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Effectiveness of Mental Health First Aid Training for Underserved Latinx and Asian American Immigrant Communities
Abstract
Introduction
Community collaboration is essential to achieving integrated care and improving mental health among immigrants in the United States This uncontrolled pilot study evaluated the effectiveness of the Mental Health First Aid (MHFA) USA training program when administrated to advocates who serve Latinx and Asian American immigrant communities, with the goal of creating frontline workers to help immigrants with mental health challenges.
Methods
A total of 89 participants completed the 8-h MHFA training program. Assessments were conducted before and after the program to measure the impact of MHFA training. Both qualitative and quantitative assessments were used, including the Mental Health Literacy Scale and the Opening Minds Scale for Healthcare Providers.
Results
The findings revealed a significant improvement in participants’ mental health literacy and anti-stigma levels, following the training. In addition, participants expressed more positive attitudes toward people with mental illness and held less-extreme views of social distance from them.
Conclusion
Through this interactive training, participants built new knowledge, skills, and confidence to apply to their work of assisting community members who may be at risk of developing mental health or substance abuse problems.
... Overseas this training has also been used in community-based interventions in the US [33,34]. Subedi et al. evaluated an MHFA course delivered to Bhutanese refugees resettled in the US, reporting positive changes around knowledge of appropriate help-seeking and useful interventions (more concordant with professionals' beliefs) for mental health problems. ...
... More recently, an 8-h adapted version of the MHFA training has been delivered and evaluated in communitybased workers assisting underserved Latin and Asian American immigrant communities in the US [34]. Findings revealed that the MHFA training was successful at helping advocates to recognize signs and symptoms of mental disorders and increasing confidence when helping immigrants who may develop mental health problems [34]. ...
... More recently, an 8-h adapted version of the MHFA training has been delivered and evaluated in communitybased workers assisting underserved Latin and Asian American immigrant communities in the US [34]. Findings revealed that the MHFA training was successful at helping advocates to recognize signs and symptoms of mental disorders and increasing confidence when helping immigrants who may develop mental health problems [34]. ...
Abstract Background Australia is an ethnically diverse nation with one of the largest refugee resettlement programs worldwide. Evidence suggests that although the risk of developing mental disorders in culturally linguistically diverse (CALD) adolescents may be elevated, professional help-seeking in CALD youth is low. This study sought to evaluate the face-to-face teen (tMHFA) and Youth Mental Health First Aid (YMHFA) training with a CALD focus, which aimed at improving mental health literacy (MHL) and skills in youth and adults assisting adolescents with mental health problems. Methods An uncontrolled pre-, post-, and follow-up design was used to measure improvement in MHL measures in year 10 students and adults. Results A total of 372 year 10 students from 2 high schools were trained. 308 responded to the pre-training questionnaire, 220 responded to the post-training questionnaire, and 256 completed the 3-month follow-up questionnaire. A total of 34 adults were trained, 32 responded to the pre-questionnaire and 31 responded to the post-training questionnaire and 20 completed the 3-month follow-up questionnaire. Following training, students were more likely to endorse ‘helpful’ adults as valid sources of help (p
... The training provides individuals with skills and knowledge to provide support, initial help, and how to reach out to someone who may be developing a mental health problem or experiencing a crisis. Youth MHFA (YMHFA), for adults who work with youth, focuses on differences between typical adolescent development and emerging mental (Banh et al., 2019;Childs et al., 2020;Corona et al., 2020;Hadlaczky et al., 2014;Lee & Tokmic, 2019;Robertson et al., 2021). We aimed to evaluate how effective MHFA and YMHFA were for participants from agricultural communities. ...
... Similar to other findings (Banh et al., 2019;Childs et al., 2020;Corona et al., 2020;Hadlaczky et al., 2014;Lee & Tokmic, 2019;Robertson et al., 2021), many of the current study's participants experienced increased knowledge, confidence, and agreement when asked about mental health topics and working with either adults or youth. Some participants may feel comfortable providing knowledge to adults; however, we found that some conversations (e.g., suicide) might be uncomfortable for some, even after completing this training. ...
Introduction. Mental Health First Aid (MHFA) was created to teach individuals how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Programs like this may be essential for agricultural communities where suicide rates have increased, and mental health stigma has been a barrier to this population. This study evaluated how effective MHFA and Youth MHFA were for participants from agricultural communities. Methods. Participants completed the MHFA (N = 38) and Youth MHFA (N = 66) programs in 2021-2022, and Extension educators offered both programs as a part of outreach efforts within agricultural contexts. Participants completed pre-, post-, and post-only evaluations as standardized by the National Council for Mental Wellbeing. Results. After completing the MHFA and Youth MHFA training, participants increased their knowledge, confidence, and skills in various mental health topics. This includes early indicators of mental health challenges, the ability to have supportive conversations, and how to provide resources to others. For example, most participants felt they became more knowledgeable about MHFA (69%) and the ability to recognize the signs and symptoms of mental health or substance use challenges (65%). Conclusion. This research has implications for supporting agricultural workers through additional mental health training, managing farm stress, and understanding mental health stigma within this community.
... However, MHFA trials have been conducted in high-income countries (including an RCT evaluating a translation of the Standard MHFA course in Hong Kong, which has a different health system to that in mainland China [Wong, Lau, et al., 2017]). The appropriateness of the training for countries with less well-resourced mental health systems and cultural differences relevant to mental health is less well understood, although some studies have explored cultural adaptation for specific and minority populations in high-income countries (Lee & Tokmic, 2019;Gurung et al., 2020). ...
... One significant benefit of MHFA is its adaptability to diverse populations; although rural communities share the quality of being sparsely populated, their cultures are wide-ranging and varied. Recent studies have demonstrated the adaptability of MHFA for use with Latinx, Asian, and First Nation populations in the United States (Crooks et al., 2018;Lee & Tokmic, 2019). ...
... Mental health providers can consider offering workshops, seminars, or collaborating with faithbased communities to offer trainings to increase mental health literacy within the Latinx community. As an example, a program evaluation conducted by Lee and Tokmic (2019) indicated that Mental Health First Aid (MHFA) programs help to increase mental health literacy within the broader Latinx community. After completion of a MHFA program designed to reduce stigma and enhance the mental health literacy of community-based workers (i.e., teachers, nurses, counselors, small business owners, police officers) employed in immigrant communities, researchers identified that participants reported more positive attitudes toward people with mental health concerns and held less-extreme views of (e.g., perceptions of dangerousness, weakness) and social distance from people with mental illnesses. ...
Globally, mental illness is still stigmatized by many. The following qualitative study explored beliefs about mental illness and help seeking among Latinx participants in the United States. Themes included mental illness suggesting inferiority and weakness, mental illness stereotypes such as crazy and dangerous, and mental illness does not exist and/or should be ignored. Implications include the importance of culturally competent clinicians being particularly warm and caring. Counselors should also consider using psychoeducation and anti-stigma efforts and interventions when practicing within the Latinx community.
... Many previous studies have shown that MHFA training is associated with improved recognition of mental disorders, mental health first aid knowledge, beliefs about effective treatments, confidence and intentions to provide assistance to individuals with mental health problems, and amount of help provided, and also with decreases in stigmatizing attitudes [18][19][20][21]. Some studies have also shown improved mental health in those who attend the training [21][22][23]. Three studies of Chinese communities in Australia and Hong Kong have also shown similar effects [24][25][26]. ...
Background
People who experience traumatic events have an increased risk of developing a range of mental disorders. Appropriate early support from people in a person’s social network may help to prevent the onset of a mental disorder or minimize its severity. Mental health first aid guidelines for assisting people who have experienced traumatic events have been developed for high-income English-speaking countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to develop culturally appropriate guidelines for people providing mental health first aid to people affected by traumatic events in China.
Methods
A Delphi expert consensus study was conducted with two panels of experts in mainland China. Experts recruited to the panels included 32 professionals with expertise in the treatment of people affected by traumatic events and 31 people with lived experience of trauma or their carers. Panel members were sent a Chinese translation of the questionnaire used for developing English-language mental health first aid guidelines. This contained 168 items describing how to help people experiencing a potentially traumatic event. Panelists were asked to rate the importance of each statement for inclusion in the Chinese guidelines. They were also encouraged to suggest any additional statements that were not included in the original questionnaire. Statements were accepted for inclusion in the adapted guidelines if they were endorsed by at least 80% of each panel as very important or important.
Results
Consensus was achieved after three survey rounds on 134 statements for inclusion in the adapted guidelines for China, with 127 adopted from the guidelines for English-speaking countries and 7 new items from the comments of panelists.
Conclusions
While many of the statements are similar to the guidelines for English-speaking countries, the panelists adapted the guidelines to China’s context, including more detailed actions on how to discuss trauma and to help the person. These guidelines will be used to form the basis of a Mental Health First Aid (MHFA) training course for China, aimed at educating the public in providing support and advice to a person who is experiencing a potentially traumatic event. Further research is needed to investigate the use of the guidelines by the Chinese public and the implementation of MHFA training in appropriate settings in China.
... Qualitative responses from trainees in this study, as well as other studies (e.g., Crisanti et al., 2015;Lee & Tokmic, 2019;Subedi et al., 2015), indicate, while MHFA appears to be helpful and effective, there is also a need for the inclusion of more cultural awareness and humility in MHFA USA training. It has been estimated that as of 2019 less than 50% of children in the United States are White (Frey, 2019). ...
This study investigated the association of training implementation factors (Quality, Impact, Usefulness) with Mental Health First Aid (MHFA)‐targeted outcomes (e.g., increased knowledge, confidence helping someone). Trainees who completed MHFA USA training in 2016 (N = 1003) were surveyed post training about its influence on their thoughts and behaviors, and about implementation factors. Some trainees completed 3‐ and 6‐month follow‐ups (N = 430, N = 276, respectively). Training Quality, Impact and Usefulness were rated highly. Differences in Quality and Impact across demographic groups were found; trainees from racially and ethnically marginalized backgrounds, and trainees with lower education levels, reported greater effect. Quality and Impact predicted positive changes in MHFA‐targeted constructs such as self‐efficacy, stigma and trainee perceived positive effect of MHFA strategies for those in crisis. Impact predicted positive change in mental health knowledge; this association strengthened over time. Results provide information about acceptability and perceived Impact of MHFA USA training and lead to recommendations for future evaluation and implementation.
... Mental Health First Aid (MHFA), a United States federally funded program, was designed to educate the public on mental health disorders and potential treatment options. It is an effective evidence-based and culturally informed tool to counter stigma by decreasing negative attitudes and enhancing supportive behaviors towards other individuals who experience mental health crises (Kitchener and Jorm 2002;Lee and Tokmic 2019). Professionals, such as teachers, have used the program (Jorm et al. 2010), and policymakers interested in immediate interventions can use it as a resource as well. ...
In 2021, the world continues to face a serious, widespread challenge from the COVID-19 pandemic. Governments and civil society are grappling with unprecedented impacts on healthcare and the economy as well as restrictions of normal social interactions of millions. Still, the climate emergency has not rested. Unless addressed, carbon levels will continue to rise through this pandemic, the development and disbursements of vaccines, and the next pandemic. From a psychological perspective, there are many commonalities between the current COVID-19 pandemic and the ongoing crisis of climate change. This whitepaper begins by summarizing the broad similarities between these two crises. From there, we draw parallels between COVID-19 and climate change across four domains of psychological research. In doing this, we identify evidence-based approaches that policymakers and other key decision-makers can adopt to holistically respond to the two global crises of climate change and public health. We conclude with a broad discussion on the role of psychological science (and other social and behavioral sciences) in policy.
... Research reveals that MHFA participants who receive training to become MHFA trainers experience greater confidence in assisting and connecting survivors of crises to mental health services as well as decreased mental health-related stigma (Lee & Tokmic, 2019; (Substance Abuse and Mental Health Services Administration, n.d.). One study evaluated the impact on trainees of an MHFA course provided to Iraqi refugees in Australia who were experiencing depression and PTSD-related problems. ...
The 2019 coronavirus disease-19 (COVID-19) pandemic has impacted the physical and mental health of individuals and communities worldwide. While research is being conducted in real-time to address the unique impacts of COVID-19, this moment is also an opportunity to learn from previous infectious disease outbreaks. The goal of this paper is to review the literature on previous infectious disease outbreaks to better understand and identify effective interventions that may help mitigate the psychological impact and collective trauma on a given community. Five strategies are recommended for developing a plan of action: (1) engage and partner with community leaders and community-based organizations; (2) establish (and re-establish) community support networks including self-help groups; (3) conduct community outreach, education, and training on the signs and symptoms of mental health issues, how to access mental health resources, and effective supportive and coping skills; (4) deploy Community Health Workers to access, engage, and educate community members; and (5) use a community capacity-building and community empowerment-oriented approach. When implemented together, these strategies have been shown to help communities reduce the mental health impact and heal from the collective trauma of an infectious disease outbreak and increase the collective efficacy of a community, resulting in increased resiliency and preparedness for future outbreaks.
Giriş: Bireylerin, kendi ülkelerinde yaşadıkları ekonomik sıkıntılar, savaş, yoksulluk, siyasi baskılar, hastalıklar, eğitim olanakları gibi çeşitli etmenler onları göçe sevk etmektedir. Göç olgusu ruh sağlığı açısından çok önemlidir. Yeni bir ülkeye alışma, kültür çatışması, sağlık sorunlarıyla ilgilenememe, çocukların eğitim ile ilgili sorunları, beslenme ve barınma gibi sorunlar göçmenlerde çeşitli ruhsal sorunlara yol açmaktadır. Travma sonrası stres bozukluğu yaşayan bazı göçmenlerde buna ek olarak majör depresyon ve anksiyete bozukluğu yaşadıkları görülmüştür. Amaç: Göç eden bireylerin yaşadıkları ruhsal sorunlar ve buna yönelik baş etme yöntemleri araştırıldıktan sonra, oluşan veya oluşabilecek riskler bağlamına ruh sağlığı hemşiresinin göçmenlere yönelik toplumsal hizmetlerini tanımlamaktır. Gelişme: Göçmenlerde oluşabilecek riskler incelendiğinde; kadın ve çocuk göçmenlerin göç sebepleri, savaş, kıtlık vb. gibi durumlar olarak görülmekteyken, erkek göçmenlerin göç sebepleri arasında daha çok, iş imkanı, barınma ve beslenme olanaklarının yetersizliği gibi durumlar sayılabilmektedir. Göçmenlerde göç edilen ülkede uyum sağlamada zorluk, damgalanma korkusu, depresyon, kültür farklılıkları, dil problemlerinden ortaya çıkan iletişim sıkıntıları ve buna bağlı olarak kadın ve çocuk göçmenlerin sağlık hizmetlerine ulaşımında zorluklar görülmüştür. Son zamanların ortak sorunu olan pandeminin etkisi ile göçmenlerde olan veya oluşabilecek sorunların artmakta olduğu gözlenmiştir. Bu bağlamda toplum ruh sağlığı hemşirelerinin göçmenlere yönelik hizmetlerinde önemli rolleri bulunmaktadır. Sonuç: Araştırmalar sonucunda göçmenlere yardım edilememesinin en büyük etmeninin iletişim, çevirmenlerin azlığı ve kültür farklılıkları olduğu görülmüştür. Bu derleme makalede göçmenlere yönelik toplum ruh sağlığı hemşireliği hizmetleri okuyucuya aktarılacaktır.
Çalışmanın temel amacı, birçok ülkede yaygın olarak uygulanan Ruhsal İlkyardımın önemi, nasıl uygulandığını ve yararlarını tartışmaktır. Ruh sağlığı sorunları yaygındır, dünya genelinde her dört kişiden biri ruh sağlığı sorunları yaşar, ancak bilgi eksikliği ve buna bağlı damgalanma, insanların erken dönemde uygun yardımı aramasını engelleyebilir. Ruh sağlığı sorunları olan kişiler, bazen yardıma ihtiyaçları olduğu konusunda içgörüye sahip olmayabilir veya onlar için etkili yardımın mevcut olduğunun farkında olmayabilirler. Aile, arkadaşlar, komşular ve meslektaşlar, bir ruh sağlığı sorununun belirti ve semptomlarını fark ettiklerinde yardım teklif ederek yardımcı olabilirler. Bir sorun erken teşhis edildiğinde, bir ruh sağlığı krizinden kaçınılması daha olasıdır. Ayrıca bireylerin yaşamı boyunca, ruh sağlığı sorunu yaşaması ya da ruhsal hastalığa sahip biriyle yakın temas kurması olasıdır. Ruh sağlığı sorunları olan insanlara yardımcı olabilecek profesyonel insanlar ve diğer destek hizmetleri bulunmasına karşın, acil durumlar ortaya çıktığında, profesyonel yardım her an mevcut olmayabilir. Yardım kaynakları mevcut olmadığında, halktan kişiler bu kişilere acil ilk yardımı sunabilir ve kişiye uygun yardım ve destek kaynaklarına yönlendirebilir. Bu da toplumdaki bireylere Ruhsal İlkyardım Eğitimi’nin verilmesiyle mümkün olabilir. Anahtar Kelimeler Ruhsal hastalık, Erken Müdahale, Ruhsal İlkyardım (MHFA)
Članek presoja uveljavljanje programa opismenjevanja o duševnem zdravju – Prva pomoč na področju duševnega zdravja – in njegove vpeljave med etnične manjšine in migrante. Osredotoča se na preoblikovanje programa v smeri kulturno občutljivih vsebin in metod izvajanja. Na podlagi evalvacije njihovih uporabnikov povzema predloge za nadaljnje izboljšave in prilagajanje njihovim »kulturnim potrebam«. Glede na rezultate omenjenih evalvacij članek opozarja na nujnost premika od upoštevanja »zgolj« kulturnih razsežnosti duševnega zdravja k obravnavi strukturnih ranljivosti, ki vplivajo na živete izkušnje migrantov, kar vključuje tudi kritično presojo samega koncepta opismenjevanja.
Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12⁻14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness.
Objective
To provide an up-to-date assessment of the effectiveness of the Mental Health First Aid (MHFA) training program on improving mental health knowledge, stigma and helping behaviour.
Design
Systematic review and meta-analysis.
Methods
A systematic search of electronic databases was conducted in October 2017 to identify randomised controlled trials or controlled trials of the MHFA program. Eligible trials were in adults, used any comparison condition, and assessed one or more of the following outcomes: mental health first aid knowledge; recognition of mental disorders; treatment knowledge; stigma and social distance; confidence in or intentions to provide mental health first aid; provision of mental health first aid; mental health of trainees or recipients of mental health first aid. Risk of bias was assessed and effect sizes (Cohen’s d) were pooled using a random effects model. Separate meta-analyses examined effects at post-training, up to 6 months post-training, and greater than 6 months post-training.
Results
A total of 18 trials (5936 participants) were included. Overall, effects were generally small-to-moderate post-training and up to 6 months later, with effects up to 12-months later unclear. MHFA training led to improved mental health first aid knowledge (ds 0.31–0.72), recognition of mental disorders (ds 0.22–0.52) and beliefs about effective treatments (ds 0.19–0.45). There were also small reductions in stigma (ds 0.08–0.14). Improvements were also observed in confidence in helping a person with a mental health problem (ds 0.21–0.58) and intentions to provide first aid (ds 0.26–0.75). There were small improvements in the amount of help provided to a person with a mental health problem at follow-up (d = 0.23) but changes in the quality of behaviours offered were unclear.
Conclusion
This review supports the effectiveness of MHFA training in improving mental health literacy and appropriate support for those with mental health problems up to 6 months after training.
Trial registration
PROSPERO (CRD42017060596)
Abstract Background Australia is a multicultural nation with a humanitarian program that welcomes a large number of Iraqi refugees. Despite the high prevalence of trauma related disorders, professional help-seeking in this group is very low. This study sought to evaluate a face-to-face mental health literacy (MHL) Course that teaches community-based workers how to provide initial help to Iraqi refugees with depression and post-traumatic stress disorder (PTSD) related problems. Methods An uncontrolled pre, post and follow-up design was used to measure improvement in MHL in community-based workers assisting Iraqi refugees. Results Eighty-six participants completed the pre- and post-training questionnaires. Forty-five (52%) completed all 3-time point questionnaires. Fifty-six percent (48/86) of participants were able to correctly recognise ‘PTSD’ as the problem depicted in a vignette before the training. This increased to 77% (66/86) after training and was maintained at follow-up with 82% (37/45) correctly recognising the problem (p = 0.032). Recognition of depression also increased from 69% (59/86) at pre-training to 83% (71/86) after training and to 82% (37/45) at follow-up. There was a significant increase in perceived helpfulness of professional treatments for depression after training (p
Background
The aim of this study was to investigate the impact of Mental Health First Aid (MHFA) training for Bhutanese refugee community leaders in the U.S. We hypothesized that training refugee leaders would improve knowledge of mental health problems and treatment process and decrease negative attitudes towards people with mental illness.
Methods
One hundred and twenty community leaders participated in MHFA training, of whom 58 had sufficient English proficiency to complete pre- and post-tests. The questionnaires assessed each participant's ability to recognize signs of depression, knowledge about professional help and treatment, and attitudes towards people with mental illness.
Results
Between the pre- and post-test, participants showed significant improvement in the recognition of symptoms of depression and expressed beliefs about treatment that became more concordant with those of mental health professionals. However, there was no reduction in negative attitudes towards people with mental illness.
Conclusions
MHFA training course is a promising program for Bhutanese refugee communities in the U.S. However, some adaptations may be necessary to ensure that MHFA training is optimized for this community.
Mental Health First Aid (MHFA) is a standardized, psychoeducational programme developed to empower the public to approach, support and refer individuals in distress by improving course participants’ knowledge, attitudes and behaviours related to mental ill-health. The present paper aims to synthesize published evaluations of the MHFA programme in a meta-analysis to estimate its effects and potential as a public mental health awareness-increasing strategy. Fifteen relevant papers were identified through a systematic literature search. Standardized effect sizes were calculated for three different outcome measures: change in knowledge, attitudes, and helping behaviours. The results of the meta-analysis for these outcomes yielded a mean effect size of Glass’s Δ = 0.56 (95% CI = 0.38 – 0.74; p < 0.001), 0.28 (95% CI = 0.22 – 0.35; p < 0.001) and 0.25 (95% CI = 0.12 – 0.38; p < 0.001), respectively. Results were homogenous, and moderator analyses suggested no systematic bias or differences in results related to study design (with or without control group) or ‘publication quality’ (journal impact factor). The results demonstrate that MHFA increases participants’ knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems. The MHFA programme appears recommendable for public health action.
Diminishing stigmatization for those with mental illnesses by health care providers (HCPs) is becoming a priority for programming and policy, as well as research. In order to be successful, we must accurately measure stigmatizing attitudes and behaviours among HCPs. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was developed to measure stigma in HCP populations. In this study we revisit the factor structure and the responsiveness of the OMS-HC in a larger, more representative sample of HCPs that are more likely to be targets for anti-stigma interventions.
Baseline data were collected from HCPs (n = 1,523) during 12 different anti-stigma interventions across Canada. The majority of HCPs were women (77.4%) and were either physicians (MDs) (41.5%), nurses (17.0%), medical students (13.4%), or students in allied health programs (14.0%). Exploratory factor analysis (EFA) was conducted using complete pre-test (n = 1,305) survey data and responsiveness to change analyses was examined with pre and post matched data (n = 803). The internal consistency of the OMS-HC scale and subscales was evaluated using the Cronbach's alpha coefficient. The scale's sensitivity to change was examined using paired t-tests, effect sizes (Cohen's d), and standardized response means (SRM).
The EFA favored a 3-factor structure which accounted for 45.3% of the variance using 15 of 20 items. The overall internal consistency for the 15-item scale (alpha = 0.79) and three subscales (alpha = 0.67 to 0.68) was acceptable. Subgroup analysis showed the internal consistency was satisfactory across HCP groups including physicians and nurses (alpha = 0.66 to 0.78). Evidence for the scale's responsiveness to change occurred across multiple samples, including student-targeted interventions and workshops for practicing HCPs. The Social Distance subscale had the weakest level of responsiveness (SRM <= 0.50) whereas the more attitudinal-based items comprising the Attitude (SRM <= 0.91) and Disclosure and Help-Seeking (SRM <= 0.68) subscales had stronger responsiveness.
The OMS-HC has shown to have acceptable internal consistency and has been successful in detecting positive changes in various anti-stigma interventions. Our results support the use of a 15-item scale, with the calculation of three sub scores for Attitudes, Disclosure and Help-seeking, and Social Distance.
Over the past two decades, new anti-immigration policies and laws have emerged to address the migration of undocumented immigrants. A systematic review of the literature was conducted to assess and understand how these immigration policies and laws may affect both access to health services and health outcomes among undocumented immigrants. Eight databases were used to conduct this review, which returned 325 papers that were assessed for validity based on specified inclusion criteria. Forty critically appraised articles were selected for analysis; thirty articles related to access to health services, and ten related to health outcomes. The articles showed a direct relationship between anti-immigration policies and their effects on access to health services. In addition, as a result of these policies, undocumented immigrants were impacted by mental health outcomes, including depression, anxiety, and post-traumatic stress disorder. Action items were presented, including the promotion of cultural diversity training and the development of innovative strategies to support safety-net health care facilities serving vulnerable populations.
The authors addressed the specific role of and contradictory results previously obtained regarding ethnic versus host support networks in influencing directly and/or buffering the impact of perceived discrimination on the well-being of immigrants. A nationwide adult probability sample (N= 2,360) included Finnish repatriates and Russian and Estonian immigrants in Finland from Russia, Estonia, and other countries of the former Soviet Union. Perceived discrimination had a significant impact on psychological well-being. The results demonstrated the importance of distinguishing between available and activated social support. In the total sample, strong evidence was obtained for the direct and the buffering effect of host support networks on well-being. In addition, social support provided by ethnic networks abroad was generally beneficial for the psychological well-being of the immigrants. Under some conditions, ethnic support networks were also beneficial for psychological well-being.
Chinese American patients with Major Depressive Disorder (MDD) tend to underutilize mental health services and are more likely to seek help in primary care settings than from mental health specialists. Our team has reported that Culturally Sensitive Collaborative Treatment (CSCT) is effective in improving recognition and treatment engagement of depressed Chinese Americans in primary care. The current study builds on this prior research by incorporating telemedicine technology into the CSCT model.
We propose a randomized controlled trial to evaluate the acceptability and effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention targeted toward Chinese Americans. Patients meeting the study's eligibility criteria will receive either treatment as usual or the intervention under investigation. The six-month intervention involves: 1) an initial psychiatric interview using a culturally sensitive protocol via videoconference; 2) eight scheduled phone visits with a care manager assigned to the patient, who will monitor the patient's progress, as well as medication side effects and dosage if applicable; and 3) collaboration between the patient's PCP, psychiatrist, and care manager. Outcome measures include depressive symptom severity as well as patient and PCP satisfaction with the telepsychiatry-based care management service.
The study investigates the T-CSCT model, which we believe will increase the feasibility and practicality of the CSCT model by adopting telemedicine technology. We anticipate that this model will expand access to culturally competent psychiatrists fluent in patients' native languages to improve treatment of depressed minority patients in primary care settings.
NCT00854542.
Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.
We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.
The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.
Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.
The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.
Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.
Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.
The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.
The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.
Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.
Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.
A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.
The United States is a country of immigrants. With the exception of Native-Americans, every other American is, or descends from, an immigrant. First and second generation immigrant children are the most rapidly growing segment of the American population, with the great majority of this population being of non-European origin. This paper reviews the unique risk factors and mental health needs of our new immigrant populations, as well as treatment and services approaches to address their unique needs.
Immigration in the Twenty-First Century is a comprehensive examination of the enduring issues surrounding immigration and immigrants in the United States. The book begins with a look at the history of immigration policy, followed by an examination of the legislative and legal debates waged over immigration and settlement policies today, and concludes with a consideration of the continuing challenges of achieving immigration reform in the United States. The authors also discuss the issues facing US immigrants, from their reception within the native population to the relationship between minorities and immigrants. Immigration and immigration policy continues to be a hot topic on the campaign trail, and in all branches of federal and state government. Immigration in the Twenty-First Century provides students with the tools and context they need to understand these complex issues.
This review evaluates the evidence on what interventions are effective in reducing public stigma towards people with severe mental illness, defined as schizophrenia, psychosis or bipolar disorder. We included 62 randomised controlled trials of contact interventions, educational interventions, mixed contact and education, family psychoeducation programs, and hallucination simulations. Contact interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.39, 95% CI: 0.22 to 0.55) and desire for social distance (d = 0.59, 95% CI: 0.37 to 0.80) post-intervention, but these were reduced after adjusting for publication bias (d = 0.24 and d = 0.40, respectively). Effects did not vary by type or length of contact. Effects at follow-up were smaller and not significant. Education interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.30, 95% CI: 0.14 to 0.47) and desire for social distance (d = 0.27, 95% CI: 0.08 to 0.46) post-intervention. Small improvements in social distance persisted up to 6 months later (d = 0.27, 95% CI: 0.05 to 0.49), but not attitudes (d = 0.03, 95% CI: -0.12 to 0.18). The combination of contact and education showed similar effects to those that presented either intervention alone, and head-to-head comparisons did not show a clear advantage for either kind of intervention. Family psychoeducation programs showed reductions in stigma post-intervention (d = 0.41, 95% CI: 0.11 to 0.70). The effectiveness of hallucination simulations was mixed. In conclusion, contact interventions and educational interventions have small-to-medium immediate effects upon stigma, but further research is required to investigate how to sustain benefits in the longer-term, and to understand the active ingredients of interventions to maximise their effectiveness.
Objective:
Stigma has been identified as a complex and problematic issue. It acts as a major barrier to accessing care and can exacerbate the experience of a health condition, particularly for clients with mental illness and substance use issues. Scales designed to assess stigmatising attitudes towards those with mental illness and substance use problems among health care providers are necessary to evaluate programs designed to reduce that stigma. The goal of this study was to evaluate the internal reliability and external validity of the Opening Minds Survey for Health Care Providers (OMS-HC).
Methods:
The current study examined the use of the OMS-HC in assessing stigma held by Community Health Centre (CHC) staff towards clients with mental and/or substance use problems. Participants represented staff from 6 CHCs in the Greater Toronto Area ( n = 190).
Results:
The OMS-HC was found to have acceptable internal reliability for the 15-item version of the scale (α = 0.766) and mixed reliability for its subscales (α = 0.792-0.673). Confirmatory factor analysis showed good absolute (root mean square error of approximation = 0.013) and relative fit (Tucker-Lewis index = 0.996) for the current data. The OMS-HC was also shown to correlate with a series of scales commonly used in stigma research.
Conclusions:
After testing for internal validity and comparing the OMS-HC to other commonly used scales for assessing stigma and attitudes concerning recovery, the scale was found to be appropriate for the CHC setting and may be advantageous over the use of multiple scales.
The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face-to-face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single-family studies, four multifamily studies, one single versus multifamily comparative study, and one peer-led, mixed-diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well-being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family–carer's well-being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed.
Objective:
Immigrants face stressors unique to the experience of migration that may exacerbate or cause mental health problems but access care at rates far below the general population, leaving them at risk of untreated mental health conditions. This review synthesizes current findings on mental health service utilization among immigrants to inform future research efforts addressing disparities in access to care.
Methods:
A systematic literature search of seven databases yielded 62 articles that met inclusion criteria: peer-reviewed reports of empirical studies based in the United States with an explicit focus on immigrant mental health service use. Each article was evaluated, and information was extracted by using a structured abstracting form.
Results:
Studies have shown that immigrants from Asia, Latin America, and Africa use mental health services at lower rates than nonimmigrants, despite an equal or greater need. Lower usage has been found to be more pronounced among men, the uninsured, and the undocumented. Structural barriers to service use reported included lack of insurance, high cost, and language barriers. Studies have shown that social support is particularly important for immigrants and that those who seek help for mental health concerns tend to turn first to family, friends, or religious leaders.
Conclusions:
Important areas for future research on disparities in mental health service use among immigrants include expanding research and analytic design to emphasize understudied groups and the heterogeneity of immigrant experiences over time, studying interventions that foster collaboration between formal and informal service sectors, and examining the role of social support in problem recognition and treatment initiation.
To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors.
Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning.
Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21).
Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.
Objective:
The aim of this study was to develop scales to assess mental health literacy relating to affective disorders, anxiety disorders and schizophrenia/psychosis.
Method:
Scales were created to assess mental health literacy in relation to depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and post-traumatic stress disorder using data from a survey of 1536 health professionals (general practitioners, clinical psychologists and psychiatrists), assessing recognition of these disorders and beliefs about the helpfulness of interventions. This was done by using the consensus of experts about the helpfulness and harmfulness of treatments for each disorder as a criterion. Data from a general population survey of 6019 Australians aged ≥ 15 was used to examine associations between scale scores, exposure to mental disorders and sociodemographic variables, to assess scale validity.
Results:
Those with a close friend or family member with a mental disorder had significantly higher mean scores on all mental health literacy scales, providing support for scale validity. Personal experience of the problem and working with people with a similar problem was linked to higher scores on some scales. Male sex, a lower level of education and age > 60 were linked to lower levels of mental health literacy. Higher scores were also linked to a greater belief that people with mental disorders are sick rather than weak.
Conclusions:
The scales developed in this study allow for the assessment of mental health literacy in relation to depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and PTSD. Those with exposure to mental disorders had higher scores on the scales, and analyses of the links between scale scores and sociodemographic variables of age, gender and level of education were in line with those seen in other studies, providing support for scale validity.
This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.
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