[Mental health literacy in spanish adolescents and its relationship with sociodemographic characteristics]

OBJECTIVE

Different studies identify mental health literacy as a protective factor for developing a mental health problem. The aim of this paper was to determine the degree of mental health literacy of the adolescent population of Barcelona, and its relationship with socio-demographic and educational variables.

METHODS

A cross-sectional study was carried out in Barcelona during the 2017-2018 academic year. A total of 1,032 young people between thirteen and seventeen years of age participated. The following variables were collected: sex, age, nationality, socioeconomic status (RDHpc) and average school grade. The aim was to determine the degree of mental health literacy (knowledge, stigma and help-seeking) of the adolescent population of Barcelona, and its relationship with socio-demographic and educational variables. Multiple linear regression analysis was performed adjusting for the effect of sociodemographic variables on the score of each scale.

RESULTS

The mean score (standard deviation) of the EMHL test was 7.28 (1.27) and 4.24 (1.14) respectively, with higher scores obtained by girls, high RDHpc, excellent score and Spanish nationality. The greatest difference in EMHL scores, adjusting for the rest of the variables, corresponded to adolescents with an excellent mean score and a high RDHpc index (with respect to the baseline category, beta=0.72 and 0.52 respectively). The mean stigma score was 27.6 (4.47) for CAMI and 8.83 (3.36) for RIBS. The variables related to a greater difference in score with respect to the baseline category and adjusted for the rest of the variables were: gender (boy=1.54) and academic grade (excellent=-2.38) for CAMI, and nationality (foreign=0.82) and academic grade (excellent=-1.30) for RIBS. The mean RIBS score was 8.83 (3.36) with the largest difference in score from baseline being foreign nationality (beta=0.82) and having a grade of excellent (1.30). Help-seeking was higher in parents and friends, with differences according to gender and nationality.

CONCLUSIONS

The level of mental health literacy is medium-low. While gender, nationality and educational attainment are the factors that are related to knowledge and stigma, socio-economic status is only related to mental health literacy.

The effectiveness of a "EspaiJove.net"- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial

BACKGROUND

The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention "EspaiJove.net" in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity.  METHODS: A clustered school-based randomised controlled trial (cRCT) design.

SUBJECTS

1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018.

INTERVENTION

Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list.

OUTCOME MEASURES

1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ.

ANALYSIS

The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling.

RESULTS

One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p < 0.005).

CONCLUSIONS

The three interventions of the EspaiJove.net programme (SP, MHL and MHL + SR) seem not to be effective in terms MHL, Stigma and help-seeking behaviours. The contact with a person who has experimented mental illness first-hand did not reduce stigma attitudes. Further research should deal with the heterogeneity of MHL interventions (concept, duration and measures) and identify which components of stigma interventions are effective.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03215654 (registration date 12 July 2017).

Validation of the semi-structured interview, the FACE Risk Profile, in people with Serious Mental Illness

People with Serious Mental Illness (SMI) could present risk behaviour that may lead to relapses. There are few instruments validated in our context to assess risk factors, but none takes into account several factors at the same time, and is specific for the risk of relapse. The objective of this work is to validate the Functional Analysis of Care Environments (FACE) Risk Profile into Spanish for people with SMI.

"EspaiJove.net"- a school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial

BACKGROUND

One half of adults who develop any mental disorder do so during adolescence. Previous literature showed that Mental Health Literacy (MHL) interventions impact mental health knowledge, reduce the associated stigma, and promote help-seeking among the adolescent population. However, evidence for the effectiveness and cost-effectiveness of these programmes remains inconclusive. The aim of this paper is to present a study protocol that evaluates the effectiveness of the " EspaiJove.net " programme. " EspaiJove.net " consists of a universal MHL intervention designed to promote mental health knowledge, increase help-seeking, reduce the stigma associated with mental illness, and prevent mental disorders in Spanish school settings.

METHODS

A school-based clustered randomised controlled trial (cRCT) design with 12 months of follow-up.

SUBJECTS

At least 408 secondary school students who attend the 3rd year of E.S.O (Compulsory secondary education for 13- to 14-year- olds) will be recruited from 8 schools within Barcelona city, Catalonia (Spain).

INTERVENTION

A dose-response intervention will be delivered with 4 arms: 1) Sensitivity Programme (SP) in Mental Health (1 h); 2) Mental Health Literacy (MHL) Programme (6 h); 3) MHL plus first-person Stigma Reduction (MHL + SR) (7 h); 4) Control group: waiting list. Primary outcomes: 1) MHL: EspaiJove.net MHL Test (EMHLT); 2) Stigma: Reported and Intended Behaviour Scale (RIBS) and Community Attitudes toward the Mentally Ill (CAMI). Others outcomes: 1) Acceptability of intervention; 2) Mental health symptoms and emotional well-being (SDQ); 3) States of Change Scale (SCS); 4) Bullying and Cyberbullying; 5) Quality of life (EQ-5D); 6) Help seeking and use of treatment; 7) Health benefits.

DISCUSSION

Results would be informative for efforts to prevent mental disorders and promote mental wellbeing in secondary school students.

TRIAL REGISTRATION

NCT03215654 (date registration July 12, 2017).

Social cognition interventions for persons with schizophrenia: evidence and clinical practice guidelines

Although most of the research conducted up to now has shown that interventions in social cognition are effective in the rehabilitation of persons with schizophrenia, there are still no clinical practice recommendations on the topic. Their development could facilitate the clinical work, resource management and the care provided to persons with such a disorder. This article addresses this need and performs a systematic review of the identified high-quality scientific evidence and develops clinical practice recommendations. A total of 40 clinical trials and 1 meta-analysis evaluating the effects of social cognition interventions for persons with schizophrenia were selected for the present study. Taking into account the evidence available and its quality, the authors developed three clinical practice recommendations on the positive effects of these interventions. The analysis of the evidence of the quality of the studies shows that more randomized controlled trials with larger sample sizes and longer follow-ups are needed in order to establish more accurately the efficacy and effectiveness of social cognition interventions and therefore to favor the generalization of the results.

Clinical case management for patients with schizophrenia with high care needs

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effects.

Considering variables for the assignment of patients with schizophrenia to a case management programme

The elements and intensity of case management (CM) practices should be established according to patients' needs. Therefore, greater understanding of patients' needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients' needs and strengthening the CM programme.

Validation of the modified DUKE-UNC Functional Social Support Questionnaire in patients with schizophrenia

PURPOSE

The modified DUKE-UNC Functional Social Support Questionnaire (FSSQ) is considered a psychometric instrument to assess the social support in patients with schizophrenia. However, it has not been validated in this patient population. This issue is addressed here by examining the tool's psychometric properties in a clinical sample of patients with schizophrenia.

METHODS

Two hundred and forty-one patients from ten Adult Mental Health Centres (AMHC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 (ICD-10) diagnosis of schizophrenia; (2) Global Assessment of Functioning (GAF) scores ≤50; (3) Illness duration of more than 2 years; and (4) Clinical stability. Patients were evaluated at baseline and at 1-year follow-up for clinical and psychosocial variables.

RESULTS

The factor analysis revealed two factors that explained 54.15 % of the variance. Internal consistency was excellent for the total FSSQ (0.87 at baseline and 0.88 at 1 year follow-up) and ranged between adequate and excellent for FSSQ domains. Correlations between FSSQ scores and those of global functioning, psychiatric symptoms, disability and quality of life ranged between small and large. There were significant differences between groups of patients with schizophrenia in FSSQ scores. Patients with higher levels of somatic complaints and patients who were disabled scored significantly lower in some or all FSSQ scores. After 1-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. There were mainly small significant associations between changes in FSSQ scores from baseline to 1-year follow-up and changes in the rest of the test scores, and AMHC visits between baseline and 1-year follow-up.

CONCLUSIONS

The FSSQ scores are reliable and valid, which suggests that the instrument is appropriate for the assessment of perceived social support in patients with schizophrenia.

The World Health Organization Short Disability Assessment Schedule: a validation study in patients with schizophrenia

PURPOSE

The World Health Organization Short Disability Assessment Schedule (DAS-s) is used for patients with schizophrenia, although no validation is available. This manuscript addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia.

METHODS

Two hundred forty-one patients from 10 Adult Mental Health Care Centers meeting the following inclusion criteria were included: (1) International Classification of Diseases, 10th Revision, diagnosis of schizophrenia; (2) Global Assessment of Functioning scores 50 or less; (3) illness duration of more than 2 years; and (4) clinical stability at assessment time. Patients were evaluated at baseline and at 1-year follow-up regarding disability, sociodemographic and clinical variables, psychosocial measures, and use of mental health services.

RESULTS

The factor analysis revealed a single factor that explained 60.57% of the variance. Internal consistency values were appropriate for the DAS-s total (0.78 at baseline and 0.78 at 1-year follow-up). Correlations between DAS-s scores and those of global functioning, psychiatric symptoms, social support, and quality of life ranged between small and moderate (range, 0.13-0.39). There were significant differences between groups of patients with schizophrenia in the DAS-s. Patients who were unemployed, with lower global functioning, with cognitive impairment, and lacking social support scored significantly lower in DAS-s scores. After 1-year follow-up, there was a nonsignificant decrease in DAS-s scores; and patients improved significantly in overall functioning and psychiatric symptoms.

DISCUSSION

This study shows that the DAS-s has good reliability and validity and suggests that it is suitable for the assessment of disability in patients with schizophrenia.

Differences in quality of life between groups of patients with schizophrenia

Introduction

Studies about Quality of Life (QOL) in schizophrenia usually involve the validation of questionnaires, the effects of treatments or its association with relevant variables but, so far, the literature about differences in QOL between groups of patients with schizophrenia is scarce.

Objectives and aims

This work aims to show differences in QOL between groups of patients with schizophrenia defined according to socio-demographic, clinical, psychosocial and use of services variables.

Method

The sample comprised 241 patients that meet the following inclusion criteria: 1) International Classification of Diseases-10 diagnosis of schizophrenia, 2) Global Assessment Functioning scores or GAF ≤ 50 and 3) Illness duration greater than 2 years. Patients were evaluated regarding socio-demographic, clinical, psychosocial and use of service variables. T-tests and analysis of variance tests were used.

Results

There were no differences in QOL between groups of patients with schizophrenia established according to socio-demographic variables. There were significant differences in QOL between groups of patients with schizophrenia defined according to clinical, psychosocial and use of service variables. Patients with schizophrenia who were anxious, disabled, lacked social support and used more social services showed poorer levels of QOL.

Conclusions

Our results are consistent with previous studies that support that, in patients with schizophrenia, the association between socio-demographic characteristics and QOL cannot be considered significant and that QOL is associated with disability, social support, psychiatric symptoms and care needs. This work highlight differences between groups of patients with schizophrenia, which may be a useful information to tailor interventions to this sample population.

The World Health Organization Quality of Life Scale Brief Version: a validation study in patients with schizophrenia

PURPOSE

The World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) is used for patients with schizophrenia although no validation is available. This work addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia.

METHODS

Two hundred forty-one patients from 10 Adult Mental Health Care Centers (AMHCC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 or ICD-10 diagnosis of schizophrenia, (2) Global Assessment of Functioning scores or GAF ≤ 50, 3) Illness duration of more than 2 years and (4) Clinical stability at assessment time. Patients were evaluated at baseline and at one-year follow-up regarding quality of life (QOL), clinical variables and other psychosocial measures.

RESULTS

Internal consistency was excellent for the total WHOQOL-BREF (0.88 at baseline and 0.89 at follow-up) and adequate (0.65-0.78 at baseline; 0.66-0.79 at one-year follow-up) for the WHOQOL-BREF domains. Correlations between WHOQOL-BREF scores and those of global functioning, psychiatric symptoms, disability and social support ranged between small and large. There were significant differences between groups of patients with schizophrenia in the WHOQOL-BREF. Patients who were anxious, disabled, lacked social support and used more social services scored significantly lower in some or all WHOQOL-BREF domains. Changes in WHOQOL-BREF scores were positively associated with changes over time in global functioning, social support and use of health services, and negatively with psychiatric symptoms and disability (correlation coefficients between small and moderate). After one-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms.

CONCLUSIONS

This study shows that the WHOQOL-BREF has good reliability and validity, and suggests that it is suitable for the assessment of QOL in patients with schizophrenia.