Pathways of adolescent intention for mental health help-seeking: Insights from the theory of planned behavior

This study evaluated the effects of a continuing education class that applied the theory of planned behavior to the intentions and behavior of mental health practitioners. In 2006 a total of 94 mental health practitioners were randomly assigned to either a standard continuing education class or one that applied principles of the theory of planned behavior. The class topic was a brief, self-report tool that assesses felt need for employment among people with serious mental illnesses. Participants' intentions to apply the tool were evaluated before and after each class. Participants' implementation of the tool was measured three months after the class. The class guided by the theory of planned behavior significantly and substantially increased the participants' intentions to use the tool in comparison with the standard class. Significantly more participants in the theory-guided class than in the standard class (74% versus 42%) had applied the tool by the three-month follow-up. Among those who implemented the assessment tool, the participants in the theory of planned behavior class also assessed significantly more of their caseload. The theory of planned behavior can improve and may be well suited to continuing education in psychiatry.

BackgroundDespite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged >18 years.MethodsThis scoping review was conducted based on the methodology presented by Arksey and O’Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel.ResultsInitially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results.ConclusionsThe present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice.

Objective Despite high risk for mental health problems, older adults with chronic diseases underutilise mental health services. This study applied the Theory of Planned Behaviour (TPB) to understand mental health help-seeking intentions among this population and identified factors which influence help-seeking intentions. Method We conducted a cross-sectional study with a non-clinical sample of 108 older adults aged 65 years or over, living with cardiovascular disease, respiratory disease, and/or type 2 diabetes. TPB variables (attitudes, subjective norms, and perceived behavioural control), intentions to seek help, and additional factors (past help-seeking behaviour, quality of life, and physical health) were assessed using standardised questionnaires. Multiple linear regressions were conducted to identify predictors of help-seeking intentions. Results 41% of the participants did not intend to seek help, and all three TPB variables were associated with help-seeking intentions. The traditional TPB model accounted for 69.7% of the variance in intentions, and the extended TPB model accounted for an additional 1.6% of the variance. Conclusions Attitudes and perceived behavioural control have the strongest association with help-seeking intentions among older adults with chronic disease. Further research is needed to identify predictors of mental health help-seeking behaviour and to develop interventions to promote help-seeking in this population. KEY POINTS What is already known about this topic: Older adults aged 65 years or over living with chronic disease are at an increased risk of mental health decline. Older adults underutilise mental health services, and consequently mental health problems often go undiagnosed and untreated in this population. A growing body of research has demonstrated the utility of the Theory of Planned Behaviour in predicting intentions to seek mental health support services. What this topic adds: Most older adults with chronic disease have some intention to seek professional mental health support when needed. Older adults with chronic disease have a high perceived ability to seek professional help. Promoting favourable attitudes towards mental health help-seeking is likely to facilitate the greatest change in help-seeking intentions in the present population.

Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members. The 2017 Air Force Community Feedback Tool was used for this study. This confidential survey was completed by a large sample of the military population (N = 10,705). The survey was used to examine relationships between the TPB-related variables and respondents with mood problems identifying a need for professional counseling, seeking MH services, and reporting that the services met their needs. Multiple linear and binary logistic regression models were utilized to analyze findings from this sample. This study highlights how attitudes, subjective norms, and perceived behavioral control impact help-seeking behavior for these individuals. Findings include the MH providers' good reputations, wait times for services, ease of access to care, and negative experiences with supervisor permission, all of which showed a statistically significant impact on help-seeking behavior. Dependent variables included "I need professional counseling," "I contacted a MH care provider in the past year to try to meet this need," and "How much the MH care provider helped you meet your needs." Each of these variables had statistically significant relationships with the connecting variables of the TPB. Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

A Longitudinal Study of Learning Engagement of Math and Science Gifted Students in Junior and Senior High School

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Objective: To understand the level of moderate - to - vigorous physical activity (MVPA) and the psychological health of adolescents, explore the relationship between MVPA and psychological health, and provide a theoretical basis for the formulation of relevant policies and measures. Methods: In five regions of Shanghai, Kunming, Urumqi, Suzhou, and Changsha, 10,327 (male: 5,231, female: 5,096) middle school students aged 12-17 were selected as the research subjects to investigate their MVPA and psychological sub - health. Data analysis uses chi - square test, non - parametric test, and logistic regression analysis. Results: The study revealed that 30.4% of adolescents faced psychological sub - health symptoms and 22.4% met the criteria for psychological sub - health status, with significant disparities. MVPA standards declined with age, and girls were more likely to have substandard MVPA levels (68.1%) than boys (56.4%). Notably, senior high school girls had a 1.303 (OR=1.303, 95% CI: 1.054-1.611, P<0.05) times higher detection rate of psychological sub - health symptoms than their MVPA level, junior high school boys had a 1.286 (OR=1.286, 95% CI: 1.041-1.589, P<0.05) times higher rate, and junior high school girls had a 1.367 (OR=1.367, 95% CI: 1.126-1.661, P<0.01) times higher rate. Additionally, there were significant differences in MVPA levels and psychological sub - health detection rates between junior and senior high school students. Conclusion: MVPA substandard is more likely to cause the prevalence of mental sub - health in female students. Focus on the mental health status of girls and junior high school students, and strengthen the psychological counseling of teenagers.

Objectives Healthy Parents and Children 21 (Tier 2) promotes health education collaboration across multifaceted sectors in order to realize a society that supports the physical and mental health of the next generation. The purpose of this report is to provide an overview of the school's health activities and present the findings obtained through surveys and health education activities at a junior high school.Methods The activities were focused on activities targeting the junior high school in Town A, Matsue City, Shimane. The town launched a pediatric lifestyle-related disease control project in 1991. Even after the municipal merger, local school health committee activities were maintained. The Division of Environmental and Preventive Medicine at Tottori University has been participating in school health activities in Town A since the beginning of the project. Elementary and junior high schools in Town A allowed medical students from Tottori University to participate in health activities for social medicine training. Herein, we discuss (1) the results of the survey conducted at A junior high school in 2022; topics included lifestyle, digital device use, and mental health (Patient Health Questionnaire-9) and (2) feedback from junior high school students, school health workers, and medical students regarding activities for social medicine training.Results Medical students provided a 50-minute health education program at A junior high school. Based on interviews and questionnaires administered to junior high students and school health workers, important health issues were identified. Accordingly, the medical students planned a program aimed at acquiring favorable lifestyle habits, with a particular focus on sleep and excessive digital device use. The program was conducted in each second-grade class. Additionally, activities at the junior high school and town A allowed us to collaborate with the Matsue City Board of Education and Youth Development Organization. They shared our concerns about adolescent lifestyles and digital device use.Conclusion Our activity provided health education on controlling digital device use and promoting favorable lifestyles using a peer education strategy. In the future, connecting related sectors and making the best use of local resources are desirable for developing activities for a broader area. Evaluating the effectiveness of these activities and establishing a system that enables primary healthcare workers, schools, and local boards of education to develop their own school health activities in collaboration with the local government are warranted.

Mental health help-seeking is often delayed in older people, and different theories have hypothesized diverse mechanisms to improve help-seeking. The theory of planned behavior (TPB) and nudge theory (NT) converge on social norms as promising targets for intervention. Despite accumulating evidence of social norm nudges in promoting health behaviors, no intervention has utilized social norms to promote mental health help-seeking in older adults. This study aims to (a) co-design social norm-nudges with different stakeholders and (b) pilot their feasibility and effects in improving mental health help-seeking intention in older people. The participatory study recruited ten older people, two social workers, and two experienced researchers to co-design the social norm nudges. All participants received three-hour training on TPB and NT principles, followed by ten interactive co-design workshops over three months. A set of 14 social norm nudges was designed and piloted among 20 older people for feasibility and effects. The participants completed a self-administered baseline questionnaire, received 14 social norm nudges over smartphones in two weeks (one message per day), completed the post-intervention questionnaire and provided feedback to the nudges afterwards. The primary outcomes were changes in subjective norms and help-seeking intention assessed using a revised Chinese version of the TPB questionnaire (C-TPB); secondary outcomes included perceived behavioral control, help-seeking attitude, perceived barriers to help-seeking (C-TPB subscales), and mental health assessed by PHQ-9, GAD-7 and UCLA-3. Preliminary results suggested the feasibility of the social norms to be delivered digitally and the effects in increasing help-seeking intention and attitude.

Since the outbreak of COVID-19 in late 2019, and until the Chinese government downgraded the pandemic control measures to Category B management in January 2023, various epidemic prevention measures were implemented across regions based on the local spread of the virus. Correspondingly, educational formats shifted between online and offline teaching according to the pandemic situation. Changes in daily life and teaching methods, along with the high initial mortality rate of COVID-19, have had varying degrees of negative impact on the mental health (MH) of adolescents. This study aimed to explore the impact of the COVID-19 pandemic status on the sleep duration (SD) and MH of adolescents, investigate the relationship between SD and MH in middle school students, and evaluate the protective effect of SD on MH. Using a convenient sampling method, 6 junior high schools and 3 senior high schools in Guiyang City, China, were selected. Random samples from two classes per grade in each school were chosen for the survey. The study was conducted annually for three consecutive years using the Mental Health Inventory of Middle-school students (MMHI-60) scale and a self-designed questionnaire. Data were analyzed using IBM SPSS version 26.0 software, employing ANOVA, cross-tabulation, and generalized linear models to examine the relationship between SD and MH scores. The SD and MH scores of middle school students in 2021, 2022, and 2023 were 436.41 ± 71.21 min/day, 423.69 ± 61.71 min/day, and 445.26 ± 65.04 min/day (F = 41.44, p < 0.001), 1.72 ± 0.63, 1.87 ± 0.73, and 1.79 ± 0.67 (F = 18.31, p < 0.001). The SD compliance rates were 34.1%, 23.9%, and 33.2%, and the MH problem detection rates were 27.9%, 36.4%, and 33.4%, respectively; there is a significant correlation between SD and MH scores among middle school students (P < 0.001); the protective effects of SD compliance on MH were 1.859 times, 2.156 times, and 1.516 times higher than those of SD non-compliance (all p < 0.001). Meeting the SD standard is a protective factor for adolescent MH. The COVID-19 pandemic and its control measures have had a severe and long-term negative impact on both SD and MH in middle school students, with differences observed between genders and academic levels. The greater the severity of the pandemic and the stricter the control measures, the more significant the negative impact on SD and MH etc.

Why Adolescent Depression Is a Global Health Priority and What We Should Do About It

BackgroundExisting evidence indicates that Muslim minorities underutilize mental health services despite a pressing need. Employing the Theory of Planned Behavior (TPB), this study seeks to explore considerations that influence mental health help-seeking by Muslims residing in California and Israel.MethodsA qualitative approach involving semi-structured interviews guided by the TPB principles was implemented with 78 Muslim participants. Thematic analysis was conducted to identify key themes.ResultsEmploying both deductive and inductive approaches, four major themes were identified: attitudes (advantages, disadvantages, and the influence of religiosity), subjective norms (the impact of significant others), perceived behavioral control (facilitators and challenges), and intentions toward seeking mental health support (influenced by gender, and prior experience). Common social and cultural norms were identified in both groups within the patterns of the TPB. The family's significance as a supportive resource emerged in both groups, but the extended family had a more profound impact among Muslims in Israel. Stigma as a barrier against seeking mental health help was stronger among Muslims in Israel, while financial barriers and socio-political context were highlighted more by Californian Muslims.ConclusionsThe findings highlighted the importance of adopting a holistic approach to mental health help-seeking among Muslims due to commonalities in approaches, irrespective of geographical differences. Variance between the two groups primarily stemmed from social factors, particularly stigma and the influence of extended family. The results underscore the universality of common aspects and emphasize the importance of addressing social norms and socio-economic realities to enhance engagement among Muslims in both countries.

Cesarean delivery on maternal request is one of the important public health issues in China. Our study aimed to apply the theory of planned behaviour to comprehensively determine the factors regarding pregnant women's preference for cesarean section and to provide references for establishing measures to reduce cesarean delivery on maternal request. This cross-sectional analysis was conducted in four women's and children's hospitals in China from May to June 2018. Eligible women arriving for routine antenatal visits at these hospitals were recruited to answer a structured questionnaire. A total of 1853 pregnant women consented to participate in the investigation, with a response rate of 88.75%. Finally, 1677 pregnant women (984 nulliparae and 693 multiparae) were involved in the analysis. Descriptive statistics and logistic regression analyses were used. Of the study participants, 20.39% preferred cesarean section. For both nulliparae and multiparae, those who had lower scores of attitudes towards vaginal delivery, lower scores of childbirth self-efficacy and higher scores of subjective norms were more likely to prefer cesarean section. Pregnant women's birth preferences were significantly associated with their attitudes towards the delivery mode, childbirth self-efficacy and subjective norms, which is consistent with the theory of planned behaviour. Interventions to reduce cesarean delivery on maternal request can be developed based on the theory of planned behaviour.

Mental health in adolescents represent a considerable public health issue in developing countries. These problems are considered a source of problem for adolescents’ quality of life. The study objective was to determine the association between mental health problems and sociodemographic variables among adolescents. A cross-sectional study was conducted from October to December 2016 using a school-based survey in 4 districts and 3 cities in West Java Province, Indonesia. Stratified multistage random sampling was used to select junior and senior high school students and self-administered questionnaires were used to collect study data which included: personal data, socioeconomic status scale, and self-reported version of Strengths and Difficulties Questionnaire (SDQ) which divided into 5 subscales. About 3452 adolescents of 32 schools were included in this study, 59% female, 56% junior high school, 56% district residence, most parents’ education were senior high school. The prevalence of mental health problems based on SDQ subscale as total difficulties, conduct problem, emotional symptoms, peer problems, hyperactivity-inattention, were abnormal 31.6, 38.9, 30, 29.3, 15.6, respectively. Mental health problems were more prevalent amongst adolescents in junior high school and residence in district area, with RR and 95% CI were 1.14 (1.04-1.26), and 1.18 (1.08-1.30). As conclusions mental health problems in adolescents were associated with education level and residence area