Mental Health Promotion Interventions Research Articles

A microcosting approach for planning and implementing community-based mental health prevention program: what does it cost?

BackgroundEstimating program costs when planning community-based mental health programs can be burdensome. Our aim was to retrospectively document the cost for the first year of planning and implementing Healthy Minds Healthy Communities (HMHC), a mental health promotion and prevention multi-level intervention initiative. This Program is among the first to use the Community Initiated Care (CIC) model in the US and is aimed at building community resilience and the capacity for communities to provide mental health support, particularly among those disproportionately impacted by COVID-19. Our objective is to share our methods for costing a program targeting 10 zip codes that are ethnically and linguistically diverse and provide an example for estimating the cost of a mental health prevention and promotion programs consisting of multiple evidence-based interventions.MethodsWe used a semi-structured interview process to collect cost data through the first year of program planning, start-up and initial implementation from key staff. We calculated costs for each activity, grouped them by major project categories, and identified the cost drivers of each category. We further validated cost estimates through extensive literature review. The cost analysis was done from the provider’s perspective, which included the implementing agency and its community partners. We delineated costs that were in-kind contributions to the program by other agency, and community partners. Sensitivity analyses were conducted to estimate uncertainty around parameters.ResultsFor the first year of the development and implementation of the program, (funded through program and in-kind) is estimated at $1,382,669 (2022 US$). The costs for the three main activity domains for this project are: project management $135,822, community engagement $364,216 and design and execution $756,934. Overall, the cost drivers for the first year of this intervention were: hiring and onboarding staff, in-person community building/learning sessions, communications and marketing, and intervention delivery.ConclusionImplementation of community-based mental health promotion and prevention programs, when utilizing a participatory approach, requires a significant amount of upfront investment in program planning and development. A large proportion of this investment tends to be human capital input. Developing partnerships is a successful strategy for defraying costs.

Follow-up and Mediation Outcomes of a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda

ABSTRACT Objective There is limited evidence for the effectiveness of mental health promotion interventions in low- and middle-income settings, especially for longer-term benefits. This study evaluates the 5-month follow-up outcomes of a movement-based mental health promotion intervention (TeamUp) for refugee children in Northern Uganda (West Nile) and further investigates what explains longer-term benefits. Methods This quasi-experimental study was conducted in four primary schools, randomly allocated to an experimental or a control condition. Enrolled in the study were 549 children ages 10–15 years (n = 265 TeamUp; n = 284 control group). Primary outcomes were psychosocial well-being (Stirling Children’s Wellbeing Scale), attitude toward school, and satisfaction with friendships (Multidimensional Students Life Satisfaction Scale [Friends and School subscales]). Mediators included social connectedness and sense of agency. Results At 5 months postintervention, 467 (85.1%) children were retained. Intent-to-treat analyses demonstrated sustained benefits for TeamUp for well-being (estimated mean difference −1.88, 95% CI −3.14 to −0.66, p = .003, effect size Cohen’s d = 0.25) and friendships (−1.52, 95% CI −2.55 to −0.48, p = .005, d = 0.25). There were no significant between-group differences for attitude toward school. Secondary benefits were shown for traumatic stress (2.18, 95% CI 0.45 to 3.91, p = .014, d = 0.21), quality of life (−1.29, 95% CI −2.31 to −0.30, p = .014, d = 0.21), bullying (0.53, 95% CI 0.08 to 0.97, p = .020, d = 0.20), and depression symptoms (1.31, 95% CI 0.09 to 2.52, p = .035, d = 0.18). Increased sense of connectedness mediates the effect of TeamUp on improving well-being (indirect effect = 0.30, SE = 0.13, p = .001), explaining 15% of variance. Conclusion This study shows sustained benefits of a mental health promotion intervention 5 months postintervention. Prolonged benefits are explained by an increase in social connectedness.

How does the macroenvironment influence brain and behaviour-a review of current status and future perspectives.

The environment influences brain and mental health, both detrimentally and beneficially. Existing research has emphasised the individual psychosocial 'microenvironment'. Less attention has been paid to 'macroenvironmental' challenges, including climate change, pollution, urbanicity, and socioeconomic disparity. Notably, the implications of climate and pollution on brain and mental health have only recently gained prominence. With the advent of large-scale big-data cohorts and an increasingly dense mapping of macroenvironmental parameters, we are now in a position to characterise the relation between macroenvironment, brain, and behaviour across different geographic and cultural locations globally. This review synthesises findings from recent epidemiological and neuroimaging studies, aiming to provide a comprehensive overview of the existing evidence between the macroenvironment and the structure and functions of the brain, with a particular emphasis on its implications for mental illness. We discuss putative underlying mechanisms and address the most common exposures of the macroenvironment. Finally, we identify critical areas for future research to enhance our understanding of the aetiology of mental illness and to inform effective interventions for healthier environments and mental health promotion.

Loneliness without distress, chosen isolation (solitude) at the workplace, and mental health and job performance: a cross-sectional study of Japanese employees.

While loneliness and social isolation in the workplace affect the mental health and job performance of employees, the effects of loneliness without distress and solitude (i.e., chosen isolation) on these outcomes are unclear. The cross-sectional association was examined by using online survey of full-time employees in Japan (n=846). The results showed that the "loneliness with distress" group had significantly higher psychological distress and lower job performance than the other groups. Work engagement was lower both in the "loneliness with distress" and "loneliness without distress" groups, compared to the "non-loneliness" group. The "unchosen isolation" and the "solitude" groups had poorer scores of psychological distress, work engagement, and work performance, compared to the "non-isolation" group. The preliminary findings showed that loneliness without distress and solitude were associated with poor levels of mental health and job performance and should become a target of mental health promotion interventions in the workplace.

Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study

ABSTRACT Objective Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention “TeamUp” in Bidibidi refugee settlement, in Northern Uganda. Method A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline. Results Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = −1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (−0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (−1.56, SE = 0.4, p = .001), physical health (−0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (−3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (−0.74, SE = 0.3, p = .007) and sense of agency (−0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms. Conclusion The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention’s effectiveness.

A Pilot Study of the Coping Together Virtual Family Intervention: Exploring Changes in Family Functioning and Individual Well-Being.

In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample.

A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Effectiveness of digital games promoting young people's mental health: A review of reviews.

Digital games are a popular form of entertainment for youth. They are often used as a therapy for psychological problems, a mental health promotion intervention, and a preventative measure. Systematic reviews and meta-analyses have been conducted to assess the effectiveness of mental health-related digital games. However, a synthesis considering all evaluation results to inform their development is missing. We performed a review of reviews to synthetize results of previous research to describe the impact of digital games on the mental health of young people aged <30 years old. We considered systematic reviews and meta-analyses published between 2012 and 2022. Searches were conducted in Scopus, Google Scholar, Pubmed, and Cochrane library systematic reviews (CENTRAL) during October 2023. Our final selection included 10 systematic reviews and meta-analyses on interventions targeting youth of both sexes aged 2-29 years old across the world. In total, 218 interventions were identified. Selected articles reported different types of games, e.g., active and non-active video games, virtual reality games, serious games. Not all digital games were conscientiously evaluated, but, in general, their impact on mental health was positive. Regarding the quality, 5 studies were of high quality, 3 of moderate quality and 2 of low quality. Overall, elements of gamification were well-accepted, but they lacked assessment through rigorous experimental conditions. Digital games for mental health are promising, but in order to be consistently effective in promoting young people's mental health and prevent psychological diseases, they should present specific features.

간호대학생의 시험불안이 우울과 삶의 질에 미치는 영향

The purpose of this study is to determine the impact of test anxiety on depression and quality of life in adopted of nursing college students. The 160 copies were analyzed by conducting a survey on test anxiety, depression, and quality of life for nursing students at K university. Correlation analysis and stepwise regression analysis were conducted to confirm. First, test anxiety and depression have a positive correlation, and test anxiety and quality of life have a negative correlation. Second, the factors affecting the depression and quality of life of nursing students are emotional factors, physical mental health, mental health, and major satisfaction, which are sub-factors of test anxiety. The significance of this study is to provide basic data for mental health promotion and educational intervention preparation to reduce depressive symptoms and improve positive mental health and quality of life in nursing students in the future.

Priority actions for promoting population mental health and wellbeing

Mental health promotion is an essential strategy for improving population mental health and wellbeing and preventing poor mental health. This paper outlines the case for governments to invest in promoting population mental health and wellbeing by adopting a mental health promotion approach.Drawing on a synthesis of the international evidence, findings are presented on effective mental health promotion interventions that can be feasibly implemented across the life course in everyday settings and that have the potential to be scaled-up at a country level. Based on a review of 111 meta-analyses and 57 systematic reviews, both universal and targeted interventions are identified, that have been shown to enhance good mental health, reduce the risk of mental ill-health, and advance population health and wellbeing. The implications of the findings for policy and practice are outlined.The policy structures and processes that are needed to support the delivery of evidence-based strategies at a population level are considered, including investing in the systems and capacity to ensure their sustained implementation. In particular, the need for policy models to support intersectoral action at a whole-of-government and whole-of-society level is outlined.

Perceived Social Support and Associated Factors among Caregivers of Individuals with Heart Failure: A Convergent Mixed Methods Study

Background. Caregivers are crucial in ensuring that their relatives with heart failure (HF) reach proper self-care levels. Despite this, the demanding nature of caring for others can lead to poor outcomes and the compromise of own needs, which raises the need for perceived social support. Prior research does not offer a thorough knowledge of how caregivers of people with HF regarded social support and the characteristics that went along with it. Purpose. The aim of this study was to develop a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with heart failure. Methods. This is a secondary analysis of a convergent mixed-methods design study. The perception of social support, mutuality, anxiety, depression, and quality of life were assessed in 158 heart failure patients and their caregivers (physical and mental dimensions). In 50 caregivers, we also performed semistructured interviews. Results. The mixed analysis and integration of qualitative and quantitative inferences revealed two main factors affecting perceived social support. First, caregivers with strong familial network and greater number of caregivers available for tangible caregiving support and moral support perceived increased sense of social support. Second, caregivers with enhanced mental health had increased sense of social support. Conclusions. Caregiver perception of social support might be influenced by mental well-being status. To improve caregivers’ perceptions of social support and community belonging, it is necessary to create and assess community- and individual-based mental health promotion interventions. To strengthen the perception of support in the heart failure caring process, more dyadic strategies should be established to improve patient-caregiver mutuality.

Effectiveness of the holistic primary school-based intervention MindMatters: study protocol for a cluster-randomised controlled trial

BackgroundThe prevalence of mental health problems in childhood and adolescence has increased significantly, not least due to the COVID-19 pandemic in Germany and other countries worldwide. Although holistic school interventions to promote mental health and prevent mental health problems are considered promising, there is currently uncertainty about their effectiveness due to evaluation studies with heterogeneous methodological quality. This paper presents the study protocol for the evaluation of the primary school module of MindMatters.MethodsAs part of a universal mental health intervention, the MindMatters primary school module ‘Learning Together with Emotions’ aims to promote social-emotional learning (SEL) in the classroom across five skill areas. In addition to classroom activities, the intervention includes a school development module to help primary schools create structures and processes to maintain and promote mental health. To evaluate the effectiveness of the intervention, a two-arm cluster-randomised controlled trial will be conducted, including schools implementing MindMatters over a 12-month period and a control group with no access to the intervention. Data will be collected before and 18 months after initiation of the intervention. Controlled for baseline conditions, multilevel regression analysis will be used to examine primary intervention outcomes at the pupil level (i.e. reductions in mental and behavioural problems). Further mediation and moderation analyses will examine whether proximal outcomes predict changes in mental health outcomes and whether school-level factors influence the effectiveness of the intervention.DiscussionThis study will contribute to strengthen the evidence base for holistic school (mental) health promotion interventions using a study design with high internal validity. Based on an intervention model, the results will not only provide insights into the relationship between proximal and distal outcomes, but will also allow conclusions to be drawn about how the implementation of the intervention affects its effectiveness. Finally, the findings also address the question of whether improved mental health has a positive effect on primary school pupils’ academic performance.Trial registrationGerman Clinical Trials Register DRKS00023762. Registered on 5 January 2021.

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries.

There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.

School principals stress, wellbeing, and health literacy during the Pandemic

Abstract Background Mental health of school principals is poorly researched in public health, despite principals being critical to the success of sustainable school development. They are the key agents enabling and leading the implementation of school health promotion, which elevates the importance of their mental health state. Evidence shows that principals are more likely to suffer from work-related stress and psychological strain, but given the additional stress during the Covid-19 pandemic, their mental health was more at risk. Health literacy could be an asset in the interplay of mental health and stress. The aim of this study is to examine the associations between principals’ corona-specific health literacy and their perceived stress, wellbeing, and psychosomatic complaints. Methods As part of the international COVID-HL school principal survey, an online study among German school principals in four federal states was conducted during the third infection wave (Mar-Apr 2021). Health literacy, perceived stress, wellbeing, and psychosomatic complaints were measured using self-report tools. Descriptive statistics, variance with subsequent post-hoc analyses and effect sizes were computed. Results A total of N = 2186 principals completed the survey, with 60.5% showing an adequate, 31.4% a problematic and 8.1% an inadequate health literacy level. Welch's ANOVA indicated significant differences between the health literacy levels and perceived stress (F(2, 423.734) = 69.51, p &amp;lt; 0.001; η2 = 0.06) as well as wellbeing (F(2, 407.343) = 33.463, p &amp;lt; 0.001; η2 = 0.034). One-way ANOVA showed significant differences between health literacy and psychosomatic complaints (F(2, 1775) = 15.94, p &amp;lt; 0.001; η2 = 0.018). Conclusions The findings emphasize that health literacy could be an asset for principals’ mental health, suggesting to include health literacy more frequently to public mental health promotion interventions. This will require an acknowledgment from public health and educational policies.

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

BackgroundWell-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia.MethodsEach intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation.ConclusionsAt present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace.Trial registrationPlease refer to Item 2a and registration ISRCTN14104664. Registered on 12th July 2022.

Uptake of signposting to web-based resources: pregnant women’s use of a preventive web-based intervention

BackgroundSignposting to web-based interventions is becoming increasingly popular in primary care. Most resources are focused on individuals with clinical problems, but less is known about the uptake of general practice (GP) signposted web-based interventions. GPs in Denmark are responsible for scheduled preventive care during pregnancy and the child’s first five years. In the “Family Well-being in General Practice” trial the web-based intervention “Resilientchild.dk” is introduced at these consultations. Resilientchild.dk is designed to improve the capacity of parents to understand the mental state of themselves, their partners, and their children. In this study we assess the uptake and use of this web-based intervention.ObjectiveTo describe participant and practice characteristics associated with the use of a web-based psychoeducational intervention. Eligible participants were pregnant women presenting at their first antenatal assessment, usually around 6–10 gestational weeks.MethodsThe study was nested in a cluster randomised trial of resilientchild.dk. We conducted a relative importance analysis, which allows for determination of the variables most strongly associated with website use. To assess the direction and magnitude of the influences of the identified variables, we applied multinomial generalized linear mixed modelling. A practice random effect allows us to account for clustering of women within practices.ResultsParity and the absence of a nurse or midwife in the practice were important factors driving a decrease in the likelihood of using resilientchild.dk. Being a student or living outside the capital city were important factors driving an increase in the likelihood of using resilientchild.dk.ConclusionThe data offer unique opportunities to assess the utilisation of a web-based mental health-promotion intervention following advice from a clinician. This study draws conclusions about which patients are likely to access similar resources and which practice characteristics encourage their use.Trial registrationRegistered in clinicaltrials.gov, Trial number: NCT04129359 Date of registration: 16/10/2019 (https://clinicaltrials.gov/ct2/show/NCT04129359).

School-based interventions for the promotion of mental health and prevention of mental health problems: review of the literature

Abstract Given the elevated prevalence of mental health symptoms in school-aged children, there are opportunities to intervene with universal and targeted interventions delivered in schools. Considering the evidence across selected reviews, school-delivered mental health promotion and illness prevention interventions show to have small and modest effects in reducing symptoms of depression and anxiety. More research is required to find out what works best, for whom and under which circumstances.

Adolescents’ difficulties, strengths and feelings of insecurity: a cross-sectional descriptive survey in Finland

The present study aimed to describe adolescents’ self-reported emotional and behavioural strengths and difficulties, as well as their insecurity feeling. In addition, the aim was to examine the association with background characteristics, and explore the association between strengths and difficulties and insecurity factors. The study was conducted among 114 secondary school pupils in Finland, using an online questionnaire. Adolescents’ emotional and behavioural difficulties and strengths, were mostly classified as normal. Strengths and Difficulties Questionnaire total score as well as internal and external score, were inversely associated with insecurity factors. Girls had significantly higher prosocial behavior compared to boys (P = 0.0007). The age of adolescents was found to be related to their internal difficulties (P = 0.02) and prosocial behavior (P = 0.01). Adolescent’s perception of their family relations as poor was associated with external difficulties (P = 0.04). The current results, can be helpful for mental health professionals who work with adolescents in order to implement appropriate and needs specific mental health promotion interventions at individual but also community level. Finally, more research is needed to validate measures for insecurity. This will support mental health professionals in their clinical practice by providing them with all the important factors needed to support adolescents.

Development and testing the feasibility of a sports-based mental health promotion intervention in Nepal: a protocol for a pilot cluster-randomised controlled trial

BackgroundMental wellbeing encompasses life satisfaction, social connectedness, agency and resilience. In adolescence, mental wellbeing reduces sexual health risk behaviours, substance use and violence; improves educational outcomes; and protects mental health in adulthood. Mental health promotion seeks to improve mental wellbeing and can include activities to engage participants in sport. However, few high-quality trials of mental health promotion interventions have been conducted with adolescents, especially in low- and middle-income countries. We sought to address this gap by testing SMART (Sports-based Mental heAlth pRomotion for adolescenTs) in a pilot cluster-randomised controlled trial (cRCT) in Bardiya, Nepal.MethodsThe objectives of the trial are to assess the acceptability and feasibility of SMART, test trial procedures, explore outcome distributions in intervention and control clusters and calculate the total annual cost of the intervention and unit cost per adolescent. The trial design is a parallel-group, two-arm superiority pilot cRCT with a 1:1 allocation ratio and two cross-sectional census surveys with adolescents aged 12–19, one pre-intervention (baseline) and one post-intervention (endline). The study area is four communities of approximately 1000 population (166 adolescents per community). Each community represents one cluster. SMART comprises twice weekly football, martial arts and dance coaching, open to all adolescents in the community, led by local sports coaches who have received psychosocial training. Sports melas (festivals) and theatre performances will raise community awareness about SMART, mental health and the benefits of sport. Adolescents in control clusters will participate in sport as usual. In baseline and endline surveys, we will measure mental wellbeing, self-esteem, self-efficacy, emotion regulation, social support, depression, anxiety and functional impairment. Using observation checklists, unstructured observation and attendance registers from coaching sessions, and minutes of meetings between coaches and supervisors, we will assess intervention fidelity, exposure and reach. In focus group discussions and interviews with coaches, teachers, caregivers and adolescents, we will explore intervention acceptability and mechanisms of change. Intervention costs will be captured from monthly project accounts, timesheets and discussions with staff members.DiscussionFindings will identify elements of the intervention and trial procedures requiring revision prior to a full cRCT to evaluate the effectiveness of SMART.Trial registrationISRCTN, ISRCTN15973986, registered on 6 September 2022; ClinicalTrials.gov, NCT05394311, registered 27 May 2022.

Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project.

Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions. The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program. A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence. Participant recruitment will commence in September 2023. The full project will be completed by March 2027. With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations. PRR1-10.2196/49670.