Mental Health Literacy of University Students in Vietnam and Cambodia

Mental health literacy (MHL) refers to knowledge and attitudes that shape the recognition, management, and prevention of mental disorders. While the topic has been exhaustively researched in Western countries, research from Southeast Asia still is limited. Previous studies in this field showed a moderate recognition of mental disorders, a high prevalence of stigmatizing attitudes and a low willingness to seek professional help among Southeastern-Asian populations. This study explored the level of MHL among university students from different parts of Vietnam and Cambodia. Correlations with influencing factors (gender, age, study year, educational attainment of the parents, urban/rural origin, ethnicity, personal experiences with mental disorders) were also explored. An online survey, using a 30-item Vietnamese version of the Mental Health Literacy Scale (MHLS), was conducted at six university sites in Vietnam and Cambodia. Data of 1032 students from different study branches were included. The MHL of Vietnamese and Cambodian university students was lower, compared to samples from Australia or the UK. Females and students with a personal experience of mental disorders (self or family) showed a significantly higher MHL. No differences in MHL were found between students from different socioeconomic backgrounds (professional attainment of parents, urban/rural origin). Findings on the influence of ethnicity were inconclusive. MHL needs to be improved among the university students of Vietnam and Cambodia. Mental health promotion should specifically target male students, students from STEM branches, and international students.     

Factors associated with mental health service use in Latino and Asian immigrant elders

Objectives: The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersen's behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services.

Method: Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders.

Results: For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders.

Conclusion: Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.     

The impact of mental health literacy,stigma, and social support on attitudes toward mental health help-seeking

Guided by the theory of reasoned action, this study built a model to examine the ways in which mental health literacy (MHL), personal stigma, self-stigma, and social support collectively influence attitudes toward mental health help-seeking. A sample of 211 participants (age range 22–64; 67.62% females) from a cross-sectional survey that examined MHL of local public housing staffs in Texas were included in a structural equation modeling analysis. MHL directly influenced attitudes. Personal and self-stigma did not mediate the relationship between MHL and attitudes. Yet, self-stigma was significantly associated with attitudes. Social support positively predicted attitudes. Findings suggest the need for improving MHL and strengthening social support to promote positive attitudes toward mental health help-seeking. Mental health education to those who are at risk for mental illness and to families who are likely to influence help-seeking attitudes of those with mental illness could be useful.     

Associations between dimensions of mental health literacy and adolescent help-seeking intentions

Background

The majority of long-term mental health problems begin during adolescence. Low mental health literacy (MHL) may impede help-seeking for these problems. Although MHL is a multidimensional construct and adolescent help-seeking can be through formal and informal means, little is known about how dimensions of MHL influence these help-seeking intentions. This study examines associations between dimensions of MHL and formal and informal help-seeking intentions among adolescents. It also investigates whether informal help-seeking mediates the association between dimensions of MHL and formal help-seeking, and whether these associations are moderated by gender.

Methods

A cross-sectional survey including measures of MHL, and help-seeking intentions was distributed to participants in 10 schools (12–17 years) across Scotland (n = 734). Data were analysed using Confirmatory Factor Analyses (CFA) and Structural Equation Modelling (SEM).

Results

Confirmatory Factor Analyses identified two distinct dimensions of MHL: ability to identify a mental health problem, and knowledge of treatment efficacy. Only knowledge of treatment efficacy was associated with increased intention to seek formal and informal help. Ability to identify a mental health problem was negatively associated with both forms of help-seeking intentions. Informal help-seeking mediated the association between both forms of MHL and formal help-seeking. Gender did not moderate the associations between MHL and help-seeking.

Conclusions

Care should be taken when providing MHL interventions to ensure that adaptive forms of MHL are promoted. Future research should investigate possible mechanisms by which discrete forms of MHL influence adolescent help-seeking as well as investigating other potential moderators of MHL and help-seeking, such as stigma.     

Frequency and Scope of Mental Health Service Delivery to African Americans in Primary Care

This study examines whether African Americans with mental health complaints visit primary care physicians more than psychiatrists, and whether they demonstrate this preference more than do Whites. It addresses also whether when presenting with mental health concerns, African Americans and Whites receive a comparable range of interventions, including psychotropic medications. National estimates using the National Ambulatory Medical Care Surveys conducted in 1995 and 1996 confirmed the first hypothesis: African American did make more mental health-related office visits to primary care physicians than did psychiatrists and they did so more than Whites. Mental health interventions on behalf of African Americans and Whites proved to be similar, except that African Americans were less likely to be provided a psychotropic medication. Because African Americans are especially likely to receive outpatient mental health services from primary care physicians, the lower quality of mental health care occurring in primary care disproportionately affects African Americans. Fewer African American visits resulted in prescribing psychotropic medications, and this corroborated findings by other researchers. More research is needed to understand this disparity.     

Rural African American clergy: Are they literate on late-life depression?

This exploratory study examined rural African American clergy's knowledge of and experience in providing support to African American elders with late-life depression. Interviews were conducted with nine African American clergy who oversaw rural churches in central Kentucky. Jorm and colleagues provide a conceptual framework for mental health literacy to explore participants’ knowledge of late-life depression. Although few clergy had direct experience with counseling a depressed older adult, all the clergy were considered literate regarding late-life depression and its treatment. These findings have implications for social workers building collaborative community treatment relationships.     

Psychiatric disorder,impairment, and service use in rural African American and white youth

BACKGROUND: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth. METHODS: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use. RESULTS: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care. CONCLUSIONS: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups.     

Predictors of Mental Health Treatment Seeking and Engagement in a Community Mental Health Center

Disparities in behavioral health treatment outcomes are multifactorial, but treatment engagement and dropout from treatment often contribute to unequal mental health outcomes in individuals with serious mental illnesses. Alcohol and other substance use disorders have been associated with poor treatment adherence and premature discontinuation of treatment, but few studies have examined these factors in a predominantly African American sample of individuals with serious mental illnesses. This study examined predictors of mental health treatment engagement and dropout in a sample of 90 African American individuals presenting for treatment at a community mental health treatment facility in Atlanta, Georgia. Having an alcohol use disorder was associated with being less likely to attend mental health follow up (OR 0.32, 95% CI 0.12–0.88). Among African American individuals with alcohol use disorders, specific, targeted interventions may be necessary to help reach individuals that are at extremely high risk of poor health and poor adherence to treatment.     

Considering context, place and culture: the National Latino and Asian American Study

This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research.     

Mental Health Literacy and Stigma Among Salvadorian Youth: Anxiety,Depression and Obsessive-Compulsive Related Disorders

This study examined (1) adolescent mental health literacy (MHL) and stigma for depression, anxiety and obsessive-compulsive and related disorders (OCRDs), and (2) demographic moderators. Participants were 383 high school students (50.9% boys) aged 11–18 years (M?=?14.12, SD?=?1.91) in El Salvador. Participants read vignettes of adolescents with mental health problems and reported on their beliefs about (1) what was wrong with the young person, (2) expected recovery time, (3) help-seeking beliefs and recommendations, and (4) stigma and preferred social distance associated with each condition. Results suggested that recognition of mental health conditions, especially anxiety disorders and OCRDs, was limited, although one third could recognize depression in a peer. Help-seeking attitudes were favorable. Adolescents were only somewhat willing to be affiliated with someone experiencing a mental health problem. Girls showed better MHL and lower stigma than boys. Stigma was lower among those with exposure to mental health problems.

     

The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community

Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss ‘Bern Epidemiological At-Risk’ study (age 16–40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.

     

Influence of mental health literacy on help-seeking behaviour for mental health problems in the Swiss young adult community: a cohort and longitudinal case–control study

Poor knowledge about mental health disorders and their treatment likely contributes to the large treatment gap reported for mental health problems. Therefore, we studied the association between mental health literacy (MHL) and active help-seeking in a community sample. Participants were recruited from an add-on questionnaire study to the ‘Bern Epidemiological At-Risk’ (BEAR) study on 16–40-year-old community subjects of the Swiss canton Bern. At baseline, data of N = 1504, and at 3-year follow-up, data of N = 535 were available. Based on an unlabelled case vignette (on depression or schizophrenia), MHL was assessed by the questionnaire of Angermeyer and colleagues. Cross-sectional and longitudinal baseline predictors of help-seeking were analysed using path analyses. Additionally, sensitivity analyses of the prospective model were computed for sex, vignette, and baseline mental health problems/disorders. Cross-sectionally, help-seeking was associated with non-endorsement of biogenetic causal explanations, presence of mental health problems/disorders, help-seeking before baseline, poorer functioning, and lower health satisfaction. The prospective model was similar; yet, help-seeking at follow-up was associated with endorsements of the causal explanation ‘biogenetics’ and, additionally, ‘childhood trauma’ but not the presence of baseline mental health problems/disorders. Sensitivity analyses revealed a significant impact on sex, vignette, and mental health problems/disorders. For example, actual functional problems were predictive in males, while health satisfaction was predictive in females. Our findings indicate that future studies on drivers of help-seeking should assess very large community samples with case vignettes on different mental disorders to examine appropriate subgroups and their likely interaction to address group-specific factors in awareness campaigns.

     

Mental health and physical health of family caregivers for persons with dementia: a comparison of African American and white caregivers

This investigation analyzed the differences between African American and white caregivers in the effects of family caregiving for a person with dementia on mental health and physical health variables (including subjective health, reported diseases and cardiovascular measures). A population-based sample of 102 caregivers is compared with 102 non-caregivers matched on ethnicity, gender and age. There were no significant group differences for mental health effects. Most significant physical health effects were attributable to main effects of ethnicity rather than caregiving status. However, African American caregivers had higher diastolic blood pressure than all other groups, a finding consistent with group-specific risk for circulatory system disorders.     

Race, psychiatric diagnosis, and mental health care utilization in older patients.

To evaluate the impact of race on mental health care utilization among older patients within given clinical psychiatric diagnoses, the authors examined a retrospective sample of 23,718 elderly veterans treated in Department of Veterans Affairs inpatient facilities in 1994. Significant racial differences in mental health care utilization found over a subsequent 2-year period were related to outpatient (but not inpatient) care; for instance: 1) African American patients with psychotic disorders had significantly fewer outpatient psychiatric visits; and 2) African American patients with substance abuse disorders had significantly more psychiatric visits than Caucasian patients in their respective groups. Although inpatient utilization appeared to be similar among races, findings related to outpatient utilization may be associated with such factors as compliance, treatment efficacy, access to health care, or possible clinician bias.     

What are the effects of providing evidence‐based information on eating disorders and their treatments? A randomized controlled trial in a symptomatic community sample

Aim: We hypothesize that a reason for the infrequent uptake of treatments by people with eating disorders is poor knowledge about treatments and outcomes for eating disorders (ED‐Mental Health Literacy; ED‐MHL). Our aim was to test putative health benefits of a brief ED‐MHL intervention. Methods: In a community‐based two‐phase survey, 122 young women (mean age 28.5 SD 6.3 years) with ED symptoms meeting DSM‐IV criteria for clinical severity were randomized to receive either a brief ED‐MHL intervention (comprising information about efficacious treatments, reputable self‐help books and where to go for further information and/or services) or information about local mental health services only. All were given feedback on their scores on measures of ED symptoms and quality of life. ED‐MHL, ED symptoms and health‐related quality of life were assessed prior to the intervention and at 6‐ and 12‐month follow‐up. Results: One hundred and two participants (84%) completed follow‐up at 12 months. Symptomatic improvement and changes in specific aspects of ED‐MHL, namely, less pessimism about how difficult EDs are to treat and improved recognition and knowledge, as well as increased help seeking, were observed in both groups. Differences between groups were uncommon but compared with control participants, those in the intervention group had improved health‐related quality of life. Conclusions: A brief community‐based intervention aimed to improve knowledge and beliefs about EDs and their treatments may be a valuable first step in improving health‐related outcomes for people with ED, but more research is needed.     

Barriers to Mental Health Help Seeking at School for Asian– and Latinx–American Adolescents

Adolescents are most likely to receive mental health services in schools compared to other settings; however, few studies have examined barriers to mental health help seeking at school for ethnic minority adolescents. The current mixed-methods study utilized surveys and semi-structured interviews to explore the mental health literacy (MHL), stigma toward mental illness, and perceived barriers toward help seeking at middle or high schools among 55 adolescents (81.8% female; 50.0% Asian–American, 44.6% Latinx–American, 5.4% Asian/Latinx bi-racial; M age = 17.13 years, SD = 2.33). Participants’ MHL was assessed using case vignettes that depicted adolescents with symptoms of depression or bulimia. Overall, 83.9% of participants correctly recognized depression and 57.1% correctly recognized bulimia from the vignettes. Stigma correlated with perceived helpfulness of the formal service providers (r = − .37, p < .01). Qualitative analysis of participant interviews revealed important knowledge, attitudinal, and practical barriers that inhibit Asian– and Latinx–American adolescents from seeking help for mental health problems at school. The current work has implications to assist school personnel and mental health providers in understanding and reducing barriers to help seeking for Asian– and Latinx–American adolescents.     

Mental health literacy about depression and schizophrenia among adolescents in Sweden

BackgroundMental health literacy (MHL) refers to an individual's knowledge of mental disorders, including the ability to recognize psychopathology and being aware of help options. Most studies of MHL have focused on adults.ObjectiveThe purpose of this study was to examine levels of MHL among adolescents.MethodsMHL was examined using two pre-established vignettes that presented an adolescent with symptoms of either depression or schizophrenia. The respondents were 426 adolescents (age mean = 16). Vignette data were analyzed both qualitatively and quantitatively.ResultsThe data showed that 42.7% and 34.7% of the respondents identified depression and schizophrenia, respectively. Depression was recognized more often by females than males. Professional help was suggested by a minority of the respondents for managing symptoms of depression (22.5%) or schizophrenia (32.6%). Altruistic behaviors, examined through the willingness to help an acquaintance with mental illness symptoms, were apparent among 58.2% of the respondents and to a greater extent in females than males. Answers following the schizophrenia vignette also revealed stigmatizing attitudes in 11.5% of the participants.ConclusionsThere are relatively low levels of MHL among teenagers in Sweden. Awareness campaigns and the implementation of psychoeducation in the school curriculum could increase MHL in this group.     

Perceived Cognitive Impairment among African American elders: health and functional impairments in daily life

Objectives: The Center for Disease Control began to assess Perceived Cognitive Impairment in 2009, yet there has been no in-depth study of how perceived decline in thinking or memory skills may be associated to the health and lifestyle of an independent community-dwelling older person. Among urban-dwelling older African Americans who are at elevated risk for cognitive impairment and dementia, we know even less regarding the interaction of these risk factors.Method: Five hundred and one African American elders (n = 501) between the ages of 55 and 95 with an average age of 70.73 years (SD = 8.6 years) participated in telephone interviews.Results: Approximately one-third of the elders reported that their memory, thinking skills, or ability to reason was worse than a year ago (n = 150; 29.9%) and 25% of this group (n = 38) reported that this Perceived Cognitive Impairment impacted their daily activities and/or warranted a consultation with their doctor. Bivariate analyses indicated that Perceived Cognitive Impairment was associated with increased health problems, mobility limitations, depressed mood, and lower social functioning.Conclusion: Elders who reported that cognitive problems impacted their daily functioning reported the greatest health and mental health problems. Perceived Cognitive Impairment is an important health variable with implications for an older adult's overall health, mobility, and mental health.     

Reading level attenuates differences in neuropsychological test performance between African American and White elders.

The current study sought to determine if discrepancies in quality of education could explain differences in cognitive test scores between African American and White elders matched on years of education. A comprehensive neuropsychological battery was administered to a sample of African American and non-Hispanic White participants in an epidemiological study of normal aging and dementia in the Northern Manhattan community. All participants were diagnosed as nondemented by a neurologist, and had no history of Parkinson's disease, stroke, mental illness, or head injury. The Reading Recognition subtest from the Wide Range Achievement Test-Version 3 was used as an estimate of quality of education. A MANOVA revealed that African American elders obtained significantly lower scores than Whites on measures of word list learning and memory, figure memory, abstract reasoning, fluency, and visuospatial skill even though the groups were matched on years of education. However, after adjusting the scores for WRAT-3 reading score, the overall effect of race was greatly reduced and racial differences on all tests (except category fluency and a drawing measure) became nonsignificant. These findings suggest that years of education is an inadequate measure of the educational experience among multicultural elders, and that adjusting for quality of education may improve the specificity of certain neuropsychological measures.     

The Economic Impact of Providing Evidence-Based Pediatric Mental Health Literacy Training to Primary Care Physicians

ObjectiveThis paper presents a review of the current state of child and adolescent mental health literacy and provides current evidence of the economic impact of a pediatric mental health literacy (MHL) training program. MethodsEmploying a case-series-comparison design, physician referrals to urgent and specialized mental health services were linked with patient-specific information comparing referrals from MHL participants and non-participating physicians. The economic impact analysis was based on changes in the admitted referral frequency and lengths of stay for the MHL group, compared to themselves pretraining, and over the same time period compared to non-participating physicians. ResultsAverage scheduled ambulatory admission rates per physician remained constant for trained and untrained pre-post groups. Average scheduled ambulatory admission wait time and length of stay reduced significantly post-training for MHL-trained physicians compared to pre-training and untrained physicians. In addition to reductions in length of stay, the total bed costs saving for emergency/inpatients admission deferrals was $2,932,112 or about $20,000 per MHL-trained physician. ConclusionThe estimated economic impact of the MHL training shows a substantial return on investment and supports wider implementation. The MHL training program should be a key feature of mental health reform strategies, as well as continuing and undergraduate medical education.