Young Men, Mental Health, and Technology: Implications for Service Design and Delivery in the Digital Age

Background

Young men are particularly vulnerable to suicide, drug, and alcohol problems and yet fail to seek appropriate help. An alternative or adjunct to face-to-face services has emerged with widespread uptake of the Internet and related communication technologies, yet very little evidence exists that examines the capacity of the Internet to engage young men and promote help seeking.

Objective

To explore young people’s attitudes and behaviors in relation to mental health and technology use. The aim was to identify key gender differences to inform the development of online mental health interventions for young men.

Methods

A cross-sectional online survey of 1038 young people (aged 16 to 24 years) was used.

Results

Young men are more likely than young women to play computer games, access online video/music content, and visit online forums. More than half of young men and women reported that they sought help for a problem online, and the majority were satisfied with the help they received. Significant gender differences were identified in relation to how young people would respond to a friend in need, with young men being less likely than young women to confront the issue directly.

Conclusions

Online interventions for young men need to be action-oriented, informed by young men’s views and everyday technology practices, and leverage the important role that peers play in the help-seeking process.     

Improving Self-Help E-Therapy for Depression and Anxiety Among Sexual Minorities: An Analysis of Focus Groups With Lesbians and Gay Men

BackgroundE-therapies for depression and anxiety rarely account for lesbian and gay users. This is despite lesbians and gay men being at heightened risk of mood disorders and likely to benefit from having access to tailored self-help resources.ObjectiveWe sought to determine how e-therapies for depression and anxiety could be improved to address the therapeutic needs of lesbians and gay men.MethodsWe conducted eight focus groups with lesbians and gay men aged 18 years and older. Focus groups were presented with key modules from the popular e-therapy “MoodGYM”. They were asked to evaluate the inclusiveness and relevance of these modules for lesbians and gay men and to think about ways that e-therapies in general could be modified. The focus groups were analyzed qualitatively using a thematic analysis approach to identify major themes.ResultsThe focus groups indicated that some but not all aspects of MoodGYM were suitable, and suggested ways of improving e-therapies for lesbian and gay users. Suggestions included avoiding language or examples that assumed or implied users were heterosexual, improving inclusiveness by representing non-heterosexual relationships, providing referrals to specialized support services and addressing stigma-related stress, such as “coming out” and experiences of discrimination and harassment. Focus group participants suggested that dedicated e-therapies for lesbians and gay men should be developed or general e-therapies be made more inclusive by using adaptive logic to deliver content appropriate for a user’s sexual identity.ConclusionsFindings from this study offer in-depth guidance for developing e-therapies that more effectively address mental health problems among lesbians and gay men.     

Prevalence of poor self-rated health and associated risk factors among older adults in Cali,Colombia

Introduction:

Self-rated health (SRH) has beeen considered an important marker of quality of life and an independent predictor of mortality in older adults.

Objective:

To determine the prevalence of poor SRH and identify risk factors associated with poor SRH among older adults residing in the Commune 18 of the city of Cali, Colombia, in 2009.

Methods:

A population-based cross-sectional study with a single-stage cluster sampling design. Sample included 314 persons aged 60 and older. The dependent variable, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Independent variables were sociodemographic, biological, mental, functional and geriatric syndromes. Logistic regression was used for multivariate statistical modeling.

Results:

Overall, 40.1% reported poor SRH (women 42.9%, men 35.0%). Factors independently associated with poor SRH were diabetes mellitus, depression, fear of falling and frailty syndrome (frail and pre-frail vs. non-frail). Widowed men reported poorer health than married men while other marital status (single/separated/divorced) was associated with better self-rated health in women.

Conclusion:

Potential modifiable factors such as depression and frailty syndrome are important determinants for poor SRH in Colombian older adults.

     

Identification of UK sickness certification rates,standardised for age and sex

Background

There is growing interest in tackling the perceived ‘sick note’ culture in the UK.

Aim

The aim of this paper was to report the rates of sickness certification in a UK population, using sick certification rates as a precursor to addressing fitness for work.

Method

Electronic records from all 14 practices included in the Keele GP Research Network were reviewed; all sickness certification records from 2005 were retrieved and corresponding consultation records were examined. Participants were 148 176 patients registered during 2005, including 6398 patients who received at least one sickness certificate during the same year.

Results

The rate of sickness certification was 101.67 certificates per 1000 person years (95% confidence interval [CI] = 100.13 to 103.21). This rate was significantly higher in women, at 109.76 certificates per 1000 person years (95% CI = 107.550 to 112.02), compared to men who had a rate of 93.68 certificates per 1000 person years (95% CI = 91.59 to 95.78; P<0.001). The rate of sickness certification was greatest for mental health conditions, followed closely by musculoskeletal conditions.

Conclusion

On average, one in 10 patients will receive a sickness certificate each year, with the highest rates occurring around 50 years of age, in women. Mental health and musculoskeletal conditions were associated with the highest rates of certification. These results provide important information to underpin the national ‘Fit for Work’ scheme, by providing targets for intervention and a benchmark against which the impact of public health initiatives to reduce certified sickness absence due to health conditions can be evaluated and monitored.     

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men

Background

High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland.

Methods

In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011.

Results

43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression.

Limitations

Community-level assessment with no control.

Conclusions

Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.     

Low Burnout and High Engagement Levels in Athletic Trainers: Results of a Nationwide Random Sample

Objective:

To assess the prevalence of occupational burnout, engagement, and somatic health complaints and the associations among these constructs experienced by certified athletic trainers (ATs). A secondary objective was to examine differences between men and women, those with more versus less postcertification experience, and ATs who worked in different occupational settings.

Design:

Survey-based, stratified, proportionate random sample of full-time ATs.

Setting:

Data were collected online from ATs employed full time in the college or university, secondary school or youth, and industrial or clinical settings.

Patients or Other Participants:

Of 3998 invited ATs, 934 replied, for a response rate of 24%. The mean age of the participants was 33.84 ± 8.29 years, and each AT worked with an average of 90 clients.

Main Outcome Measure(s):

The dependent variables were perceived stress, occupational burnout, engagement, and somatic health complaints.

Results:

Although 17.2% of participants were in the most advanced stages of burnout, low levels of burnout and high degrees of occupational engagement were observed. Women ATs and those working in the college or university settings scored higher for burnout, whereas men and those in the clinical or industrial settings scored higher for engagement. Women also reported significantly more somatic health complaints than men did.

Conclusions:

The overall prevalence of burnout in ATs was relatively small, but sex and occupational-setting differences were observed and deserve greater scrutiny.     

Gender issues in contraceptive use among educated women in Edo state, Nigeria

Background

While traditional contraception is widely used, in southern Nigerian modern contraception is a relatively recent phenomenon. Modern contraception is more wide spread among the educated and sexually active youth in Nigeria. Few studies have been done on contraception among educated women in Nigeria

Objectives

This study was carried out in December 2000 to determine factors that influence the choice of contraceptives among female undergraduates at the University of Benin and Edo State University Ekpoma.

Methods

Data was collected from a sample of 800 female undergraduates matched ethnic group, socio economic status, religion and rural urban residence. Subjects were selected by proportional representation and the instrument used was closed ended questionnaire.

Results

The responses obtained were analysed using Spearman Rank Correlation co-efficient and regression analysis. Findings revealed the highest correlation for availability (r = .96) vis a vis the use of various types of artificial contraceptive and cost (r =.96), next was safety (r = .95) and effectiveness (r = .95). Others were peer group influence (r = .80) and convenience (r = .77).

Conclusion

An important step in improving women''s reproductive health is the involvement of men. Health programmes should conduct campaigns to educate men about reproductive health and the role they can assume in family planning.     

A systematic review of the impact of adherence on the effectiveness of e-therapies

Background

As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions.

Objective

The aim of this study was to systematically review the e-therapy literature to (1) describe the methods used to assess adherence and (2) evaluate the association of adherence with outcome of these interventions.

Methods

A systematic review of e-therapy interventions was conducted across disease states and behavioral targets. Data were collected on adherence measures, outcomes, and analyses exploring the relationship between adherence measures and outcomes.

Results

Of 69 studies that reported an adherence measure, only 33 (48%) examined the relationship between adherence and outcomes. The number of logins was the most commonly reported measure of adherence, followed by the number of modules completed. The heterogeneity of adherence and outcome measures limited analysis. However, logins appeared to be the measure of adherence most consistently related to outcomes in physical health interventions, while module completion was found to be most related to outcomes in psychological health interventions.

Conclusions

There is large variation in the reporting of adherence and the association of adherence with outcomes. A lack of agreement about how best to measure adherence is likely to contribute to the variation in findings. Physical and psychological outcomes seem influenced by different types of adherence. A composite measure encompassing time online, activity completion, and active engagements with the intervention may be the best measure of adherence. Further research is required to establish a consensus for measuring adherence and to understand the role of adherence in influencing outcomes.     

Health seeking behaviour and challenges in utilising health facilities in Wakiso district,Uganda

Background

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.

Objectives

To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.

Methods

The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.

Results

While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants'' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.

Conclusions

There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.     

Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain

Background

Economic recession affects quality of life by increasing rates of mental disorders in particular. Social support can be an important protective factor.

Aim

To estimate the impact of being personally affected by an economic crisis on health-related quality of life (HRQoL), taking into account the possible buffering effect of perceived social support.

Design and setting

Data from the first wave (March 2012 to November 2012) of the ‘Social Support and Quality of Life Study’, a longitudinal study carried out in a primary health care centre in a deprived neighbourhood of Barcelona, Spain.

Method

A total of 143 participants were assessed using the 12-item Short-Form Health Survey, the List of Threatening Experiences and the Duke Social Support scales. The effect of economic crisis on mental and physical HRQoL was assessed using ordinary least squares regression models to test the interaction between social support and having experienced an economic crisis.

Results

There was no statistical association between having suffered an economic crisis and physical HRQoL. The interaction between social support and economic crisis was also tested without finding any statistical association. An interaction was detected between social support and economic crisis in relation to mental HRQoL; those who had low levels of social support and had also experienced an economic crisis had the lowest levels of mental HRQoL.

Conclusion

Social support constitutes a safety net that offers protection against the adverse effect of economic recessions on mental health. Primary care professionals are in a key position to promote social activities and to strengthen social networks in the community.     

What Are Young Adults Saying About Mental Health? An Analysis of Internet Blogs

Background

Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care.

Objective

To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18–25 years of age) with mental health concerns to understand their experiences.

Methods

We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18–25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods.

Results

Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others.

Conclusions

The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults’ sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.     

A Mixed-Methods Study on the Acceptability of Using eHealth for HIV Prevention and Sexual Health Care Among Men Who Have Sex With Men in China

Background

Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care.

Objective

This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care.

Methods

We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care.

Results

The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns.

Conclusions

MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.     

Primary-care based participatory rehabilitation: users' views of a horticultural and arts project

Background

Participation in horticulture and arts may improve wellbeing in those with mental and physical illness.

Aim

To conduct an in-depth exploration of the views and experience of participants of a primary-care-based horticultural and participatory arts rehabilitation project (Sydenham Garden).

Design and setting

Qualitative interview study of a primary-care-based horticultural and participatory arts rehabilitation project in South London.

Method

Semi-structured interviews were conducted with 16 participants (referred to as ‘coworkers’) of Sydenham Garden. Seven were female. Participants were aged between 38 and 91 years and had a range of severe mental and physical health problems; most had depression. The interviews were analysed using constant comparison and thematic analysis.

Results

Data were overwhelmingly positive concerning participation. Coworkers considered participation in the project to promote wellbeing by providing purposeful and enjoyable activity and interest, improving mood and self-perceptions, and providing an escape from life’s pressures. Being outdoors was considered therapeutic. The most-valued aspect of participation was the social contact derived as a result of it. Many of the coworkers who were interviewed developed transferable skills, including nationally recognised qualifications, which they valued highly.

Conclusion

Delivery of horticultural therapy and participatory arts is a feasible model for improving wellbeing in patients in primary care who have serious illness. Longer-term studies are needed to address what happens to people after leaving such projects.     

Contraceptive non-use and associated factors among university students in 22 countries

Background

The aim of this study was to investigate contraceptive non-use and associated factors (socio-demographics, sexual behaviour, internal assets and mental health) among undergraduate university students in 22 countries.

Methods

Using anonymous questionnaires, data was collected from 16979 undergraduate university students (mean age 20.8, SD=2.8) from 23 universities in 22 countries.

Results

Of the total sample of 16979 undergraduate university students, 7032 (41.9%) reported to have been sexually active in the past 12 months. Of those who had been sexually active, 42.6% reported never (42.7% among male and 42.6% among female students) using contraceptives in the past 12 months. In multivariate regression analysis, among both men and women, younger age, religious affiliation (Hindu; and among women only being Muslim), intrinsic religiosity, and sexually protective behaviour were associated with contraceptive non-use. Lack of internal assets (among men, low life satisfaction and lack of personal control, and among women low personal mastery) ; among women not having depressive symptoms and among men having PTSD symptoms were associated with contraceptive non-use.

Conclusion

Low contraceptive use was found and several factors identified as associated with contraceptive non-use may help guide intervention efforts.     

The therapeutic relationship in e-therapy for mental health: a systematic review

Background

E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues.

Objective

Our objective in this study was to systematically review the therapeutic relationship in e-therapy.

Methods

We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form.

Results

From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome.

Conclusions

Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.     

Do Online Mental Health Services Improve Help-Seeking for Young People? A Systematic Review

Background

Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people.

Objective

This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years.

Results

Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified.

Conclusions

Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.