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Richardson R, Dale HE, Robertson L, Meader N, Wellby G, McMillan D, Churchill R. Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database Syst Rev 2023; 8:CD013127. [PMID: 37606172 PMCID: PMC10444982 DOI: 10.1002/14651858.cd013127.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
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.
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Affiliation(s)
| | - Holly Eve Dale
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | | | | | - George Wellby
- Department of Psychiatry, West London Mental Health NHS Trust, London, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
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Rosenbaum LL, Bhakta S, Wilcox HC, Pas ET, Girgis K, DeVinney A, Hart LM, Murray SM. Cultural Adaptation of the teen Mental Health First Aid (tMHFA) Program from Australia to the USA. SCHOOL MENTAL HEALTH 2023; 15:1-19. [PMID: 37359156 PMCID: PMC10107592 DOI: 10.1007/s12310-023-09576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 06/28/2023]
Abstract
teen Mental Health First Aid (tMHFA) is an evidence-based program developed in Australia that teaches young people in grades 10-12 how to identify and respond to signs of mental health challenges and crises among peers. Recognizing the growing adolescent mental health crisis in the USA, the National Council for Mental Wellbeing, in partnership with a Johns Hopkins University research team, used a multimethod research approach to adapt the program culturally and contextually from Australia to the USA. The goals of the study were to engage adolescents, MHFA instructors, and content area experts (N = 171) in a process to determine: how to retain the elements of the course that were evidence-based and effective while adapting the program for US students, what topics to add so US students have the essential information and skills teens needed to help a friend experiencing a mental health challenge or crisis, what changes to make to curriculum materials to ensure the style and delivery resonate with US students, and what tools to include so the program is implemented safely and with fidelity in diverse US schools. This paper outlines the adaptation process, including engaging participants, identifying key recommendations for modification, and making changes to the tMHFA program. The findings demonstrate the types of adaptations that may be needed to facilitate implementation and maintenance of program effectiveness when introducing tMHFA to new populations of students in the USA. In addition, the process outlined can be replicated toward this purpose as the program continues to expand both in the USA and in other countries.
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Affiliation(s)
- Lacey L. Rosenbaum
- Mental Health First Aid, National Council for Mental Wellbeing, Washington, DC USA
- Mental Health and Resilience Group, Cheverly, MD USA
- International Psychology Department, The Chicago School of Professional Psychology, Washington, DC USA
| | - Sanjana Bhakta
- Mental Health First Aid, National Council for Mental Wellbeing, Washington, DC USA
| | - Holly C. Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Elise T. Pas
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Karen Girgis
- Mental Health First Aid, National Council for Mental Wellbeing, Washington, DC USA
| | - Aubrey DeVinney
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Laura M. Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, Melbourne, Australia
- School of Psychology and Public Health, Le Trobe University, Melbourne, Australia
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Manchanda T, Stein A, Fazel M. Investigating the Role of Friendship Interventions on the Mental Health Outcomes of Adolescents: A Scoping Review of Range and a Systematic Review of Effectiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2160. [PMID: 36767526 PMCID: PMC9915149 DOI: 10.3390/ijerph20032160] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Friendships are crucial in adolescent development. This paper presents a scoping review, followed by a systematic review, to assess friendship interventions and their impacts on the mental health outcomes of adolescents aged 12-24 years. Studies were included if they incorporated a friend or authentic social group in an intervention dedicated to improving mental health outcomes and well-being. Twenty-four studies were included in the scoping review, and eighteen in the systematic review. Data from 12,815 adolescents were analysed; three prominent themes emerged. The most common theme was promoting mental health literacy, followed by supporting help-seeking, and friendship-building/combating isolation. Most evaluations focused on the individual who had received the intervention, rather than their wider friends who would have been potential contacts and experienced any altered interactions. Of the studies focusing on friendship-building, all had positive short-term outcomes but inconclusive long-term effects. Two studies recruited friends from an individual's authentic social group. While opportunities for improving mental health literacy and help-seeking emerged as key themes, the role of friends in mental health interventions has only been included in a small number of studies. Given that friends are a key point of contact for many adolescents, a better understanding of their domains of influence, particularly on mental health, will potentially enhance interventions.
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Brady CM, Childs KK. Implementation and evaluation of a juvenile mental health training for law enforcement in a medium-sized jurisdiction. BEHAVIORAL SCIENCES & THE LAW 2023; 41:1-18. [PMID: 35043489 DOI: 10.1002/bsl.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
The need for specialized training programs that are focused on youth mental health needs, awareness of community-based services, and de-escalation skills is growing across law enforcement agencies due to calls for service that involve youth in mental health crisis. The current study evaluates a juvenile mental health training for law enforcement that was developed based on agency needs. The training was completed by 159 officers and a pre-/post-test design was used. Findings suggest that officers were satisfied with the training and improvements were seen across several training constructs (confidence, preparedness, stigma, resource awareness, and de-escalation skills). Satisfaction with the training predicted change in confidence and preparedness. Recommendations for future research and the implementation of juvenile mental health trainings are discussed.
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Affiliation(s)
- Caitlin M Brady
- Department of Criminal Justice & Criminology, Georgia Southern University, Statesboro, GA, USA
| | - Kristina K Childs
- Department of Criminal Justice, University of Central Florida, Orlando, FL, USA
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Morgan AJ, Wright J, Mackinnon AJ, Reavley NJ, Rossetto A, Jorm AF. Development of the Mental Health Support Scale: A New Measure of Mental Health First Aid Behaviors. Assessment 2022:10731911221106767. [PMID: 35758161 DOI: 10.1177/10731911221106767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental health first aid (MHFA) courses teach community members the knowledge and skills needed to recognize and respond to mental health problems until professional help is received or the crisis resolves. This study aimed to develop a reliable and valid measure of MHFA behaviors. A pool of actions that were recommended and not recommended were selected from MHFA guidelines and developed into two scales measuring either intended or provided support. Items were tested with a sample of 697 adults. Item response theory guided the selection of final items. The Mental Health Support Scale (MHSS) Intended version has 23 items across two subscales and the MHSS-Provided has 12 items across two subscales. These scales demonstrated convergent validity, discrimination between respondents with and without MHFA expertise, and acceptable measurement precision across a range of skill levels. Overall, findings suggest that the MHSS is a valid and useful measure of MHFA behaviors.
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Affiliation(s)
- Amy J Morgan
- The University of Melbourne, Victoria, Australia
| | | | | | | | - Alyssia Rossetto
- The University of Melbourne, Victoria, Australia.,Mental Health First Aid Australia, Parkville, Victoria, Australia
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Forthal S, Sadowska K, Pike KM, Balachander M, Jacobsson K, Hermosilla S. Mental Health First Aid: A Systematic Review of Trainee Behavior and Recipient Mental Health Outcomes. Psychiatr Serv 2022; 73:439-446. [PMID: 34346736 PMCID: PMC8814050 DOI: 10.1176/appi.ps.202100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental Health First Aid (MHFA) is a globally disseminated course that trains members of the public to recognize and respond to mental health issues in their communities. Although substantial evidence suggests that MHFA training is associated with positive changes in knowledge, attitudes, and behavioral intent, little is known about how MHFA trainee-delivered aid supports mental health needs. This systematic review sought to summarize the extant research evaluating MHFA trainees' helping behaviors and the impacts of these behaviors on people experiencing a mental health problem (i.e., recipients). METHODS Electronic databases were searched for MHFA evaluations published before or on March 9, 2021. Studies that evaluated at least one outcome related to trainee helping behavior or recipient mental health were included in the synthesis. Outcomes were organized into three categories: trainee use of MHFA skills, helpfulness of trainees' actions, and recipients' mental health. Only studies that compared pre- and posttraining outcomes, included a control group, and directly evaluated MHFA were used to assess its efficacy. RESULTS The search identified 31 studies, nine of which met criteria to assess MHFA efficacy. The findings of the nine studies indicated that MHFA had mixed effects on trainees using the skills taught in the course and no effects on the helpfulness of trainees' actions or on recipient mental health. CONCLUSIONS The findings indicate that there is insufficient current evidence that MHFA improves the helping behaviors of trainees or the mental health of those receiving helping behaviors. They highlight a crucial research gap that should be prioritized as MHFA continues to grow in popularity.
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Affiliation(s)
- Sarah Forthal
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
| | - Karolina Sadowska
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
| | - Kathleen M Pike
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
| | - Manya Balachander
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
| | - Kristina Jacobsson
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
| | - Sabrina Hermosilla
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York City (Forthal, Sadowska, Pike, Balachander, Jacobsson); Institute for Social Research, University of Michigan, Ann Arbor (Hermosilla)
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Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology - mixed methods evaluation of RCT. BMC Public Health 2022; 22:297. [PMID: 35164721 PMCID: PMC8842894 DOI: 10.1186/s12889-022-12581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents. METHODS Two three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second. In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions. In the parental arm, in addition to the 'Favoring-Myself-Young's ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via "Favoring Myself" smartphone application. Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire. RESULTS Feasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application. The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm. CONCLUSIONS Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm. TRIAL REGISTRATIONS NCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).
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Kusaka S, Yamaguchi S, Foo JC, Togo F, Sasaki T. Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review. Front Psychiatry 2022; 13:816508. [PMID: 35586407 PMCID: PMC9108239 DOI: 10.3389/fpsyt.2022.816508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents. METHODS PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies. RESULTS Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others. CONCLUSIONS A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.
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Affiliation(s)
- Sakurako Kusaka
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Satoshi Yamaguchi
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Jerome Clifford Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fumiharu Togo
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
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