Abstract
High rates of mental illness and addictions are well documented among youth in Nicaragua. Limited mental health services, poor mental health knowledge and stigma reduce help-seeking. The Mental Health Curriculum (MHC) is a Canadian school-based program that has shown a positive impact on such contributing factors. This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua. High school and university students (aged 14-25 years) were assigned to intervention (12-week MHC; n=567) and control (wait-list; n=346) groups in a non-randomized design. Both groups completed measures of mental health knowledge, stigma and function at baseline and 12 weeks. Multivariate analyses and repeated measures analyses were used to compare group outcomes. At baseline, intervention students showed higher substance use (mean difference [MD]=0.24) and lower perceived stress (MD=-1.36) than controls (p<0.05); there were no other group differences in function. At 12 weeks, controlling for baseline differences, intervention students reported significantly higher mental health knowledge (MD=1.75), lower stigma (MD=1.78), more adaptive coping (MD=0.82), better lifestyle choices (MD=0.06) and lower perceived stress (MD=-1.63) (p<0.05) than controls. The clinical significance as measured by effect sizes was moderate for mental health knowledge, small to moderate for stigma and modest for the other variables. Substance use also decreased among intervention students to similar levels as controls (MD=0.03) (p>0.05). This pilot investigation demonstrates the benefits of the MHC in a low-and-middle-income youth population. The findings replicate results found in Canadian student populations and support its cross-cultural applicability.
Highlights
Mental disorders tend to have onset in childhood and adolescence and if left global mental health untreated, often carry into adulthood (Kessler et al 2009)
It is estimated that 10–20% of youth (
About 80% of those with mental illness, addictions or suicidal behaviour live in low- and middle-income countries (LMICs), where such stressors are endemic (WHO, 2009) and 50% of the population is under age 24 (UNFPA, 2014)
Summary
Mental disorders (mental illnesses and addictions) tend to have onset in childhood and adolescence (most frequently in the 15–24 age range) and if left global mental health untreated, often carry into adulthood (Kessler et al 2009). Reviews of school-based programs have noted that structured initiatives that focus on mental health literacy may have more robust benefits in improving knowledge, coping skills and resilience, increasing help-seeking, and reducing stigma among youth (Weare & Nind, 2011; Fazel et al 2014; Fernandez et al 2016). Better coping is associated with decreased substance abuse (Griffin et al 2002), which is a common maladaptive coping strategy among youth to cope with mental illness and stress (Roberts et al.2009) The efficacy of such programs has been noted to be enhanced by teacher delivery and integration into the regular curriculum (Neil & Christensen, 2009; Weare & Nind, 2011). This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua
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