Mental Health Literacy Jorm, Anthony F.
The American psychologist,
04/2012, Volume:
67, Issue:
3
Journal Article
Peer reviewed
For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type ...of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.
Background:
Despite the high prevalence of mental health disorders worldwide, a significant proportion of distressed individuals do not seek professional help. Digital technology can be a potential ...bridge to reduce the treatment gap for mental disorders. A systematic review was undertaken to examine the technology-based interventions aimed at improving help-seeking attitude, intention, or behavior for mental health concerns.
Methods:
The literature search was conducted in January–February 2020 through various e-databases using relevant keywords that targeted help-seeking interventions for mental health disorders via different technology modes.
Results:
21 studies (15 randomized controlled trials and six non-randomized studies) were reviewed. The included studies were published between April 2006 to February 2020. Majority of the interventions led to an increase in the help-seeking variables. The crucial role of online delivery, participant involvement, and embedded links to professional services in encouraging help-seeking is highlighted. The review emphasizes the need for understanding utility of multicomponent interventions with personalized elements targeting help-seeking behavior, particularly in low-middle-income countries, and studies involving longer duration follow-ups.
Conclusion:
This systematic review is the first of its kind to examine technology-based interventions to improve help-seeking for mental health and suggests that such interventions play a crucial role in positively impacting help-seeking. The complex interplay between the relevant variables such as mental health literacy, stigma, help-seeking attitude, intention and behavior, and the intervention components that may have a differential bearing on these variables are issues that merit urgent attention in further research.
Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions ...such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap.
Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854).
Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96).
Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.
Objective:
Psychological distress and suicide rates are climbing in Australia despite substantial mental health programme investment in recent decades. Understanding where individuals prefer to seek ...support in the event of a personal or emotional crisis may help target mental health resources to where they are most needed. This study aimed to explore individual differences in help-seeking preferences that may be leveraged for early intervention and mental health service design.
Method:
Latent profile analysis was used to explore the help-seeking preferences of 1561 Australian online help-seekers who elected to complete a psychological distress screening on a popular mental health website, Beyond Blue.
Results:
Four latent profiles of help-seeker emerged that illustrate distinct preference channels for support: help-negaters, professional help-seekers, family help-seekers and help-affirmatives. Help-negaters were the least likely to consider seeking help from any source, recorded the highest levels of psychological distress and suicidal ideation, and were more likely to be younger. Help-affirmatives were the most likely to seek help from any source, particularly from religious leaders, and were more likely to speak a language other than English at home.
Conclusion:
Many individuals experiencing mental health concerns will prefer to seek support from family or community contacts rather than professionals, and some will not seek help at all. Diversity in help-seeking preferences should be considered when designing mental health services, outreach and psychoeducation materials.
Background
While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with ...intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not.
Method
This cross‐sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help‐Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help.
Results
Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well‐being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self‐concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO.
Conclusion
Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.
Background
Alcoholics Anonymous (AA) is a world‐wide recovery mutual‐help organization that continues to arouse controversy. In large part, concerns persist because of AA's ostensibly ...quasi‐religious/spiritual orientation and emphasis. In 1990 the United States’ Institute of Medicine called for more studies on AA's effectiveness and its mechanisms of behavior change (MOBC) stimulating a flurry of federally funded research. This paper reviews the religious/spiritual origins of AA and its program and contrasts its theory with findings from this latest research.
Method
Literature review, summary and synthesis of studies examining AA's MOBC.
Results
While AA's original main text (‘the Big Book’, 1939) purports that recovery is achieved through quasi‐religious/spiritual means (‘spiritual awakening’), findings from studies on MOBC suggest this may be true only for a minority of participants with high addiction severity. AA's beneficial effects seem to be carried predominantly by social, cognitive and affective mechanisms. These mechanisms are more aligned with the experiences reported by AA's own larger and more diverse membership as detailed in its later social, cognitive and behaviorally oriented publications (e.g. Living Sober, 1975) written when AA membership numbered more than a million men and women.
Conclusions
Alcoholics Anonymous appears to be an effective clinical and public health ally that aids addiction recovery through its ability to mobilize therapeutic mechanisms similar to those mobilized in formal treatment, but is able to do this for free over the long term in the communities in which people live.
•Students with suicidal thoughts/behaviors reported decreased help-seeking intentions.•A history of professional help-seeking was associated with increased intentions.•Informal help-seeking (i.e., ...disclosure) was not sufficient to predict intentions.•Imperative to identify students with suicidal thoughts (key precursor to attempts).•Future work must explore mechanisms to promote intentions in at-risk students.
Suicide is a leading cause of death in college-aged youth, yet only half of all college students report engaging in professional mental health help-seeking. We examined how the various aspects of young adults’ suicidality were associated with their openness to pursue professional mental health care in the future (i.e., “future help-seeking intentions”). Multilevel binary logistic regressions were tested in a sample of 24,446 U.S. college undergraduates with suicidality. The moderating effect of past service utilization on future help-seeking intentions was also tested. Strikingly, young people reporting past-year suicidal ideation, past-year suicidal attempts, and self-reported likelihood of a future suicide attempt demonstrated decreased likelihood of future help-seeking intentions, while those reporting prior diagnosis of a mental health condition and/or past service utilization demonstrated an increased likelihood. Past service utilization also significantly moderated the effect of suicide disclosure, such that youth reporting prior disclosure and prior professional treatment-seeking demonstrated greater odds of future help-seeking intentions relative to those who had disclosed suicidality but never utilized professional services. In order to mitigate the mental health crisis facing youth, further exploration is necessary to understand why students with suicidality do not report openness to seek help. It is also imperative to develop and implement novel strategies to identify at-risk students, understand and alleviate relevant barriers to treatment, and promote positive help-seeking attitudes and behaviors.
Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a ...therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index ISI) and depression (Beck Depression Inventory-II BDI-II) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval CI 6.60, 17.27, p < .001) more points, and ISI scores dropped by 6.59 (95% CI 3.04, 10.15, p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. Conclusions: CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment.
We tested antecedents (paternalistic beliefs; Study 1) and consequences (social change potential; Study 2) of autonomy‐ and dependency‐oriented help and developed scales assessing paternalistic ...beliefs and both forms of help. In Study 1 (N = 143 Germans), we focused on paternalistic beliefs as an antagonist to social change and a key distinguishing variable between engagement in both forms of help. As expected, paternalistic beliefs were positively related to dependency‐oriented help, mediated by concern for a positive national moral image, but negatively related to autonomy‐oriented help, mediated by perceived competence of refugees. In Study 2, both refugees (N = 80) and Germans (N = 94) perceived autonomy‐oriented help to have more potential for social change than dependency‐oriented help.
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking.
The review addresses the following hypotheses:1. Individual counselling is ...more effective than no treatment or brief advice in promoting smoking cessation.2. Individual counselling is more effective than self-help materials in promoting smoking cessation.3. A more intensive counselling intervention is more effective than a less intensive intervention.
We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field in May 2016.
Randomized or quasi-randomized trials with at least one treatment arm consisting of face-to-face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow-up at least six months after the start of counselling.
Both authors extracted data in duplicate. We recorded characteristics of the intervention and the target population, method of randomization and completeness of follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically-validated rates where available. In analysis, we assumed that participants lost to follow-up continued to smoke. We expressed effects as a risk ratio (RR) for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model. We assessed the quality of evidence within each study using the Cochrane 'Risk of bias' tool and the GRADE approach.
We identified 49 trials with around 19,000 participants. Thirty-three trials compared individual counselling to a minimal behavioural intervention. There was high-quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self-help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% confidence interval (CI) 1.40 to 1.77; 27 studies, 11,100 participants; I
= 50%). There was moderate-quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (nicotine replacement therapy) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I
= 0%). There was moderate-quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I
= 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences.
There is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit. There is moderate-quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention.
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