Review of mental health promotion interventions in schools

Purpose

The prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used.

Methods

The authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature.

Results

Initial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative.

Conclusions

A range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations.

     

Effects of a classroom-based educational resource on adolescent mental health literacy: A cluster randomised controlled trial

Evidence suggests that poor mental health literacy is a key barrier to help-seeking for mental health difficulties in adolescence. Educational programs have shown positive effects on literacy, however, the evidence base remains limited and available studies have many methodological limitations. Using cluster Randomised Control Trial (RCT) methodology, the current study examines the impact of ‘HeadStrong’, a school-based educational intervention, on mental health literacy, stigma, help-seeking, psychological distress and suicidal ideation. A total of 380 students in 22 classes (clusters) from 10 non-government secondary schools was randomised to receive either HeadStrong or Personal Development, Health and Physical Education (PDHPE) classes. Participants were assessed pre- and post-intervention, and at 6-month follow-up. Literacy improved and stigma reduced in both groups at post-intervention and follow-up, relative to baseline. However, these effects were significantly greater in the HeadStrong condition. The study demonstrates the potential of HeadStrong to improve mental health literacy and reduce stigma.     

Using participatory video to challenge the stigma of mental illness: a case study

The diagnosis of mental ill health continues to attract substantial stigma in western society, with evidence suggesting public attitudes to be increasingly negative. Recent reviews have highlighted the extensive research on the nature of this stigma but with limited work on the development of strategies to challenge the stigma. The aim of this case study was to explore the potential of researchers and mental health service users (MHSUs) working collaboratively to identify the main problems the service users experience in their everyday lives and to produce a video challenging the negative image of mental ill health. Discussions were held with volunteers involved in a mental health media action group; all volunteers had been or were currently MHSU. These discussions identified a variety of problems including difficulties in everyday social interaction and negative portrayal of mental ill health in the media. A short video was developed with volunteers summarizing the issues they had raised: this was subsequently shown to a wider audience. The MHSUs reported considerable personal benefits of participation in the project. The paper discusses these findings and the process of producing the video.     

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

BackgroundMental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but little is known about which digital interventions are most effective.AimsTo evaluate the effectiveness of two digital single-session interventions (Shamiri-Digital and Digital-CBT (cognitive-behavioural therapy)) among Kenyan adolescents.MethodsWe will perform a school-based comparative effectiveness randomised controlled trial. Approximately 926 Kenyan adolescents will be randomly assigned to one of three conditions: Shamiri-Digital (focused on gratitude, growth mindsets and values), Digital-CBT (focused on behavioural activation, cognitive restructuring and problem solving) or a study-skills control condition (focused on note-taking and essay writing skills). The primary outcomes include depressive symptoms (measured by the Patient Health Questionnaire-8), anxiety symptoms (Generalized Anxiety Disorder Screener-7) and subjective well-being (Short Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes include acceptability, appropriateness, primary control and secondary control. Acceptability and appropriateness will be measured immediately post-intervention; other outcomes will be measured 2 weeks, 4 weeks and 12 weeks post-intervention.ResultsWe hypothesise that adolescents assigned to Shamiri-Digital and adolescents assigned to Digital-CBT will experience greater improvements (assessed via hierarchical linear models) than those assigned to the control group. We will also compare Shamiri-Digital with Digital-CBT, although we do not have a preplanned hypothesis.ConclusionsOur findings will help us evaluate two digital single-session interventions with different theoretical foundations. If effective, such interventions could be disseminated to reduce the public health burden of common mental health problems.Trial registration numberPACTR202011691886690.     

Fighting the stigma: a unique approach to marketing mental health.

Although stigma is a problem, there is a definite solution. As this material suggests, an impact can be made by targeting various markets. Since these markets have either positive, negative or neutral impressions of their local mental health organizations and related services, knowing the rating of the organization and related services helps to identify the most likely targets. Advertising can directly affect the strength of that rating in a positive direction. The extent of that effect, whether it's a change in attitude or level of recognition, will depend on the continuity of the message, the channels of communication, and synchronization of distribution. In addition, the degree of impact is contingent on how amenable the target audience is to the message. In the case of mental health, the lower level of acceptability presents an even greater challenge. The FTS project takes on the challenge with a marketing plan that is necessary because our publics say it's necessary. And it can work because, again, our publics say it works. The supporting evidence is more than just an increase in name recall and favorability factors. The supporting evidence results from any project which has been planned and implemented with the consumer in mind. Finally, the supporting evidence is clear in the interest and contributions of each participant in the FTS pilot as well as the 27 mental health organizations in 17 U.S. markets which have participated in FTS 11.     

A multifaceted intervention to improve mental health literacy in students of a multicampus university: a cluster randomised trial

Purpose

The aim of the current study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in students of a multicampus university in Melbourne, Australia.

Methods

In this cluster randomized trial, nine university campuses were paired (some pairs included more than one campus), with one of each pair randomly assigned to either the intervention or control condition. The interventions were designed to be whole-of-campus and to run over 2 academic years with their effectiveness assessed through recruitment of a monitoring sample of students from each campus. Interventions included emails, posters, campus events, factsheets/booklets and mental health first aid training courses. Participants had a 20-min telephone interview at baseline and at the end of academic years 1 and 2. This assessed mental health literacy, help seeking, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level.

Results

There were no effects on psychological distress and alcohol use. Recall of intervention elements was greater in the intervention group at the end of year 2. Students in the intervention group were more likely to say they would go to a drug and alcohol centre for alcohol problems at the end of 6 months.

Conclusion

Although education and awareness may play a role in improving mental health literacy, it is likely that, to achieve changes in psychological distress, interventions would need to be more personalized and intensive.     

Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial

BACKGROUND: It is controversial whether regular changes of external ventricular drains can reduce cerebrospinal fluid (CSF) infection. OBJECTIVE: To carry out a randomised controlled clinical trial over a two year period to determine whether a regular change of ventricular catheter every five days could reduce CSF infection and improve outcome. METHODS: 103 patients requiring external ventricular drains for more than five days and with no evidence of concurrent CSF infection were studied. The patients were randomised to regular change of ventricular catheter (every five days) and no change unless clinically indicated. RESULTS: The CSF infection rates were 7.8% for the catheter change group and 3.8% for the no change group, respectively (rate ratio = 1.80, 95% confidence interval 0.33 to 9.81, p = 0.50). No significant difference was found in intensive care unit stay, ward stay, or clinical outcome between the two groups. CONCLUSIONS: Regular changes of ventricular catheter at five day intervals did not reduce the risk of CSF infection. A single external ventricular drain can be employed for as long as clinically indicated.