Facilitating factors and barriers in help-seeking behaviour in adolescents and young adults with depressive symptoms: A qualitative study

Evaluation of a school-based depression prevention approach among adolescents with elevated depressive symptoms attending special education: study protocol of a cluster randomized controlled trial

BACKGROUND

Adolescents are at risk of developing depressive symptoms and suicidality. Those attending special education, because of cognitive, physical, behavioral, emotional or learning disabilities, form a particularly vulnerable subgroup concerning the development of depressive disorders. Despite the fact that school-based prevention programs effectively reduce the risk of developing a depressive disorder in adolescents, approximately 7% of Dutch adolescents attend special education and remain unreached. There is also a lack of knowledge about effectiveness of depression and suicide prevention in this group. This study aims to evaluate the effectiveness of the adapted indicated prevention program 'At Full Force - Special Needs Education' for adolescents attending special education presenting elevated depressive symptoms.

METHODS

We will perform a cluster randomized controlled trial (RCT) to test the effectiveness of an indicated prevention program 'At Full Force - Special Needs Education'. Participating schools will randomly be assigned to the intervention or control condition. A safety net consisting of gatekeepers will be realized at every school. Adolescents will be screened for depressive symptoms. Those with heightened levels of depressive symptoms can participate in the RCT. Participants in the intervention condition will receive a CBT-based prevention group training during school hours, comprising eight meetings of 45 min each. The training is a modified version of a previously studied training in general education called At Full Force (in Dutch: Op Volle Kracht). The control condition consists of care as usual. All participants and their parents will complete assessments at baseline, post-intervention and 6- and 12 months follow-up. At all times, adolescents will be guided to mental health care if necessary. The primary outcome will be depressive symptoms. Secondary outcomes will be suicidality, anxiety and somatic symptoms. Additional exploratory analyzes will be conducted.

DISCUSSION

Adolescents in special education usually encounter numerous challenges. Adolescents participating in the preventive training are expected to show lower levels of depressive symptoms at follow-up compared to the control condition. Depression prevention can favorably impact pre-existing psychopathology trajectories and can avert additional life challenges associated with depression.

TRIAL REGISTRATION

Clinicaltrials.gov NCT06203899 on January 2nd 2024.

PROTOCOL VERSION

 May 6th 2025 (v2.1).

Patients' perceptions with high-risk diabetic foot on early access to medical care: A qualitative study

AIMS

To explore the perception of patients with high-risk diabetic foot on early access to medical care.

DESIGN

Qualitative interview study.

METHODS

We conducted a qualitative exploratory and descriptive study involving 11 community-based patients with high-risk diabetic foot residing in Hunan, China. Interviews were systematically coded and categorized into thematic groups using Colaizzi's method.

RESULTS

There were five main themes and nine subthemes, namely, (1) Attitude toward healthcare-seeking, (2) Lack of disease knowledge: (a) low symptom alertness, (b) necessity of health education, (3) Hospital visits: (a) doctor-patient relationship, (b) level of medical institutions, (c) obstacles in seeking healthcare, (4) Financial consideration: (a) apprehension about adding to family burden, (b) medical insurance to ease financial stress, (5)Environmental impact: (a) family and social supports, (b) communication between patients.

CONCLUSIONS

Patients with high-risk diabetic foot have barriers to early intention to seek medical care, and it is the result of a combination of many factors. Healthcare providers should provide relevant interventions for patients, and health insurance systems should be improved to increase coverage to facilitate timely access.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study

AIM

This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations.

DESIGN

Strauss and Corbin's Grounded Theory.

METHODS

Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached.

RESULTS

A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment.

CONCLUSION

Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process.

IMPLICATIONS FOR THE PROFESSION

Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment.

IMPACT

This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations.

REPORTING METHOD

The COREQ guidelines were utilised.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Mental Health Help-Seeking Among Young Internal Migrants in China: Shame as a Double-Edged Sword

Young migrants in mainland China are vulnerable to mental health issues and are reluctant to seek help from professional sources. Shame is considered an important culture-specific emotion affecting professional help-seeking. The current study aimed to investigate the moderating role of shame in the association between psychological stress and help-seeking in young internal migrants in China. 415 internal migrants (mean age = 29.20; SD = 4.81) were recruited to participate in the survey study with oversampling of those who sought help before. Multiple linear regression and Zero-inflated Poisson regression models were used to examine the moderating effects of shame on the stress-intention and stress-behavior relations, respectively. Among the 65.0% of participants with high psychological stress, 62.6% of them never sought professional help for their mental health issues. The results demonstrate that shame significantly reduced the positive association between psychological stress and professional help-seeking behavior. Conversely, shame also played a protective role, mitigating the negative association between psychological stress and professional help-seeking intention. The findings underline the importance of addressing shame-related issue prior to therapy and developing promotion strategies to improve young migrants' mental health.

Efficacy of home-based and inpatient treatment for children and adolescents in psychiatric crisis: A systematic review protocol

PURPOSE

Children and adolescents experiencing psychiatric crises often undergo inpatient treatment, which may limit family involvement, stigmatize young individuals, and impede the application of therapeutic outcomes in their daily lives. This situation can result in increased rates of rehospitalization, the development of chronic conditions, and prolonged hospital stays. Home-based treatment represents a potential alternative to traditional inpatient care. The objective of the planned systematic review is to provide a comprehensive comparison of the effectiveness and cost-effectiveness of inpatient and home-based treatment modalities, with a particular focus on primary outcome parameters such as psychopathology, family functioning, and social functioning. Furthermore, secondary outcomes, including rates of relapses and rehospitalizations, will be evaluated.

METHODS

The systematic search will be conducted using Medline, Embase, PsycInfo and Cochrane databases, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The included studies will undergo a rigorous quality assessment using the Cochrane Risk of Bias (RoB2) tool for randomized trials and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool for non-randomized studies. Where appropriate, data will be synthesized by meta-analysis using R-Studio and supplemented by sensitivity analyses to assess the robustness of the results. The overall quality of the evidence is assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

DISCUSSION

The planned systematic literature review will provide a synthesis of the current state of research on the comparative effectiveness of both treatment modalities. The objective is to furnish information for the delivery of effective patient care that also represents a cost-efficient solution for the healthcare system.

SYSTEMATIC REVIEW REGISTRATION

This review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42023458888.

The Impact of Life and Adverse Childhood Events on Help-Seeking Behaviours-A Cross-Sectional Survey of School-Age Adolescents in Jordan

Traumatic life and childhood events are associated with adverse health outcomes, particularly for adolescents, who are vulnerable to such events and exhibit distinct health behaviours and needs. Nevertheless, the influence of exposure to these events on their help-seeking behaviour remains largely unexplored, especially in the Eastern Mediterranean region. This study aims to estimate the prevalence of adverse events among adolescents in Jordan and examine how adverse events shape the help-seeking behaviours.

METHODS

A national cross-sectional survey of 4407 school-age (12-18 years) adolescents living in Jordan was conducted between December 2022 and April 2023 using multi-state stratified cluster sampling. The study utilised self-report questionnaires as well as validated tools. These were adapted to ensure cultural relevance and sensitivity and translated to Arabic.

RESULTS

The prevalence of at least one adverse event is around 16%, while that of four or more ACEs stands at around 41% in our population. The most commonly reported event was being infected or having a family member infected with COVID-19 at 60.3%. Specific individual characteristics and traumatic events appeared to shape their help-seeking behaviour, particularly family affluence and smoking status as well as exposure to COVID-19.

CONCLUSIONS

The study underscores the need to understand help-seeking patterns among school-age adolescents in light of exposure to traumatic events. Based on this study's findings, special attention should be paid to the impact certain events have on adolescents' mental health and their help-seeking behaviours. Positive help-seeking behaviours that resonate with adolescents' beliefs, emphasising contextual factors in mental health coping, should be promoted.

Prevalence of depressive, anxiety, and stress symptoms and barriers to mental health services among medical students at Jazan University, Saudi Arabia: A cross-sectional study

Medical students represent the future of the healthcare workforce. However, the demanding nature of medical education places them at an increased risk of mental health issues. Ensuring their mental well-being is crucial for maintaining a competent and compassionate healthcare system. This study aims to determine the prevalence of depression, anxiety, and stress, along with barriers to accessing mental health services among medical students. A cross-sectional self-administered online survey conducted among medical students of Jazan University, Saudi Arabia, from September 2023 to March 2024. Descriptive and inferential statistical analyses were conducted using International Business Machines Corporation Statistical Package for the Social Sciences version 27.0.1 (Chicago). The study included 390 participants. Median scores for depression, anxiety, and stress were 14.00, 12.00, and 16.00, respectively, with interquartile ranges of 4.00 to 22.00, 4.00 to 20.00, and 6.00 to 24.00. Depression severity categories showed that 38.2% were normal, while 11.5%, 31.8%, 13.6%, and 4.9% experienced mild, moderate, severe, and extremely severe symptoms, respectively. Anxiety severity classifications revealed 37.4% as normal, with 6.2%, 17.4%, 10.0%, and 29.0% falling into mild, moderate, severe, and extremely severe categories, respectively. For stress, 49.2% were normal, while 11.0%, 16.7%, 14.1%, and 9.0% experienced mild, moderate, severe, and extremely severe levels, respectively. Barriers to accessing mental health care included a preference for self-management, confidentiality concerns, societal judgment, and fears of career-related repercussions. This study highlights a high prevalence of depression, anxiety, and stress among medical students at Jazan University, with notable gender differences and symptom severity. Addressing barriers to mental health care, such as confidentiality concerns and societal stigma, is essential to improving service utilization and student well-being.

Context counts: a qualitative study on how adolescents activate social resources to develop and practice health literacy

BACKGROUND

Recently, the importance of social networks and other contextual factors in shaping health literacy of adolescents has gained recognition. However, research often simply refers to context without explicitly describing it. In this qualitative study, we aimed to explore how adolescents activate their (social) resources to develop and practice health literacy within a Swiss cantonal school health service program and in their everyday lives.

METHODS

This study is based on a secondary analysis of interviews from an evaluation of the school health service in the canton of Zug, focusing on the final health screening in the 7th grade (corresponding to an average age of 14 years). Semi-structured interviews were conducted with 16 students. The data was analyzed using thematic analysis and constructivist grounded theory to identify and refine key themes.

RESULTS

Our analysis revealed that adolescents' interactions with their social networks, including family members, teachers, healthcare providers, and peers, were significant resources in their health literacy practices. Other resources included school health services, regular curricula and the internet. The activation of these resources was moderated by several factors that functioned as activators or deactivators, which we divided into three categories: relationships, health system, and pre-existing health literacy. Prominent activators in the category relationships involved good rapport and trust, whereas fear of judgment deactivated resources. In the category health system, access to resources as well as opportunities for participation in dealing with health information, challenges and services were important activators (or when missing, deactivators). Finally, participants demonstrated that pre-existing health literacy in the form of pre-existing knowledge and motivation and attitudes served as an activator of their resources to develop and practice health literacy in a 'virtuous circle'. Thus, although health literacy development and practice were dependent upon their social networks, adolescents played key roles as active agents while navigating health.

CONCLUSIONS

Our findings highlight potential (de)activators of adolescents' resources, primarily those available within their social networks, in the development and practice of health literacy. Results contribute to the literature on adolescent health literacy by shedding light on the often under-described concept of context. Explicit consideration of context provides actionable insights for educators, healthcare providers, and policymakers seeking to support adolescents in the development and practice of health literacy.

The Acceptability and Effects of Internet-Based Cognitive Behavioral Therapy on Depressive Symptoms and Remission in 13- to 17-Year-Old Adolescents: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to evaluate the acceptability and effects of internet-based cognitive behavioral therapy (iCBT) or CBT-oriented interventions compared with control groups on depressive symptoms, remission of depression, and quality of life (QOL) in adolescents.

METHODS

We searched English and Chinese databases for randomized controlled trials up to October 10, 2024 that investigated the effects of iCBT compared with controls in adolescents exhibiting elevated depressive symptoms or diagnosed with depression. Standardized mean differences (SMDs), relative risks (RRs), and 95% confidence intervals were applied to evaluate the pooled effects of outcomes.

RESULTS

A total of 19 RCTs involving 3574 cases were included in this study. We found small effects on depressive symptoms severity at different time points (posttest: SMD = -0.49 [-0.66, -0.33]; 3-month follow-up [FU3]: SMD = -0.21 [-0.30, -0.11]; FU6: SMD = -0.18 [-0.35, -0.02]; FU12: SMD = -0.38 [-0.56, -0.20]). We also found a significant effect in depression remission rate at the posttest (RR = 1.74 [1.36, 2.21]) and a significant effect in QOL at the posttest (SMD = 0.30 [0.07, 0.54]). However, the result regarding acceptability was nonsignificant (RR = 1.22 [0.76, 1.97]). No significant publication bias was found in these results.

CONCLUSION

iCBT or internet-based CBT-oriented interventions can effectively reduce depressive symptom severity and improve depression remission rate and QOL in depressed adolescents. These results are preliminary and require further validation through future systematic reviews.

'I'm still su!c!dal when you're done with the paperwork': an inductive framework thematic analysis of #camhs on TikTok

BACKGROUND

Young people are sharing their experiences of Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom on TikTok. Little is known about the content of these videos and their influence on young people's attitudes towards seeking professional mental health support.

METHODS

This study explored how CAMHS is represented in a sample of 100 #camhs TikTok videos using participatory inductive framework thematic analysis.

RESULTS

Four themes were developed alongside young people as co-researchers: (a) CAMHS can be frustrating and unhelpful, but sometimes life-saving, (b) Young people can feel their distress is invalidated by CAMHS, (c) CAMHS makes young people feel responsible for their distress, and (d) Young people may not feel CAMHS professionals are trustworthy. Video content described dismissive responses to expressions of suicidal ideation, professional knowledge being privileged over lived experience, and breaches of confidentiality. Some shared positive experiences of CAMHS helping to keep them safe.

CONCLUSIONS

Together, the themes reflect a representation of CAMHS as a service where adults are powerful and young people occupy a subjugated position. This may influence young people's professional help-seeking behaviour. Recommendations for clinical practice and future research are presented.

Videoconferencing in mental health services for children and adolescents receiving child welfare services: a scoping review

BACKGROUND

Videoconferencing is considered an alternative to face-to-face consultations and a possibility to help overcome access-to-care barriers in mental health care services. Barriers to child and adolescent mental health services are particularly apparent in the case of children and adolescents receiving child welfare services. This scoping review aims to provide an overview of research on videoconferencing in the mental health treatment of children and adolescents receiving support from child welfare services.

METHODS

This scoping review follows the review framework outlined by the Joanna Briggs Institute. The following databases were searched from January 2012 to April 2024: Scopus, Web of Science, PubMed, PsycINFO (Ovid), CINAHL Plus, Social Services Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Google Scholar.

RESULTS

The search yielded 4322 unique records and resulted in the inclusion of 22 articles that met the inclusion criteria. The studies originated from Denmark, England, Australia, Norway, Canada, Chile, and the USA, and were grouped into four areas: (1) videoconferencing to increase access to mental health treatment for vulnerable groups (2) young people's perspectives (3) videoconferencing in interdisciplinary collaborative meetings, and (4) use, awareness, and acceptance of videoconferencing among health and social care providers.

CONCLUSIONS

This scoping review shows that if videoconferencing in mental health care is to become an established and trusted method aimed at children and adolescents receiving child welfare services, several unresolved and potentially negative issues need attention and more research. This particularly applies to whether videoconferencing decreases or exacerbates inequalities in access to mental health services. A further question is whether new barriers are raised by screen-based treatment to threaten good therapeutic relationships, and by extension treatment quality and clinical outcomes.

Mental health literacy of undergraduate radiography students in Zimbabwe

INTRODUCTION

Assessing the Mental Health Literacy (MHL) of students is crucial in having an understanding of mental health knowledge gaps, stigma, wrong beliefs, risk factors, and treatment-seeking behaviour. The aim of this study was to use a validated scale to examine the MHL of radiography students at a tertiary institution in Harare, Zimbabwe.

METHODS

A cross-sectional descriptive survey was conducted to assess the MHL of radiography students at a tertiary institution in Harare, Zimbabwe, using a validated MHL scale. Individual t-tests and analysis of variance (ANOVA) tests were conducted for each variable to examine the differences between groups expected to differ in their MHL.

RESULTS

A total of 89 students were enrolled into the study. The overall mean MHL score was 96.62 (SD-9.55), with students less knowledgeable on environmental, social, familial, or biological factors that increase the risk of developing a mental illness. Gender had no statistically significant effect on the overall score, t(83) = -0.81, p = 0.42 [Males had mean score = 95.64, SD = 10.14; and Females had mean score = 97.35, SD = 9.12]]. However, there was a significant difference in recognition of disorders by gender, t(83) = -2.42, p = 0.02, with female students (M = 26.24, SD =2.68) scoring higher than male students (M =24.69, SD =3.21). In addition, students with a previous history of mental health disorders scored higher (M =26.86, SD = 2.19) than those with no previous history (M =25.47, SD =3.04), however the difference was not statistically significant.

CONCLUSION

The students in the current study demonstrated lower MHL compared to most studies in the literature. Students were less knowledgeable about environmental, social, familial, or biological factors that increase the risk of developing a mental illness. Furthermore, a correlation between MHL and mental health experience was demonstrated. The implication of these findings is that the curriculum ought to be developed to help undergraduate radiography students become more knowledgeable about mental health and comfortable seeking appropriate support.

Digital health technologies and major depressive disorder

There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.

What do rural young people want from their mental health service

INTRODUCTION

Rural young people have high rates of mental illness and low rates of help-seeking making it crucial to extend research about service improvement in rural and remote Australia.

OBJECTIVE

To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide.

DESIGN

This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes.

FINDINGS

Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth-focus, and evidence-based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring.

DISCUSSION

The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified.

CONCLUSION

Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes.

Understanding and preventing nonadherence and treatment dropout in adolescents and young adults with anxiety and depressive disorders

Dropout from psychological or pharmacological treatment for anxiety and depressive disorders is common. It is especially problematic in adolescents and young adults because of the adverse consequences for their development. Reasons for treatment dropout can be divided into therapy-process related factors, attitudinal aspects, and practical issues. Adjusting treatment to patient preferences and shared decision making, improving the therapeutic alliance, and interventions such as (family) psychoeducation, motivational interviewing, and help with practical issues are promising strategies to optimize engagement and adherence.

Impact of Parental Mental Health and Help-Seeking on Adolescents' Suicidal Ideations and Help-Seeking Behaviors

This study aimed to evaluate the impact of parental mental health on adolescent offspring. Data regarding 6512 families from the 2010-2021 Korean National Health and Nutrition Examination Survey were analyzed; among them, 428 were placed in the suicidal ideation (SI) group and 421 were placed in the matched control (MC) group. This number was selected for the use of the propensity score matching method. The findings highlighted significant associations between parental mental health and adolescent suicidal ideation, with mothers in the SI group having higher odds of Diagnosed Depression (OR 2.109, 1.023-4.350 95% CI), Depressive Mood (OR 2.155, 1.224-3.793 95% CI), and Suicidal Ideation (OR 2.532, 1.322-4.851 95% CI) compared to the MC group. Regarding the fathers, paternal Suicidal Ideation (OR 4.295, 1.747-10.599 95% CI) was the only significant factor for adolescent suicidal ideation. In contrast, maternal depressive symptoms and help-seeking behavior significantly impacted adolescent help-seeking; Maternal Depressive Mood increased with adolescent Help-Seeking (OR 4.486, 1.312-15.340 95% CI) while Maternal Suicidal Ideation reduced the probability of Help-Seeking in the SI group (OR 0.15, 0.031-0.721, 95% CI). Chronic and severe depressive symptoms in mothers could make adolescents less likely to seek help for their suicidal ideations. Therefore, clinicians working with adolescents should prioritize a family-oriented approach.

Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms

BACKGROUND

Major depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people's feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms.

METHODS

We carried out in-depth, semi-structured interviews with N = 22 young people aged 17-25 (M_age = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships.

RESULTS

Participants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others' Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts.

CONCLUSIONS

Young people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

Association between childhood trauma and mental health disorders in adolescents during the second pandemic wave of COVID-19, Chiclayo-Peru

Introduction

The COVID-19 pandemic has significantly affected mental health, with children and adolescents being particularly vulnerable. Evidence on the association between childhood trauma and mental health outcomes in schoolchildren during the pandemic is limited. This study aimed to evaluate this relationship in Chiclayo city, northern Peru, during the second wave of COVID-19.

Methods

A cross-sectional secondary data study was conducted, measuring childhood trauma using the Marshall's Trauma Scale, depressive symptomatology (PHQ-9), and anxiety symptomatology (GAD-7). Additional variables assessed were alcohol use (AUDIT), resilience (abbreviated CD-RISC), and socio-educational data. Prevalence ratios were estimated using generalized linear models.

Results

Among 456 participants, 88.2% were female, with a mean age of 14.5 years (SD: 1.33). Depressive symptomatology prevalence was 76.3% (95%CI: 72.14-80.15) and increased by 23% in schoolchildren with childhood trauma (PR: 1.23; 95%CI: 1.10-1.37). Factors positively associated with depressive symptomatology included increasing age, seeking mental health help during the pandemic, and severe family dysfunction. Anxiety symptomatology prevalence was 62.3% (95%CI: 57.65-66.75) and increased by 55% in schoolchildren with childhood trauma (PR: 1.55; 95%CI: 1.31-1.85). Anxiety symptomatology was positively associated with mild, moderate, and severe family dysfunction.

Conclusion

Schoolchildren exposed to childhood trauma are at increased risk for depressive and anxiety symptoms. Monitoring the impact of the COVID-19 pandemic on adolescent mental health is vital. These findings can assist schools in establishing effective measures to prevent mental health outcomes.

Effect of Animal-Assisted Therapy (AAT) on Social Interaction and Quality of Life in Patients with Schizophrenia during the COVID-19 Pandemic: An Experimental Study

PURPOSE

Most patients with schizophrenia exhibit low willingness to return to society because of negative social experiences. The COVID-19 pandemic led to severe social isolation for schizophrenia patients. However, animal-assisted therapy (AAT) can improve individuals' empathy, social functions, and quality of life. The study aimed to evaluate the effectiveness of AAT in improving social interactions and quality of life in patients with chronic schizophrenia during the COVID-19 pandemic.

METHODS

An experimental study was conducted, with six institutions for psychiatric rehabilitation in Taiwan as the case institutions. Patients in these institutions were randomly allocated to the experimental group, which received 60 minutes of AAT once a week for 12 weeks, or the control group, which engaged in routine discussion groups and watched short films about animals. Comparisons between the two groups were made before and after the intervention on social function, social adaptive function, and quality of life. Data were collected before the intervention (T1), immediately after the intervention (T2), and 3 months after the intervention (T3).

RESULTS

Comparison between groups showed that social functioning was significantly higher in the experimental group than in the control group at T2. However, there was no sign of improvement in social adaptive functions of the experimental group. The experimental group exhibited significantly higher quality of life than the control group at T2 and T3.

CONCLUSIONS

There was an impact of COVID-19 on the studied effects. AAT improved social functioning and quality of life in patients with chronic schizophrenia. The effect on quality of life lasted only up to 3 months after the intervention. AAT should be promoted for use as a community-based rehabilitation tool in patients with chronic schizophrenia.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2200061715. https://www.chictr.org.cn.

Review: School-based mental health literacy interventions to promote help-seeking - a systematic review

BACKGROUND

School-based mental health literacy interventions aim to prevent mental disorders and promote mental wellbeing through improving the knowledge and understanding of mental health, mental disorders, and reducing stigma. Evidence suggests that good mental health literacy helps young people recognise mental health difficulties in themselves and in others, and seek help for mental health problems. Improved help-seeking can allow for early intervention, which prevents the progression of mental disorders and ultimately reduces the burden of mental disorders. The aim of this review is to identify and synthesise evidence on the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes.

METHODS

We searched MEDLINE, Embase, PsycINFO, ERIC, Child Development and Adolescent Studies, British Education Index and ASSIA (June 2020). Additional searches were conducted a year later to identify any new publications (June 2021). We included randomised controlled trials (RCTs) assessing the effectiveness or cost-effectiveness of school-based interventions to improve help-seeking outcomes for children and young people aged 4-18 years. Included studies were critically appraised.

RESULTS

We identified 11 studies investigating help-seeking outcomes of school-based mental health literacy interventions including a total of 7066 participants from 66 secondary schools. Overall, there is no strong evidence for the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes, including general attitudes towards help-seeking, personal intentions to seek help, knowledge of when and how to seek help for mental disorders, confidence to seek help, and actual help-seeking behaviours. None of the studies investigated the cost-effectiveness of the interventions.

CONCLUSION

The lack of standardised measures with established reliability and validity for help-seeking outcomes, and the incomprehensive consideration of the multi-faceted concepts of MH literacy and MH stigma have contributed to the scarcity of evidence for the effectiveness. Future research should focus on developing standardised measurement tools and including economic evaluations to understand pragmatic and financial aspects of school-based mental health literacy interventions.

Promoting Mental Health Help-Seeking Behaviors by Mental Health Literacy Interventions in Secondary Education? Needs and Perspectives of Adolescents and Educational Professionals

Mental health literacy (MHL) interventions in secondary schools may help to improve competencies that adolescents require to stay mentally healthy and seek help if mental health problems arise. These MHL interventions should be tailored to the needs of adolescents and educational professionals (EPs) to reach sustainable implementation and long-term effectiveness. However, evidence is lacking on these needs. Thus, our aim was to explore their experiences with, and perspectives on, mental health help seeking and needs regarding MHL interventions. We performed online focus group discussions and interviews with adolescents (n = 21; 13-19 years) and EPs (n = 12) and analyzed the data using directed content analysis. We identified three themes related to mental health help seeking: (1) Limited MHL competencies of adolescents, (2) Limited competencies of EP to provide mental health support, and (3) Limited mental health promotion in the school environment. We further identified three themes regarding MHL interventions: (1) Addressing basic mental health knowledge and skills, (2) Interactive and easily accessible, and (3) Sustainable implementation. Improving the MHL competencies of adolescents and EPs, and creating a mental health-literate school environment can promote adolescents' mental health help seeking. Our findings highlight the importance of developing MHL interventions that are tailored to both adolescents' and EPs needs.

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers

BACKGROUND

Depression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria.

METHODS

An adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores.

RESULTS

A total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers.

CONCLUSIONS

School-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.

Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: a qualitative study

BACKGROUND

Previous research on barriers and facilitators regarding treatment-seeking of adults with depressive and anxiety disorders has been primarily conducted in the Anglosphere. This study aims to gain insight into treatment-seeking behaviour of adults with depressive and anxiety disorders in a European healthcare system.

METHODS

In-depth semi-structured interviews were conducted with 24 participants, aged ≥18 years and diagnosed with an anxiety disorder and/or depressive disorder according to DSM-IV. Participants were purposively sampled from an outpatient department for mental health care in the Netherlands. The seven steps of framework analysis were used to identify relevant themes emerging from the interviews.

RESULTS

Data analysis suggested an interplay between individual aspects, personal social system, healthcare system and sociocultural context influences. Amongst the most relevant themes were mental health illiteracy, stigma, a negative attitude toward professional help, the influence of significant others and general practitioner, and waiting time. Financial barriers were not of relevance.

CONCLUSIONS

Even in a country with a well-developed mental health care system and in absence of financial barriers, there are many barriers to treatment-seeking in adult patients with depressive and anxiety disorders. National campaigns to increase awareness and decrease stigma in the general population, and to empower the social environment might reduce the treatment gap.

Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis

Background

A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear.

Objectives

The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved.

Methods

Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0.

Results

The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma.

Conclusion

The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.

"Love in the Later Years…": Perceptions of Sex and Sexuality in Older Indian Adults - a Qualitative Exploration: «Любовь в позднем возрасте... »: восприятие секса и сексуальности у пожилых людей в Индии (качественный анализ)

BACKGROUND

The world faces global population ageing. With this demographic shift and increased life-expectancy, healthcare services are focused on healthy ageing. Sexual health is a vital yet neglected dimension of general health and wellbeing in older adults. This study aimed to explore sexual experiences and perceptions of sexuality among older people in India.

METHODS

A qualitative approach with social constructivist paradigm was used. 20 participants aged above 60 years were recruited through purposive sampling until thematic saturation was reached. In-person, in-depth interviews were conducted using a semi-structured guide after an initial pilot study. They were audio-recorded, transcribed, and translated verbatim. Thematic analysis was conducted, and rigor ensured through triangulation and respondent validation.

RESULTS

The overarching categories were "sexuality as a mode of resilience", "emotional stability and intimacy as attributes of sexual pleasure", and "lack of sexual rights awareness". The main categories (themes) were sexual experiences (intimate touch, non-penile sex, personal meanings of sexuality), partner expectations (companionship, support, continuity of care, proximity), and barriers against sexual expression (social stereotypes, stigma, lack of audience in healthcare services). The older people were accepting of their sexual difficulties and coped through relationship dynamics. Participant voices are discussed with regard to the socio-cultural context.

CONCLUSION

Sexual wellbeing is connected with "ageing well". Our findings suggest that older people retain sexual desires and fantasies through changed patterns and expectations. Healthcare services, policymakers and academia need to be informed about older people's sexual needs and rights.

Facilitating factors for seeking help for mental health problems among Norwegian adolescent males: A focus group interview study

BACKGROUND

Young males are overrepresented in suicide statistics and underrepresented in statistics of help-seeking and receiving help from formal health services compared with young females. Few studies have examined facilitating factors for help-seeking among adolescent males with no previous experience seeking mental health help. This study aimed to explore thoughts, attitudes, and experiences regarding facilitating factors toward formal help-seeking for mental health problems among Norwegian adolescent males.

METHOD

Three focus group interviews were conducted, each including four adolescent males with no experience with help-seeking or receiving help from a help service for mental health problems. The interviews addressed topics such as barriers and facilitating factors for help-seeking and preferences regarding structural factors and modes of delivery of help. Data were analyzed according to the systematic text condensation method.

RESULTS

The analysis revealed three main categories of facilitating factors: (1) transparent information and available help services, (2) proactive and outreaching help services, and (3) the possibility for discreet help-seeking.

CONCLUSIONS

Improving help-seeking is integral to accessing care and improving mental health. Help services can be more accessible and approachable for male adolescents if they offer discretion, the possibility to remain anonymous, the option to receive help in a convenient context, and outreach services.