The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students

Memorable Messages About Mental Health Among International Students in the United States: A Mixed-Method Study

This study investigated the memorable messages about mental health that international students (N = 199) received from various sources since arriving on campus in the U.S. Utilizing the memorable messages framework, we examined the types of messages (normalizing, strategizing, minimizing) they received and their association with message satisfaction, mental health stigma, and attitude toward help-seeking. The most frequently recalled messages were normalizing messages (49.2%), followed by strategizing messages (31.7%), and minimizing messages (9.5%). Participants who recalled normalizing and strategizing messages reported higher satisfaction and a more favorable attitude toward help-seeking compared to those who recalled minimizing messages. These findings offer theoretical implications for memorable messages and immigrant populations, as well as practical implications for campaign messaging and design. These results can guide university officials in tailoring their efforts to meet the mental health needs of this vulnerable population.

Undergraduate students with and without mental health concerns have different perceptions of disclosing mental health challenges to instructors

Many undergraduates report having mental health concerns (MHC), which can reduce academic success. Students with MHC are encouraged to seek help from their instructors but may not because of perceived negative reactions by instructors and peers. This suggests stigma about MHC may differentially impact help-seeking between students with and without MHC, yet disclosure perceptions between these groups have not been investigated. This study surveyed students with and without MHC in the same classes about their hypothetical disclosure of MHC. Students in several introductory biology classes were asked whether they identified as having MHC, whether they would or would not hypothetically disclose MHC to an instructor, and why. Thematic analysis identified reasons underlying student disclosure choices, which were sorted into the three beliefs of the Theory of Planned Behavior: attitudes, subjective norms, and behavioral control. Of the 803 respondents, 50% self-identified as having MHC. Students with MHC were less likely to hypothetically disclose their MHC to an instructor than students without MHC. Students with and without MHC who said they would disclose gave similar reasons aligned with attitude beliefs. Students with MHC who said they would not disclose perceived that the instructor wouldn't care (attitude beliefs). Students without MHC who would not disclose were concerned about keeping their MHC private (subjective norms beliefs). Students without MHC who said 'it depends' indicated more concerns about impact on their course performance (attitude) than students with MHC. This research found different perceptions of disclosure between students with and without MHC in these courses and suggested that students with MHC focus more on negative instructor reactions, while those without MHC focus on privacy and performance. These different perceptions may contribute to students with MHC perceiving disclosure as a negative social cost versus a positive academic benefit.

[Factors influencing the levels of fear regarding psychotherapy in adolescents with depression]

OBJECTIVES

To investigate the factors influencing the levels of fear regarding psychotherapy in adolescents with depression.

METHODS

A prospective study was conducted among 258 adolescents with depression who were treated in the outpatient service and inpatient department of the First Affiliated Hospital of Nanchang University from September 2023 to March 2024. A questionnaire survey was performed. The questionnaires used included General Information Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Self-Compassion Scale, Self-Concealment Scale, Depression Self-Stigma Scale, and Thoughts About Psychotherapy Survey. The factors influencing the levels of fear regarding psychotherapy were analyzed among the adolescents with depression.

RESULTS

The levels of fear regarding psychotherapy in the adolescents with depression were positively associated with the scores on the Patient Health Questionnaire-9, Self-Concealment Scale, and Depression Self-Stigma Scale (P<0.05), and were negatively associated with the score on the Self-Compassion Scale (P<0.05). Concerns about therapist responsiveness were negatively associated with the score on the Self-Compassion Scale (P<0.05), and were positively associated with the scores on the Generalized Anxiety Disorder-7 and Depression Self-Stigma Scale (P<0.05). The adolescents from one-child families had significantly higher levels of concerns about therapist responsiveness than those from non-one-child families (P<0.05). The levels of image concerns were positively associated with the scores on Patient Health Questionnaire-9, Self-Concealment Scale, and Depression Self-Stigma Scale (P<0.05); the levels of coercion concerns were positively associated with the scores of the Patient Health Questionnaire-9 and Self-Concealment Scale (P<0.05) and were negatively associated with the score on the Self-Compassion Scale (P<0.05). Middle school students had a significantly higher risk of coercion concerns than university students (P<0.05).

CONCLUSIONS

In adolescents with depression, the levels of fear regarding psychotherapy are associated with educational levels, only-child status, depression symptoms, anxiety symptoms, self-compassion, self-concealment, and depression self-stigma.

Perceived stigma, mental health, and campus support among Latina/o and White college students

Objective: College campuses can play a pivotal role in promoting mental health awareness and reducing stigma among college students. This study examines the effect of Latina/o and White students' mental health on their perceived self stigma and public stigma and the moderating role of college and university campuses' support toward perceived stigma. Participants: Survey responses of 51,821 Latina/o and White college students were examined. Method: Hierarchical regression analyses were conducted between anxiety/depressive symptoms, supportive campuses, and students' perceived self/public stigma. Results: Findings reveal that Latina/o students have statistically significantly lower perceived self/public stigma and higher anxiety/depressive symptoms than White students. Regression results show that campus support moderates the association between anxiety/depressive symptoms on perceived self stigma for White but not Latina/o students. Conclusion: Campuses need to identify ways to provide Latina/o students with more mental health awareness and support.

The help-seeking process and predictors of mental health care use among individuals with depressive symptoms: a machine learning approach

Purpose

The goal of the study was to identify the most important influences on professional healthcare use of people with depressive symptoms. We incorporated findings from research areas of health behaviors, stigma, and motivation to predict the help-seeking process variables from a wide range of personal factors and attitudes.

Methods

A sample of 1,368 adults with untreated depressive symptoms participated in an online survey with three-and six-month follow-ups. We conducted multiple linear regressions for (a) help-seeking attitudes, and (b) help-seeking intentions, and logistic regression for (c) help-seeking behavior with machine learning methods.

Results

While self-stigma and treatment experience are important influences on help-seeking attitudes, complaint perception is relevant for intention. The best predictor for healthcare use remains the intention. Along the help-seeking process, we detected a shift of relevant factors from broader perceptions of mental illness and help-seeking to concrete suffering, i.e., subjective symptom perception.

Conclusion

The results suggest a spectrum of influencing factors ranging from personal, self-determined factors to socially normalized factors. We discuss social influences on professional help-seeking and the use of combined public health programs and tailored help-seeking interventions.

Clinical trial registration

German Clinical Trials Register (https://drks.de/search/en): Identifier DRKS00023557.

"This Is Me" an Awareness-Raising and Anti-Stigma Program for Undergraduate Nursing Students: A Pre-Post Intervention Study

BACKGROUND

Stigma education for nursing students has focused solely on stigma reduction, with studies showing temporary improvements in attitudes. However, nursing education research should also emphasize the importance of critical reflection and self-reflection to enhance attitudes, beliefs, topic comprehension, and learning satisfaction. This study aimed to evaluate the effectiveness of the "This is me" intervention regarding knowledge, attitudes, and communication skills of senior undergraduate nursing students in responding to mental illness-related stigma.

METHODS

This study employed a psychoeducational intervention for reducing mental illness stigma, using a questionnaire survey to assess pre- and post-intervention effects, with 37 eligible nursing students undergoing clinical training in psychiatric services between 16 May and 15 July 2022. Instruments included sociodemographic and health questions, the MICA-4 scale to evaluate students' attitudes toward mental illness, the MAKS to measure mental health knowledge, the Empathy Scale (JSPE-S), the Intergroup Anxiety Scale (SS-12), and the Attribution Questionnaire (AQ-27).

RESULTS

Most students were female (73.0%) and single (70.3%), with a mean age of around 29 years. After implementing the psychoeducational program, there was a statistically significant increase in overall stigma-related knowledge (MAKS: Z = -1.99, p < 0.05), a decrease in intergroup anxiety (IAS: Z = -3.42, p < 0.05), and reductions in the perceptions of patients as dangerous (AQ27-Dangerousness: Z = -2.399, p < 0.05) and fear (AQ27-Fear: Z = -2.415, p < 0.05). Additionally, there was an improvement in empathy, specifically in Perspective Taking (JSPE: Z = -2.555, p < 0.05).

CONCLUSIONS

This program may contribute to mental health literacy related to stigma, positively impacting therapeutic relationships and communication with people with mental illness and resulting in more effective care practices.

Examining bystander intervention for peer depression and sociodemographic correlates among university students in Singapore

Introduction

The Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) study evaluated the impact of an intervention developed and implemented in Singapore on attitudes towards depression in university students. We aimed to assess the likelihood of university students intervening when their peers suffer from depression, before and after the ARTEMIS intervention.

Methods

390 students were recruited from a university in Singapore. The ARTEMIS intervention comprised a lecture by a trained mental health professional, a sharing session by a person with lived experience of depression, and a question-and-answer segment with a panel. The Bystander Intervention Scale for Depression (BISD) was administered at baseline, post-intervention, and 3-month follow-up. BISD assessed four factors: acceptance of responsibility to intervene, knowledge on how to intervene, awareness of depression among peers, and vigilance towards possible symptoms of depression. Linear mixed models were conducted to investigate associations. Sociodemographic correlates were also examined.

Results

A favourable shift in all factors was observed at post-intervention, which weakened at 3-month follow-up. Having past experience in the mental health field (β=1.50) and older age (β=0.18) were significantly associated with knowledge on how to intervene. Having social contact with mental illness (SCMI) and past experience in the mental health field (PEMHF) were significantly associated with awareness of depression among peers (SCMI β=0.89, PEMHF β=0.43) and vigilance towards possible symptoms of depression (SCMI β=0.39, PEMHF β=0.61).

Discussion

The short-term results of the intervention appeared promising across all BISD factors; however, these results were not sustained after 3 months. Future research should include the impact of 'booster' interventions over time. Sociodemographic factors that were identified to be significant correlates should also be considered when planning for future interventions.

Improving Mental Health Outcomes in Patients with Major Depressive Disorder in the Gulf States: A Review of the Role of Electronic Enablers in Monitoring Residual Symptoms

Up to 75% of individuals with major depressive disorder (MDD) may have residual symptoms such as amotivation or anhedonia, which prevent full functional recovery and are associated with relapse. Globally and in the Gulf region, primary care physicians (PCPs) have an important role in alleviating stigma and in identifying and monitoring the residual symptoms of depression, as PCPs are the preliminary interface between patients and specialists in the collaborative care model. Therefore, mental healthcare upskilling programmes for PCPs are needed, as are basic instruments to evaluate residual symptoms swiftly and accurately in primary care. Currently, few if any electronic enablers have been designed to specifically monitor residual symptoms in patients with MDD. The objectives of this review are to highlight how accurate evaluation of residual symptoms with an easy-to-use electronic enabler in primary care may improve functional recovery and overall mental health outcomes, and how such an enabler may guide pharmacotherapy selection and positively impact the patient journey. Here, we show the potential advantages of electronic enablers in primary care, which include the possibility for a deeper "dive" into the patient journey and facilitation of treatment optimisation. At the policy and practice levels, electronic enablers endorsed by government agencies and local psychiatric associations may receive greater PCP attention and backing, improve patient involvement in shared clinical decision-making, and help to reduce the general stigma around mental health disorders. In the Gulf region, an easy-to-use electronic enabler in primary care, incorporating aspects of the Hamilton Depression Rating Scale to monitor amotivation, and aspects of the Montgomery-Åsberg Depression Rating Scale to monitor anhedonia, could markedly improve the patient journey from residual symptoms through to full functional recovery in individuals with MDD.

The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: mediating roles of perceived social support and psychological help-seeking stigma

INTRODUCTION

Mental health literacy is viewed as a significant factor that may facilitate an individual's pursuit of professional psychological assistance. However, it is important to explore further influencing factors that might underlie this association. This study, employing the framework of the Theory of Planned Behavior (TPB), aims to examine the relationship between mental health literacy and the behavior of seeking professional psychological help, with a focus on the potential mediating roles of perceived stigma and social support in this context.

METHODS

We surveyed 911 college students in seven regions of China (406 males and 505 females, aged between 19 and 25 years old; M age = 19.65, SD = 1.41) utilizing self-report measures, including the Mental Health Literacy Questionnaire, Professional Psychological Help-Seeking Behavior Scale, Professional Psychological Help-Seeking Stigma Scale, and Perceived Social Support Scale. A chain mediation model was developed to analyze the interconnections between mental health literacy, stigma related to seeking psychological help, perceived social support, and professional psychological help-seeking behaviors.

RESULTS

The mediation effect analysis indicates that: (1) mental health literacy significantly positively correlates with professional psychological help-seeking behaviors; (2) both perceived social support and professional psychological help-seeking stigma significantly mediate the relationship between mental health literacy and professional psychological help-seeking behavior; (3) perceived social support and the stigma associated with seeking professional psychological help play a chained mediating effect between mental health literacy and the behavior of seeking professional psychological help.

DISCUSSION

This study found that mental health literacy indirectly facilitates professional psychological help-seeking behaviors by enhancing the perception of social support and reducing the stigma associated with seeking such help. These findings help in understanding how improving mental health literacy and perceived social support while reducing stigma can increase the likelihood of individuals seeking professional psychological assistance. The results are significant for enhancing the utilization of mental health services and implementing mental health education programs in universities.

Impact of mental and developmental disorders on disability in Japanese university students: A cross-sectional study

OBJECTIVE

This study utilized the World Health Organization Disability Assessment Schedule version 2 (WHODAS 2.0) to identify vulnerable students and explore the impact of mental and developmental disorders on disability.

PARTICIPANTS

A total of 156 undergraduates who visited support service offices at large-scale universities in Japan between April 2018 and March 2020 were included.

METHODS

The 36-item WHODAS 2.0 was administered, and data were gathered regarding mental and developmental disabilities. Mann-Whitney and Kruskal-Wallis tests were conducted.

RESULTS

Parents/guardians typically initiated consultation with student support services. Students whose parents had initiated consultation did not have higher scores in any WHODAS domain except "Life Activities." In every WHODAS domain except "Cognition," the "Mental Disorder" group scored significantly higher than the "No Disorder" group. The addition of "Developmental Disorders" significantly increased WHODAS scores, except in "Mobility."

CONCLUSIONS

The WHODAS is a useful tool for identifying vulnerable students.

Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial

INTRODUCTION

Stigma is one of the most frequently identified help-seeking barriers, but there is a lack of research on the effects of stigma reduction interventions on actual mental health help-seeking behaviors during crucial academic years. This research explores the effects of stigma on university students' mental health care help-seeking behaviors before and during the pandemic.

METHODS

A randomized control trial spanned from 2019 to 2021 at the University of Porto, along five evaluation moments, with students into one control group and two intervention groups-the interventions aimed to reduce depression stigma.

RESULTS

Among the 702 participants (mean age 18.87, 59.4 % female), the intervention groups significantly increased help-seeking behaviors. In 2020, the intervention groups, having reduced stigma, continued to demonstrate to be more prompt to seek mental health help. In 2021, 22 months, the effects of the intervention on help-seeking were no longer significant; however, participants in the intervention groups showed less severe symptomatology.

CONCLUSION

Stigma reduction interventions have a pronounced effect on enhancing help-seeking behaviors among university students, even during times of crisis. This study advocates for prioritizing stigma reduction in academic settings, highlighting its value in promoting mental health access during crucial academic and life challenges.

Suicide prevention curriculum development for health and social care students: Protocol for a scoping review

Suicide has become a serious public health concern and international research has shown that the majority of individuals who die by suicide had receive healthcare in the year prior to their death. This presents an opportunity for suicide prevention by strategically training healthcare students in suicide prevention knowledge and skills. The objective of this scoping review is to identify literature that describes the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. Studies will only be considered eligible for inclusion if they describe the design, development, implementation and/or evaluation of suicide prevention curricula being delivered to healthcare or social care degree students in higher education. Quantitative, qualitative, and mixed method studies published between 2011 and 2023 (inclusive) and in the English language will be considered eligible. This scoping review will be conducted according to the PRISMA guidelines for scoping reviews (PRISMA-ScR). The developed search strategy will be implemented across six databases: PubMed, ERIC (Education Resources Information Center), PsycINFO, Embase, CINAHL and Web of Science. Several grey literature sources will also be consulted. Further potential results will be located by hand-searching the reference lists of included articles. The search strategy will include variations of the terms: 'student', 'suicide prevention' and 'education'. The search will be limited to titles, abstracts, and keywords in databases that allow it. Two reviewers will complete the screening using the predefined inclusion criteria. A third reviewer will resolve any conflicts during the screening and eligibility appraisal processes. Results will be presented in the form of tabulated results and an accompanying narrative summary, describing key findings and context related to learning outcomes, methodologies employed and implementation of the identified programmes.

Nursing Students' Attitudes Toward Seeking Psychological Help Associated to Self-Stigma and Perceived Social Stigma

Introduction

Nursing students often experience stress due to their educational demands and developmental stage. This study focuses on nursing students to investigate the relationship between their attitudes toward seeking psychological help and their levels of perceived self-stigma and social stigma.

Methods

This was a descriptive correlational study, in which 791 nursing students participated through convenience sampling between April and May 2022. Data were collected using the Attitude Towards Seeking Psychological Help Scale-R (ASPH-R), the Stigma Scale for Receiving Psychological Help (SSRPH), and the Self-Stigma of Seeking Help (SSOSH). The data were analyzed using Pearson correlation and multiple linear regression analysis. The article adheres to the STROBE checklist in its organization and presentation.

Results

Positive attitudes towards seeking psychological help were negatively correlated with self-stigma (r=-0.39, P<0.01) and social stigma perceptions (r=-0.17, P<0.01), while negative attitudes were positively correlated with self-stigma (r=0.50, P<0.01) and social stigma (r=0.47, P<0.01). Variables of sex, age, self-stigma, and social stigma significantly contributed to explaining attitudes towards seeking psychological help.

Conclusion

Social stigma and particularly self-stigma significantly influence nursing students' attitudes towards seeking psychological help. Therefore, it is recommended that authorities develop psychoeducational interventions aimed at enhancing nursing students' mental health awareness and reducing self-stigma.

Stamp Out Stigma: a national campaign to decrease stigma and increase behavioral health in fire service

Firefighters are at risk for behavioral health problems; however, mental health stigma is a barrier to seeking treatment. Although effective treatments exist, many firefighters report that internal stigma prohibits presentation for effective care. This study aimed to decrease stigma about behavioral health in fire service through the development and delivery of a peer-led anti-stigma intervention campaign called Stamp Out Stigma (SOS). SOS consisted of three related phases. During Phase 1 (n = 12), we produced testimonials and piloted the videos with firefighters to determine which were most compelling. During Phase 2 (n = 23), we beta-tested our training curriculum with two departments, resulting in a significant decrease in internalized stigma but not in self-stigma. During Phase 3 (n = 73), we presented the curriculum to two cohorts of firefighters. Participation in the SOS workshop was associated with a significant decrease in firefighters' self-stigma from pre-, M = 22.7, SD = 6.3, to post-workshop, M = 20.8, SD = 5.5, t(66) = 3.2, p = 0.002. Participation in the SOS workshop was associated with a significant decrease in firefighters' internalized stigma, M = 2.0, SD = 0.5, to post-workshop, M = 1.8, SD = 0.4, t(66) = 2.8, p = 0.007. The SOS approach to stigma reduction is promising for modifying negative attitudes toward mental health and treatment seeking among professional firefighters.

Barriers and facilitators of older adults for professional mental health help-seeking: a systematic review

BACKGROUND

Older adults are at an increased risk for mental health issues, yet they are less likely to seek professional help. This systematic review aims to identify and summarize literature on the barriers and facilitators that older adults face when seeking professional mental health help.

METHODS

A comprehensive literature search was conducted using multiple databases including PubMed-Medline, EMBASE, ProQuest central, CINAHL and Scopus to identify relevant studies published between 2010 and 2021 that focused on barriers and/or facilitators to seeking help for depression, anxiety, and psychological distress among older adults aged 65 years or older. Studies' risk of bias was assessed using the Newcastle-Ottawa Scale and results of studies were synthesized guided by the methodological framework of Rodgers and colleagues.

RESULTS

A total of eight cross-sectional studies, from Australia, United States, Mexico, Netherlands, and Malaysia met the inclusion criteria for this review. Included studies reported that the majority of their participants had anxiety or depression, yet they exhibited a preference for informal mental health help over professional help. Stigma, negative beliefs about mental health professional services, and cost were the most reported barriers. Main reported facilitators were prior positive experience with mental health services and high socioeconomic status.

CONCLUSION

Older adults are in need of interventions normalizing mental health help seeking and ensuring these services are accessible in terms of costs. This should be the focus of policy makers, healthcare providers, and public health practitioners working with older adults.

PROTOCOL REGISTRATION

PROSPERO 2021 CRD42021238853.

Understanding the Physical Health Problems of People with Psychotic Disorders Using Digital Storytelling

People with psychotic disorders struggle to be heard and express concerns beyond their mental health, especially concerns related to the side effects of treatment. Using digital storytelling, this study aimed to uncover and expose the underlying systems that oppress people with psychotic disorders from meeting their physical health needs. The stories revealed two themes: body as a contested site and biological entity with society, and (in)visible patient and paternalism. Spivak's theory of subalternity provided the theoretical basis for a critical analysis and discussion of the experiences. More research is required to highlight the power relations and structures that lead to health disparity in psychiatry.

Understanding Aotearoa New Zealand University Students Intentions to Seek Help If Experiencing Mental Distress: A Comparison of Naturalistic and Interventional Findings

University students globally are consistently identified as a vulnerable group for mental distress and suicide. Despite this, students report low engagement in help-seeking behaviours. This series of studies aimed to assess barriers to help-seeking for students and the impact of an intervention that sought to increase support-seeking intentions. In Study 1, 373 undergraduate psychology students completed items related to depression, anxiety, suicidal ideation, stigma, and help-seeking intentions. In Study 2, 133 undergraduate psychology students were randomly allocated into one of three intervention groups (control, infographic, video) and completed measures as used in Study 1. Despite experiencing clinically relevant symptoms and recent suicidal ideation, students in Study 1 tended to report low intentionality to seek help, citing perceptions that their distress was not serious enough or a desire to handle their issues independently. In Study 2, an infographic about different support services increased student's intentions to access support services and reduced their perception that their issues were not serious enough. Overall, Aotearoa New Zealand students endorsed similar barriers to help-seeking as students in other countries. Importantly, we demonstrated that a simple infographic intervention reduced perceptions regarding these common barriers and may increase students' knowledge about when to seek help.

Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review

BACKGROUND

Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes.

OBJECTIVES

To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.

METHODS

A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.

RESULTS

Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs.

CONCLUSIONS

This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.

Employer and Co-worker Perspectives on Hiring and Working with People with Mental Health Conditions

The purpose of this study was to understand perspectives towards hiring and working with people with mental health conditions (PMHC). Semi-structured interviews with 25 employers and 20 co-workers were carried out. Thematic analysis was used to analyse the data. The barriers to hiring and working with PMHC identified through the interviews were concerns about safety, incompetence, PMHC not being able to get along with others, requiring more training and supervision as well as medical costs and reputational risks to the hiring organisation. Employers and co-workers suggested that improving mental health literacy of staff, pairing the PMHC with trained work buddies, having access to mental professionals when needed, and providing incentives for hiring PMHC such as tax rebates are likely to improve attitudes towards hiring and working with PMHC. Their suggestions for the additional supports required should be considered when developing initiatives to promote inclusivity of PMHC in workplaces.

Self-compassion promotes mental help-seeking in older, not in younger, counselors

While self-compassion and mental help-seeking are two important aspects emphasized in mental health literature and counseling practice, very little research has focused on how these two are associated particularly among counseling professionals-individuals providing mental health support to others but whose mental health are often overlooked. This cross-sectional study investigated a moderated mediation model examining the role of age and attitudes in the positive influence of self-compassion on mental help-seeking intention. Using a paper-and-pencil survey, data were collected from a total of 158 Filipino counseling professionals. Results revealed that mental help-seeking attitudes significantly and partially mediated the positive association between self-compassion and mental help-seeking intention. Additionally, age significantly moderated the positive relationship between self-compassion and mental help-seeking attitudes. The significant positive influence of self-compassion on mental help-seeking attitudes was strong among older participants, weak among middle-age, and diminished among younger participants. The findings provided insights on the importance of a self-compassion-based approach to counselor training. The implications of preserving counselors' mental health in counseling practice were discussed.

Psychometric properties of the Depression Stigma Scale in the Portuguese population and its association with gender and depressive symptomatology

Background

Stigma is one of the most significant constraints on people living with depression. There is a lack of validated scales in Portugal to measure depression stigma; therefore, the Depression Stigma Scale (DSS) is essential to the depression stigma research in Portugal.

Methods

We developed the adaptation process with the ITC Guidelines for Translation and Adapting Tests taken into consideration. We collected the sample as part of the OSPI program—Optimizing suicide prevention programs and their implementation in Europe, specifically within the application in Portugal, and included 1693 participants. Floor-ceiling effects and response ranges were analyzed, and we calculated Cronbach alphas, and Confirmatory Analysis. Validity evidence was tested with two well-documented hypotheses, using data on gender and depression symptoms.

Results

The sample was well comparable with the general Portuguese population, indicating its representativeness. We identified a three-factor structure in each subscale (personal and perceived stigma): weak-not-sick, discrimination, and dangerous/unpredictable, with good model fit results. The Cronbach's alphas were satisfactory, and validity was confirmed.

Conclusions

This study established the validity and demonstrated good psychometric properties of the DSS in the Portuguese population. The validation of the DSS can be beneficial in exploring stigma predictors and evaluating the effectiveness of stigma reduction interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01945-7.

Strategies to Reduce Mental Illness Stigma: Perspectives of People with Lived Experience and Caregivers

BACKGROUND

Reducing the stigma surrounding mental illness is a global public health priority. Traditionally, anti-stigma campaigns were led by mental health professionals/organisations and had an emphasis on increasing mental health literacy. More recently, it has been argued that people with lived experience have much to contribute in terms of extending and strengthening these efforts. The purpose of this paper was to elicit views and suggestions from people with lived experience (PWLE) as well as from informal caregivers of people with mental health conditions, on effective strategies to combat the stigma surrounding mental illness.

METHODS

Six focus group discussions (FGDs) were carried out with PWLE recruited at outpatient services at the Institute of Mental Health, Singapore, and five FGDs were carried out with informal caregivers who responded to advertisements for the study between March and November 2018. In all, the sample comprised 42 PWLE and 31 caregivers. All the FGDs were transcribed verbatim and were analysed using thematic analysis. A pragmatic approach was adopted for the study, and the researchers did not assume any particular philosophical orientation.

RESULTS

Four overarching themes depicting strategies to combat stigma were identified through thematic analysis. They were (1) raising mental health awareness, (2) social contact, (3) advocacy by influential figures or groups, and (4) the legislation of anti-discriminatory laws.

CONCLUSIONS

These strategies were in line with approaches that have been used internationally to disrupt the process of stigma. Our study has further identified nuanced details on how these strategies can be carried out as well as possible areas of priority in the Singapore landscape.

How I cope at university: Self-directed stress management strategies of Australian students

Universities across the world remain under-resourced and frequently unequipped to provide the required support to the increasing demand of students experiencing mental health problems. While there is a considerable amount of research focusing on university student stress levels, interventions to address them, and coping strategies adopted by students, little research has reported on the strategies students choose to manage their stress and how that relates to their self-identified sources of stress as well as to what universities are offering to support their mental health and wellbeing. The present study provides a contribution in this direction, reporting on a study that surveyed over 3200 students from three large Australian metropolitan universities and interviewed three groups of university staff who provide student wellbeing services. Results highlight differences between what students and staff perceive as main sources of stress and best strategies to address them. In addition, students recommend task-oriented, pro-active coping strategies more often to their peers than engage in them themselves. The findings of the study further reinforce the need to develop an understanding of student coping strategies with a lens considerate of students' perspectives and preferences to authentically support their wellbeing, better informing planning and service delivery.

Who asked you? Young People and practitioners identify ways to facilitate access to mental health supports

Background: Despite representing the highest level of total population mental health burden, young people are the least likely to seek help from mental health services. It has been suggested that service design can influence the likelihood that young people will look for help, but little is known about how young people would like a service to be designed. This study addresses a gap in research regarding how mental health services can be designed to facilitate access for young people.                          Methods: A collective intelligence, scenario-based design methodology was used to facilitate stakeholders to identify and prioritise ways to improve youth mental health services. In total, 74 15–17-year-olds from three geographically diverse schools in Ireland worked to identify barriers to help-seeking and to generate and prioritise options in response to barriers. Nine practitioners with experience of working in youth mental health services rated all options in terms of both potential impact on help-seeking and feasibility for service implementation. Results: A total of 326 barriers across 15 themes were generated by youth stakeholders, along with 133 options in response to barriers. Through a process of voting, young people identified 30 options as the most impactful for improving access to mental health services. Of these options, 12 were also rated by practitioners as having both high potential impact and high feasibility. These 12 options focused on four areas: making services more familiar and welcoming; providing specialist mental health input in schools; improving parental understanding; and improving the visibility of appropriate supports. Conclusions: The results of the current study inform mental health service innovation and development, in particular, by highlighting potentially impactful and feasible ways to adapt existing mental health services to improve young people’s help-seeking behaviour.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore

BACKGROUND

After decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students.

METHODS

390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted.

RESULTS

The CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p <  0.001). Gender (β = - 1.19, 95% CI: - 2.10, - 0.27, p = 0.01) and nationality (β = - 1.23, 95% CI: - 2.35, - 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (β = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (β = - 0.34, 95% CI: - 0.52, - 0.16, p <  0.001) and CMHI (β = - 0.22, 95% CI: - 0.45, - 0.002, p = 0.048).

CONCLUSION

The anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China

Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS). Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS. Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p < 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable. Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.

Recognition of Depression and Help-Seeking Preference Among University Students in Singapore: An Evaluation of the Impact of Advancing Research to Eliminate Mental Illness Stigma an Education and Contact Intervention

Background: The SMHS 2016 revealed that young adults in Singapore had the highest 12-month prevalence of mental disorders, with depression being the most prevalent condition. Additionally, the study found that those with higher education were less likely to seek treatment. The recognition of mental illness and knowledge of where to seek help has been found to influence one's ability to seek timely psychological help. This study thus aims to evaluate the effects of ARTEMIS, an education and contact intervention on university students' recognition of depression and help-seeking preference. Methods: A total of 390 university students were recruited over a period of 6-months (October 2018 to April 2019). Students had to attend a one-off intervention which comprised a lecture on depression and personal contact with a person with lived experience of mental illness. Recognition of depression and help-seeking preference were assessed using a vignette approach, at pre- and post-intervention as well as at 3-month follow-up. Results: The intervention was effective at improving student's recognition of depression and this effect was sustained at 3-months follow-up. The intervention was also effective in shifting student's help-seeking preference, although the effects were not sustained at 3-month follow-up. Having a close friend or family with mental illness was associated with better recognition, and being able to correctly recognize depression was linked to a preference to seek psychiatric over non-psychiatric help. Conclusion: This study elucidated the efficacy of a knowledge-contact-based intervention in improving university students' recognition of depression and help-seeking preference. However, while the benefits on recognition of depression is more enduring, it is more transient for help-seeking beliefs, and booster sessions may be needed to improve the long-term effectiveness of the intervention on help-seeking preference. Lastly, to investigate the generalizability of this study's findings, future studies could replicate the current one across other non-self-selected samples, such as by integrating the intervention as part of student's orientation.