who are younger, male, born outside Australia and of a lower level of education. As rates of specific help-seeking intentions for students were relatively low, there is a need for further exploration of the barriers to help seeking from professional sources.

The influence of stigma on young people's help-seeking intentions and beliefs about the helpfulness of various sources of help

PURPOSE

In this study, we examined whether young people's help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents' stigmatising attitudes towards young people with mental disorders.

METHODS

A national telephone survey was conducted with 3,746 Australians aged 12-25 years and 2,005 of their parents. Stigmatising attitudes, help-seeking intentions, and perceived helpfulness of various sources of help were assessed in relation to four vignettes of a young person with a mental disorder (psychosis, depression, depression with alcohol misuse or social phobia).

RESULTS

Unlike 'stigma perceived in others', the 'weak-not-sick', 'social distance' and 'dangerous/unpredictable' dimensions of young people's stigma were associated with both help-seeking intentions and helpfulness beliefs about various sources of help. Attributing mental disorder to a personal weakness rather than an illness was associated with less intention to seek help from a doctor and less positive beliefs about professional sources (including doctors, counsellors, and psychologists). In contrast, young adults aged 18-25 years who perceived the vignette character as more dangerous or unpredictable had greater intention to seek help from a psychiatrist and a helpline, and more positive beliefs about psychiatrists. Greater social distance was associated with less intention to seek help from informal sources and less positive beliefs about these sources. No consistent pattern of associations was found for parent stigma.

CONCLUSIONS

The findings suggest that different dimensions of youth stigma differentially influence help-seeking intentions and beliefs about the helpfulness of different sources of help.

Actions taken by young people to deal with mental disorders: findings from an Australian national survey of youth

AIMS

The study examined actions taken by young people to deal with mental disorders and the factors associated with help-seeking and self-help behaviours.

METHODS

Participants in a 2006 national survey of Australian youth (aged 12-25 years) were contacted 2 years later and participated in telephone interviews based on a vignette of one of the following disorders: depression, depression with alcohol misuse, social phobia and psychosis. Personal experiences of these disorders and subsequent self-help and help-seeking behaviours were examined.

RESULTS

Of the 2005 participants interviewed, 275 (14%) reported experiencing a mental disorder since January 2007, most commonly depression. The most frequent sources of help were family (77%) and close friends (73%). General practitioners (GPs) were consulted by 53% of respondents. The most frequent self-help behaviours were physical activity (70%) and getting up early and out in the sunlight (46%). Beliefs about the helpfulness of interventions at baseline were compared with actual use in the following 2 years. Interventions ranked higher for beliefs about helpfulness than actual use mainly included consulting health professionals and cutting down on substance use. Interventions ranked higher for actual use than beliefs typically included lifestyle interventions but also included consulting GPs.

CONCLUSIONS

Young people with mental health problems are more likely to seek help from close friends and family and to use self-help interventions than to access professional help, although over half of survey respondents had visited a GP. Help seeking tended to be better predicted by intentions to seek help than by beliefs about the helpfulness of interventions.

Young people's recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey

OBJECTIVE

The aim of the study was to carry out a national survey in order to assess young people's recognition and beliefs about treatment for depression, anxiety disorders and schizophrenia/psychosis.

METHOD

In 2011, telephone interviews were carried out with 3021 Australians aged between 15 and 25 years. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, depression with alcohol misuse, psychosis/schizophrenia, social phobia or post-traumatic stress disorder (PTSD). Questions were asked about what was wrong with the person, help-seeking intentions and the likely helpfulness of a broad range of interventions.

RESULTS

Rates of recognition of depression were relatively high, with almost 75% of respondents using the correct label. Rates of recognition for the psychosis (schizophrenia) and PTSD vignettes were similar, with around one third of respondents using the correct labels. Only 3% of respondents were able to correctly label social phobia. Intentions to seek help were highest for depression with suicidal thoughts and lowest for social phobia, with family members nominated the most likely sources of help across all vignettes.

CONCLUSIONS

Most young people believe in the importance of seeking professional help and they have good recognition of depression. However, there is still potential for young people's mental health literacy to improve in the areas of recognition and treatment beliefs for all the mental disorders covered in this survey, particularly social phobia which has very low recognition rates and a lower perceived need for treatment.

Nonmedical healing methods: knowledge and behavior among parents of children with mental health problems

This study examined knowledge and behavior concerning nonmedical healing methods used by parents whose children present with mental health problems and to determine the factors affecting this behavior. Knowledge of a variety of nonmedical health methods was found to be more common than use of such methods. Among those expressing knowledge of such methods, religious procedures were found to be more common than those that are nutrition related. Also, nonmedical healing method use increased as the mother's age decreased. We found a significant relationship between nonmedical healing method--using behavior and a positive family history of nonmedical healing method usage. Education about mental health problems and their treatment is very important, especially for young mothers. Increased understanding about nonmedical healing methods among health care providers will improve the patient-family-provider relationship.

What is the role of general practice in addressing youth mental health? A discussion paper

BACKGROUND

Mental and substance use disorders are a leading cause of morbidity among young people. Policy and clinical services in Ireland are endeavouring to address these twin issues.

AIMS

To review the emerging literature on the role of general practice in addressing youth mental health and to discuss the implications of this literature for further research, education and service delivery.

METHODS

We conducted a review of 'PubMed' and a web search of relevant national/international primary/mental healthcare agencies and professional bodies.

RESULTS

Although general practice has an important role in addressing youth mental health, there are challenges in how young people seek help. Specifically, young people do not engage with healthcare agencies and many factors which act as barriers and enablers in this regard have been identified. The detection and treatment of mental and substance use disorders by GPs can be improved and implementing interventions to improve screening and early intervention are likely to be valuable.

CONCLUSIONS

General practice is a central agency in addressing youth mental health and complex multifaceted interventions (education, clinical guidelines, and promoting awareness) are likely to support its role. Further research exploring this issue is a priority.

First aid actions taken by young people for mental health problems in a close friend or family member: findings from an Australian national survey of youth

This study examined the first aid actions taken by young people to help someone they know and care about who was experiencing a mental health problem and the characteristics of the first aid provider (respondent) and recipient which influence these first aid actions. Participants in a national survey of Australian youth (aged 12-25 years) completed a two-year follow-up phone interview based on one of the following disorders in vignettes: depression, depression with alcohol misuse, social phobia and psychosis. Participants were asked if they knew a family member or close friend who had experienced a similar problem to the vignette character since the initial interview and those who did reported on any actions taken to help the person. Of the 2005 participants interviewed, 609 (30%) reported knowing someone with a similar problem, with depression (with or without alcohol misuse) being the most common problem. Respondent age and gender, recipient gender, and type of mental health problem, all influenced first aid actions. Findings indicate that peers are a major source of support for young people with mental health problems and underscore some important areas and subgroups of young people to target for interventions to improve young people's mental health first aid skills.

Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications

OBJECTIVE

Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (ie, attitudes toward mental illness and beliefs about the efficacy of psychiatric medications).

METHOD

Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcoholism Screening Test, the Drug Abuse Screening Test, Day's Mental Illness Stigma Scale, the Attitudes Toward Psychiatric Medication scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on the campus of a large state university or through online classes offered through the same university.

RESULTS

High rates of psychiatric medication misuse were shown (13.8%) when compared to rates of medical use (6.8%), and students with prescriptions for psychiatric drugs were also more likely to be misusers (χ(2) = 20.60, P < .001). Psychiatric medication misusers reported less stigmatized beliefs toward mental illness, including lower anxiety around the mentally ill (t = 3.26, P < .001) as well as more favorable attitudes toward psychiatric medications (t = 2.78, P < .01) and stronger beliefs in the potential for recovery from mental illness (t = -2.11, P < .05). Students with more stigmatized beliefs had greater concerns about psychiatric medications and less favorable beliefs regarding their effectiveness. Reasons for misuse varied by medication class, with 57.1% of stimulant misusers noting help with studying as their primary reason for use and 33.3% of benzodiazepine misusers noting attempts to get high or "party" as their primary reason for misuse.

CONCLUSIONS

Results suggest the need for improved education regarding the nature of mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs.

Youth mental health first aid: a description of the program and an initial evaluation

BACKGROUND

Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions.

METHODS

The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries.

RESULTS

The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were maintained at follow-up. Over the first 3 years of this program, a total of 318 instructors were trained to deliver the course and these instructors have delivered courses to 10,686 people across all states and territories in Australia. The program has also spread to Canada, Singapore and England, and will spread to Hong Kong, Sweden and China in the near future.

CONCLUSIONS

Initial evaluation suggests that the Youth Mental Health First Aid course improves participants' knowledge, attitudes and helping behaviour. The program has spread successfully both nationally and internationally.

TRIAL REGISTRATION

ACTRN12609000033246.

Actions that young people can take to prevent depression, anxiety and psychosis: beliefs of health professionals and young people

BACKGROUND

Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance.

METHODS

Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12-25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis.

RESULTS

Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety.

LIMITATIONS

The surveys assessed beliefs, but not actual use of preventive strategies.

CONCLUSIONS

Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety.

Healthy minds for country youth: help-seeking for depression among rural adolescents

OBJECTIVE

To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents.

DESIGN

Cross-sectional survey.

SETTING

Two rural secondary schools in south-east South Australia.

PARTICIPANTS

Seventy-four secondary school students aged 14 to 16 years.

MAIN OUTCOME MEASURE(S)

Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire.

RESULTS

Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0-100.0%) than a doctor (82.4%, 72.1-89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories.

CONCLUSIONS

Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.

Facilitating early intervention: experiences of young people and implications for the shaping of headspace services

OBJECTIVE

The aim of this study was to gain an understanding of the factors that facilitate entry of young people into the Australian mental health care system with a view to developing headspace service delivery in youth-friendly directions.

METHOD

Fifteen semi-structured interviews were conducted with experienced mental health help-seekers in early adulthood.

RESULTS

Social factors involving families, friends and professionals dominated discussions about the initiation and voluntary continuation of mental health care.

CONCLUSIONS

A range of social interactions combine to facilitate the entry of young people into care. The actions of families and friends are very important for the initiation of care while the clinicians' modes of communicating with young people are critical in making the experience of care comfortable and worth the perseverance. If genuine service delivery reform is to be achieved, taking account of the views of young people who have overcome the well-documented obstacles to care is invaluable for the ongoing development of youth-friendly services such as those offered by headspace.

Mental health first aid training for high school teachers: a cluster randomized trial

BACKGROUND

Mental disorders often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster randomized trial.

METHODS

The trial was carried out with teachers in South Australian high schools. Teachers at 7 schools received training and those at another 7 were wait-listed for future training. The effects of the training on teachers were evaluated using questionnaires pre- and post-training and at 6 months follow-up. The questionnaires assessed mental health knowledge, stigmatizing attitudes, confidence in providing help to others, help actually provided, school policy and procedures, and teacher mental health. The indirect effects on students were evaluated using questionnaires at pre-training and at follow-up which assessed any mental health help and information received from school staff, and also the mental health of the student.

RESULTS

The training increased teachers' knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training. However, no effects were found on teachers' individual support towards students with mental health problems or on student mental health.

CONCLUSIONS

Mental Health First Aid training has positive effects on teachers' mental health knowledge, attitudes, confidence and some aspects of their behaviour.

TRIAL REGISTRATION

ACTRN12608000561381.

Room for improvement: mixed portrayal of young people with mental illness on Australian television news

OBJECTIVE

The aim of the present study was to review television news depiction of mental illness in children and adolescents to test the hypothesis that positive portrayals of adults with mental illness also apply to young people.

METHODS

Content and frame analysis of first-person depictions and overall news angle was carried out to determine whether depictions were positive, neutral or negative.

RESULTS

The media portrayal of young people with mental illnesses was mixed. Overall, 10 items (29%) of news angles were positive, 13 items (37%) neutral and nine items (26%) negative. Positive themes were significantly less frequent for young people compared to adults (10 items, 29% compared to 151 items, 66%), and negative themes were more frequent (nine items, 26% vs 21 items, 9%). First-person depictions, however, were similar for young people and adults (24 items, 69% vs 150 items, 66%). An anti-medication sub-theme was notable.

CONCLUSIONS

Overall the portrayal of young people with mental illnesses on television news is not as positive as that for adults. Similar to adults, however, first-person depictions resulted in a more positive representation of young people. Fewer first-person depictions in combination with an anti-medication theme and historically less access to appropriate services for young people may have contributed to the less positive results for young people with mental illnesses.

Predictors of safety-related enquiries about psychotropic medication in young people and families accessing a medicines information service

BACKGROUND

Many consumers express concerns about the safety of psychotropic medication for young people. Despite the increased use of psychotropic medication in children and adolescents, few studies have examined information needs of this group and predictors of safety-related concerns.

METHODS

This study was conducted within a national, consumer-based medicines information service. Between September, 2002, and December, 2005, all calls relating to use of psychotropic medications in children and adolescents were identified and reviewed. Information extracted included call characteristics, reason for calling, prior information, and medication details. Calls related to safety were compared to calls about non-safety-related issues.

RESULTS

A total of 286 calls related to psychotropic medication in young people were reviewed. The majority of callers were adults calling on behalf of either a child (73.4%) or client (12.9%). Stimulants were the most common medication enquired about (44.0% of calls), followed by antidepressants (40.2%), and antipsychotics (18.9%). More than half of all calls were for medicines not registered for pediatric use. Almost two thirds of calls related to safety issues (61.9%; 177/286). Safety-related calls were not related to specific medication groups (e.g., stimulants or antidepressants). Significant and independent predictors of safety-related concerns were medication not registered for pediatric use (p < 0.05), receipt of lay information (p < 0.05), concomitant enquiry about nonpsychotropic medication (p < 0.01), and a potential medication problem (p < 0.05).

CONCLUSIONS

Safety is one of the key areas of concern in young people and families accessing a medicines information service with questions about psychotropic medication. Off-label use of medication was common and may contribute to safety concerns. Provision of information that is tailored for young people has the potential to improve outcomes in this group.

Interventions that are helpful for depression and anxiety in young people: a comparison of clinicians' beliefs with those of youth and their parents

BACKGROUND

The aim of the research was to assess the consensus of clinicians about the appropriate treatments for depression and anxiety in youth, to discover any major differences between clinicians' beliefs and those of young people and their parents, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people.

METHODS

Postal surveys were carried out on the beliefs of Australian general practitioners, psychiatrists, psychologists, and mental health nurses about what are helpful interventions for depression and social phobia in a 15-year old and in a 21-year old. The clinician data were compared to findings from an earlier national survey of Australian youth aged 12-25 years and their parents.

RESULTS

The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. Young people and their parents showed much lower endorsement than clinicians of antidepressants and cognitive-behavior therapy, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups.

LIMITATIONS

The survey was adapted from one designed for the public and did not allow clinicians to express complex opinions.

CONCLUSIONS

Clinicians show substantial consensus about appropriate treatments. However, there are some major differences in beliefs between clinicians and young people, which may be a barrier to optimal help-seeking.

Relaxation for depression

BACKGROUND

Many members of the public have negative attitudes towards antidepressants. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques.

OBJECTIVES

To determine whether relaxation techniques reduce depressive symptoms and improve response/remission.

SEARCH STRATEGY

The register of trials kept by the Cochrane Collaboration Depression, Anxiety and Neurosis Group was searched up to February 2008. We also searched the reference lists of included studies.

SELECTION CRITERIA

Studies were included if they were randomised or quasi-randomised controlled trials of relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) in participants diagnosed with depression or having a high level of depression symptoms. Self-rated and clinician-rated depression scores and response/remission were the primary outcomes.

DATA COLLECTION AND ANALYSIS

Two reviewers selected the trials, assessed the quality and extracted trial and outcome data, with discrepancies resolved by consultation with a third. Trial authors were approached for missing data where possible and missing data were estimated or imputed in some cases. Continuous measures were summarised using standardised mean differences and dichotomous outcomes by risk ratios.

MAIN RESULTS

There were 15 trials with 11 included in the meta-analysis. Five trials showed relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (SMD -0.59 (95% CI -0.94 to -0.24)). For clinician-rated depression, two trials showed a non-significant difference in the same direction (SMD -1.35 (95% CI -3.06 to 0.37)).Nine trials showed relaxation produced less effect than psychological (mainly cognitive-behavioural) treatment on self-reported depression (SMD = 0.38 (95% CI 0.14 to 0.62)). Three trials showed no significant difference between relaxation and psychological treatment on clinician-rated depression at post intervention (SMD 0.29 (95% CI -0.18 to 0.75)).Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments.

AUTHORS' CONCLUSIONS

Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Further research is required to investigate the possibility of relaxation being used as a first-line treatment in a stepped care approach to managing depression, especially in younger populations and populations with subthreshold or first episodes of depression.

The mental health literacy of rural adolescents: Emo subculture and SMS texting

OBJECTIVE

This study sought to explore the mental health literacy of adolescents living in a rural area in Australia through in-depth, semi-structured interviews, with a view to identifying areas for further research and making recommendations for improved education programs around mental health.

METHOD

Nine Year 10 students (two boys and seven girls) from a rural secondary school in South Australia read two vignettes, one portraying depression and the other schizophrenia. Semi-structured individual interviews that focussed on the vignettes were audio-taped, transcribed and analysed for thematic content.

RESULTS

The data yielded a number of main themes, many of which have been previously identified in the literature. Two new findings also emerged. These were the role of Emo subculture and dealing with distress, and the value of confiding in another person through short message service (SMS) texting.

CONCLUSIONS

The impact of Emo subculture and SMS texting on mental health literacy requires further exploration. It is suggested that these two findings are not confined to rural youth, but may have national and international relevance.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

BACKGROUND

Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.

METHODS

To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12-25 years and 2005 of their parents, which included questions about the same strategies.

RESULTS

A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.

CONCLUSION

Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.

Mental Health First Aid: an international programme for early intervention

AIM

To describe the development of the Mental Health First Aid (MHFA) programme in Australia, its roll-out in other countries and evaluation studies which have been carried out.

METHODS

A description of the programme's development and evaluation, its cultural adaptations and its dissemination in seven countries.

RESULTS

The programme was developed in Australia in 2001. By the end of 2007, there were 600 instructors and 55,000 people trained as mental health first aiders. A number of evaluations have been carried out, including two randomized controlled trials that showed changes in knowledge, attitudes and first aid behaviours. Special adaptations of the course have been rolled out for Aboriginal and Torres Strait Islander peoples and some non-English speaking immigrant groups. The course has spread to seven other countries with varying degrees of penetration. In all countries, the programme has been initially supported by government funding. Independent evaluations have been carried out in Scotland and Ireland.

CONCLUSIONS

The concept of first aid by the public for physical health crises is familiar in many countries. This has made it relatively easy to extend this approach to early intervention by members of the public for mental disorders and crises. Through MHFA training, the whole of a community can assist formal mental health services in early intervention for mental disorders.

Improving mental health literacy as a strategy to facilitate early intervention for mental disorders

Good mental health literacy in young people and their key helpers may lead to better outcomes for those with mental disorders, either by facilitating early help-seeking by young people themselves, or by helping adults to identify early signs of mental disorders and seek help on their behalf. Few interventions to improve mental health literacy of young people and their helpers have been evaluated, and even fewer have been well evaluated. There are four categories of interventions to improve mental health literacy: whole-of-community campaigns; community campaigns aimed at a youth audience; school-based interventions teaching help-seeking skills, mental health literacy, or resilience; and programs training individuals to better intervene in a mental health crisis. The effectiveness of future interventions could be enhanced by using specific health promotion models to guide their development.