Mental Health Help-seeking Behavior Research Articles

Acculturation and Social Stigma: Mental Health Communicative Action and Help-seeking Behaviors among Chinese Immigrants in the United States

ABSTRACT This study explored the role of social stigma in affecting Chinese immigrants’ likelihood to engage in dialogues regarding mental illness and seek professional help. Moreover, this study hypothesized that Chinese immigrants who are more acculturated would perceive relatively less social stigma toward mental illness. Results from a nationwide survey of 421 Chinese immigrants in the United States provided empirical support for the important roles of acculturation and social stigma in influencing Chinese immigrants’ communicative action and behavioral intentions regarding mental illness and mental health services. The findings offered theoretical and practical implications. Interventions and education programs that target stigma tolerance and cultural competency may be appropriate to reduce social stigma among Chinese immigrants. Increased opportunities to engage in dialogues regarding mental illness may also be key in reducing stigma and increasing the likelihood to seek professional help.

A qualitative investigation of mental health in women of refugee background resettled in Tasmania, Australia

BackgroundWomen of Refugee Background (WoRB) are a highly vulnerable population with complex going mental health needs following resettlement. In Australia, there has been a substantial increase in WoRB being resettled in rural and regional locations. Despite this, no research to date has specifically focused on factors contributing to mental distress in WoRB in regional resettlement locations. The current study aimed to address this gap in literature.Methods21 semi-structured qualitative interviews were conducted with WoRB and service providers in regional locations of Tasmania, Australia. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed utilising Braun and Clarke (Qual Res Psychol 3(2):77–101, 2006) framework for conducting thematic analysis.ResultsThematic analysis revealed that WoRB conceptualised mental health as a pathogenic entity, which significantly influenced their mental health help-seeking behaviours. The findings also highlighted how resettlement to a rural and regional location of Australia may exacerbate many of the factors which contribute to ongoing mental distress in WoRB.ConclusionsThe findings of the current study build upon existing research which indicates the adverse impacts post-migrations stressors can have on the mental health of individuals of refugee background. Furthermore, this study suggests that the current services and supports available to WoRB resettled in regional locations of Australia are inadequate, and under-resources. These findings are discussed in regard to practical and policy implications which should be addressed to better support the mental health of WoRB resettled in rural and regional locations of Australia.

Evaluating a Sport-Based Mental Health Literacy Intervention in Australian Amateur Sporting Adolescents.

Youth amateur sporting environments present an untapped, under-researched, and potentially vital avenue for targeted mental health intervention programs. This study evaluates such an intervention in 12 sporting clubs, comprising of 330 Australian youth aged 12-15 years (M = 13.73, SD = 0.79). Mental health literacy, help-seeking intentions, and help-seeking behaviors were measured throughout the season using a repeated-measures experimental-control design. Multilevel modelling revealed the intervention successfully improved mental health literacy and help-seeking intentions in particular cohorts, such as youth scoring low in these constructs pre-intervention and youth who had not previously received the intervention. This study demonstrates the efficacy of interventions to effect positive change in amateur sporting youth, highlighting a convenient method to improve mental health in young people.

Military and Veteran help-seeking behaviors: Role of mental health stigma and leadership

ABSTRACT Mental health stigma has been identified as a barrier to help-seeking in the United States. This may be particularly salient for military personnel who tend to report higher mental health stigma than the general population. Evidence suggests that both supportive and destructive military leadership are related to service members’ attitudes toward seeking help. In the current study, a sample of military service members and Veterans (N = 232) completed an online survey regarding mental health stigma, previous experiences with military leaders, and mental health help-seeking behaviors. Findings indicated that destructive and supportive leadership experiences were significantly related to self stigma, public stigma, and help-seeking. Military members and Veterans who experienced destructive leadership were more likely to report internalized mental health stigma, which decreased the likelihood of seeking help. Supportive leadership, on the other hand, was associated with greater likelihood of seeking help for mental health concerns, and was indirectly related to help-seeking through lower self-stigma. Findings suggest that the military leadership style plays a significant role in service members’ and Veterans’ willingness to seek assistance for mental health concerns.

An Application of Social Marketing Theory to develop a social marketing campaign to address mental health literacy and help-seeking behavior among male college students

Male college students have been observed to have low mental health literacy and help-seeking behaviors. The purpose of this study was to apply social marketing theory to address mental health literacy among male undergraduate students in order to improve both mental health literacy and help-seeking behaviors. The current study employed qualitative methods involving key informant interviews among male undergraduate university students (n = 26). Participants were provided three vignettes representing a male college student presenting with anxiety, depression, or stress during the key informant interviews. The concepts from the key informant interviews were mapped onto the social marketing theory marketing mix (product, price, place, promotion). The social marketing mix identified methods to improve professional help-seeking behaviors (product) among male undergraduate students by reducing stigma, both perceived social stigma and self-stigma, as well as addressing masculine norms (price) in locations where students are comfortable, such as the university health center or the Internet (place), by connecting the physical signs and symptoms (promotion) to mental health concerns. Findings were translated into a targeted and tailored social marketing campaign implemented in male restrooms in the campus recreation center. Social marketing theory is a valuable tool for developing targeted and tailored social marketing programs for mental well-being among college students.

Mental health and wellbeing of postgraduate researchers: exploring the relationship between mental health literacy, help-seeking behaviour, psychological distress, and wellbeing

ABSTRACT Studies of Postgraduate Researchers (PGRs) have highlighted that the population may be at risk of developing symptoms of common mental health problems. Early intervention and preventative measures may reduce this risk, such as improving mental health literacy (MHL). However, it is unclear what the relationship is between MHL and outcomes such as help-seeking behaviour, psychological distress and wellbeing, in PGRs. Therefore, the current study aimed to explore this relationship. A secondary aim of this study was to compare data collected from PGRs with undergraduate students. Two hundred and forty-one PGRs from two universities in England completed an anonymous online quantitative survey, with PGRs reporting on their MHL, help-seeking behaviour, psychological distress, and wellbeing, in addition to demographic and academic characteristics. Results indicated that 70% of PGRs were experiencing symptoms categorised as mild to severe psychological distress. Stepwise multiple regressions revealed that lower levels of wellbeing predicted higher levels of distress and lower levels of help-seeking behaviour. Compared with undergraduate students, PGRs in this study reported higher levels of psychological distress compared to undergraduate students, after adjusting for age, sex, and previous diagnosis of a mental health problem, as well as MHL, after adjusting for sex and previous diagnosis (p < 0.05). No significant differences were observed between the groups for help-seeking behaviour, or wellbeing (all p > 0.05). Study findings suggest that PGRs, at the start of the academic year, are distressed and may not be seeking appropriate help for their concerns. Further studies should explore the environmental factors that may exacerbate mental health concerns beyond that associated with a challenging degree, within the PGR population.

Assessing Trends in Physician Assistant Student Depression Risk, Suicidal Ideation, and Mental Health Help-Seeking Behavior.

The purpose of this study was to assess how physician assistant (PA) student depression risk, suicidal ideation, and mental health help-seeking behaviors change during didactic training and the relationship between depression risk and demographic factors. Data were obtained through an anonymous online survey sent to didactic students in 7 PA programs during orientation and again at midpoint of the didactic year. Descriptive statistics, independent samples t-testing, and one-way ANOVA analyses were used to assess trends in patient health questionnaire (PHQ-9) scores over the 6-month time period. The PHQ-9 is the module of the PHQ that measures severity of depression risk. The orientation survey response rate was 82.7% (287/347) and the midpoint survey response rate was 62% (217/350). Analysis revealed that mean PHQ-9 scores increased significantly from 2.49 to 6.42 (p < 0.001) from orientation to midpoint of the didactic year, with 18.9% of students having scores of 10 or greater at midpoint compared to 4.5% at orientation. Thoughts of self-harm and/or suicidal ideation in the past 2 weeks also increased from 3.5% to 7.4% during the same time frame. Additionally, students' likelihood of seeking mental health help decreased between orientation and midpoint despite the concurrent increases in depression risk and suicidal ideation. Rising PHQ-9 scores indicated an increased risk of major depression among didactic-year PA students. Further research on early screening methods and factors that encourage help-seeking behaviors may serve to inform programs about how to create learning environments that mitigate depression risk and promote wellbeing during professional training.

Help-seeking for mental health problems among older adults with chronic disease: an application of the theory of planned behaviour

ABSTRACT 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.

Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students

The current study sought to understand the influence of cultural values on mental health attitudes and help-seeking behaviors in college students of diverse ethnic backgrounds. Asian and Latinx college students (N = 159) completed an online survey in which they reported on their adherence to cultural values as measured by ethnicity-specific cultural values and general attitudes towards mental health. Factor analysis revealed two common factors of cultural values irrespective of ethnicity: Interdependent Orientation (IO) and Cultural Obligation (CO). Regardless of ethnicity, the more students endorsed IO values, the less likely they were to perceive a need for mental health treatment. IO value adherence was also predictive of more negative attitudes towards mental health. CO values were not predictive of perceived need or help-seeking behaviors. Findings highlight the importance of understanding shared cultural values across ethnic-racial groups and considering how the multidimensionality of culture may help explain shared mental health behaviors crossing lines of ethnic group membership.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers.

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers’ level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Mental Health Literacy and Help-Seeking Behaviours Among Undergraduate Pharmacy Students in Abha, Saudi Arabia.

BackgroundThe serious mental health problems experienced by university students could have a negative impact on their long-term mental, social and physical health as well as their academic achievements. The ability to recognise a condition, and knowledge about mental health issues and sources of help, are among the factors influencing help-seeking behaviour in young individuals. This study was conducted to examine the mental health literacy among undergraduate pharmacy students and to assess whether mental health literacy is linked to a stronger intention to seek help.MethodsThis prospective cross-sectional study used an online self-administered questionnaire. A total of 271 pharmacy students at King Khalid University completed the questionnaire and agreed to participate in the study.ResultsThe mental health literacy in the current study (M=112.53) was found to be lower than that reported in international research using the MHLS. Students with no history of mental health issues scored significantly higher in help-seeking behaviours from informal sources (M=23.65, SD=6.88) than those with a previous history (M=19.03, SD=7.58), F (1, 269)=11.76, p=0.001. The study revealed a significant positive correlation between mental health literacy and help-seeking behaviours r(271)=0.26, p<0.01.ConclusionThis study demonstrates that there is a positive correlation between mental health literacy and help-seeking behaviours. Implementing appropriate interventions could be a key priority in improving the mental health literacy and help-seeking behaviour of students.

Barriers and Facilitators to Professional Mental Health Help-Seeking Behavior: Perspective of Malaysian LGBT Individuals

Abstract This qualitative study explored the facilitators and barriers influencing professional mental health help-seeking among Malaysian LGBT young adults (n = 28). The main barriers identified were internal resistance, lack of resources and information about mental health, limited availability and accessibility to services, negative perception of mental health services, and stigma against LGBT communities. The facilitators were self-awareness, having resources and information, accessibility or availability of mental health services, and positive attitudes and beliefs about these services. Perspectives from our participants strongly highlight the requirement of culturally competent practices and LGBT-affirmative policies for better provision of mental health services among the LGBT communities.

Effect of a peer\u2010led intervention combining mental health promotion with coping\u2010strategy\u2010based workshops on mental health awareness, help\u2010seeking behavior, and wellbeing among university students in Hong Kong

BackgroundThe psychological well-being of university students is an important factor in successfully coping with the demands of academic life. This study aimed to assess the impact of a peer-led intervention of mental health promotion combined with coping-strategy-based group workshops on mental health awareness and help-seeking behavior among university students in Hong Kong.MethodA mixed-method concurrent design was used for this study. Quantitative data, based on one-group pretest-posttest design, were collected using Mental Health Knowledge Schedule Questionnaire to assess mental health awareness, and Attitude Towards Seeking Professional Help Questionnaire-Short Form to examine help-seeking behavior of university students from The Hong Kong Polytechnic University. Qualitative data were collected from written post-activity reflections and focus group discussions which were thematically analyzed.ResultsA total of 62 university students (mean age: 23.2 ± 5.1 years) were included in this study. Mental health awareness was significantly improved (p = 0.015, 95% Confidence Interval of − 2.670, − 0.297) after program implementation. Help-seeking behavior mean score increased from pretest to posttest, however, no significant difference was observed (p = 0.188, 95% CI = − 1.775, 0.355). Qualitative analysis revealed that the program helped participants learn about coping strategies to help themselves and others with mental health challenges.ConclusionsThe peer-led intervention provided a positive impact through increased mental health awareness and knowledge of coping strategies on self-help and helping others among university students. Further study could focus on the impact of the program when applied regularly throughout the entire academic year.

Representations of mental health problems in the UK press: A focus group study

Sensationalist newspaper reports reinforce existing public stigma against individuals with mental health problems. To better understand the impressions that people with mental health problems have of press representations of mental health problems, and the negative consequences newspaper reporting can have on those affected, two focus groups and five interviews were conducted with 16 participants (aged 24 to 72 years) who were directly or indirectly affected by mental health problems. Recordings were transcribed verbatim, coded and analysed using deductive and inductive coding approaches to Thematic Analysis. Two main themes were developed: perceived misrepresentations about mental health problems, and perceived consequences of misrepresentations. The results from this focus group study highlight how misrepresentations of mental health problems in the press create and reinforce public stigma and misinformation and inhibit communication about mental health problems and help-seeking behaviour.

청년의 정신건강 리터러시와 도움요청 행동 - 도움요청에 관한 낙인, 태도, 의도의 매개효과 분석 -

본 연구의 목적은 우리나라 20대 청년의 정신건강 리터러시가 정신건강 도움요청 행동에 미치는 영향을 살펴보고, 도움요청에 대한 낙인, 태도, 의도의 매개 효과를 확인하는 데 있다. 이를 위해 20대 청년 411명에 대한 온라인 설문조사를 통해 자료를 수집하고 도움요청의 자원별로 정신건강 리터러시, 사회적 낙인, 자기 낙인, 태도, 그리고 의도로 구성된 구조모형 총 4가지를 구성하여 이들 요인 간 구조적 관계를 검증하였다. 연구결과, 연구모형 1(정신의료 서비스이용 모형)과 연구모형 2(상담·심리치료 서비스이용 모형)의 경우, 정신건강 리터러시가 서비스 이용에 영향을 미치는 과정에서 영향요인 간 직·간접 영향이 유의했다. 그러나 연구모형 3(지역사회 정신건강 서비스이용 모형)과 연구모형 4(온라인·전화상담 서비스이용 모형)의 경우, 영향요인 간 관계성은 도움요청 의도까지만 유의했으며 각각의 도움요청 행동에는 유의한 직·간접 영향을 미치지 않는 것으로 나타났다. 이러한 결과는 정신건강 리터러시가 정신의료와 심리치료 도움요청 행동에 대한 결정을 촉진하는 주요 요인임을 보여주는 것으로서, 20대 청년을 대상으로 한 정신건강 예방 및 증진 서비스 마련에 있어 정신건강 리터러시 수준 향상에 중점을 둔 전략의 필요성과 중요성을 잘 보여주고 있다. 이에 결론에서는 20대 청년을 위한 정신건강 리터러시 교육의 필요성과 온오프라인 교육 전략, 기존의 정신건강서비스 기관을 비롯하여 청년 관련 사업을 수행하는 기관의 서비스 보완 및 확장 방안을 제시하였다.

Attitude and help-seeking behavior of the community towards mental health problems.

BackgroundCommunity attitude towards mental health problems and help-seeking behavior plays a major role in designing effective community based mental health interventions. This study aimed to assess the attitude, help-seeking behavior, and associated factors of the Jimma zone community towards mental health and mental health problems.MethodsA community-based cross-sectional study design was employed. A respondent from each of the 423 systematically selected households was interviewed using a pretested, structured, and interviewer-administered questionnaire. Accordingly, a community’s attitude towards mental health problems was measured by the adapted version of the “Community Attitude towards Mentally Ill questionnaire (CAMI)” and help-seeking behavior was measured by a general help-seeking questionnaire. Data were entered into Epi-data version 3.1 and exported to SPSS version 23.0 for analysis. Bivariate and multivariate logistic regression analysis was done to determine the independent predictors of the outcome variable.ResultsAmong the total 420 study participants (197,46.9%) of them had an overall unfavorable attitude towards mental illness. The majority (153,36.4%) of the study participants agreed on avoidance of anyone who has mental health problems and (150,35.7%) participants described marrying a person with a mental health problem or recovered from the problem is foolishness. Moreover, regression analysis showed family monthly income (AOR = 0.24, 95%CI:0.06–0.91) and occupational status (AOR = 0.57, 95%CI:0.34–0.96) were found to be the predictors of community attitude towards mental health problems. The study finding also revealed a significant number of the respondents preferred non- medical treatment approaches.ConclusionAlmost half of the respondents had an unfavorable attitude towards mental health problems and the traditional and religious help-seeking intention was high. This suggests the need for designing effective community based mental health interventions to improve the general public attitude and help-seeking behavior towards mental health problems.

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial.

BackgroundMental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.ObjectiveThe goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.MethodsA 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.ResultsA total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).ConclusionsPrompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.Trial RegistrationClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461International Registered Report Identifier (IRRID)RR2-10.2196/resprot.6446

Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study.

BackgroundGender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations.ObjectiveWe aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications.MethodsThree investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram’s search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator’s data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag.ResultsAll three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X2=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X2=1.533, P=.22; X2=1.241, P=.27; X2=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X2 values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair.ConclusionsWomen are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma.

Mental Health Literacy Intervention on Help-Seeking in Athletes: A Systematic Review.

Mental health literacy (MHL) is recognised as a major factor in whether athletes seek help when they experience mental health difficulties. Therefore, the current study aimed to provide a systematic review of the effectiveness of MHL training programmes in improving mental health knowledge and help-seeking and reducing stigma among athletes. To identify intervention studies of MHL programmes, five electronic databases were systematically searched for articles published before May 2020. The selection procedure was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All kinds of study designs were included. Effect sizes were calculated for mental health knowledge, stigma reduction and help-seeking attitudes, intentions and behaviours. Risk of bias was assessed for each study using the Cochrane tool and the Newcastle–Ottawa quality assessment scale. Five studies (1239 participants in total) were selected for review. Overall, either small or medium effects were found for mental health knowledge, stigma reduction, help-seeking attitudes, and intentions for post- and follow-up interventions, whereas a null effect was found in help-seeking behaviours for both post- and follow-up interventions. Furthermore, three studies had a low risk of bias, and two had a high risk of bias. MHL interventions can enhance help-seeking attitudes and intentions and mental health knowledge and reduce stigma but do not increase help-seeking behaviours for now. Further studies should evaluate interventions to enhance help-seeking behaviours. Furthermore, the methodological quality of studies, including randomized controlled trials and other designs, should be improved in future research.

Editorial Perspective: A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help‐seeking behaviour of adolescents during the pandemic. The ProHEAD‐online trial aims at improving help‐seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD‐online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time‐limited increase in utilization of the ProHEAD‐online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence‐based online service in the field of mental health within the current crisis and beyond.