A school intervention for mental health literacy in adolescents: effects of a non-randomized cluster controlled trial
Ingunn Skre
ingunn.skre@uit
0
Oddgeir Friborg
0
2
Camilla Breivik
0
1
Lars Inge Johnsen
0
3
Yngvild Arnesen
0
1
Catharina Elisabeth Arfwedson Wang
0
0
Department of Psychology, Faculty of Health Sciences, University of Troms
,
Troms
,
Norway
1
Clinic for Child and Adolescent Mental Health, University Hospital of North Norway
,
Troms
,
Norway
2
Psychiatric Research Centre, University Hospital of North Norway
,
Troms
,
Norway
3
Family Health Services
,
Mandal Municipality, Mandal
,
Norway
Background: Mental health for everyone is a school program for mental health literacy and prevention aimed at secondary schools (13-15 yrs). The main aim was to investigate whether mental health literacy, could be improved by a 3-days universal education programme by: a) improving naming of symptom profiles of mental disorder, b) reducing prejudiced beliefs, and c) improving knowledge about where to seek help for mental health problems. A secondary aim was to investigate whether adolescent sex and age influenced the above mentioned variables. A third aim was to investigate whether prejudiced beliefs influenced knowledge about available help. Method: This non-randomized cluster controlled trial included 1070 adolescents (53.9% boys, M age14 yrs) from three schools in a Norwegian town. One school (n = 520) received the intervention, and two schools (n = 550) formed the control group. Pre-test and follow-up were three months apart. Linear mixed models and generalized estimating equations models were employed for analysis. Results: Mental health literacy improved contingent on the intervention, and there was a shift towards suggesting primary health care as a place to seek help. Those with more prejudiced beleifs did not suggest places to seek help for mental health problems. Generally, girls and older adolescents recognized symptom profiles better and had lower levels of prejudiced beliefs. Conclusions: A low cost general school program may improve mental health literacy in adolescents. Gender specific programs and attention to the age and maturity of the students should be considered when mental health literacy programmes are designed and tried out. Prejudice should be addressed before imparting information about mental health issues.
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Background
Public knowledge and beliefs about mental disorders,
also termed mental health literacy, may be crucial to the
early recognition of mental health problems, and to the
seeking and acceptance of mental health care [1,2]. Most
mental disorders show their first signs, and increase in
prevalence, from childhood through adolescence [3].
This is true both for anxiety, depression, schizophrenia
[3] and eating disorders [4]. Universal health promotion/
prevention programmes are aimed at all members of a
population or cohort, in contrast to targeted programmes,
that are aimed at specific risk groups, or sub-groups [5].
The school is the obvious arena for universal programmes
[6,7]. A considerable research literature exists on health
promotion programmes aimed at schools, mainly from
English language countries [5]. Norwegian health
authorities have recommended a series of programmes for use in
schools [8]. The efficacy of some programmes in
Norwegian samples has been studied [9,10]. The purpose of
the present study was to examine the possible effect of
the universal school programme Mental health for
everyone [11].
Mental health literacy
Jorm [1,2] defines mental health literacy as: a)
recognition of mental disorder, knowledge and belief about b)
risk factors and causes, as c) self-help interventions and
d) professional help available, as e) attitudes which
facilitates recognition and appropriate help seeking, and
finally as f ) knowledge about how to seek mental health
information. According to this definition, there should
be a direct connection between knowledge about and
attitudes towards mental health problems, and the ability
to both recognise symptoms of mental disorder, and to
seek help appropriately.
Recognition of mental disorder
Recognition of mental disorder has been operationalized
[12] as the ability to identify and name a mental disorder
based on a written case vignette. Studies have reported
conflicting results for the identification of disorders from
such vignettes. Jorm and colleagues [12] found that 40%
of an adult Australian sample identified depression and
30% identified schizophrenia. Lauber and colleagues [13]
found that 40% of a Swiss sample aged 1676, identified
depression and 75% identified schizophrenia. The highest
level of case recognition for depression (81%) was
reported in rural residents in Queensland, Australia by
Bartlett and colleagues [14]. Contrasting, Suhail [15]
found that only 20% percent of Pakistani people were
able to identify depression, and even less (5%) were able
to identify psychosis from a written vignette, and
furthermore that level of education was a predictor of correct
identification. In young Australian respondents, the
ability to ide (...truncated)