Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour

Associations between exposure to potentially psychologically traumatic events and mental ill health among New Zealand firefighters: A cross-sectional study

BACKGROUND

Fire and emergency services personnel face unique occupational hazards, including repeated exposure to potentially psychologically traumatic events (PPTEs), which can impact their mental health. Despite growing awareness, comprehensive data on the mental health of fire and emergency services personnel in New Zealand remains sparse.

PURPOSE

This study examined the prevalence of symptoms of mental health disorders, including PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder, and assessed the association between PPTE exposure, coping mechanisms, and mental ill health among New Zealand firefighters and commanders.

METHODS

A comprehensive online survey using the Qualtrics platform was administered to fire and emergency personnel, assessing exposure to PPTEs and various mental health parameters. The survey utilized standard assessment tools including the PHQ-9, GAD-7, SPRINT, and AUDIT-C alongside measures of life satisfaction, emotional numbing and demographic questions.

MAIN FINDINGS

The prevalence of symptoms of Major Depressive Disorder (24 %), Generalized Anxiety Disorder (13 %), and probable PTSD (13 %) among 1264 fire and emergency personnel are higher than those observed in the general population. High exposure to PPTEs was associated with higher odds of reporting moderate-to-severe symptoms of Major Depressive Disorder, Generalized Anxiety Disorder, and probable PTSD. Also of note were findings revealing a high prevalence of potentially hazardous drinking patterns (68 %).

CONCLUSIONS

Highlights a critical need for effective mental ill health prevention and support programs tailored to fire and emergency personnel, considering their high exposure to PPTEs and elevated risk of experiencing symptoms of Major Depressive Disorder, Generalized Anxiety Disorder, and PTSD.

Collaborating to support school reintegration following suicide-related crises: Voices from the field

Adolescent psychiatric hospitalization for suicide-related crises continues to rise. Although previous reviews have identified frameworks for supporting youth as they return to school settings, there is a need to identify and address barriers to collaboration across hospitals and schools. This qualitative study explored school and hospital professional perspectives to inform a pathway toward partnership for improving practices for school reintegration. As part of a larger project that has been developing guidelines for adolescent school reintegration following psychiatric hospitalization for suicide-related crises, the present study explored professional perceptions of (a) school interactions during hospital stays and (b) recommendations for adolescents, families, school professionals, and hospital professionals. We conducted in-depth interviews with 19 school professionals and seven hospital professionals and analyzed transcribed interviews using Applied Thematic Analysis. Communication and collaboration emerged as cross-cutting themes across research questions, with additional themes considered across a continuum of care. Findings inform the ways in which professionals can collaborate to support adolescent recovery, spanning universal approaches implemented in advance of a crisis to approaches enacted during and following psychiatric care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Exploring attitudes towards seeking help for mental health problems among university students from racially minoritised backgrounds: a systematic review and thematic synthesis

BACKGROUND

University students from racially minoritised backgrounds are at an increased risk of experiencing mental health difficulties but are less likely to seek support compared to students from racial and ethnic majority backgrounds. To increase the accessibility and appropriateness of mental health support for university students, it is important to understand the attitudes towards seeking help for mental health of underserved student groups. This is the first systematic review to synthesise the available qualitative data which explores attitudes toward seeking help for mental health problems among students from racially minoritised backgrounds.

METHODS

This systematic review includes qualitative studies exploring attitudes towards seeking help for mental health difficulties among racially minoritised university students. A literature search was carried out using PsycINFO, CINAHL, Medline and Web of Science in March 2024. Participants were racially minoritised university students. Data were synthesised using a thematic synthesis.

RESULTS

Of 493 papers identified, 15 were included in the final thematic synthesis following methodological appraisal of their quality using the Critical Appraisal Skills Programme. There were a total of 314 participants across all included papers. Four analytical themes were identified: "cultural attitudes" outlined how culturally specific experiences of stigma, lack of conversations about mental health, faith, and gender influenced attitudes; "interpersonal relationships" explored the impact of family and peer relationships on attitudes; "psychological barriers" described how psychological constructs, such as preference for self-reliance and feared consequences of disclosure, were culturally-informed barriers to help-seeking; and "systemic barriers" encompassed the structural barriers, discriminatory practices and perceived cultural incompetence of services and institutions that negatively impacted on attitudes towards help-seeking for mental health difficulties.

CONCLUSION

Culture, identity and social inequality inform attitudes towards help-seeking among racially minoritised students. Exploration of how these factors interact with university systems may improve the provision of mental health support. Systemic change is needed within universities and mental health services to tackle inequality and improve support for racially minoritised students.

Establishing Proof-of-Concept for the Feasibility and Implementation of a Point-of-Sale Firearm Safety Counseling Program: A Qualitative Case Study

Safe firearm storage is critical for injury prevention, yet there is limited evidence surrounding effective interventions to promote storage behaviors among owners. One potential avenue for intervention is at the point-of-sale, a concept well-proven in the nutrition promotion and tobacco cessation space. This study explored firearm retailer attitudes toward a firearm storage intervention delivered at the point of sale. Seventeen in-depth interviews were conducted with firearm retailers from a suburban gun shop in Fort Bend, USA. This semi-structured interview assessed firearm retailer perceptions of the proposed point-of-sale intervention. Interviews were transcribed and independently coded to identify themes that emerged from participants' statements. Data were organized and analyzed using an inductive-deductive hybrid approach. Most retailers expressed high acceptability and appropriateness of implementing interventions at the point of sale. Six key themes were identified: (a) retailers viewed point-of-sale safe storage programs as acceptable; (b) the appropriateness of interventions varied depending on customer group; (c) specific program design considerations were important for successful implementation; (d) retailer self-efficacy differed across retailers; (e) barriers and (f) facilitators to consider for successful program implementation. Results indicate general favorability toward point-of-sale programs given supportive infrastructures. Interventions delivered through trusted relationships in firearm shops represent a promising approach to promoting safer storage. However, important nuances and barriers were also identified.

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.

A Mixed Methods Approach to Korean-Youth Mental Health First Aid (K-YMHFA): A Pilot Study

PURPOSE

Korean immigrant families are growing in the Southern United States (U.S), an area where culturally specific resources can be limited. Korean immigrant families encounter distress in navigating the American culture, but cultural stigma impedes discussion within the family. An evidence-based mental health awareness program called Youth Mental Health First Aid (YMHFA) exists to serve as gatekeeper training for lay adults to identify and support youth experiencing mental health challenges. This study aimed to evaluate the feasibility of a culturally adapted Korean-YMHFA (K-YMHFA) program among Korean immigrants in the Southern U.S.

MATERIALS AND METHOD

Using a mixed methods approach, a quantitative survey was distributed before and after program completion (N = 24), and a follow-up interview following program completion was also completed (N = 12). Quantitative analysis conducted a paired sample t-test, qualitative analysis conducted directed content analysis, and mixed methods analysis developed joint displays.

RESULTS

Participant's mental health literacy, confidence and control in YMHFA skills, and positive attitude toward YMHFA skills significantly increased, and stigma decreased after the training. Participants also provided information on specific steps for increasing cultural relevancy and sustainability within the community. Overall, mixed methods analysis indicated that the program was feasible in the context of Korean immigrants in the Southern U.S.

CONCLUSION

Despite the growing Korean community, the Southern U.S. has limited Korean ethnic services. With the feasibility of K-YMHFA, advocacy in promoting K-YMHFA is needed to counteract the limited resources while serving as an early intervention for youth and families in distress.

Coping with peer suicidality, help-seeking intentions, and suicidal attitudes among Asian adolescents: a mixed-methods study in Hong Kong

BACKGROUND

Adaptive responses to peer suicidality and the involvement of professional help are crucial for adolescent suicide prevention and may be influenced by suicidal attitudes. This study aimed to explore Hong Kong adolescents' responses to and help-seeking intentions for suicidal peers and to examine the influence of suicidal attitudes.

METHOD

This study used an exploratory sequential mixed-methods approach targeting Hong Kong adolescents aged 15-19 between September 2018 and October 2019. Adolescents' reactions to peer suicidality, suicidal attitudes, and willingness to help were examined through six focus groups and 12 individual interviews (N = 40). A cross-sectional survey (N = 1676) was subsequently conducted to investigate the prevalence of different responses to peer suicidality, help-seeking intentions, differences by background characteristics, and the impacts of suicidal attitudes.

RESULTS

Qualitative findings revealed three major themes: attitudes toward suicide, reactions to peer distress and suicidality, and willingness to help suicidal individuals. Most survey respondents reported actively responding and seeking informal help, but not professional support. Differences were observed based on sex, academic performance, and self-suicidality. Notably, a stigmatizing attitude was positively associated with both response types and informal help-seeking intentions. The belief that suicide is unpreventable was positively associated with passive responses but negatively associated with active responses and informal help-seeking intentions.

CONCLUSIONS

Our findings highlight variability in adolescents' responses to peer suicidality and help-seeking intentions, underscoring the need for attitude-tailored courses and more systematic, action-based gatekeeper training. Recommendations are provided to enhance the effectiveness of mental health first aid programs through public education, school interventions, and media campaigns.

Enhancing warning signs of mental health literacy: Evaluating a digital base intervention for health profession students

BACKGROUND

Despite its importance, Mental health literacy (MHL) among nursing and other health profession students often remains inadequate, potentially impacting their future roles as healthcare providers. This inadequacy can lead to delayed or inappropriate care for individuals with mental health concerns, perpetuating adverse outcomes and increasing the burden on healthcare systems.

AIM

To evaluate a digital-based intervention designed to enhance the warning signs of mental health literacy among health profession students.

DESIGN

A quasi-experimental, one-group pretest-posttest study design was used to conduct the current study.

METHODS

A non-randomized trial was conducted using digital mental health literacy intervention about the warning signs of mental illness (DWS), involving a convenience sample of 493 undergraduate health profession students. Mental Health Literacy Survey About Warning Signs of Mental Illness was developed and validated to measure the participants' mental health literacy before and after the intervention.

RESULTS

Almost all Warning Signs of Mental Illness Literacy items were significantly increased from pre- to post-intervention. Both sub-sums representing the knowledge subscale (items 1 to 11) and attitude subscale (items 12 to 15) significantly increased to 4.4 (CI 3.7, 5.0) and 0.7 (CI 0.5, 0.9), respectively. Differences were more extensive and significant on the knowledge subscale items 0.4 (CI 0.3, 0.5) than on the attitude subscale mean items 0.2 (CI 0.1, 0.2).

CONCLUSION

The DWS is an effective and easy-to-use education program for health profession students. The current study is an initial step toward building a body of knowledge about mental health literacy in the region.

How to Approach a Child About Concerns for Their Mental Health and Seeking Help: A Delphi Expert Consensus Study to Develop Guidelines on Mental Health First Aid for Supporting Children

BACKGROUND

Adults who live or work with children are an important source of support and are gateways to professional help when a child is experiencing a mental health problem. This study aimed to develop consensus-based guidelines on how adults such as parents, educators or health professionals should approach a child aged 5-12 years to discuss concerns about the child's mental health and seek help.

METHODS

A Delphi consensus method with three rounds was used. Experts were recruited from six countries to form three panels: health professionals, educators and people with lived experience (parents and carers, and young people with mental health problems). Statements to be rated were sourced from an online search of websites designed for adults who live or work with children. Further suggestions for statements came from panellists. Statements that reached 80% consensus across all panels were included in the guidelines.

RESULTS

132 participants completed the Round 1 survey, reducing to 54 by Round 3. A total of 248 statements were presented to panel members, with 151 being endorsed and included in the guidelines.

CONCLUSIONS

These guidelines represent the first recommendations developed for members of the public providing mental health first aid to children aged 5-12 years.

PATIENT OR PUBLIC CONTRIBUTION

Lived experience advocates (i.e. those with lived experience of a mental health problem in childhood and/or caregiving experience of raising a child with a mental health problem) were involved at two stages of this research: As part of the Advisory Group for the project and as expert panel members. Advisory Group members provided input into the conduct of the study and the content and design of the research outputs. Panel members provided their expertise to review every item to be included in the guidelines, proposed new items to be included, and reviewed and approved the finalised output documents.

Adult perceptions of mental health access barriers facing youth in rural Washington State: A group concept mapping study

PURPOSE

To explore adult community members' perspectives concerning barriers to mental health care that confront rural-dwelling youth.

METHODS

Group concept mapping, a participatory community-engaged research method, was used. Adult community members brainstormed and sorted statements describing barriers rural youth encounter in accessing mental health services. Point and cluster maps were created to visualize conceptual similarities between statements. Statements were rated according to their commonness and importance (1: low commonness/importance, 5: high commonness/importance).

FINDINGS

Thirty-five adults sorted and/or rated 71 barriers facing rural youth in accessing mental health services. Seven conceptual clusters were identified: system-level barriers, knowledge and communication, youth concerns, parent/guardian concerns, parent/guardian barriers, costs and convenience, and school-level barriers. Within youth concerns, community members also identified a subcluster focused on stigma. Common and important statements related to limited after-school programs and community mental health support initiatives.

CONCLUSIONS

Group concept mapping methodology provides structure for conceptualizing challenges facing rural youth in accessing mental health services. Policies should be informed by rural community concerns and priorities. After-school and support programs may align with mental health needs identified by rural communities.

Pharmacists' mental health support behaviors with simulated patients: A mixed-methods pilot study

BACKGROUND

Simulated mental health role-plays provide a safe and relevant learning experience for pharmacy students, improving confidence in and attitudes toward providing mental health support. Little research explores the use of mental health role-plays, enacted by trained actors, with pharmacists.

OBJECTIVES

This study aimed to pilot the adaptation of simulated patient (SP) role-plays, from the university classroom with students, to a workshop with pharmacists, and explore pharmacists' experiences.

METHODS

Pharmacists attended a two-hour workshop. Trained actors enacted simulated scenarios (previously developed for pharmacy education) with pharmacist volunteers while being observed by peers, a workshop facilitator, and mental health consumer educator (MHCE). Pharmacists engaged in self-assessment immediately post-roleplay, followed by performance feedback and debrief discussions with MHCEs, workshop facilitators, and peers. Pharmacists completed pre- and post-workshop surveys exploring intended mental health support behaviors, then invited to participate in an interview exploring their workshop experiences and opinions about using mental health role-plays in clinical practice (via mystery shopping). Non-parametric tests were conducted to analyse role-play and survey scores, and thematic analyses were undertaken on interview transcripts.

RESULTS

Thirty-five pharmacists attended the workshop. Fourteen role-plays were analysed. Pharmacist self-assessment scores were significantly lower than MHCE scores (P = 0.028). Overall, the role-plays significantly increased pharmacists' intentions in supporting a person experiencing mental health crises such as suicide and psychosis, as well as encouraging other supports (P < 0.05). Four themes emerged from interviews (n = 4): realistic context for skills application and practice, benefits of observing, self-assessment and feedback, and integrating into clinical practice (via mystery shopping).

CONCLUSION

SP role-plays of mental health symptoms and crises, enacted by trained actors, may effectively assess and enhance pharmacists' intended mental health support behaviors. It is recommended that the SP method is adapted into clinical practice, via repeated mystery shopping visits with immediate performance feedback, to shape pharmacists' mental health support behaviors.

Health literacy & Chagas disease knowledge: A cross-sectional study in Southern Loja Province, Ecuador

Objective

Health literacy is associated with many patient outcomes. This study sought to determine the association between a person's level of health literacy and their knowledge about Chagas disease.

Methods

A cross-sectional survey was conducted with people living in two counties in rural Loja Province, Ecuador who attended a mobile health clinic. The communities in which the study was conducted are at high risk of Chagas disease and have limited access to both health care and educational resources. The Spanish version of Short Assessment for Health Literacy measured health literacy. The Chagas Disease Knowledge questionnaire measured knowledge of Chagas disease. T-tests and correlational analysis were used to assess associations.

Results

Overall 85 people participated in this study. A majority of the respondents were female (64.1%), and a plurality were married (40.7%) and had education less than secondary (40.7%). The average age of the sample was 44.31 ± 18.85. Health literacy levels and Chagas disease knowledge in the communities were low. About half of people had inadequate health literacy. No association between health literacy and Chagas knowledge was found.

Conclusion

Health literacy levels and Chagas disease knowledge were not found to be correlated. Explanations for the lack of association may include common causes of inadequate investment in Chagas disease education as well as neglect of health systems in rural Ecuador. Efforts to improve both health literacy and Chagas disease knowledge in poorer, rural areas of Ecuador are needed.

Innovation

This is the first study to assess relationships between health literacy and knowledge of Chagas disease in an uninfected population. For novel conditions, relationships between health literacy and disease knowledge should be investigated before communication campaigns are adapted.

Knowledge of medications for opioid use disorder and associated stigma among primary care professionals

BACKGROUND

Medications for opioid use disorder (MOUD) are the gold standard. However, significant barriers limit their use in the primary care setting, including limited knowledge of the medications and stigmatizing attitudes. In this study, we assess knowledge levels among primary care-aligned professionals (PCPs) currently in practice, and whether knowledge of MOUD is associated with stigma and treatment attitudes.

PARTICIPANTS AND METHODS

Using rosters from the state of Ohio licensing boards, we surveyed 403 physicians, nurse practitioners, and physician associates in 2022, on the mechanism of different MOUD, as well as stigma and treatment attitudes. To assess MOUD knowledge, we employed descriptive and bivariate statistics. We fit four linear regression models, which controlled for empathy towards patients with OUD and provider demographics to assess the relationship between MOUD knowledge and four endpoints: stigma, perceived controllability of opioid use, perceived vulnerability to opioid use disorder, and support for abstinence-only treatment.

RESULTS

43% of participants correctly identified the mechanism of all 3 medications whereas 13% of participants did not identify the mechanism of any MOUD correctly. MOUD knowledge was higher among physicians as compared to nurse practitioners and physician associates. Lower MOUD knowledge was associated with more negative attitudes towards patients with OUD and MOUD treatment.

CONCLUSION

Expanding access to MOUD treatment requires a trained and willing health-care professional (HCP) workforce. Our findings highlight considerable variation in clinician knowledge of MOUD and suggest that knowledge levels are also related to negative attitudes towards patients with OUD and MOUD. Training interventions that increase knowledge, as well as focus on stigma reduction, are critical for reducing the longstanding treatment gap for opioid use disorder.

Youth Mental Health First Aid (YMHFA): A Change Initiative in an Underresourced School

Background: School-aged children with unidentified mental illnesses experience poor health outcomes; managing this issue requires a collaborative community approach. Objectives: The objective was to implement an evidence-based mental health education and sustainment program within an underresourced school setting for staff and parents/guardians supervising children to optimize adult mental health literacy (MHL). Methods: The intervention included Youth Mental Health First Aid (YMHFA) training; measurements of pre- and post-MHL were completed with the Mental Health Literacy Scale (MHLS). Sustainment was achieved by developing a school-centered mental health toolkit and integrating a school champion. Results: There was a significant MHL score change from pretest to posttest. The toolkit bolstered sustainability by increasing the utilization of community resources. Conclusions: This mental health awareness initiative proved effective and can be expanded across similar underresourced schools to fill voids.

Professor Hippo-on-Campus: Developing and evaluating an educational intervention to build mental health literacy among university faculty and staff

Objective: The development and evaluation of the Professor Hippo-on-Campus Student Mental Health Education Program, a mental health literacy intervention for post-secondary faculty and staff, is described. It includes 3-hour virtual, asynchronous e-modules and an optional 2-hour, synchronous workshop. Participants: All faculty and staff in a single university were invited to participate (February 2020-January 2021). Methods: Pre-and post-module and post-workshop surveys were conducted, assessing knowledge, attitudes, stigma, behavioral intentions, and confidence. Paired t-tests and regressions assessed change. Satisfaction was assessed through closed and open-ended questions, analyzed descriptively and through qualitative content analysis. Results: Four hundred and fifty staff and faculty completed the pre-survey, 262 completed the post-survey, and 122 completed a workshop survey. Participation resulted in improvements in knowledge, attitudes, stigma, and confidence with high levels of satisfaction. Conclusion: The program provides tailored student mental health training to post-secondary staff and faculty, which appears to increase their mental health literacy.

Evaluation of Mental Health First Aid Training and Simulated Psychosis Care Role-Plays for Pharmacy Education

OBJECTIVE

This study explored the impact of Mental Health First Aid (MHFA) training and simulated psychosis care role-plays on pharmacy students' stigma, confidence, and behaviors when supporting people experiencing mental health symptoms or crises.

METHODS

MHFA training was delivered to final year pharmacy students. Post-MHFA training, students were invited to participate in simulated psychosis care role-plays (co-designed and content validated with mental health stakeholders) with trained actors. Role-plays were observed by peers, tutors, and mental health consumer educators (MHCEs). Students immediately engaged in self-assessment, feedback, and debrief discussions with peers, tutors, and MHCEs. Quantitative analyses (ANOVA and chi-square tests) were conducted on scores awarded by each rater (self, tutor, MHCE) and for each scenario (n = 3). Students completed a 15-item survey exploring mental health stigma and mental health confidence, at 3 timepoints (pre-MHFA training, post-MHFA training, and post-role-plays). Survey scores were analyzed using paired t tests.

RESULTS

Of 209 MHFA-trained students, 86 participated in role-play. The self-assessment mean score was the lowest and the MHCEs' mean score highest. Post-MHFA training, 14 survey item scores significantly improved, implying reduced stigma and increased confidence in providing psychosis care. Post-role-play scores suggested improvements in 12 survey items.

CONCLUSION

Psychosis care role-plays are associated with short-term improvements in pharmacy students' stigma and mental health confidence post-MHFA training; students' self-assessment scores are lower than tutors and MHCEs. It is recommended that future studies further integrate observed behaviors with self-reported data and use simulated patients in clinical practice to evaluate MHFA outcomes longitudinally.

Youth Mental Health First Aid Training: Impact on the Ability to Recognize and Support Youth Needs

Youth Mental Health First Aid (YMHFA) trains individuals who regularly interact with youth to identify youth experiencing mental health challenges. Several studies demonstrate positive training impacts, but few assess whether the training equally impacts participants of different demographic and professional backgrounds or those who participate in different training modalities. Using a pre-post follow-up design with a comparison group, this study examined changes in participants' confidence in their ability to recognize and support youth mental health needs 1 to 2 months after training. Data were collected over two years (2021-2023) from training participants (n = 480) and comparable non-participants (n = 51). The authors examined whether changes in confidence varied by participant race/ethnicity, professional role in the education or mental health fields, and training modality (online versus hybrid). Training participants' confidence in supporting youth mental health increased significantly compared to non-participants. Although the training was effective for all participants, those with less mental health experience benefited more, consistent with previous research. While both in-person and hybrid training were effective, in-person training participants reported slightly higher confidence scores than virtual at follow-up. Study findings suggest that educational and social service organizations should offer this training to their staff and community members who interact with youth, prioritizing participants with less prior mental health training and delivering training through an in-person training modality when possible. However, additional research is needed to explore how aspects of in-person training, such as trainer characteristics and group dynamics, impact outcomes.

Integrating mental health literacy into Chinese college student mental health education in the post-COVID-19 era

This study investigates the influence of COVID-19 on the mental health of Chinese college students and evaluates the current status of mental health literacy (MHL) education. With mental health issues among students becoming increasingly prominent due to the pandemic and rapid social changes, enhancing MHL is critical. The research highlights the necessity of integrating mental health education with MHL to foster resilience and effective coping strategies. It proposes a model combining online and offline education to maximize accessibility and engagement. By examining both domestic and international perspectives, the study underscores the importance of comprehensive mental health education reform in the post-pandemic era. This integrated approach aims to improve students' mental well-being, reduce stigma, and encourage help-seeking behaviors, ultimately contributing to a healthier and more supportive campus environment.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

Development of mental health first aid guidelines for psychosis for Brazil: A Delphi expert consensus study

Psychotic symptoms can be highly debilitating for those experiencing them. Community members, including family and friends, can play a crucial role in providing support to a person during the early stages of psychosis, provided they have the necessary resources. Mental health first aid guidelines for psychosis have been developed for high-income countries and this study aimed to adapt those guidelines for Brazil. A Delphi expert consensus method was used to gather the views and opinions of 28 health professionals and 24 individuals with lived experience of psychosis in Brazil over two survey rounds. Firstly, 403 statements were translated from English to Brazilian-Portuguese. In the Round 1 survey, participants were asked to rate each statement based on how important they believed it was for it to be included in the Brazilian guidelines. They were also asked to suggest new actions if they wished. Consensus was reached on 257 statements. Eight new statements were created and endorsed from panelists' comments, and a further 45 statements were unique to the Brazilian guidelines. There was a modest level of similarity between the English-language and Brazilian guidelines. However, the Brazilian guidelines had a greater focus on the importance of family support for people with psychosis and stigma as a possible barrier for openly discussing help-seeking actions for mental health problems in Brazil.

A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.

Simulated psychosis care role-plays for pharmacy curricula: a qualitative exploration of student experiences

PURPOSE

Mental Health First Aid (MHFA) training is embedded in various tertiary healthcare curricula. However, opportunities for students to practise their newly acquired MHFA skills before entering the clinical practice workforce are lacking. The purpose of this study was to explore pharmacy students' experiences of MHFA training and post-MHFA simulated psychosis care role-plays.

METHODS

Final-year pharmacy students received MHFA training, after which they were invited to participate in simulated patient role-plays with trained actors, whilst being observed by peers, pharmacy tutors and mental health consumer educators (MHCEs). Immediately after each role-play, the role-playing student engaged in self-assessment, followed by performance feedback and debrief discussions with the tutor, MHCE and observing peers. All MHFA-trained students were invited to participate in audio-recorded focus groups to explore their experiences. Audio-recordings were transcribed verbatim and thematically analysed.

RESULTS

MHFA training was delivered to 209 students, of which 86 participated in a simulated patient role-play as a role-player and the remaining students observed. Seven focus groups were conducted with 36 students (mean duration 40 min, SD 11 min). Five themes emerged: scenario reactions, realistic but not real, mental health confidence, MHFA skills application, feedback and self-reflection.

CONCLUSION

Students enjoyed the post-MHFA simulated psychosis care role-plays, which provided opportunities to apply and reflect on their newly-acquired MHFA skills in a safe learning environment. These experiences enhanced students' confidence to support people in the community, experiencing mental health symptoms or crises, and could be an add-on to MHFA training in the future.

Digital empowerment in mental health: A meta-analysis of internet-based interventions for enhancing mental health literacy

Background

Poor mental health literacy (MHL) in the global population significantly contributes to the treatment gap associated with mental disorders. In the digital age, leveraging Internet-based MHL interventions offers scalability and broader accessibility. This meta-analysis aimed to evaluate the effects of Internet-based interventions in improving MHL and mental health.

Method

Up to Feb 2024, seven databases were searched for Internet-based interventions on MHL (knowledge, stigma, help-seeking attitudes and intentions) and mental disorders (general distress, anxiety, and depressive symptoms). The random-effects meta-analyses at post-intervention and long-term follow-up assessments were performed.

Results

Twenty-nine eligible studies involving 11,582 participants were included. Significant positive effects were observed across various domains: knowledge increase (immediate: g = 0.459, 95 %CI: 0.285 to 0.634; follow-up: g = 0.487, 95 %CI: 0.348 to 0.626), immediate stigma reduction (g = -0.332, 95 %CI: -0.479 to -0.186), immediate enhancement of help-seeking attitudes (g = 0.168, 95 %CI: 0.046 to 0.3291) and help-seeking intentions (g = 0.135, 95 %CI: 0.072 to 0.198), as well as immediate mental health improvements (g = -0.074, 95 %CI: -0.115 to -0.033).

Conclusion

Overall, these findings underscore the promising effects of internet-based interventions in improving MHL and mental health, while maintaining these effects over time remains challenging, particularly in reducing stigma and promoting long-term help-seeking behaviors. Addressing methodological limitations, adopting a more interactive approach, and implementing targeted interventions are crucial to maximizing the effectiveness and advancing mental health care worldwide.

Universal mental health training for frontline professionals: evaluation of pilot trial in Ukraine

Background

Increasing accessibility of mental health services and expanding universal health coverage is possible worldwide by using a task-shifting approach as partial delegation of some mental health support tasks to trained non-mental health service providers in order to use the available workforce more efficiently. The Universal Mental Health Training (UMHT), which is dedicated to this aim, was developed and piloted in Ukraine. The UMHT is an educational program for frontline professionals on high-quality and evidence-based responses to the mental health needs of the population they serve.

Methods

The pilot trial of UMHTs' effectiveness was conducted with 307 frontline professionals divided into 24 training groups. The control group included 211 persons with the same occupation background who participated in training later (waiting list). All the groups took part in eight-hour training, which includes one introductory module that introduces the mental health topic alongside a five-step model of UMHT, two disorders-focused modules with the steps adjusted to work with specific disorders, and the final module that considers possible difficulties frontline professionals might experience. Three effectiveness measurements were used in the outcome assessment: readiness to interact with people with mental health issues at work, mental health awareness and mental health proficiency.

Results

Analysis of the outcome data for the frontline professionals who underwent the UMHT revealed a moderate effect size related to the knowledge of mental health conditions, mental health awareness, and increasing the readiness to interact with people with mental health issues in comparison to the control group.

Conclusions

High-level utilisation of the UMHT at work by trained professionals confirms the effectiveness of the developed intervention. Obtained results favour the continuation of the development of the UMHT and future implementation research in this field in Ukraine and potentially in other low- and middle-income countries.

Epidemiological analysis of fatal and non-fatal firearm injuries occurring in gun establishments in the United States, 2015-2022

BACKGROUND

Firearm-related injury represents a significant public health problem in the USA. Firearm purchasing has risen nationwide and there has been increased efforts to deploy injury prevention initiatives within gun establishments. However, firearm-related risks and harms that may occur inside these high-exposure settings are not well characterized.

METHODS

This secondary analysis leveraged Gun Violence Archive data to quantify firearm injury prevalence rates within different types of gun establishments from 1 January 2015 to 31 December 2022. Data were restricted to incidents that occurred in gun ranges, gun shops, and public and private ranges. The following incident characteristics were available in the individual-level data: date, location, injury count, fatality count, victim demographics (age, sex), shooting intent (suicide/self-inflicted, assault/homicide, unintentional, undetermined) and establishment type.

RESULTS

Over 7 years, 445 non-fatal and 183 fatal shooting events occurred across 576 unique establishments. Non-fatal, unintentional injuries predominated in stand-alone firing ranges whereas fatal, self-inflicted injuries concentrated in retail shops with accompanying firing ranges. Firearm-related assaults were prevalent among stand-alone retail shops.

CONCLUSION

Overall, this secondary analysis underscores that the prevalence of firearm injury in gun establishments across the USA is low, and these settings should continue to be studied as important contexts for intervention. Interweaving public health interventions into gun establishments presents an opportunity to potentially reduce associated harms to consumers interacting within these environments.

An exploratory analysis of moderating effects in a non-randomized, quasi-experimental evaluation of a college-based mental health literacy curriculum

Objective: To assess possible moderating variables that influence the effectiveness of a college-based mental health literacy curriculum, Mental Health Awareness and Advocacy (MHAA). Participants: Students at a Western University in the United States (MHAA treatment group: N = 474; Comparison group: N = 575). Methods: Using a non-randomized, quasi-experimental design over six semesters (2017-2019), students in the treatment and control groups reported on key demographic factors, experiences with mental health, and their knowledge, self-efficacy, and behaviors related to mental health literacy in a pretest/post-test format. Linear mixed effects models were used to assess moderation. Results: MHAA curriculum's efficacy varied based on participants' current depression and anxiety levels, whether they had prior personal experience with a mental health concern, whether they had been diagnosed with a mental health concern, and whether they had experienced suicidal thoughts. Conclusions: Reducing anxiety and depression among students may increase the efficacy of the MHAA program.

Evaluating suicide attitudes and suicide literacy in adolescents

BACKGROUND

Two of the most common modifiable barriers to help-seeking for mental health problems during adolescence are stigma and poor mental health literacy. However, relatively little is known about stigma as it relates to suicide, and knowledge about suicidality in this age group.

AIMS

To assess levels of suicide literacy and suicide attitudes in an adolescent sample, and to identify correlates of these constructs.

METHODS

Data were drawn from the pre-intervention survey of the Sources of Strength Australia Project. A total of 1019 adolescents aged between 11 and 17 years participated. Suicide literacy and attitudes were measured alongside potential correlates including psychological distress, suicidal ideation, mastery, previous exposure to suicidal thinking and behaviour, and demographics.

RESULTS

Participants more strongly endorsed attitudes attributing suicide to isolation/depression, compared to attitudes glorifying or stigmatising suicide. Gaps in knowledge about suicide included the risk factors, signs and symptoms. Key correlates of suicide attitudes and literacy included age, gender and cultural background.

CONCLUSION

Findings highlight the need for further education activities in schools and public awareness campaigns that address the gaps in suicide knowledge and attitudes. Such activities would assist in the identification of suicide risk among young people and improve help-seeking in this population.

A mixed-methods project on the impact of the mental health first aid training on French university students' knowledge, attitudes and practices

AIM

University students are increasingly affected by mental health problems and need prompt support. The aim of this project was to assess the impact of the mental health first aid (MHFA) training on students' knowledge, attitudes and practices (KAP) concerning mental health in the short, mid and long-term.

METHODS

Three studies were conducted in Bordeaux, France, from May 2021 to March 2022. The first study collected data from 55 students 1 to 6 months after they had followed the training to examine its efficacy in the mid-long term. The second study collected data immediately before and after the training to evaluate the KAP of 52 students in the short-term (1 to 10 days). The third study consisted of 14 semi-structured interviews with students trained since 2020 to identify the training's long-term impact (3 to 18 months). Descriptive statistics were used for studies one and two, and framework analyses for study three.

RESULTS

Most participants reported that their KAP about mental health had improved after the training. In the first study, 94.2% of students reported being ready to intervene during a psychotic crisis in their peers. In the second study, 75.0% of students reported improved mental health-related knowledge and decreased stigma. All students in the third study reported that they had assisted at least one person after the training.

CONCLUSIONS

These were the first data on the impact of the French MHFA on KAP. While not exhaustive, findings suggest that deploying the training would be beneficial to French students.

Help-seeking intentions of UK construction workers: a cross-sectional study

BACKGROUND

In response to the high rates of poor mental health in the construction industry, numerous workplace interventions have been designed to address the known and suspected risk factors to employee mental health and well-being. A key challenge of these strategies is low engagement in support services.

AIMS

The goals of this research were to investigate the help-seeking intentions of employees in the construction industry, explore levels of mental well-being in this population and provide insight into employee engagement with mental health support strategies.

METHODS

Employees from two UK construction companies completed an online cross-sectional questionnaire (n = 119), designed to measure help-seeking intentions, levels of mental well-being and worker attitudes towards workplace mental health support strategies.

RESULTS

One-third of the sample reported experiencing an episode of mental health difficulties in the past 6 months. Employees reported a greater preference for seeking support from informal versus formal help sources. Participants were most likely to seek help from a partner and least likely to seek help from a Mental Health First Aider/ Champion. The study also showed some association between help-seeking intention and age of employees.

CONCLUSIONS

Given the poor levels of mental well-being in this population, it is essential that adequate workplace support is provided. Whilst formal help sources are important for this population, our study highlights the potential benefits of informal help sources to support employees. Future interventions may therefore wish to consider developing tailored, informal workplace support networks and programmes.

Zoo professionals and volunteers in the U.S: experiences and prevalence of burnout, mental health, and animal loss

Introduction

Burnout and mental health among animal care and health professionals (ACHPs) has received increasing attention in recent years. Despite rapid growth of research in this area, the wellbeing of individuals who work and/or volunteer in zoo settings has received minimal attention.

Method

An anonymous online survey was created to evaluate zoo staff and volunteers' experiences of animal-related loss, rates of professional fulfillment and burnout, mental health, perceived organizational support, and resilience. Participants included 1695 zoo professionals (72% ACHPs, 20% other staff) and volunteers (7%) who were recruited through relevant professional listservs and online platforms, and flyers on zoo grounds.

Results

ACHPs reported higher levels of anxiety, depression, and burnout and lower levels of professional fulfillment than other zoo staff and volunteers. The most common animal-related losses experienced by ACHPs in the past year were unexpected death (80%) and anticipated loss (74%), with more than half of these losses occurring within the past 3 months. ACHPs' reported bond with animals under their care was positively associated with depression and anxiety. Having a formal ritual or process following the death of an animal was positively associated with job fulfillment and perceived organizational support and negatively associated with depression and burnout-yet only 17% of participants in our sample indicated that their zoo had such a process or ritual.

Discussion

Our findings suggest that many ACHPs are struggling with burnout, anxiety, depression, and low rates of professional fulfilment and perceived organizational support. We recommend that zoos develop organizational plans that foster a culture which normalizes and validates grief/loss experiences and is proactive in responding to animal loss, related trauma, and other occupational stressors. The results of this research demonstrate the need for systemic changes within the zoo industry, for the betterment and welfare of both humans and the animals under their care.

Participants' experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting

We explored participants' experiences of a counsellor-supported PTSD Coach mobile application intervention (PTSD Coach-CS) in a randomised controlled trial. PTSD Coach-CS participants, who received the intervention and self-completed a custom-designed questionnaire at intervention completion were included (n = 25; female = 20; ages 19-59; isiXhosa = 22). This questionnaire comprised questions regarding the feasibility, acceptability and potential impact of the PTSD Coach-CS intervention, and general psychological support in our setting. Data were analysed using Braun and Clarke's thematic analysis. Three main themes emerged. (i) Participants' largely positive experiences of treatment procedures included the safe space created by the counsellor support in combination with the PTSD Coach application, allowing them to learn about and understand their lived experiences, and to accept their PTSD diagnoses. (ii) Positive perceptions of the PTSD Coach application, yet raising important concerns (e.g., lack of family involvement) for future consideration. (iii) Intervention-specific and systemic treatment barriers (e.g., stigma) providing important information to inform and increase the usefulness of the PTSD Coach-CS intervention. The findings suggest that the PTSD Coach-CS intervention may help address the need for access to suitable care for South African adults with PTSD. Some contextual barriers must be considered in further intervention implementation.

Hybrid-delivered community psychoeducation for people aged 50 and older: A mixed-method evaluation and lesson learned

Introduction

Hybrid training mode comprising in-person and teleconferencing sessions is effective and sustainable, yet no standardized principles guide its development for older people. This study aimed to develop a set of principles for hybrid-mode psychoeducation for older people from the experiences of middle-aged and older people in two folds: (1) examining the effects of hybrid-mode community psychoeducation and (2) identifying features that could enhance participants' experience.

Methods

We delivered 12-hour Older Person Mental Health First Aid and 3-hour late-life depression training to adults aged 50 and older in in-person and hybrid modes. Hybrid group participants received technology-related support, including in-advance training and on-site support. All participants completed assessments on depression literacy, depression stigma, meaning in life, social support, depressive symptoms, and anxiety pre-and post-intervention and evaluated the program in open-ended questions.

Results

A total of 471 in-person and 346 hybrid group participants completed the psychoeducation and post-assessment (80.4 % female, mean age = 64.73 years, SD = 7.29). Linear mixed models revealed improvements in depression literacy, depression stigma, meaning in life, social support, and anxiety (B = -1.43 to 0.13, all p < .001), with no significant difference between in-person and hybrid groups. Thematic analysis of open-ended questions identified three themes: (1) informational content with case studies, (2) hardcopy course handouts, and (3) interactive learning environment.

Discussion/conclusion

Hybrid-mode and in-person psychoeducation had comparable benefits on middle-aged and older people. The TORCH principles, an acronym for Technology provision, On-site technical support, Rehearsal, Connection with group members, and Hardcopy notes, was derived from practice wisdom and qualitative findings to support older people in online learning.

Effects of the Mental Health Supporter Training Program on mental health-related public stigma among Japanese people: A pretest/posttest study

Aim

The Mental Health Supporter Training Program is a national project conducted in Japan. This study aimed to determine the effects on mental health-related stigma, mental health literacy, and knowledge about mental health difficulties and support techniques among program participants.

Methods

The target population was local residents of a wide range of generations in Japan. Outcomes were assessed at baseline (T1), immediately postintervention (T2), and at the 6-month follow-up (T3). A mixed model for repeated-measures conditional growth model analyses were employed to examine the effects of the intervention over time (T1, T2, T3). We also calculated effect sizes using Cohen's d.

Results

The program had a significantly favorable pooled effect on the Japanese version of the Reported and Intended Behaviour Scale score after adjusting for covariates (reported behavior [t = 3.20, p = 0.001]; intended behavior [t = 8.04, p < 0.001]). However, when compared at each time point, only intended behavior from T1 to T2 showed a significant difference (t = 8.37, p < 0.001). Significant pooled effects were found for mental health literacy (knowledge: t = 19.85, p < 0.001; attitude: t = 15.02, p < 0.001), knowledge of mental health (t = 28.04, p < 0.001), and psychological distress (t = -2.41, p = 0.016).

Conclusion

The results suggest that the program might be effective for improving intended, but not reported, behavior in the short term and for improving mental health literacy, knowledge of mental health, and psychological distress.

Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents

Road traffic accidents (RTAs) are among the most frequent negative life-events. About one in five RTA survivors is susceptible to posttraumatic stress disorder (PTSD). Knowledge about needs for, and usage of, mental health services (MHSs) may improve options for care for RTA victims. The current study aimed to assess rates of victims using different MHSs, including psychotherapy, pharmacotherapy and support groups, and to explore correlates of needs for and use of these MHSs. Further, we aimed to estimate the treatment gap in post-RTA care, defined as including people with probable PTSD who did not use MHSs and people wanting but not getting help from MHSs. Dutch victims of nonlethal RTAs (N = 259) completed self-report measures on needs for and use of MHSs and PTSD. Results showed that 26% of participants had utilized care from psychotherapy, pharmacotherapy or support groups. Among people with probable PTSD, this was 56%. Increased posttraumatic stress was the strongest correlate of MHS use. Forty-eight participants (17.8%) had an unmet care need and represented the treatment gap. Commonly reported reasons and barriers preventing MHS use were perceptions that problems were limited or would disappear without care and financial worries. Regarding possible future care, participants reported a preference for face-to-face (over online) help from a psychologist (over other professionals). The treatment gap for Dutch RTA victims may be limited. However, a significant number of RTA victims need care but do not obtain this care. Care options may be improved by reducing practical barriers to MHSs and increasing mental health literacy and acceptability of different forms of care (besides face-to-face care).

Assessing the efficacy of the 'Bicho De 7 Cabeças' B-learning school-based program in enhancing mental health literacy and reducing stigma

The prevalence of mental disorders in adolescents has a considerable impact on daily life, restricting tasks and diminishing overall quality of life while potentially leading to stigmatization. This study aims to measure the impact of a mental health literacy intervention program, called "Bicho de 7 Cabeças" project, in b-learning format, on the increase of knowledge and the decrease of stigma in young people from Póvoa de Varzim, in Portugal. A quasi-experimental study was conducted, from November 2022 to May 2023, involving an experimental group ("Bicho de 7 Cabeças" protocol) and an active control group (informational brochures), utilizing a pre-test/post-test design. Mental Health Literacy Measure-MHLM, Mental Health Promoting Knowledge Scale-MHPK-10, Mental Illness Knowledge Schedule-MAKS, Reported and Intended Behaviour Scale-RIBS, and Community Attitudes toward People with Mental Illness-CAMI were used. A total of 504 young students from the 9th grade enroll in this study, with a mean age around 14 years old. There is a significant difference between stigma (p <.001) and knowledge (p <.001) scores at baseline and follow-up. The results of this study shows that interventions aimed at young people for the promotion of mental health literacy and stigma reduction are needed and more initiatives should be implemented in schools to address these problems.

Redevelopment of mental health first aid guidelines for substance use problems: a Delphi study

BACKGROUND

Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice.

METHODS

The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included.

RESULTS

103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines.

CONCLUSIONS

This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

Development of mental health first-aid guidelines for psychosis: a Delphi expert consensus study in Argentina and Chile

BACKGROUND

Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina.

METHODS

A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina.

RESULTS

Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy.

CONCLUSIONS

While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.

Mental Health First Aid Training for Allied Health Clinical Educators: A Pre- and Post-Evaluation

Purpose

Health profession students may experience mental health issues during training, and clinical educators report that they don't feel confident in supporting students with these issues. This study explored whether a customized Mental Health First Aid (MHFA) training programme changed the knowledge, perceptions, intentions, and confidence of clinical educators in supporting students with mental health issues in the workplace.

Method

Twenty-four allied health clinical educators from a tertiary health service attended a two-day customized MHFA course. The educators completed assessments before (n = 21) and after (n = 23) the course. Quantitative data was analyzed using independent t-tests. Qualitative data was thematically analyzed using content analysis.

Results

Knowledge improved significantly (p = <0.001). The confidence to manage students with mental health issues increased significantly (p < 0.001). A significant change in perception was only found with respect to a character in a scenario being dangerous or unpredictable. Intentions to assist co-workers and students with mental health issues improved for all items but not necessarily significantly.

Conclusions

This programme improved educators' knowledge of mental health, perceptions of people with mental health issues, intentions of providing help, and confidence to support people with mental health issues.

Associations between college students' personal experience with mental health issues and their mental health literacy: a strengths-based perspective

BACKGROUND

Mental health literacy (MHL) programs are a promising approach to help prevent mental health issues (MHI) among college students; however, there is an increasing need to understand individual factors that influence the development of students' MHL.

AIMS

Following a strengths-based approach, we examined if college students' individual characteristics and MHI experience were associated with students' MHL.

METHODS

Using two vastly different college samples (Sample 1, N = 617; Sample 2, N = 306), we used the Mental Health Awareness and Advocacy framework, guided by the health belief model and social-cognitive theory, to investigate associations between students' mental health literacy, demographic factors, and their previous experience with MHI.

RESULTS

Results from nested regression analyses suggest that personal experiences with MHI are associated with higher MHL (knowledge, self-efficacy, and behaviors), even after controlling for key individual characteristics. Prior experience with having an MHI and receiving therapy appeared to be most important in explaining MHL behaviors.

CONCLUSIONS

Students with personal experience with an MHI may be one of the most valuable resources for increasing MHL and utilization of mental health resources on college campuses. Additional implications and future research directions are offered.

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

BACKGROUND

Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context.

METHODS

A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels.

RESULTS

Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs.

CONCLUSIONS

A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

COVID-19 and coping: Absence of previous mental health issues as a potential risk factor for poor wellbeing in females

COVID-19 has caused unprecedented disruption to everyday life. Unsurprisingly, this has resulted in increased prevalence of poor mental wellbeing. While previous mental health issues have been consistently flagged as a risk factor, the absence of these may also leave individuals vulnerable due to a lack of psychological coping strategies. This study explored the change in symptoms of anxiety, depression, and trauma in 167 females who provided data at four timepoints over the course of the first year of the pandemic. There was a significant effect of time on the extent of the change in depression but, for all wellbeing measures, those with current or previous mental health issues experienced a similar magnitude of change as those with no previous issues. This suggests that low-risk individuals may be faring worse, relatively. Ensuring that this group is not overlooked will be imperative in protecting and re-building the wellbeing of the nation.

Stigmatizing attitudes towards mental illness: A cross-sectional survey of Australian medical students

OBJECTIVES

We aimed to assess the degree of stigmatizing attitudes and psychological distress amongst Australian medical students in order to better understand factors that may impact help-seeking behaviours of students. We hypothesize that sociodemographic factors will not significantly predict stigmatizing attitudes, and increasing levels of psychological distress will be associated with increasing stigma.

METHODS

A cross-sectional online survey was distributed to medical students at Western Australian universities and members of the Australian Medical Students' Association. Stigma was scored using the Mental Illness Clinicians' Attitudes (MICA-2) scale. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS). Participants provided information about gender, age, spirituality, financial hardship, treatment for mental illness, and experience in psychiatry.

RESULTS

There were 598 responses. The mean (Standard Deviation) MICA-2 score was 36.8 (7.5) out of a maximum of 96, and the mean (SD) HADS depression score was 4.7 (3.7). The mean (SD) HADS anxiety score was 9.3 (4.4). Past or current treatment for a mental illness was associated with lower MICA-2 scores. There was no association between MICA-2 and HADS scores, or sociodemographic factors.

CONCLUSIONS

Our results demonstrate relatively low MICA-2 scores and high HADS-A scores overall, with no association between HADS scores and stigma.

Breaking the endometriosis silence: a social norm approach to reducing menstrual stigma and policy resistance among young adults

OBJECTIVE

Endometriosis is a menstrual disorder that affects one in ten women. Diagnosis often takes several years due to low awareness and menstrual stigma. In this study, we employed a social norm approach (SNA) to investigate the effects of an educational leaflet on endometriosis knowledge, menstrual stigma, and acceptance of paid menstrual leave among women and men.

METHODS

The 3 × 2 online experiment tested the influence of either descriptive norm messages or both descriptive and injunctive norm messages (compared to a control group, factor 1) in an educational leaflet by taking the role of addressee's sex into account (quasi-experimental factor 2). The study included 796 German participants aged 16-35.

RESULTS

Men exhibited significantly poorer knowledge, stronger menstrual stigma, and weaker policy acceptance compared to women. No significant main effect of the social norm messages on menstrual stigma was found. In contrast, the combined norm messages seem to be beneficial when addressing policy acceptance. Moreover, compared to the control group, the intervention material indirectly influenced stigma and policy acceptance through increased knowledge.

CONCLUSIONS

Providing information about social norms appears to be an effective strategy for educating not only women but especially men about menstrual disorders like endometriosis.

Effectiveness of teen Mental Health First Aid in Improving Teen-to-Teen Support Among American Adolescents

BACKGROUND

teen Mental Health First Aid (tMHFA) is an Australian school-based universal program for grade 10 to 12 students. tMHFA teaches teens how to recognize and respond to a peer in crisis or experiencing mental health concerns.

METHODS

Schools implementing tMHFA in 2019 and 2020 were propensity score matched, yielding a sample of instructors (n = 130) and students (n = 1915) in 44 high schools in 24 American states. Effectiveness and acceptability were assessed with student surveys at baseline and after implementation.

RESULTS

There were significant findings for primary outcomes, including improved helpful first aid intentions (Cohen ds = 0.57 to 0.58), confidence supporting a peer (ds = 0.19 to 0.31); the number of adults rated as helpful (ds = 0.37 to 0.44); and reductions in stigmatizing beliefs (ds = 0.21 to 0.40) and "harmful first aid intentions" (ds = 0.11 to 0.42). Instructors and students rated the program favorably with students sharing improvements on their recognition and responses to mental health problems and crises.

CONCLUSION

tMHFA is an effective, feasible, and scalable training program for increasing mental health literacy and decreasing mental health stigma in adolescents in the short term, consistent with trials of tMHFA in Australian adolescents.

Assessing the impact of blue and green spaces on mental health of disabled children: A scoping review

During recent decades, there has been a growing consideration of the role of blue and green spaces on mental health of children, but there is insufficient attention in the literature to the mental health of children with disabilities. This paper presents an overview of the evidence on how blue and green spaces affect the mental health of children with various disabilities. A database search found twenty studies eligible for the review, after several consecutive screening stages. Most studies used a cross-sectional design and were carried out in Europe. The results consistently indicate that blue and green space can reduce emotional, behavioral, and social problems in disabled children. A protective association was found between the level of blue or greenness and depressive and anxiety symptoms. Moreover, in most of the studies there were no significant changes in the result after adjusting for socioeconomic confounders. Generally, there is an identified need for more short-term exposure studies in this area, focusing on the impact of landscape design elements on mental health of disabled children. The findings of this scoping review call on urban planners, health care workers and decision makers to consider appropriate measures and interventions providing more blue and green space exposure to disabled children.

Defining the scope and content of mental health guidelines for community sport in Australia: A Delphi study

Regular sport participation can lead to several known physical and psychological health benefits. However, some sport environments may be contributing to the development of mental health disorders in participants. Elite sporting organisations have introduced several guidelines and positions statements to ensure psychologically safe sport environments, but these are often not applicable to the recreational sport setting. To guarantee psychologically safe sport environments for all participants, there has been an urgent call to develop mental health guidelines for recreational sport. To ensure future guidelines meet the needs of recreational sport environments, and are feasibly implemented, collaboration with experts is needed. The aim of this study was therefore to explore and synthesise the opinions of experts on the scope and content of mental health guidelines for community sport using the Delphi technique. Twenty-one experts from around Australia participated in two Delphi rounds, one qualitative and one quantitative, to reach consensus on key areas of future guidelines. Five key groupings were identified from the qualitative responses, which led to the identification of 13 key statements related to the provision of mental health promotion, prevention, and care in sport. Eight of the statements related to the role of community sport organisations in the promotion of positive mental health, and prevention of mental health problems. None of the statements were concerned with mental health care as most experts did not indicate this was the responsibility of community sport clubs. An additional five statements related to the responsibilities of the different levels of sport governance. Practical implications and future directions for the development of mental health guidelines for recreational sport are discussed.

Mental health first aid training among healthcare French students: a qualitative study

Background

Healthcare students are a population more at risk for mental health issues, especially anxiety, depression, and suicidal thoughts. The health faculty of Université Paris Cité in France, Paris has implemented a Mental Health First Aid (MHFA) course aiming to improve students' mental health literacy, self-care and peer-support and to decrease stigma about mental illness. We conducted a qualitative study exploring the lived experience of this MHFA training course among healthcare students so to better assess its implementation within this specific context and population.

Methods

This qualitative study used the five-stage inductive process to analyze the structure of lived experience (IPSE) approach. All the healthcare students that had completed the 2-day MHFA training were approached to participate. Data was collected through individual semi-structured interviews and inclusion continued until data saturation was reached. Data analysis was based on an inductive, descriptive, and structuring procedure to determine the structure of lived experience characterized by the central axes of experience.

Results

Twenty students were included. Data analysis produced a common structure of lived experience based on three central axes of experience, (1) a personal experience, (2) a student experience and (3) a professional experience. The participants all experienced this course intertwined within these 3 axes. Their motivation to take the course was personal -being of feeling concerned by the topic-, was study-oriented - to learn and revise psychiatry- and was professional - so to develop both practical and soft skills. In their personal experience, participants reported a transformative experience and some interventions with friends and family, while both in their student and professional experience, they felt frustrated with both the content and the form of the course.

Conclusion

The results reported similar outcomes reported in the literature about skills, knowledge, and awareness; but mostly produce original avenues about how to better adapt such course to this specific population so to better address students' expectations and mental health issues. This MHFA course -with an adapted content addressing eating disorders, self-mutilations and sexual and gender-based violence - could be part of the early curriculum of healthcare students. The latter could then benefit from a level 2/advanced MHFA course years later specifically tailored for healthcare professionals.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.