Changes in depression‐related mental health literacy in young men from rural and urban South Australia

Objective: To examine rural and urban differences in depression‐related mental health literacy, experience of depression and help‐seeking. Design: Cross‐sectional population‐based survey stratified by rural and urban area. Setting: A random and representative sample of South Australian rural and urban young men aged between 15 and 30 years. Outcome measures: Mental health literacy as determined by recognition and exposure to classical symptoms of depression; perceived helpfulness of various interventions and treatment‐seeking behaviour. Results: Recognition of depression increased significantly in rural and urban young men between 1998 and 2008. More rural young men than urban men identified symptoms of depression in 1998 (odds ratio (OR): 1.53, 95% confidence interval (CI), 1.01–2.40, P < 0.05), but that was not evident in 2008 (OR: 1.32, 95% CI, 0.80–2.25, P = 0.30). Both groups were more likely to have a close friend experience symptoms of depression and to use antidepressant medications in 2008 compared with 1998. Rural young men experienced a significant increase in recognition of personal depressive symptoms (OR: 3.73, 95% CI, 1.72–8.40) and levels of confidence in psychiatrists and psychologists (OR: 2.40, 95% CI, 1.34–4.31) in 2008 compared with 1998. Both rural and urban young men were significantly less likely to rate dealing with problems on their own as helpful in 2008 as in 1998. Conclusions: There has been an increase in both rural and urban young male mental health literacy between 1998 and 2008, especially in rural young men. Whether this will translate into a reduction of depression and associated suicide, with a reversal of the rural/urban suicide differential, remains to be seen.     

Bullying among 18 to 23‐year‐old women in 2013

Objective: To identify the prevalence of bullying among women aged 18–23 in 2013, and to describe the demographic characteristics, health and risk factors of those who experienced bullying. Methods: Cross‐sectional analysis using data from the 1989–95 cohort of the Australian Longitudinal Study on Women's Health, a nationally representative cohort (n=16,801). Results: More than one‐quarter of women (28.4%) indicated they had never been bullied, 53.4% reported experiencing bullying in the past and 18.2% indicated that they were recently bullied. Women who had experienced bullying were more likely to have lower levels of education, less likely to be studying or employed, and had more difficulty managing on their income. Women who experienced bullying were more likely to use tobacco or illicit drugs, be overweight or obese and to be sedentary. Even after adjusting for these factors, women who had experienced bullying were at risk of poor physical health, psychological distress, suicidal thoughts and self‐harm. Conclusions: This is the first nationally representative study to demonstrate the strong association between being a victim of bullying and health outcomes in a post‐school‐age population. Implications for public health: The findings highlight the need for interventions for women who have already experienced bullying and are past school age.     

Mental health support for youth offending teams: a qualitative study

The objective of the present study was to examine the views of professionals working in youth offending teams (YOTs) on a new model for providing mental health service support within the context of an interagency setting. Focus groups were used and data were analysed according to the constant comparative method. The setting consisted of two YOTs, one in an inner-city area and the other in a rural/semi-urban area, where primary mental health workers operate at the interface between YOTs and the specialist child and adolescent mental health services. Seventeen YOT professionals participated in four focus groups. Four themes were identified: previous experiences of specialist mental health services; issues of interagency working; the role of the primary mental health worker within the YOT; and recommendations for the future. Overall, the clinical component of the role (assessment and intervention), and the accessibility and responsiveness of the mental health staff were consistently valued, while there were mixed responses on role definitions within the team, consultation and training. It is concluded that mental health service provision through primary mental health workers is a useful model for interagency partnerships for high-risk client groups with multiple and complex mental health needs.     

Evaluating a low‐intensity cognitive behavioural program for young people in regional Australia

NewAccess is a low‐intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild‐to‐moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild‐to‐moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017‐2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall ‘reliable improvement’ and ‘recovery rates’ were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a ‘youth‐friendly’ service environment.     

Conceptualisations of positive mental health and wellbeing among children and adolescents in low‐ and middle‐income countries: A systematic review and narrative synthesis

BackgroundMental illnesses are the leading causes of global disease burden. The impact is heightened in low‐ and middle‐income countries (LMICs) due to embryonic care systems and extant barriers to healthcare access. Understanding children and adolescents'' conceptualisations of mental health wellbeing in these settings is important to optimize health prevention and promotion initiatives.ObjectiveTo systematically review and synthesize children and adolescents'' conceptualisations and views of mental health and wellbeing in LMICs.DesignTen databases were systematically searched from inception to July 2020 and findings from included studies were synthesized.ResultsTwenty papers met eligibility criteria comprising qualitative, quantitative and mixed methods studies. Children and adolescents identified aspects of mental health and wellbeing, including positive affect and outlook and having sufficient personal resources to face daily challenges. Identified factors recognized the importance of activating both kin and lay networks in supporting and maintaining wellbeing. Conceptualisations of mental health and wellbeing were varied and influenced by culture, developmental stage and gender.Discussion and ConclusionsIrrespective of environmental and sociocultural influences on concepts of wellbeing and mental health, children and adolescents in LMICs can conceptualise these constructs and identify how they pursue positive mental health and wellbeing important for developing age and culture‐appropriate community mental health strategies. Our review highlights the need to extend inquiry to wider developmental stages and both across and within specific populations in LMICs.Patient and Public InvolvementInitial results were presented at stakeholder workshops, which included children, adolescents, parents and health professionals held in Indonesia in January 2019 to allow the opportunity for feedback.     

Sexual identities and lifestyles among non-heterosexual urban Chiang Mai youth: implications for health

Using quantitative and qualitative data we explore perspectives on and experiences of sexual lifestyles and relationships among more than 1750 young people aged 17–20 years who reside in urban Chiang Mai, Thailand. We focus on respondents' representations and understandings of their sexual/gender identities derived mainly from in-depth interviews and focus group discussions, supplemented with observations and field notes. Our results show that while many young Thais described themselves as heterosexual women or men, others described themselves as gay, kathoey, tom, dii, bisexual or something else. The terms gay, kathoey, tom and dii are commonly used by these Thais to denote a range of sexual/gender identities relating to persons who are sexually or romantically attracted to the same sex. We use case studies to illustrate the distinctive characterisations, sexual lifestyles and relationships of each of these identities, together with possible health implications.     

Health discourse,sexual slang and ideological contradictions among Mozambican youth: implications for method

Despite the urgency of improving an understanding of sexual cultures in the face of a globally devastating HIV epidemic, methodological reflection and innovation has been conspicuously absent from qualitative research in recent years. Findings from fieldwork on condom use among young people in Mozambique confirm the need to remain alert to the ideological and linguistic bias of applied methods. Interviewing young people about their sexuality using a conventional health discourse resulted in incorrect or socially acceptable answers rather than accurate information about their sexual behaviour. Young people's resistance to enquiry, the paper argues, is due to ideological contradictions between their sexual culture and slang, on the one hand, and Western health discourses associated with colonial and post-colonial opposition to traditional culture and languages, on the other. Mixing colloquial Portuguese and changana sexual slang is constructed around ideas of safedeza and pleasure, while dominant health discourses address sexuality as both ‘risky’ and ‘dangerous’. In order to gain a deeper understanding of sexual cultures and to make HIV prevention efforts relevant to young people, it is suggested that researchers and policy makers approach respondents with a language that is sensitive to the local ideological and linguistic context.     

The health and well‐being of children and young people who are looked after: Findings from a face‐to‐face survey in Glasgow

Evidence suggests children and young people who are looked after (LACYP) may have poorer health outcomes than children and young people in the general population, particularly in relation to mental health. This paper discusses findings from a survey of the health and well‐being of LACYP in Glasgow. A structured questionnaire used in the 2010 Glasgow Schools Survey (GSS) was adapted and administered in face‐to‐face interviews with 130 young people aged 11–18 in 2014–2015 to investigate various aspects of health and well‐being including physical activity, diet and sleep, smoking, alcohol and drugs, health feelings and worries, behaviours, attitudes and expectations. LACYP were more likely to report that they had tried drugs, slightly more likely to have scores indicating a high level of difficulties on the Strengths and Difficulties Questionnaire (SDQ) and less likely to report that they ate fruit and vegetables, used active transport methods to get to school and expected to go on to further or higher education; however, reported rates of physical activity, smoking and drinking were similar. LACYP were less likely to report that they had engaged in antisocial behaviour, truancy or bullying or been exposed to environmental tobacco smoke, less likely to worry or have low self‐esteem, and more likely to rate their health positively. There were some variations according to placement type. The findings of this study present a more positive picture of the health and well‐being of LACYP in Glasgow than might have been expected but should be treated with caution due to small sample size. Further research is needed to identify differences in relation to placement type and to determine whether being looked after might be associated with improved health and well‐being outcomes for some children and young people.     

How to build a game for empirical bioethics research: The case of ‘Tracing Tomorrow’

It is becoming increasingly clear that the field of empirical bioethics requires methodological innovations that can keep up with the scale and pace of contemporary research in health and medicine. With that in mind, we have recently argued for Design Bioethics—the use of purpose‐built, engineered research tools that allow researchers to investigate moral decision‐making in ways that are embodied and contextualized. In this paper, we outline the development, testing and implementation of a novel prototype tool in the Design Bioethics Workshop—with each step illustrated with collected data. Titled ‘Tracing Tomorrow’ (www.tracingtomorrow.org), the tool is a narrative game to investigate young people''s values and preferences in the context of digital phenotyping for mental health. The process involved (1) Working with young people to discover, validate and define the morally relevant cases or problems, (2) Building and testing the game concept in collaboration with relevant groups and game developers, (3) Developing prototypes that were tested and iterated in partnership with groups of young people and game developers and (4) Disseminating the game to young people to collect data to investigate research questions. We argue that Design Bioethics yields tools that are relevant, representative and meaningful to target populations and provide improved data for bioethics analysis.Patient or Public ContributionIn planning and conducting this study, we consulted with young people from a diverse range of backgrounds, including the NeurOX Young People''s Advisory Group, the What Lies Ahead Junior Researchers Team, Censuswide youth participants and young people from the Livity Youth Network.     

Perceptions and attitudes towards exercise among Chinese elders – the implications of culturally based self‐management strategies for effective health‐related help seeking and person‐centred care

Background

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health‐care providers across the world. Little is known about the health‐care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.

Objective

This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere.

Design

A Grounded Theory approach using purposive and theoretical sampling with in‐depth semi‐structured interviews.

Setting and participants

Chinese elders were recruited from Chinese communities in the North West of England. Thirty‐three participants were interviewed face‐to‐face and audio‐recorded.

Results

Participants self‐managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person‐centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health‐related advice when exercise was often used as a self‐monitored barometer to assess their perceived health status.

Discussion and conclusion

Chinese elders may undertake inappropriate exercise, leading to high‐risk situations, if appropriate professional information is not provided. Health‐care practitioners should devote attention to understanding Chinese elders'' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person‐centred approach that acknowledges and works with self‐management practices is advocated.