Beyond Silence: A Randomized, Parallel-Group Trial Exploring the Impact of Workplace Mental Health Literacy Training with Healthcare Employees

The effect of an in-service training programme on mental health literacy of family physicians

Mental health literacy is defined as 'information that helps to recognise, manage or prevent mental disorders' and is of significant importance within health services. The present study aims to evaluate the effect of MHSSP (Mental Health Services Strengthening Program) training on mental health literacy in family physicians working in primary care. A total of 689 people participated in the study. Of these, 274 (39.85%) had received MHSSP training, while 415 (60.2%) had not received in-service mental health training. The Mental Health Literacy Scale and the Mental Health Knowledge Questionnaire were administered online to all participants. Scores on the mental health knowledge questionnaire and mental health literacy scales were significantly higher for physicians with MHSSP training. The findings of this study support the notion that mental health literacy should be considered a significant concept in both society and among health professionals, with the potential for any activity aimed at enhancing mental health literacy having a favourable impact on health services.

Mental health first aid training and assessment for healthcare professionals and medical nursing students: a systematic review

PURPOSE

To summarize the effect of mental health first aid (MHFA) on paramedics and medical nursing students and provide direction to future training and research.

METHODS

Seven databases, including Web of Science, PubMed, Embase, Cochrane, China Knowledge, Wanfang, and China Biomedical Literature Database, were searched for relevant studies from database establishment up to January 31, 2023. The Cochrane risk of bias tool was used to assess the quality of randomized controlled trials, qualitative studies, and single-armed trials on the basis of the literature evaluation criteria developed by the JBI Center for Evidence-Based Healthcare in Australia. Mixed-sex studies were assessed by using the mixed-methods assessment tool (MMAT 2018).

RESULTS

The review identified 11 studies that met the criteria, most of which reported on the effects of MHFA training in terms of mental health literacy (referred to as MHL), MHFA intentions and confidence, stigma, and changes in social distance. A few studies analyzed the strengths and weaknesses of MHFA training courses, motivation to complete MHFA, barriers and facilitators to MHFA training, and participants' perceptions of implementing MHFA training.

CONCLUSIONS

The MHFA curriculum is practical for healthcare workers and medical nursing students. In the future, a standardized training program based on the population characteristics of healthcare workers and medical nursing students must be developed to standardize the measurement of outcome indicators to reflect the effectiveness of implementing the MHFA training curriculum. Our study has been registered to PROSPERO under registration number CRD42024519793.

Sticky interventions for a sticky problem: A systematic review of recent workplace mental health stigma reduction interventions with implications for training transfer

INTRODUCTION

Organizations are increasingly turning their attention to managing the stigma associated with mental health conditions. Most interventions tend to be training-based; however, research on mental health stigma reduction has not adopted theories and concepts from health and safety training literature to evaluate how effective these interventions are, and what training design and delivery features result in better training transfer.

METHOD

To fill this gap and develop a strategic agenda for future research, we undertook a systematic qualitative literature review of 27 articles (including both published and unpublished studies), as well as some high-quality grey literature. We applied a health and safety training transfer model and used descriptive and thematic analyses to critically appraise the articles reviewed.

RESULTS

Our analysis highlighted how existing studies focus on short-term learning outcomes (i.e., changes in knowledge, skills, and attitudes) without considering the actual experience of the training (i.e., training engagement) and long-term outcomes (i.e., training transfer). Although most reviewed studies considered training design (e.g., trainer credibility) and delivery factors (e.g., online vs. face to face), the consideration of pre-training factors was absent.

CONCLUSIONS AND PRACTICAL APPLICATIONS

Avenues for future research such as exploring ways to boost behavioral change following stigma training, and practical implications to boost transfer of stigma reduction trainings, mapped against the training transfer framework, are also explored.

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis

AIM

To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs.

DATA SOURCES

Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot.

RESULTS

Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches.

CONCLUSION

Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial

BACKGROUND

Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs.

OBJECTIVE

This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months.

METHODS

A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress.

RESULTS

Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024.

CONCLUSIONS

If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/55529.

The Effectiveness of Interventions on Improving the Mental Health Literacy of Health Care Professionals in General Hospitals: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Suboptimal mental health literacy levels among general hospital health care professionals negatively impact the care coordination of patients with physical-mental comorbidity.

AIMS

This review is to examine the evidence on the effectiveness of interventions to improve the mental health literacy of general hospital health care professionals.

METHODS

A systematic search of literature was conducted in 13 electronic databases with manual searching of reference lists from 1980 to 2021. Studies were screened by pre-set eligibility criteria, that is, participants who were general hospital health care professionals taking care of adult patients, the interventions aimed at improving any components of participants' mental health literacy, comparisons were alternative active intervention or no intervention, and the primary outcomes were any aspects of mental health literacy.

RESULTS

Eight randomized controlled trials (N = 1,732 participants) were included in this review. Evidence indicated that mental health literacy interventions with educational components can improve components of the health care professionals' mental health literacy, in terms of mental health knowledge and mental illness-related attitudes/stigma. In addition, few studies evaluated all components of participants' mental health literacy.

CONCLUSIONS

Based on the available evidence, educational interventions had a positive effect on components of general hospital health care professionals' mental health literacy. Health care organizations should provide educational programs to enhance general hospital health care professionals' mental health literacy. Further studies are needed to explore interventions that target all components of general hospital staff's mental health literacy and to evaluate its impact on the psychiatric consultation-liaison service utilization in general hospitals, as well as patient outcomes.

Addressing Health Care Workers' Mental Health: A Systematic Review of Evidence-Based Interventions and Current Resources

Background. Mental health is declining in health care workers. Objectives. To provide a comprehensive assessment of intervention literature focused on the support and treatment of mental health within the health care workforce. Search Methods. We searched online databases (e.g., Medline, PsycINFO). Selection Criteria. We selected manuscripts published before March 2022 that evaluated the target population (e.g., nurses), mental health outcomes (e.g., burnout, depression), and intervention category (e.g., mindfulness). Data Collection and Analysis. Of 5158 publications screened, 118 interventions were included. We extracted relevant statistics and information. Main Results. Twenty (17%) earned study quality ratings indicating design, analysis, and implementation strengths. Randomized controlled trials were used by 52 studies (44%). Thirty-eight percent were conducted in the United States (n = 45). Ninety (76%) reported significant changes, and 46 (39%) reported measurable effect sizes. Multiple interventions significantly reduced stress (n = 29; 24%), anxiety (n = 20; 17%), emotional exhaustion or compassion fatigue (n = 16; 14%), burnout (n = 15; 13%), and depression (n = 15; 13%). Authors' Conclusions. Targeted, well-designed mental health interventions can improve outcomes among health care workers. Public Health Implications. Targeted health care‒focused interventions to address workers' mental health could improve outcomes within this important and vulnerable workforce. (Am J Public Health. 2024;114(S2):S213-S226. https://doi.org/10.2105/AJPH.2023.307556).

Mobilising strategic alliances with community organisations to address work-related mental injury: a qualitative study guided by collaboration theory

BACKGROUND

A critical policy issue in Australia and worldwide is the escalating rates of work-related mental injury that have been linked to the lack of help-seeking behaviours of at-risk workers. Strategic alliances between community organisations, statutory bodies, and mental health service providers could expand the efficacy and reach of mental health literacy and peer support initiatives that can encourage help-seeking, however, there is limited evidence to support the development of such approaches. This study used a qualitative design based on collaboration theory to explore the factors influencing community organisation leaders' decisions to provide such initiatives through collaboration with relevant third parties.

METHODS

Repositories of submissions into mental health reviews and publicly available registers in Australia were used to identify twenty-two participant organisations (n = 22), which were categorised according to the International Classification of Non-Profit Organisations (Culture & Recreation, Social Services, and Development & Housing). Eleven of these organisations demonstrated an interest in collaborating with third parties and extending efforts to deliver work-related mental health initiatives through contributions to mental health reviews. Leaders were interviewed to understand differences in perspectives on potential collaborations.

RESULTS

Organisations that did not make submissions were reluctant to engage in such efforts due to limitations in expertise/capacity, and perceived mission misalignment. Third-party support from statutory bodies and mental health service providers addressing these perceived limitations may improve their confidence, and willingness to engage. Regardless of their category, all considered the benefit of such collaboration included improving the acceptability, approachability, availability, and efficacy of work-related mental health initiatives. Equity was seen as supporting decision-making/leadership, while power imbalance was a barrier. Third-party contributions that could facilitate collaboration included expert support/credibility, administration, formal structures, supportive policy, and joining networks, however, red tape was a challenge. Shared values, vision, practice, and networking were identified as supporting positive communication and interpersonal relations.

CONCLUSION

The study establishes that, adequately supported and resourced, community organisations are willing to align strategically with statutory bodies and mental health service providers to use their unique position in the community to deliver work-related mental health literacy and peer support programmes for at-risk workers to improve help-seeking behaviours.

Augmenting mental health literacy of troops in a large military station: A novel approach

Background

Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops.

Materials and Methods

1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months.

Results

Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months.

Conclusions

Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

Mental Health First Aid as a tool for improving mental health and well-being

BACKGROUND

The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations.

OBJECTIVES

To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered.

SEARCH METHODS

We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries (ClinicalTrials.gov and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023.

SELECTION CRITERIA

We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months.

AUTHORS' CONCLUSIONS

We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.

Interventions to reduce the stigma of mental health at work: a narrative review

BACKGROUND

While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace.

OBJECTIVE

We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work.

METHOD

The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health.

RESULTS

These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date.

DISCUSSION AND CONCLUSION

Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review

OBJECTIVES

Increasing access to mental health support is a key factor for treating mental disorders, however, important barriers complicate help-seeking, among them, mental health related stigma being most prominent. We aimed to systematically review the current evidence for interventions focusing on reducing stigma related to mental health problems in small and medium enterprises (SMEs).

DESIGN

Systematic review with a focus on interventions targeting mental health related stigma in the workplace in accordance with PRISMA guidelines. The methodological quality of included articles was assessed using the Quality Assessment Tool for Quantitative Studies Scale.

DATA SOURCES

PubMed, Ovid Medline, PsycINFO, Scopus, and Cochrane databases and Google Scholar were searched from January 2010 until November 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included experimental or quasi-experimental studies about workplace interventions aiming to reduce stigma, where the outcomes were measured in terms of stigmatisation against depression, anxiety and/or other mental health problems.

DATA EXTRACTION AND SYNTHESIS

Records were screened by two independent reviewers after inspecting titles and abstracts and a full-text read of the articles to assess whether they meet inclusion criteria. The results were synthesised narratively.

RESULTS

We identified 22 intervention studies, 3 with high quality, 13 with moderate quality and 6 with weak quality. Only 2 studies included SMEs, but no study focused on SMEs exclusively . The mode of delivery of the intervention was face to face in 15 studies, online in 4 studies and mixed in 3 studies. We found a significant reduction in stigmatising attitudes in almost all studies (20/22), using 10 different instruments/scales. Effects seemed to be independent of company size. Online interventions were found to be shorter, but seemed to be as effective as face-to-face interventions.

CONCLUSIONS

Although we did not find interventions focusing exclusively on SMEs, it is likely that antistigma interventions also will work in smaller workplaces.

TRIAL REGISTRATION

PROSPERO: ID: CRD42020191307.

Factors Related to Mental Health of Foreign Care Workers in Long-Term Care Facilities in Japan during the COVID-19 Pandemic-A Comparative Study

This study aimed to evaluate the factors related to the mental health of foreign care workers in Japan's long-term care (LTC) facilities and compare their results with those of native care workers. We conducted a cross-sectional survey covering 80 LTC facilities across Japan between August and November 2021. The survey mainly included mental health, workload, reward, sense of coherence, loneliness, COVID-19-specific factors and sociodemographic variables. The results show that workload was a distinct feature associated with the mental health of foreign care workers (n = 172) when compared with those of native care workers (n = 154). In addition, we found that the relationship between cultural adaptation and mental health in a sample of foreign care workers was mediated by loneliness and sense of coherence (SOC). Finally, we found that reward, loneliness, SOC, and COVID-19-specific factors had significant impacts on the mental health of both foreign and native care workers. These findings highlight the importance of support measures from the workplace for foreign care workers. Workplace interventions that focus on workload, reward, and sense of coherence strategies are required to address mental health improvement and may still be of value in dealing with the continuing COVID-19 pandemic.

Psychological needs of critical care staff and barriers to accessing support: A qualitative study

Worldwide, critical care staff are vulnerable to mental health difficulties. Support is varied and uptake is minimal.Therefore, barriers need to be understood in order to be addressed; doing so may improve staff's mental health, resulting in positive consequences. This qualitative research took place between September 2020–November 2020 at a National Health Service critical care unit in England. Participants were critical care staff (n = 9). Data were collected through semistructured interviews and analyzed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used to report the findings, with analysis resulting in six themes: support is the team together in the moment, keeping work‐related difficulties from the forefront of the mind, it's just part of the job, stigma makes it hard to speak up about psychological difficulties, normalizing psychological support, and desire for psychological support within critical care. Psychologist presence in critical care, as well as further options for support, may help to reduce barriers and improve staff mental health. Further research is needed to evaluate staff outcomes across multiple sites to refine understanding and interventional approach.

Becoming peer educators in workplace mental health: Qualitative exploration of challenges and opportunities

BACKGROUND: Peer-led workplace mental health training programs informed by the principles of contact-based education have shown promising results, but research evidence largely focuses on measuring outcomes for service recipients with little attention to the experiences of peer educators in delivering these interventions. OBJECTIVE: To gain in-depth knowledge about the opportunities and challenges experienced peer educators recruited to lead a mental health literacy training program for healthcare workers. METHODS: An interpretive description approach was used to explore the experiences of peer educators in providing a structured two-day “Beyond Silence” workplace mental health training program. Peer educators were healthcare workers with personal mental health experience, who completed an additional leadership training. Semi-structured telephone interviews were conducted with seven peer educators. Data collection and analysis was concurrent and iterative, employing inductive analysis. RESULTS: Four overarching themes captured the key opportunities and challenges faced by peer educators: 1) the art and science of providing mental health literacy training, 2) power of personal stories, 3) competence as a journey or a destination and 4) the dual role of educator and advocate. CONCLUSIONS: Recommendations are provided for recruitment, training, and support for peer educators. Future research could focus on longitudinal evaluation of engagement and sustainability of peer educators in this role.

The Effectiveness of Mental Health Literacy Curriculum among Undergraduate Public Health Students

Mental health literacy (MHL) plays an important role in public health. Improving MHL can promote mental health at the individual and public levels. To date, no published studies have assessed the effectiveness of MHL curriculum interventions among undergraduate public health students. The participants in this study were undergraduate public health students (n = 48) who were enrolled in an 18-week MHL curriculum for 100 min per week. MHL was assessed using the Mental Health Literacy Scale for Healthcare Students. A paired sample t-test was performed to examine the immediate and delayed effects of the MHL curriculum. The total MHL score significantly improved, and a moderate effect size was found directly after the intervention and six weeks later. There were significant differences in the recognition of mental illness (p < 0.01), help-seeking efficacy (p < 0.05), and help-seeking attitude (p < 0.05) in the five components of MHL between pre- and post-test. Furthermore, significant improvements were obtained for the maintenance of positive mental health (p < 0.05) and reduction of mental illness stigma (p < 0.001) between the pre-test and follow-up. Our findings provide evidence for the development and implementation of an MHL curriculum for public health education.

Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour

OBJECTIVES

Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours.

DESIGN

This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker's intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them.

SETTING

This study took place within three large white-collar organisations in the Australian state of Victoria.

PARTICIPANTS

Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach.

RESULTS

Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers.

CONCLUSIONS

Identifying workers' beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study

BACKGROUND

Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention.

METHODS

The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects.

DISCUSSION

This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile.

CLINICAL TRIAL REGISTRATION

[www.ClinicalTrials.gov], identifier [NCT05578066].

Effects of online stigma-reduction programme for people experiencing mental health conditions: A systematic review and meta-analysis

Despite the increased awareness of mental health-related issues, people experiencing mental health conditions have continued to face stigmatization worldwide. The literature on help-seeking behaviours has frequently highlighted the development of self-stigma because of public stigma and emphasized the need to address public stigmatization faced by them. Given the increasing acceptance of digital services in recent years, this systematic review aimed to examine the effects of online and face-to-face anti-stigma interventions in reducing public stigma towards people experiencing mental health conditions. A search was conducted on the Cochrane Library, CINAHL, PubMed, Embase, PsycInfo, and ProQuest from inception of the databases to October 2020. Studies were included in this review if they have explored: (i) public stigmatization towards people of all ages with different types of mental health conditions; (ii) online interventions; and (iii) face-to-face interventions. Nine studies were included in this review, of which only five were included in the meta-analysis as the remaining four had incomplete data. The meta-analysis included an aggregate of 1203 participants while the four excluded studies included 713 participants. Results revealed that online interventions performed favourably with small effect sizes in comparison to face-to-face, wait-list control, and no-intervention groups. Results from the studies excluded from the meta-analysis also found a significant reduction of public stigmatization with online interventions. Such findings provide insightful evidence for the effectiveness of online interventions in reducing public stigmatization. Hence, mental health organizations and groups can consider adopting online interventions suitable for their target audience and type of mental health conditions.

Corporate Application of Health Literacy

BACKGROUND

The growing concern of low health literacy in populations combined with the interest of companies to develop cultures of health and the emerging interest in the workplace as an arena for improving health literacy is increasingly acknowledged. This study aimed to explore how companies currently apply the concept of health literacy as part of their health efforts in the work sphere.

METHODS

A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. The search was performed in the databases PubMed, Science Direct, and Directory of Open Access Journals from July 2019 to August 2019 and included the search terms "health literacy," "health literate," and "health competence" combined with the search terms "company/companies," "corporation/corporates," "workplace," "business," and "organization." Studies were eligible for inclusion if they (1) were written in English or German, (2) were concerned with employers/employees, companies, corporations, or organizations, (3) dealt with health literacy in particular, and (4) were formatted as journal articles, systematic literature reviews, or book chapters.

KEY RESULTS

The search identified 20 articles. A thematic analysis resulted in 5 clusters with 2 to 3 sub-themes illustrating the characteristics of how corporations apply health literacy. The clusters entailed the conceptualization of health literacy, its measurement, and the application of health literacy in strategies, interventions, and training.

DISCUSSION

The literature review reveals that the application of health literacy by companies is in its infancy. More research and practical experience are warranted on how companies can mobilize and facilitate a health literate workforce. [HLRP: Health Literacy Research and Practice. 2021;5(3):e218-e225.] Plain Language Summary: This literature study explored the role of advancing health literacy in companies. Five aspects were identified as important, including the understanding of the concept, its measurement, and its integration into strategies, interventions, and training. The involvement of management and the staff was crucial for success.

The Impact of Mental Health Literacy Training Programs on the Mental Health Literacy of University Students: a Systematic Review

Student mental health is of growing concern for the university education sector. Supporting opportunities to increase mental health literacy of students is one strategy in which universities and colleges are actively investing to support students build their capacity to be well. This study is a systematic review of mental health literacy training (MHLT) programs, other than Mental Health First Aid training, to examine their impact on the mental health literacy of university students. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Online Resource 1) and A Measurement Tool to Assess Systematic Reviews (AMSTAR2) guidelines. Search terms related to mental health literacy concepts, mental health literacy training and university students were used in four major databases (i.e. EBSCOhost, Ovid, ProQuest and Web of Science), retrieving a total of 1219 articles, with 44 studies selected for full-text review, and a final number of 24 studies included for review based on pre-determined eligibility criteria. Results were reported against three main themes: types of MHLT offered; common practices, processes and implementation elements; and effectiveness of intervention. Results indicate a high level of variability in approaches to mental health literacy interventions and measures of assessment and reporting. Additionally, reported benefits to mental health literacy failed to report on comparable units of improvement or the sustainability of benefits. Although it is in the best interest of universities to prioritise early intervention programs to address mental health and improve wellbeing, more robust data is required to establish the effectiveness of MHLT programs in achieving this aim.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c)

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.

Implementing practices focused on workplace health and psychological wellbeing: A systematic review

RATIONALE

Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

OBJECTIVE

We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development.

METHODS

We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies).

RESULTS

Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance.

CONCLUSIONS

The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].

Predictors of Psychological Distress and Mental Health Resource Utilization among Employees in Malaysia

We sought to examine predictors of psychological distress among employees as well as the level of awareness and usage of available mental health resources by employees through their own organizations. The Malaysian Healthiest Workplace survey cross-sectional dataset was used to explore the association between psychological distress, a range of health conditions, as well as mental health resource awareness and usage in a sample of 11,356 working Malaysian adults. A multivariate logistic regression was conducted to determine predictors of high psychological distress. Comorbid illnesses that were associated with psychological distress were mental illness (OR 6.7, 95% CI 4.39-10.14, p = 0.001), heart conditions (OR 2.17, 95% CI 1.18-3.99, p = 0.012), migraines (OR 1.59, 95% CI 1.33-1.90, p = 0.001), bronchial asthma (OR 1.43, 95% CI 1.11-1.85, p = 0.006), and hypertension (OR 1.42, 95% CI 1.07-1.88, p = 0.016) compared to individuals with no comorbid conditions. A total of 14 out of 17 comorbid medical illnesses were associated with elevated levels of psychological distress among employees. Awareness and usage of support services and resources for mental health were associated with lower psychological distress. These findings extend the literature by providing further evidence on the link between chronic illness, occupational type, as well as awareness and use of mental health resources by psychological distress status.

Nurses' Attitudes Toward Psychiatric Help for Depression: The Serial Mediation Effect of Self-Stigma and Depression on Public Stigma and Attitudes Toward Psychiatric Help

This study aimed to examine the mediating effects of self-stigma and depression on the public stigma and nurses’ attitudes toward psychiatric help. A cross-sectional study with 184 nurses at one general hospital in South Korea was conducted employing a self-administered survey, using the Attitudes toward Seeking Psychological Help Scale, the Beck Depression Inventory-II Scale, and the modified Depression Stigma Scale. A multiple-mediation analysis procedure was applied to analyze the data. Each indirect effect of self-stigma (B = −0.0974, bootLLCI, bootULCI: −0.1742, −0.0436) and depression (B = −0.0471, bootLLCI, bootULCI: −0.1014, −0.0060) is statistically significant in the relationship between public stigma and attitudes toward psychiatric help. The individualized intervention for enhancing positive attitude or motivation for seeking help at the personal level of the nurse and depression tests—including regular physical health check-ups—is necessary.

Making the World of Difference: a service user-led education programme reshaping the learning environment in psychiatry

OBJECTIVE

To describe the implementation of a service user-led learning programme implemented within the education of undergraduate medical students and psychiatric registrars.

CONCLUSION

This programme has the potential to impact on the learning of those early in their medical career and future consultant psychiatrists. Ongoing research will help to explain the reach and depth of the programme and the elements of greatest benefit.

Psychische Gesundheitskompetenz am Arbeitsplatz

Zusammenfassung. Das Mental Health Literacy tool for the Workplace (MHL-W; Moll, Zanhour, Patten, Stuart & MacDermid, 2017 ) ist ein vignettenbasiertes Instrument mit 16 Items zur Messung psychischer Gesundheitskompetenz im Arbeitskontext. Nach der Übersetzung ins Deutsche sowie einer Anpassung der Vignetten anhand einer qualitativen Expertenbefragung, wurde das MHL-W-G an zwei deutschsprachigen Stichproben mit 122 Studierenden sowie 317 Berufstätigen hinsichtlich Reliabilität, Konstruktvalidität, Messinvarianz, Geschlechtereffekte und Faktorstruktur analysiert. Erstmalig wurde die Faktorenstruktur (EFA/CFA) des MHL-W-G untersucht: Im Gegensatz zu dem von Moll et al. (2017) ursprünglich angenommenen einfaktoriellen Modell zeigte ein Modell zweiter Ordnung eine deutlich bessere Passung. Weiterführende Analysen ergaben gute interne Konsistenzen und Intraklassenkorrelationen. Die Ergebnisse deuten auf Messinvarianz des MHL-W-G unabhängig vom Geschlecht hin. Insgesamt lassen die psychometrischen Eigenschaften den Schluss zu, dass mithilfe des MHL-W-G psychische Gesundheitskompetenz am Arbeitsplatz reliabel und valide erfasst werden kann.

A multi-faceted community intervention is associated with knowledge and standards of workplace mental health: the Superior Mental Wellness @ Work study

BACKGROUND

Poor psychosocial work environments, such as those with low psychological support and high demands, can be harmful to the mental health of workers. In Canada, the National Standard for Psychological Health and Safety in the Workplace (the Standard) provides a comprehensive framework for organizations to identify hazards that may contribute to the psychological harm of employees. This study examines the association between a multi-faceted community intervention, the Superior Mental Wellness @ Work program designed to increase awareness of mental health and the National Standard, and outcomes assessing increased awareness and response to the Standard. These outcomes included the 1) prioritization of workplace mental health; 2) familiarity with the Standard; and 3) knowledge of mental health.

METHODS

A quasi-experimental design was used to assess the associations of interest. Surveys were sent to two random samples of employer representatives pre-and post-intervention. Intervention participants were also compared to non-participants at the post-intervention stage. T-tests and chi-square tests were used to compare differences between pre- and post-intervention outcomes and also between intervention participants and non-participants identified at the post-intervention survey.

RESULTS

The multi-faceted community intervention was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. When comparing those companies who participated in the intervention versus those who did not, participants were more likely to prioritize mental health in the workplace. Participants reported a greater need for support to address workplace mental health, poorer perceived mental health of employees, and greater stigma than non-participants. However, participants were more likely to be familiar with the Standard, have an action plan to implement the Standard, and be prepared to champion mental health in the workplace. Participants also had greater knowledge of workplace mental health in general compared to non-participants.

CONCLUSIONS

The multi-faceted community intervention, the Superior Mental Wellness @ Work project, was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. Such a multi-faceted intervention has the capacity to improve mental health literacy and awareness of the Standard.