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Coaches’ Mental Health Literacy and Role Perceptions for Supporting Young People’s Mental Health
Journal of Applied Sport Psychology
Abstract
Coaches’ engagement in helping behaviors such as promotion, prevention, and early intervention may help to support young people’s mental health. The purpose of this study was to examine how coaches’ mental health literacy and role perceptions would relate to their engagement in these helping behaviors with young people in the sporting environment. Two hundred ninety-six Gaelic games coaches (M age = 41.96, SD = 9.78; 14% female) completed an online survey containing a self-report measure of mental health literacy relevant to depression, and measures examining role perceptions (i.e., role breadth and role efficacy) for and engagement in prevention, promotion, and early intervention. Results from three path analyses revealed that mental health literacy was not directly associated with any of the helping behaviors, but there were significant indirect effects of mental health literacy for promotion, prevention, and early intervention via role breadth and role efficacy. Enabling coaches to engage in these helping behaviors by developing their knowledge, competence, and beliefs that these actions are an expected part of the role may provide an alternative and informal source of initial support for young people.
Lay summary: This study investigated coaches’ mental health literacy, their role perceptions, and how these factors may influence coaches’ engagement in behaviors that can support young people’s mental health. The results suggest that developing coaches’ knowledge, competence, and beliefs may enable them to engage in these helping behaviors within the sporting environment.
... Brick et al. (2022) reported that 94.29% of referees (N = 438) experienced abuse while refereeing, with the frequency of abuse inversely related to mental wellbeing, and positively related to anxiety, depression, and intentions to quit via distress. In youth coaches, Duffy et al. (2021) found that 34% of coaches reported personal experience of a mental health issue. A significant, positive relationship was found between personal experience of mental ill-health and depression literacy, with role breadth and role efficacy positively associated with engagement in promotion, prevention, and early intervention for mental ill-health, but depression literacy was not directly related to these outcomes (Duffy et al., 2021). ...
... In youth coaches, Duffy et al. (2021) found that 34% of coaches reported personal experience of a mental health issue. A significant, positive relationship was found between personal experience of mental ill-health and depression literacy, with role breadth and role efficacy positively associated with engagement in promotion, prevention, and early intervention for mental ill-health, but depression literacy was not directly related to these outcomes (Duffy et al., 2021). ...
... Recommendation 2: clear guidelines and education are needed for mental health support Given evidence of mental health concerns among several populations in Gaelic games (e.g., Brick et al., 2022;Duffy et al., 2021;Gouttebarge et al., 2016;Sheehan et al., 2018), this calls for basic education on mental health across all levels and roles. Awareness should be raised of factors within Gaelic games that can potentially malnourish mental health, for which most evidence to date has developed with players. ...
Gaelic games are a family of indigenous Irish sports played in Ireland and across the world. With recent growth in research on the psychology of Gaelic games and developments in sport science policy in this context, there is a need to map and clarify understanding of psychology in Gaelic games. Against this backdrop, we conducted a scoping review that aimed to identify and synthesise current literature on the psychology of Gaelic games, with the intention of generating findings that could have implications for research, policy, and practice. After electronic database searches and manual searches up to September 2023, we included data from 42 articles involving 4963 Gaelic games participants in the review. We organised findings into eight categories: mental health and wellbeing; burnout; youth coaching practices; psychology of injury; attentional processes; optimal experiences and performing under pressure; identity; and female coach development. In light of the findings, we offer (a) five recommendations for researchers to strengthen the quality of research in future, and (b) five implications for policy and practice, some of which might also be transferable to other sport contexts. We believe that consideration of our recommendations for research can build a stronger and more coherent evidence base for policy and practice. By doing so, this can ultimately lead to more meaningful and tangible benefits for all in Gaelic games.
... One such potential outlet are youth sport coaches, who can provide a trusted first point of contact for provision of initial support and guidance to youth athletes. The provision of additional mental health support and signposting to professional mental health services could be vital if coaches possess the mental health literacy to do so and view it as a key part of their coaching role (Duffy et al, 2019;Jorm, 2012). Coaches who demonstrate higher levels of mental health literacy are likely then more willing to take on the initiative to provide support, and to attempt to reduce the stigma around seeking support (Gorczynski et al., 2020), thus demonstrating the need for the current study. ...
... Sport coaches continue to play a meaningful role in the lives of young people and remain well placed to contribute to the support of athlete mental health. However, addressing the mental health support role of sport coaches has had limited academic focus, and merits further investigation (Duffy et al., 2019;Ferguson et al., 2019;Mazzer & Rickwood, 2015a). The coach-athlete relationship is also key to the athlete well-being process (Davis & Jowett, 2014) and coaches are often able to foster a supportive environment in which participants feel safe and where trust is paramount. ...
... To date, depression has been the focus of a considerable proportion of the academic literature addressing mental health literacy. This focus is as a result of the prevalence of depression in society and the links between depression and suicide (Duffy et al., 2019;Ferguson et al., 2019;Mazzer & Rickwood, 2015a), which is also prevalent in Northern Ireland (O'Neill & O'Connor, 2020). Although this literature has provided some valuable knowledge surrounding depression specifically, studies tend not to address the many other nonclinical mental health issues currently faced in society which are an identified knowledge gap in the literature (Duffy et al., 2019;Hawton et al., 2013). ...
The purpose of the present study was to assess the influence of the Irish Football Association’s “Ahead of the Game” coach education training programme on mental health literacy of youth football coaches in Northern Ireland, and to gain insights into coaches’ own role perceptions of providing mental health support for athletes. A total of 105 coaches (90% male and 10% female; M age = 37.84, SD = 8.81, M experience = 9.53, SD = 6.59) completed an online survey examining mental health literacy and role perceptions of providing mental health support for athletes. A total of 40% of the sample completed the “Ahead of the Game” mental health literacy training programme, while 60% of the sample served as the comparison group. Results showed that participants who had completed the training programme demonstrated significantly higher mental health literacy in comparison to those who had not yet undertaken the programme. Thus, the “Ahead of the Game” programme may be useful for increasing mental health literacy. Youth sport coaches are an accessible and trusted outlet as a first point of contact to provide initial mental health support for athletes, thus advocating for the integration of mental health literacy training as a key part of coach education.
... Despite its potential, Breslin et al. (2019) highlighted the need for greater understandings around mental health provision in non-elite sporting contexts and in particular, greater certainty about their effectiveness to deliver programs that meet their targeted outcomes. Within the community sport club context, sports coaches and club leaders have an important role that can include explicitly communicating to athletes that their mental health is important, supporting help-seeking behavior, modelling language and behaviors that avoid stigmatizing mental illness and connecting to health services (Bissett, Kroshus, & Hebard, 2020;Breslin, Haughey, Donnelly, Kearney, & Prentice, 2017;Duffy, Rooney, & Matthews, 2021). Ferguson et al. (2019) identified that sport coaches perceive their role to include the promotion of mental health, but many felt they were not adequately trained in this area. ...
... Impacts on the wider club membership were not measured in this research. Pierce, Liaw, Dobell, & Anderson (2010) were unable to demonstrate the benefits of enhanced leader skills and confidence to address mental health on the wider playing group in their research while (Duffy, Rooney, & Matthews, 2021) were unable to show a direct association of mental health literacy with promotion, prevention, and early intervention. ...
... Given the potential for non-elite sporting clubs to act as a resource for promoting mental health, supporting coaches and leaders within community sporting clubs to improve mental health literacy and support help-seeking is important (Breslin, Haughey, Donnelly, Kearney, & Prentice, 2017). Programs like TYF have potential to counter the reported lack of expertise, confidence and capacity to more actively promote the mental wellbeing of sporting club members (Ferguson et al., 2019;Mazzer & Rickwood, 2015;Duffy, Rooney, & Matthews, 2021). Coaches and leaders who can recognize and respond to players struggling with mental health issues contribute to strategies that support increasing access and coverage (McGorry, Purcell, Goldstone, & Amminger, 2011;Duffy, Rooney, & Matthews, 2021), although the extent to which this has an impact on the wider playing group has not been established in this research or elsewhere (Pierce, Liaw, Dobell, & Anderson, 2010;Duffy, Rooney, & Matthews, 2021). ...
Community sports coaches and leaders can have an important role to play as informal resources for sporting adolescents and adults at risk of mental ill-health. Supporting coach mental health literacy using programs has potential to enhance opportunities for coach-player support. This study aimed to evaluate a community sport mental health literacy program and its capacity to improve club leader confidence to support and refer (primary outcome), awareness of resources, beliefs about mental health and stigmatizing attitudes (social distance). A cluster-randomized controlled evaluation was conducted with measures taken at baseline (around 2 weeks prior to intervention), immediately post-program and at a nine-month follow up. Twenty-five community Australian Rules Football clubs from metropolitan and regional centres were sampled and matched by size and location. Coaches or sport leaders (n = 265) were randomized by club to either the intervention group or a waitlist control group. A multivariate analysis of variance (pre-test scores as covariates) revealed participants in the ‘Tackle Your Feelings’ (TYF) program reported improved outcomes compared to controls on measures tied to leader confidence to support and refer, knowledge of resources to support mental health, general help-seeking and stigmatizing attitudes tied to social distance. A fifth measure of beliefs about mental illness was not impacted by the program. A nine-month comparison group follow-up indicated some decay in scores over time. The results suggest that TYF programs can be effective at improving coach mental health literacy in community sporting club contexts.
... It is important to identify these mechanisms as they could be targeted through interventions with the aim of increasing engagement in prevention and early intervention behaviors. A recent study by Duffy et al. (2021) examined predictors of coaches' engagement in prevention and early intervention behaviors, focusing on depression literacy and perceptions of role breadth (i.e., whether a person regards an activity as part of their role) and role efficacy (i.e., an individual's confidence in his or her capabilities to carry out a particular task or behavior). The investigators in this study found both role breadth and role efficacy predicted engagement in these behaviors and these factors mediated the role of depression literacy. ...
... Prevention items included "I encourage a young person to talk to their parents about their personal problems" and early intervention was measured with items such as "I personally contact the family of a young person whose mental health I am concerned about." These scales have demonstrated acceptable internal consistency, and discriminant validity in previous studies with sports coaches and teachers (Duffy et al., 2021;Mazzer & Rickwood, 2013. ...
... For example, utilizing evidence-based behavior change techniques linked to enhancing selfefficacy, such as demonstrating the behavior, and problem solving potential barriers to engaging in the behavior (Connell et al., 2019). In a similar fashion to Duffy et al. (2021), role breadth was associated with prevention and early intervention but did not mediate the relationship between depression literacy and either behavior. Therefore, increasing a coach's depression literacy may be unlikely to further strengthen their beliefs that these behaviors are part of their role. ...
Coaches’ mental health literacy is associated with increased engagement in prevention and early intervention behaviors. However, few studies have explored the factors that may influence these relationships. The purpose of this study was to explore whether role breadth and role efficacy mediate the relationship between coach depression literacy and prevention and early intervention, and to assess whether gender or stigma moderates any mediation effects. One thousand and forty five coaches (M = 42.71 years old; SD = 11.52; 30% female) completed an online survey exploring depression literacy, personal stigma, role breadth and efficacy and engagement in prevention and early intervention. Path analysis was conducted, followed by mediation and moderated-mediation analyzes. The overarching model for each behavior was confirmed. Role efficacy but not role breadth partially mediated the relationship between depression literacy and each behavior. Gender did not moderate any mediation relationships. Personal stigma moderated the relationship between depression literacy and prevention and early intervention. Coaches with lower levels of personal stigma, reported higher levels of depression literacy and were more confident to engage in prevention and early intervention. Increasing coaches’ knowledge and confidence may lead to increased engagement in prevention and early intervention. However, for coaches with high levels of personal stigma, approaches that go beyond the provision of knowledge may be required.
... This is supported by evidence that mental health literacy is associated significantly with early intervention, prevention, and promotion among youth coaches. 29 It is therefore postulated that coaches need the appropriate knowledge, competence, and beliefs to effectively monitor and support the mental health of EYAs. 29 ...
... 29 It is therefore postulated that coaches need the appropriate knowledge, competence, and beliefs to effectively monitor and support the mental health of EYAs. 29 ...
Context
Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs).
Evidence Acquisition
A narrative overview of the literature combined with the clinical and research expertise of the authors.
Study Design
Narrative overview.
Level of Evidence
Level 5.
Results
EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility.
Conclusion
A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes “youth” and “elite” in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport.
SORT
Level C.
... Responses were given on a 5-point Likert scale, ranging from 1 "strongly disagree" to 5 "strongly agree." These scales have been used in a range of studies regarding mental health promotion and have demonstrated high levels of reliability (Duffy et al., 2021). In this study, McDonald's omega for role breadth was ω = .87 ...
... Alongside knowledge and intention, there are other important determinants that influence engagement in a behavior, such as the alignment of the behavior to a person's social or professional role, and their beliefs about their capabilities to engage in the behavior (Cane & O'Connor, 2012). In the present study, role breadth and role efficacy were considered important determinants to assess as recent research has highlighted the importance of these factors to promote engagement in mental health promotion behaviors (Duffy et al., 2021). Consequently, the One Good Coach™ module highlighted the role of the coach in promoting youth mental health, thus targeting role breadth, while the module also highlighted the simple behaviors that coaches could engage in to support their athletes, with the aim of increasing coaches' confidence to engage in such behaviors. ...
The study aim was to evaluate the preliminary efficacy and acceptability of an e-learning module to increase sports coaches’ mental health literacy and intention to engage in mental health promotion. Thirty-five coaches completed measures at baseline and 1-week follow-up. Mixed methods were used to assess the acceptability of the module, including interviews with 15 coaches. Coaches’ knowledge, confidence and intention to engage in mental health promotion increased at 1-week follow-up. Coaches found the module to be acceptable with the content perceived to be informative, the design visually appealing, and the module realistic to be implemented more broadly within their sport.
... The relationships between MHL, confidence, and MHL-related behaviors have also been explored in previous research. In a sample of 269 Gaelic games coaches, it was shown that MHL did not have a direct influence on prevention or early intervention, but these behaviors were indirectly influenced by MHL through role efficacy (Duffy, Rooney, & Matthews, 2021). Results from recent research shows having improved knowledge in a certain area (i.e., recognizing a mental wellness issue) leads to a coach feeling more confident in their ability to deal with these types of concerns. ...
... Despite not being specifically defined in the extant student-athlete alcohol use literature, alcohol consumption literacy (as defined in this study) shares conceptual overlap and was based on factors associated with MHL. MHL has been shown to indirectly influence promotion, prevention, and early intervention through role efficacy among coaches (Duffy et al., 2021). For example, a coach may help an athlete identify ways to manage stress if they feel more confident in their role of preventing mental wellness-related issues. ...
The rate of alcohol consumption among student-athletes places them at risk for engaging in unsafe behaviors. Although coaches play a key role in regulating alcohol use among athletes, many lack the knowledge and self-confidence to be effective. This study aimed to examine the relationship between alcohol consumption literacy and alcohol confrontation efficacy among NCAA head coaches and attempted to identify types of training and education wanted to better manage student-athlete alcohol use. A total of 518 NCAA head coaches completed alcohol consumption literacy and alcohol confrontation efficacy measures and two open-ended questions about what kind of alcohol training, information, and skills were needed. When accounting for previous education/training and gender of team coached, alcohol consumption literacy predicted all confrontation efficacy subscales. Content analysis showed coaches wanted training related to alcohol literacy, effective communication, and prevention planning. Findings have implications for designing alcohol prevention and intervention programs aimed at NCAA coaches.
... Through initiatives like health education, case management, basic health screenings and ease of access to services, health outreach programmes are essential for enhancing and expanding the reach of healthcare. These actions can enhance the health of people and communities both directly and indirectly 37 . To demonstrate how outreach activities have benefited health outcomes, it is crucial to track and assess them. ...
Despite global agreements on adolescents' sexual and reproductive health and rights, access to and the utilisation of these services by the adolescents remain underutilised in low and middle-income countries. The aim of the study was to explore challenges and improvement strategies of adolescent-friendly health services in the northwest of Namibia. This study employed a qualitative approach utilising an explorative strategy. Semi-structured interviews were used to collect the data. Fifteen nurses were selected using a convenience sampling technique. The interviews were audio recorded, transcribed verbatim and the data were analysed using thematic analysis. The data analysis led to the emergence of the following three themes: Challenges affecting the delivery of Adolescent Friendly Health Services, Challenges affecting participation of adolescent to AFHS and strategies to improve the provision of adolescent-friendly health services. Findings from this study revealed several barriers reportedly faced by adolescents in accessing AFHS as including a lack of comprehensive sexual reproductive health (SRH) services in many healthcare facilities, a lack of trained staff, unfavourable environments for adolescents, a lack of information about the services provided, and recruitment of providers who are not friendly to young people and adolescents. This study findings may lead to an improvement in the provision of such services in healthcare settings. The study can lead to an improvement in the provision of adolescent-friendly services in health care settings. It can help the Ministry of Health and Social Services, along with its agencies, to formulate strategies that can be used to mitigate the challenges d in the provision of adolescent-friendly services.
... Scholars also acknowledge the role of coaches and support staff, such as athletic trainers, in athletes receiving adequate mental health care (Beasley, Hardin, & Palumbo 2022;Bissett & Tamminen, 2020;Duffy et al., 2021;Gorczynski, 2018;Mazerolle et al., 2013). In one of the first explorations of MHL in coaches and support staff, Sullivan et al. (2019) found athletic trainers and coaches had average MHL, but due to their influence on athletes, should have higher levels of MHL. ...
Mental health is an emerging area of interest in sport, but there is a paucity of educational initiatives in sport management curricula to train the next generation of sport managers to address the mental health needs of athletes, a type of knowledge that the mental health literature operationalizes as mental health literacy. One goal of accrediting bodies such as the Commission on Sport Management Accreditation is for excellence in sport management education; thus, due to the changing landscape of sport, sport management curricula should incorporate mental health literacy competencies. This educational research review provides justification for the inclusion of mental health literacy competencies in sport management curricula and accreditation standards, as well as pedagogical strategies for implementation.
... The coach has been identified as a key figure in creating an environment that supports the mental health of athletes (Duffy et al., 2021;Lebrun et al., 2020). As a result, athletes have reported being more likely to engage in help-seeking behaviours when their coach was understanding and supportive (Gulliver et al., 2012). ...
In partnership with the Canadian Mental Health Association, Ontario Division, the purpose of this study was to conduct a post-season evaluation of the effectiveness of a mental health and suicide-awareness program called Talk Today, delivered to elite adolescent male hockey players and their support staff. The study was conducted using a sequential explanatory mixed-methods design that began with a quantitative phase followed by a qualitative phase. In total, 105 participants (49 athletes, 56 staff) completed online questionnaires and 12 (6 athletes, 6 staff) participated in qualitative interviews. Results integrated quantitative and qualitative findings to examine participants’ perceptions of acceptability of the program, acquisition and application of knowledge, and perceptions of stigma following the program. Findings revealed that 78% of athletes and 90% of staff reported high levels of satisfaction with the program, 85% of athletes and 87% of staff felt they acquired knowledge on mental health including access to resources, and 68% of athletes and 87% of staff felt they could provide more effective support to individuals with mental health issues. Participants felt the program helped them to identify, approach, and support someone experiencing mental health issues. Additionally, participants reported lower levels of personal stigma in comparison to levels of public stigma towards persons with mental health problems. Overall, results suggest a high level of openness to a mental health and suicide-awareness program among elite male adolescent athletes. Given that this group typically holds negative attitudes towards mental health, these findings are promising for the future implementation of such programs.
... NGBs and those working in the sports industries have a duty of care to ensure that athletes are appropriately prepared for participation at such a high-level event given the implications for athletes' mental health (Grey-Thompson 2017). Various strategies have been offered to achieve this, for example improving the mental health literacy of coaches at all stages of the athletes' journey (Duffy, Rooney, and Matthews 2021). The findings from our study were clear, Olympic athletes, irrespective of their prior performance at an Olympic Games, express a desire for support in preparing for the post-Olympic experience. ...
The post-Olympic period is complex and distressing for many Olympic athletes; preparing for the likely impacts of the Olympic Games amongst returning athletes is fundamental in managing the negative responses articulated as the post-Olympic blues. Mindful of the need for the development of interventions that can support athletes, this study engaged Olympic athletes in: (a) discussing their experiences relating to the Olympic and post-Olympic periods and, (b) informing the researchers on Olympians’ opinions on the management of the post-Olympic blues. Fourteen Olympic athletes from the United Kingdom took part in focus groups which were analysed using Thematic Analysis. The analysis produced six mutually exclusive themes, The Olympic Dream, The Olympic Nightmare, Commodification, Perceptions of Social Support, Limited Preparation, and Managing and Overcoming. Through these themes the Olympians provided suggestions into how the content and potential facilitation of future interventions could better support athletes through their experiences. The findings were clear, Olympic athletes irrespective of whether they had previously competed in an Olympic Games expressed a desire for support in preparing for the post-Olympic experience. They expressed that this should be delivered primarily after the Olympic Games, with several athletes highlighting the value of an awareness raising session beforehand. Athletes proposed a shift away from expert sport psychology delivery of interventions in favour of a programme which was pragmatic in terms of content and delivered by former Olympians.
While the environment in which National Collegiate Athletic Association coaches operate makes them susceptible to mental health issues, many do not seek professional help. The Reasoned Action Approach posits that attitudes, perceived behavioral control, and perceived norms shape intentions for help-seeking behaviors. This study was designed to: (a) validate two commonly utilized instruments measuring psychological help-seeking beliefs for use with National Collegiate Athletic Association coaches; (b) assess coaches’ attitudes, perceived behavioral control, and perceived norms toward seeking mental health services for themselves; and (c) examine differences in beliefs based on gender, race, coaching role, age, and coaching experience. N = 1,424 National Collegiate Athletic Association Division I, II, and III coaches participated. Confirmatory factor analyses indicated the Inventory of Attitudes Toward Seeking Mental Health Services provides valid and reliable measurements for participants’ beliefs toward seeking services for themselves. Participants reported moderately positive attitudes, perceived behavioral control, and perceived norms. Male coaches indicated significantly lower positive beliefs than female coaches.
Resumo Introdução: A situação pandémica da COVID-19 colocou à prova a saúde mental, em particular, de atletas jovens e de seus treinadores, envolvendo todos numa incerteza permanente e global, e forçando-os a enfrentar adversidades, gerir emoções e relações e a testar orientações sanitárias e novas soluções. Objetivos: Identificar as principais alterações na perceção do papel social e no funcionamento psicológico do treinador de desporto, produzidas pelo prolongado período pandémico. Métodos: Entrevistas semiestruturadas a quatro treinadores especialistas na formação de atletas jovens de diferentes modalidades desportivas, com idades compreendidas entre os 34 e os 63 anos (M=48,0). Resultados: Foram identificadas as ações prioritárias, os recursos pessoais e sociais mobilizados, aprendizagens efetuadas e dificuldades sentidas enquanto procuraram lidar com os variados constrangimentos surgidos. Conclusão: Da adversidade vivenciada, decisiva da capacitação efetuada, decorrem implicações sobre a necessidade de atualização dos programas de formação de treinadores bem como para a intervenção psicológica com essa população. Palavras-chave: covid-19, treinadores de desporto, literacia, saúde mental Abstract Introduction: The COVID-19 pandemic tested the mental health of young athletes and their coaches, involving everyone in permanent and global uncertainty, forcing them to face adversity, manage emotions and relationships and check health guidelines and new solutions. Objectives: To identify the perceived main changes in sports coaches’ social role and psychological functioning produced by the prolonged pandemic. Methods: Semi-structured interviews with four coaches specialized in training young athletes from different sports, aged between 34 and 63 years (M=48.0). Results: Priority actions, personal and social resources mobilized, lessons learned, and difficulties experienced while dealing with the various emerging constraints were identified. Conclusion: Considering the adversity experienced, which is recognized as decisive for psychological empowerment, there are some implications: the need to update educational programmes for coaches and psychological intervention with this population. Keywords: covid-19, sports coaches, literacy, mental health
Resumo Introdução: As intervenções de enfermagem de promoção da saúde mental positiva (SMP)em adolescentes aumentam a autoestima, as habilidades socio emocionais e a capacidade de resolução de problemas dos jovens, diminuem o estigma, e permitem incrementar a esperança. Objetivos: Analisar uma intervenção de promoção de saúde mental positiva em adolescentes em contexto escolar. Metodologia: Estudo quase-experimental com pré e pós-teste, numa amostra não probabilística de 72 adolescentes. Foi aplicado um programa de SMP por enfermeiros especialistas de saúde mental no grupo experimental. Para a recolha de dados foi usado questionário de autopreenchimento online que continha todos os instrumentos de medida, aplicados ao grupo experimental antes e depois da intervenção de promoção de saúde mental positiva. Resultados: Verificou-se melhoria da SMP, diminuição do estigma, diminuição da vulnerabilidade psicológica e aumento dos níveis de esperança. Conclusão: A intervenção de enfermagem de promoção da saúde mental positiva teve uma forte adesão dos adolescentes e uma melhoria nos indicadores de saúde mental estudados. Palavras-chave: saúde mental, enfermagem, adolescentes, literacia Abstract Introduction: Nursing interventions to promote positive mental health (PMH) in adolescents increase self-esteem socio- emotional and problem-solving skills of young people, reduce stigma and increase hope. Objective: To analyse the programme's effectiveness in promoting adolescents' positive mental health in a school context. Methodology: A Quasi-experimental study using pre and post-test in a non-probabilistic sample of 72 adolescents. A PMH programme was applied by specialist mental health nurses in the experimental group. An online self-completion questionnaire was used for data collection, which contained the measurement instruments applied to the experimental group before and after the PMH intervention. Results: There was an improvement in PMH, a decrease in stigma, a decrease in psychological vulnerability and an increase in levels of hope. Conclusion: The positive mental health promotion nursing intervention had a strong adherence by adolescents and improved the mental health indicators under study. Keywords: mental health, nursing, adolescents, literacy
Perceptions towards mental health symptoms and disorders seem to be shaped by societal, environmental, cultural, and personal beliefs. As such, differences may exist across different sub-groups or cultures which could, in turn, influence treatment and prevention. The present study considered performers’, selected from different environments, knowledge, attitudes, and reactions towards a common mental health disorder; namely, depression. To do so, a vignette-method was employed with 197 participants (nathletes = 97, nperforming artists = 17, nmilitary forces = 26, and ngeneral population = 57) to examine the groups’ ability to discriminate between depression levels, together with their reactions and personal attitudes towards people presenting such symptomatology. Statistical analyses showed that the severity of depression, as depicted in the vignettes, exerted a significant influence on participants’ recognition and reactions. Moreover, an age effect was observed on participants’ reactions, whilst a between-group effect was identified regarding groups’ attitudes and beliefs towards depression. Differences in knowledge, reactions, and attitudes towards symptoms of depression identified in relation to performance environments add to the literature stressing the need for context-specific mental health interventions.
Several evidence-based programs to improve mental health literacy (MHL) are available; however, few have been adapted for youth athletes and sport-club settings. This systematic review aimed to investigate the impact of MHL initiatives, inclusive of education, resources and information, on the mental health of youth elite athletes. Studies were included if they examined a mental health program for young athletes (10–24 years) and reported MHL outcomes in either young people or their extended support network. A systematic search of the PubMed, Scopus and SPORTDiscus databases was conducted with no language or publication restrictions from July 2020 until September 2020. Thirteen studies were included for analysis in the review. Six studies included adolescent athletes, four studies included parents of adolescent athletes, six studies included coaching staff and three studies included female athletic populations. Five of these studies were qualitative and eight quantitative. The broad study search identified a lack of well designed, intervention-based research on MHL programs for youth elite athletes despite high demand for context specific programs. No literature that met eligibility criteria addressed MHL in youth female elite athletes exclusively. These findings limit dissemination and program transferability. This study also reinforces the influence parents and coaches have on the mental wellbeing of young elite athletes. To enhance the quality of MHL initiatives, programs developers should focus on the development of tailored resources for youth athletes with a gendered focus and incorporating opportunities for coach and parent engagement.
An increasing amount of scholarly work has attempted to understand the reasons for poor rates of help-seeking for symptoms of mental health disorders all around the world. One particular body of work has focused on ‘mental health literacy’ (MHL) defined as knowledge about mental health disorders that are associated with their recognition, management, and prevention. In this paper we report a non-systematic review of studies on MHL, to give non-expert academics, policy makers and practitioners an understanding of the field. We find that studies consistently show that the general public have relatively poor recognition of the symptoms of mental health disorders and appear to emphasise self-help over traditional medical treatments. In addition, we find that there are age, gender, educational, urban-rural and cross-cultural differences in MHL, which may differentially affect rates of help-seeking in different contexts. Implications and future directions for research are considered in conclusion.
The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (Mage = 44.86 ± 5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n = 42) or a community-matched control group (n = 24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.
Objectives
The prevalence of mental health problems among adolescents is alarmingly high. With lower rates of accessing services than young women, young men and boys represent a group at high risk of developing mental health problems. Organised sport represents one important, but under-studied, avenue for supporting mental health. This study aimed to explore adolescent males' perspectives on sport as a context for supporting mental health.
Design
Interpretivist qualitative design.
Method
Participants were 55 adolescent males aged 12–17 years (M = 14.73; SD = 1.67) who were currently participating in organised basketball, soccer, Australian Rules Football, swimming, cricket, or tennis. Sixteen focus groups were conducted which lasted, on average, 48 min (SD = 9.25). Data were analysed inductively and thematically, with strategies employed to enhance rigour and trustworthiness.
Results
Findings indicated that these adolescent males perceived sport to be an engaging vehicle for supporting mental health, particularly in teams, and through interest in elite athletes' mental health. They considered coaches and parents/family to be key support individuals. In addition, these adolescents expressed a need to know how to help individuals close to them who may be struggling with a mental health issue. Finally, the participants perceived the need for resources to prevent and cope with mental health issues.
Conclusion
This study suggests that sport is a promising, and potentially engaging avenue for supporting mental health. Adolescents perceive need for clubs, parents, and coaches to develop knowledge around mental health, and in particular, desire strategies for providing help.
Background:
The aim of the current study was to conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. The second aim was to review the study quality and to report on the validity of measures that were used to determine the effectiveness of programs.
Methods:
Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: PsycINFO, MEDLINE (OVID interface), Scopus, Cochrane, CINAHL and SPORTDiscus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools.
Results:
Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes was used to assess indices of mental health awareness and well-being. Mental health referral efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias.
Conclusions:
Further, well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply the psychological theory of behaviour change when developing and evaluating complex interventions.
Trial registration:
PROSPERO CRD42016040178.
Purpose
The World Health Organization estimates that millions of people across the world experience mental health problems, yet traditionally athletes have been poorly supported to manage their mental health. The purpose of this paper is to apply the Theory of Planned Behaviour to determine the effect of a mental health awareness programme on sports coaches’ knowledge and intentions to offer support to athletes who experience mental health problems.
Design/methodology/approach
Adult coaches ( n =244) were recruited to attend the Mood Matters in Sport Programme mental health awareness intervention or act as a control. A 2 (group) × 2 (time) quasi-experimental design was adopted. All participants completed the Mental Health Knowledge Schedule and Reported and Intended Behaviour Scale at the beginning and end of the programme. Two months postprogramme delivery focus groups were conducted.
Findings
A mixed analysis of variance showed a significant interaction effect wherein there were improvements in mental health knowledge and intentions to offer support compared to the control group. Focus group findings provided further detail on how to support mental health awareness in sport clubs.
Practical implications
Knowledge and intentions to offer support can be enhanced through a short mental health awareness programme. The already established social networks available in sport clubs can provide a natural environment for delivering mental health awareness programmes. The programme facilitated discussion on mental health issues and highlighted that future programmes should contain more sport-related examples (i.e. case studies, videos, etc.).
Originality/value
This is the first study to apply the Theory of Planned Behaviour to mental health awareness programmes in a sport setting.
The Active Healthy Kids Global Alliance organized the concurrent preparation of Report Cards on the physical activity of children and youth in 38 countries from 6 continents (representing 60% of the world’s population). Nine common indicators were used (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments), and all Report Cards were generated through a harmonized development process and a standardized grading framework (from A = excellent, to F = failing). The 38 Report Cards were presented at the International Congress on Physical Activity and Public Health in Bangkok, Thailand on November 16, 2016. The consolidated findings are summarized in the form of a Global Matrix demonstrating substantial variation in grades both within and across countries. Countries that lead in certain indicators often lag in others. Average grades for both Overall Physical Activity and Sedentary Behavior around the world are D (low/poor). In contrast, the average grade for indicators related to supports for physical activity was C. Lower-income countries generally had better grades on Overall Physical Activity, Active Transportation, and Sedentary Behaviors compared with higher-income countries, yet worse grades for supports from Family and Peers, Community and the Built Environment, and Government Strategies and Investments. Average grades for all indicators combined were highest (best) in Denmark, Slovenia, and the Netherlands. Many surveillance and research gaps were apparent, especially for the Active Play and Family and Peers indicators. International cooperation and cross-fertilization is encouraged to address existing challenges, understand underlying determinants, conceive innovative solutions, and mitigate the global childhood inactivity crisis. The paradox of higher physical activity and lower sedentary behavior in countries reporting poorer infrastructure, and lower physical activity and higher sedentary behavior in countries reporting better infrastructure, suggests that autonomy to play, travel, or chore requirements and/or fewer attractive sedentary pursuits, rather than infrastructure and structured activities, may facilitate higher levels of physical activity.
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.
Background:
Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions.
Purpose:
This research aims to develop and test a methodology for linking BCTs to their mechanisms of action.
Methods:
Study 1 (published explicit links): Hypothesised links between 93 BCTs (from the 93-item BCT taxonomy, BCTTv1) and mechanisms of action will be identified from published interventions and their frequency, explicitness and precision documented. Study 2 (expert-agreed explicit links): Behaviour change experts will identify links between 61 BCTs and 26 mechanisms of action in a formal consensus study. Study 3 (integrated matrix of explicit links): Agreement between studies 1 and 2 will be evaluated and a new group of experts will discuss discrepancies. An integrated matrix of BCT-mechanism of action links, annotated to indicate strength of evidence, will be generated. Study 4 (published implicit links): To determine whether groups of co-occurring BCTs can be linked to theories, we will identify groups of BCTs that are used together from the study 1 literature. A consensus exercise will be used to rate strength of links between groups of BCT and theories.
Conclusions:
A formal methodology for linking BCTs to their hypothesised mechanisms of action can contribute to the development and evaluation of behaviour change interventions. This research is a step towards developing a behaviour change 'ontology', specifying relations between BCTs, mechanisms of action, modes of delivery, populations, settings and types of behaviour.
Mental illnesses are as prevalent among elite athletes as in the general population. Despite this, there is little research examining how to enhance mental health literacy or helping behaviors in elite sport environments. A Mental Health in Sport (MHS) workshop was therefore developed and its effects on mental health literacy and confidence studied in 166 coaches and support staff working with elite athletes and teams in Australia. Results indicated that participants increased their knowledge of the signs and symptoms of common mental illnesses and were more confident in helping someone who may be experiencing a mental health problem. We conclude that even a very brief intervention can be effective in improving the mental health literacy and confidence of key persons in elite sport environments, and may promote early intervention and timely referral of elite athletes with mental health concerns to appropriate professionals.
Objective: To demonstrate that six common errors made in attempts to change behaviour have prevented the implementation of the scientific evidence base derived from psychology and sociology; to suggest a new approach which incorporates recent developments in the behavioural sciences.
Study design: The role of health behaviours in the origin of the current epidemic of non-communicable disease is observed to have driven attempts to change behaviour. It is noted that most efforts to change health behaviours have had limited success. This paper suggests that in policy-making, discussions about behaviour change are subject to six common errors and that these errors have made the business of health-related behaviour change much more difficult than it needs to be.
Methods: Overview of policy and practice attempts to change health-related behaviour.
Results: The reasons why knowledge and learning about behaviour have made so little progress in alcohol, dietary and physical inactivity-related disease prevention are considered, and an alternative way of thinking about the behaviours involved is suggested. This model harnesses recent developments in the behavioural sciences.
Conclusion: It is important to understand the conditions preceding behaviour psychologically and sociologically and to combine psychological ideas about the automatic and reflective systems with sociological ideas about social practice.
Objective:
To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders.
Method:
Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire.
Results:
Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents.
Conclusion:
Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.
Background Evidence suggests that mental health literacy among the public is low, and stigmatizing attitudes are widespread. So far the effects of anti-stigma campaigns are small, and studies demonstrate that negative attitudes have been quite stable through recent decades. Aims To investigate the relationships between mental health literacy, experience of mental illness and stigmatizing attitudes/social distance towards people with depression or psychosis. Methods A cross-sectional study in which staff members from public services in Sweden (n = 1027) completed questionnaires covering demographic data, self-reported experience of mental illness, identification of a vignette for depression or psychosis, beliefs about helpful interventions for the illness presented in the vignette, and attitudes and social distance towards people with the illness. Results About 50% of participants could identify depression and less than 40% psychosis. A higher degree of mental health literacy was related to less stigma and social distance but mainly towards people with depression. A similar relationship was shown for having personal or family experience of mental illness and attitudes/social distance. Negative attitudes and social distance were significantly higher in all aspects measured towards a person with psychosis than a person with depression. Conclusions A higher degree of mental health literacy relates to more positive attitudes and less desire for social distance towards people with depression. The differences between depression and psychosis should be taken into account in anti-stigma interventions.
This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted. This paper reports on the findings for interventions promoting the positive mental health of young people (aged 6--18 years) in school and community-based settings.
Searching a range of electronic databases, 22 studies employing RCTs (N = 11) and quasi-experimental designs conducted in LMICs since 2000 were identified. Fourteen studies of school-based interventions implemented in eight LMICs were reviewed; seven of which included interventions for children living in areas of armed conflict and six interventions of multicomponent lifeskills and resilience training. Eight studies evaluating out-of-school community interventions for adolescents were identified in five countries. Using the Effective Public Health Practice Project (EPHPP) criteria, two reviewers independently assessed the quality of the evidence.
The findings from the majority of the school-based interventions are strong. Structured universal interventions for children living in conflict areas indicate generally significant positive effects on students' emotional and behavioural wellbeing, including improved self-esteem and coping skills. However, mixed results were also reported, including differential effects for gender and age groups, and two studies reported nonsignficant findings. The majority of the school-based lifeskills and resilience programmes received a moderate quality rating, with findings indicating positive effects on students' self-esteem, motivation and self-efficacy. The quality of evidence from the community-based interventions for adolescents was moderate to strong with promising findings concerning the potential of multicomponent interventions to impact on youth mental health and social wellbeing.
The review findings indicate that interventions promoting the mental health of young people can be implemented effectively in LMIC school and community settings with moderate to strong evidence of their impact on both positive and negative mental health outcomes. There is a paucity of evidence relating to interventions for younger children in LMIC primary schools. Evidence for the scaling up and sustainability of mental health promotion interventions in LMICs needs to be strengthened.
Drawing from the theories of self-determination (SDT; Ryan & Deci, 2000) achievement goals (AGT; Nicholls, 1989), and, in particular, Vallerand’s four-stage casual sequence embedded in his hierarchical model of intrinsic and extrinsic motivation (HMIEM; Vallerand, 1997, 2001), this study tested a motivational model in the sport context via structural equation modeling (SEM). Based on the responses of 370 young male soccer players (M age = 14.77), the path analysis results offered overall support for the proposed model. A perceived task-involving climate emerged as a positive predictor of the satisfaction of the three psychological needs, while a perceived ego-involving climate was a negative predictor of relatedness satisfaction. The results also support positive paths between satisfaction of the three psychological needs and intrinsic motivation, while intrinsic motivation was positively linked to subjective vitality and future intention to participate. The implications of the coach-created motivational climate are discussed in the light of its implications for the quality and potential maintenance of sport involvement among young athletes.
Much of the global burden of disease is associated with behaviors—overeating, smoking, excessive alcohol consumption, and
physical inactivity—that people recognize as health-harming and yet continue to engage in, even when undesired consequences
emerge. To date, interventions aimed at changing such behaviors have largely encouraged people to reflect on their behaviors.
These approaches are often ineffectual, which is in keeping with the observation that much human behavior is automatic, cued
by environmental stimuli, resulting in actions that are largely unaccompanied by conscious reflection. We propose that interventions
targeting these automatic bases of behaviors may be more effective. We discuss specific interventions and suggest ways to
determine whether and how interventions that target automatic processes can enhance global efforts to prevent disease.
Mental disorders are more common in young adults than at any other life stage. Despite this, young people have low rates of seeking professional help for mental health problems. Young elite athletes have less positive attitudes toward seeking help than nonathletes and thus may be particularly unlikely to seek help. Interventions aimed at increasing help-seeking in young elite athletes are warranted.
To test the feasibility and efficacy of three Internet-based interventions designed to increase mental health help-seeking attitudes, intentions, and behavior in young elite athletes compared with a control condition.
We conducted a randomized controlled trial (RCT) of three brief fully automated Internet-based mental health help-seeking interventions with 59 young elite athletes recruited online in a closed trial in Australia. The interventions consisted of a mental health literacy and destigmatization condition, a feedback condition providing symptom levels, and a minimal content condition comprising a list of help-seeking resources, compared with a control condition (no intervention). We measured help-seeking attitudes, intentions and behavior using self-assessed surveys. Participation was open to elite athletes regardless of their mental health status or risk of mental illness.
Of 120 athletes initially agreeing to participate, 59 (49%) submitted a preintervention or postintervention survey, or both, and were included in the present study. Adherence was satisfactory, with 48 (81%) participants visiting both weeks of assigned intervention material. None of the interventions yielded a significant increase in help-seeking attitudes, intentions, or behavior relative to control. However, at postintervention, there was a trend toward a greater increase in help-seeking behavior from formal sources for the mental health literacy/destigmatization condition compared with control (P = .06). This intervention was also associated with increased depression literacy (P = .003, P = .005) and anxiety literacy (P = .002, P = .001) relative to control at postintervention and 3-month follow-up, respectively, and a reduction in depression stigma relative to control at postintervention (P = .01, P = .12) and anxiety stigma at 3-month follow-up (P = .18, P = .02). The feedback and help-seeking list interventions did not improve depression or anxiety literacy or decrease stigmatizing attitudes to these conditions. However, the study findings should be treated with caution. Due to recruitment challenges, the achieved sample size fell significantly short of the target size and the study was underpowered. Accordingly, the results should be considered as providing preliminary pilot data only.
This is the first RCT of an Internet-based mental health help-seeking intervention for young elite athletes. The results suggest that brief mental health literacy and destigmatization improves knowledge and may decrease stigma but does not increase help-seeking. However, since the trial was underpowered, a larger trial is warranted.
2009/373 (www.clinicaltrials.gov ID: NCT00940732), cited at http://www.webcitation.org/5ymsRLy9r.
An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework.
Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis.
There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): 'Knowledge', 'Skills', 'Social/Professional Role and Identity', 'Beliefs about Capabilities', 'Optimism', 'Beliefs about Consequences', 'Reinforcement', 'Intentions', 'Goals', 'Memory, Attention and Decision Processes', 'Environmental Context and Resources', 'Social Influences', 'Emotions', and 'Behavioural Regulation'.
The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.
The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.
For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.
Little is known about the efficacy of Internet-based information interventions in increasing depression literacy or reducing depression stigma and depressive symptoms in people from non-English-speaking backgrounds.
Our objective was to investigate the effects of Multicultural Information on Depression Online (MIDonline), an Internet-based multilingual depression-specific information resource, on depression literacy, depression stigma, and depressive symptoms in Greek-born and Italian-born immigrants to Australia.
In all, 202 Greek- and Italian-born immigrants aged 48 to 88 years were randomly allocated to an online depression information intervention (n =110) or a depression interview control group (n = 92). Participants allocated to the information intervention only had access to the website during the 1- to 1.5-hour intervention session. The primary outcome measures were depression literacy (depression knowledge), personal stigma (personal stigma toward people with a mental illness), perceived stigma (participants' views about the probable attitude of the general community toward people with mental illness), and depressive symptoms. Depression literacy, personal and perceived stigma, and depressive symptoms were assessed at preassessment, postassessment, and at a 1-week follow-up assessment. The trial was undertaken at Monash University, Melbourne, Australia. Randomization and allocation to trial group were carried out using a computer-generated table.
For depression literacy, there was a significant difference between the MIDonline and the control group with those in the MIDonline intervention displaying higher depression literacy scores postassessment (F(1,178) = 144.99, P < .001) and at the follow-up assessment (F(1,178) = 129.13, P < .001) than those in the control group. In addition, those in the MIDonline intervention showed a significantly greater decrease in mean personal stigma scores postassessment (F(1,178) = 38.75, P < .001) and at the follow-up assessment (F(1,176) = 11.08, P = .001) than those in the control group. For perceived stigma, there was no significant difference between the MIDonline intervention and the control group at postassessment (F(1,178) = 0.60, P = .44) and at the follow-up assessment (F(1,176) = 1.06, P = .30). For level of depression, there was no significant difference between the MIDonline intervention and the control group at preassessment (F(1,201) = 0.56, P = .45), postassessment (F(1,178) = 0.03, P = .86), or at the follow-up assessment, (F(1,175) = 1.71, P = .19). Within group effect sizes for depression literacy were -1.78 (MIDonline) and -0.07 (control); for personal stigma, they were 0.83 (MIDonline) and 0.06 (control); for perceived stigma, they were 0.14 (MIDonline) and 0.16 (control); and for depressive symptoms, they were 0.10 (MIDonline) and 0.10 (control).
Current results suggested that the Internet may be a feasible and effective means for increasing depression knowledge and decreasing personal stigma in non-English-speaking immigrant populations residing in English-speaking countries. The lack of change in perceived stigma in this trial is consistent with results in other trials examining online depression stigma interventions in English-speaking groups.
ISRCTN76460837; http://www.controlled-trials.com/ISRCTN76460837 (Archived by WebCite at http://www.webcitation.org/5xjxva4Uq).
Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions.
The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries.
The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were maintained at follow-up. Over the first 3 years of this program, a total of 318 instructors were trained to deliver the course and these instructors have delivered courses to 10,686 people across all states and territories in Australia. The program has also spread to Canada, Singapore and England, and will spread to Hong Kong, Sweden and China in the near future.
Initial evaluation suggests that the Youth Mental Health First Aid course improves participants' knowledge, attitudes and helping behaviour. The program has spread successfully both nationally and internationally.
ACTRN12609000033246.
Improved mental health in the population requires a long-term and holistic approach involving multiple sectors of the community not just mental health service providers. People in authority over others, that is, parents, teachers and employers, could provide a leverage point for a universal intervention to promote mental health in those in their care. A telephone survey of 1,000 metropolitan and 500 country male and female respondents was conducted in Western Australia. Four types of ‘authority’ persons were identified (parents, teachers, trainers and supervisors) and asked what they thought they could do, if anything, to ensure that those in their care remained mentally healthy. Responses were coded into dominant themes across the four types of respondents, the most common being: providing stimulation; providing positive reinforcement; good communication; recognising and dealing with problems openly and sympathetically; ensuring physical activity; not overworking and providing adequate rest breaks; goal setting; not disparaging or being overcritical; and encouraging relationships with family and others. The results are discussed in terms of Hawkins and Catalano’s concepts of participation, opportunity and recognition, and Warr’s influences on mental health. The findings can be used to identify areas where salience can be increased through mental health promotion.
Mental ill health, especially depression, is recognised as an important health concern, potentially with greater impact in rural communities. This paper reports on a project, Coach the Coach, in which Australian rural football clubs were the setting and football coaches the leaders in providing greater mental health awareness and capacity to support early help seeking behaviour among young males experiencing mental health difficulties, especially depression. Coaches and other football club leaders were provided with Mental Health First Aid (MHFA) training.
Pre-post measures of the ability of those club leaders undertaking mental health training to recognise depression and schizophrenia and of their knowledge of evidence supported treatment options, and confidence in responding to mental health difficulties were obtained using a questionnaire. This was supplemented by focus group interviews. Pre-post questionnaire data from players in participating football clubs was used to investigate attitudes to depression, treatment options and ability to recognise depression from a clinical scenario. Key project stakeholders were also interviewed.
Club leaders (n = 36) who were trained in MHFA and club players (n = 275) who were not trained, participated in this evaluation. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. They reported that this training built upon their existing skills, fulfilled their perceived social responsibilities and empowered them. Indirect benefit to club players from this approach seemed limited as minimal changes in attitudes were reported by players. Key stakeholders regarded the project as valuable.
Rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable.
Mediation is said to occur when a causal effect of some variable X on an outcome Y is explained by some intervening variable M. The authors recommend that with small to moderate samples, bootstrap methods (B. Efron & R. Tibshirani, 1993) be used to assess mediation. Bootstrap tests are powerful because they detect that the sampling distribution of the mediated effect is skewed away from 0. They argue that R. M. Baron and D. A. Kenny's (1986) recommendation of first testing the X --> Y association for statistical significance should not be a requirement when there is a priori belief that the effect size is small or suppression is a possibility. Empirical examples and computer setups for bootstrap analyses are provided.
Analogous to checklists of recommendations such as the CONSORT statement (for randomized trials), or the QUORUM statement (for systematic reviews), which are designed to ensure the quality of reports in the medical literature, a checklist of recommendations for authors is being presented by the Journal of Medical Internet Research (JMIR) in an effort to ensure complete descriptions of Web-based surveys. Papers on Web-based surveys reported according to the CHERRIES statement will give readers a better understanding of the sample (self-)selection and its possible differences from a "representative" sample. It is hoped that author adherence to the checklist will increase the usefulness of such reports.
The objective of this study was to empirically disentangle role perceptions related to organizational citizenship behavior (OCB) that have been confounded in past research, investigate their unique relationships with both an affiliative (helping) and a challenging (taking charge) form of OCB, and determine their relative importance in explaining these 2 forms of OCB. The authors also examined whether role discretion and role breadth independently moderate the procedural justice-to-OCB relationship. The authors surveyed 225 engineers in India and their direct supervisors. The results showed that 3 of the 4 facets of OCB role perception explain unique variance in either helping or taking charge, and that role breadth moderates the relationships between procedural justice and both helping and taking charge. The authors discuss implications of these findings for OCB theory and research, as well as for managerial practice.
Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact.
A postal screening questionnaire was sent to a random sample of the general population aged 20-64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).
Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic.
Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.
Young people have a high prevalence of mental health problems, yet tend not to seek help. Trusted adults in young people’s lives, such as teachers and sports coaches, can make a major positive contribution to the mental health of young people. Teachers and
sports coaches may be in a position to be effective in supporting young people’s mental health through promotion, prevention and early intervention. This study reports findings from interviews with 21 teachers and 13 sports coaches of young people aged 12 to 18 in
Canberra, Australia, regarding their perceptions of the relevance and effectiveness of their role in supporting young people’s mental health. Both teachers and coaches perceived having influential but slightly different roles to play in supporting mental health. There may be potential to elevate the influence of teachers and coaches as sources of support for young people and their mental health care.
Coaches play an important role in the lives of adolescents in sport and have the potential to greatly impact on athlete mental health. This study aimed to investigate coaches’ perceptions of their role in supporting adolescent mental health. Twenty coaches participated in five focus groups. Results revealed that coaches perceive their role to be diverse and inclusive of the promotion of mental health. Some believed they have a role in facilitating professional help seeking but were not adequately trained in the area of mental health. We present recommendations regarding the tailoring of mental health literacy training for youth sport coaches.
Many young males experience significant mental health concerns but do not access treatment. Community gatekeepers are individuals who are in contact with such groups and have the potential to support them in getting appropriate help. Sport coaches have been identified as potential gatekeepers for adolescent males, but are likely to need the support of parents for this role. This study investigated parent’s views of coaches as gatekeepers. Semi-structured interviews were conducted with 22 parents of adolescent males between the ages of 12 and 17 years, participating in five different sports. Four global themes emerged: communication; support; relationships; and, awareness. Many participants felt that the coach would be a good candidate for gatekeeper, but others felt that it would depend on how successful they are in relation to the skills identified in the themes. Future research is needed to evaluate the effectiveness of gatekeeper training programmes for developing these skills.
Objectives:
This study examined national trends in 12-month prevalence of major depressive episodes (MDEs) in adolescents and young adults overall and in different sociodemographic groups, as well as trends in depression treatment between 2005 and 2014.
Methods:
Data were drawn from the National Surveys on Drug Use and Health for 2005 to 2014, which are annual cross-sectional surveys of the US general population. Participants included 172 495 adolescents aged 12 to 17 and 178 755 adults aged 18 to 25. Time trends in 12-month prevalence of MDEs were examined overall and in different subgroups, as were time trends in the use of treatment services.
Results:
The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.
Conclusions:
The prevalence of depression in adolescents and young adults has increased in recent years. In the context of little change in mental health treatments, trends in prevalence translate into a growing number of young people with untreated depression. The findings call for renewed efforts to expand service capacity to best meet the mental health care needs of this age group.
The United States is engaged in ongoing dialogue around mental illness. To assess trends in this national discourse, we studied the volume and content of a random sample of 400 news stories about mental illness from the period 1995-2014. Compared to news stories in the first decade of the study period, those in the second decade were more likely to mention mass shootings by people with mental illnesses. The most frequently mentioned topic across the study period was violence (55 percent overall) divided into categories of interpersonal violence or self-directed (suicide) violence, followed by stories about any type of treatment for mental illness (47 percent). Fewer news stories, only 14 percent, described successful treatment for or recovery from mental illness. The news media's continued emphasis on interpersonal violence is highly disproportionate to actual rates of violence among those with mental illnesses. Research suggests that this focus may exacerbate social stigma and decrease support for public policies that benefit people with mental illnesses.
This paper examines the issue of board composition within non-profit sport organizations operating in a federated governance structure. The Gaelic Athletic Association (GAA) is used as a case study to illustrate the challenges and complexities of comprising a board that has the requisite skill set to carry out its function in a rapidly changing operating environment. Interviews (n = 10) supported by document analysis were conducted with senior ranking officials within the Association in order to analyse the integral factors related to board composition within the GAA. Findings show that the Association heavily relies on the delegate system of board composition, potentially limiting its ability to appoint a board that has a commercially orientated focus reflecting the professionalization and commercialization of the contemporary sport industry. Practical and theoretical implications of these findings are discussed along with suggestions for future research.
This study aimed to investigate coaches' awareness of mental health in youth sport, as well as their perceived role breadth and ability to support young people's mental health. Interviews were conducted with 13 sports coaches of young people aged 12-18 from Canberra, Australia. Interview transcripts were analysed using a combination of inductive and deductive qualitative content analysis. Coaches recognised that their role breadth allows them to be a useful source of support for young people's mental health by way of identifying concerns, facilitating help-seeking behaviour and promoting engagement in sports. Further training in mental health would boost coaches' ability to assist confidently and effectively, leading to benefits for young people's mental wellbeing and sporting experience. Coaches are in a position to positively impact young people's mental health, and set expectations for themselves to actively support young people in this way. Supporting mental health may be an area of future growth for the role of a youth sports coach.
Assessing overall model fit is an important problem in general structural equation models. One of the most widely used fit measures is Bentler and Bonett's (1980) normed index. This article has three purposes: (1) to propose a new incremental fit measure that provides an adjustment to the normed index for sample size and degrees of freedom, (2) to explain the relation between this new fit measure and the other ones, and (3) to illustrate its properties with an empirical example and a Monte Carlo simulation. The simulation suggests that the mean of the sampling distribution of the new fit measure stays at about one for different sample sizes whereas that for the normed fit index increases with N. In addition, the standard deviation of the new measure is relatively low compared to some other measures (e.g., Tucker and Lewis's (1973) and Bentler and Bonett's (1980) nonnormed index). The empirical example suggests that the new fit measure is relatively stable for the same model in different samples. In sum, it appears that the new incremental measure is a useful complement to the existing fit measures.
Mental health is an issue for the whole community. Effective support and intervention for mental health can be carried out across a range of contexts. This paper investigated teachers' and coaches' relative involvement in promotion, prevention and early intervention activities for young people's mental health. A set of activities representing promotion, prevention and early intervention for mental health was developed through expert consensus and was used in an online survey completed by 124 teachers and 147 coaches within Canberra, Australia. Results indicated both teachers and coaches frequently performed activities which promote young people's mental health. Teachers more commonly engaged in behaviour that supported prevention and early intervention for mental health than coaches. Encouraging adults in community-based roles to take early action in supporting young people's mental health is important to reduce the burden of mental health problems among young people and strengthen available pathways to mental health care.
Research reveals limited knowledge of children's mental health among caregivers. This paper identifies predictors of mental health literacy among parents of children diagnosed with mood disorders that are seeking or already receiving help. Secondary data analysis using multivariate regression was conducted on data from a randomized, controlled efficacy trial with a sample of 165 children. Mental health literacy was higher for parents who were female, white, higher educated and had children who were older, had a bipolar diagnosis or received more services. Lifetime experience with mental health disorders also predicted literacy. Public mental health efforts are needed to raise caregiver mental health literacy.
Teachers and youth sports coaches are in prominent positions to support young people and their mental health. However, the way these professionals perceive their roles is likely to be a powerful influence on such behaviour. This article investigates and compares the effect of four types of role perceptions—role breadth, instrumentality, efficacy, and discretion—on teachers' and coaches' engagement in helping behaviour that supports young people's mental health through promotion, prevention, and early intervention. An online survey was completed by 117 teachers and 131 coaches. Results from three multiple group path analyses revealed role breadth, instrumentality, and efficacy significantly influenced teachers' and coaches' helping behaviour. The extent to which role perceptions predicted helping behaviour did not differ between teachers and coaches. Assisting teachers and coaches to carry out promotion, prevention, and early intervention behaviour increases young people's access to mental health support and may help to reduce the burden of mental health problems among Australian young people.
Objective
This paper assessed the associations between sports participation and the development of psychological strengths and difficulties during childhood.
Design
Two-year follow up study of a sample of 4,042 Australian children who were followed from age 8 years to 10 years.
Methods
Parents reported children's participation in organised sports, and completed the Strengths and Difficulties Questionnaire. Univariate general linear models were used to examine the association between changes in sports participation and psychological strengths and difficulties at 10 years, adjusting for psychological strengths and difficulties at age 8.
Results
Children who maintained participation in sport had lower rates of parent-reported psychological difficulties at 10 years compared with children who dropped out of sport. Less internalising problems were also reported for children who participated in organised sports compared to children who dropped out of sports and children who did not participate in sports. These relationships did not differ by BMI, socioeconomic status, or parental education.
Conclusion
Greater psychological difficulties are experienced by children who drop out of sports, and greater social and emotional problems are experienced by children who drop out of sports and who do not participate in organised sports. Due consideration should be given to the quality and implementation of sporting programs to ensure that they provide benefits to mental health. Due consideration should also be given to the potential psychological difficulties being experienced by children who drop out of organised sports as a higher level of psychological difficulties may be experienced prior to or subsequent to dropout.
The age at which most young people are in higher education is also the age of peak onset for mental and substance use disorders, with these having their first onset before age 24 in 75% of cases. In most developed countries, over 50% of young people are in higher education.
To review the evidence for prevention and early intervention in mental health problems in higher education students. The review was limited to interventions targeted to anxiety, depression and alcohol misuse.
Interventions to review were identified by searching PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Interventions were included if they were designed to specifically prevent or intervene early in the general (non-health professional) higher education student population, in one or more of the following areas: anxiety, depression or alcohol misuse symptoms, mental health literacy, stigma and one or more behavioural outcomes.
For interventions to prevent or intervene early for alcohol misuse, evidence of effectiveness is strongest for brief motivational interventions and for personalized normative interventions delivered using computers or in individual face-to-face sessions. Few interventions to prevent or intervene early with depression or anxiety were identified. These were mostly face-to-face, cognitive-behavioural/skill-based interventions. One social marketing intervention to raise awareness of depression and treatments showed some evidence of effectiveness.
There is very limited evidence that interventions are effective in preventing or intervening early with depression and anxiety disorders in higher education students. Further studies, possibly involving interventions that have shown promise in other populations, are needed.
Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy").
A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia.
A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette.
Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics.
If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.
Little is known about the efficacy of educational interventions for reducing the stigma associated with depression.
To investigate the effects on stigma of two internet depression sites.
A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive-behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention.
Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive-behavioural therapy literacy.
The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.
Changing population behavior and reducing health disparities: Exploring the potential of “choice architecture” interventions
- T M Marteau
- G J Hollands
- M P Kelly
A new incremental fit index for general structural equation models
- K A Bollen
The mental health of young people in Ireland: A report of the Psychiatric Epidemiology Research across the Lifespan (PERL) group Dublin. Royal College of Surgeons in Ireland
- M Cannon
- H Coughlan
- M Clarke
- M Harley
- I Kelleher