Universal Mental Health Promotion Programs Research Articles

A Universal Mental Health Promotion Program that Demonstrates Psychosocial Benefits for Elementary School Students Who Perceive Low Emotional Self-Efficacy

ABSTRACT Using a quasi-experimental design with no control groups, this pilot study aimed to test the effectiveness of a universal mental health promotion program for elementary school students in an underserved United States-Mexico border community. A total of eighty-five fifth and sixth grade students participated in this program and completed the emotional domain of the Self-Efficacy Questionnaire for Children before and after the intervention. Preliminary program benefits were identified among students who perceived low emotional self-efficacy prior to program participation. The program satisfaction rate was over 60%. About 70% of the participants expressed both confidence and competence in using calming tools for future stressful events. This study supports the use of occupational- and activity-based programs in public elementary schools that serve predominantly Hispanic students from low socioeconomic households. Implications for future occupational therapy practice and research are discussed.

Cost-effectiveness of a mindfulness-based mental health promotion program: economic evaluation of a nonrandomized controlled trial with propensity score matching

BackgroundMental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce.ObjectiveTo evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany.MethodsThe single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based prevention program to usual care based on propensity score matching. Participants (N = 1166) were recruited via a large statutory health insurance fund. Health outcome was assessed with the Hospital Anxiety and Depression Scale (HADS). Cost outcomes were actually incurred costs compiled from the health insurance’ records. Incremental cost-effectiveness ratios (ICER) were analyzed from a societal and a health care perspective for a 12-month time horizon with sampling uncertainty being handled using nonparametric bootstrapping. A cost-effectiveness acceptability curve was graphed to determine the probability of cost-effectiveness at different willingness-to-pay ceiling ratios.ResultsFrom a societal perspective, prevention was cost-effective compared to usual-care by providing larger effects of 1.97 units on the HADS (95% CI [1.14, 2.81], p < 0.001) at lower mean incremental total costs of €-57 (95% CI [− 634, 480], p = 0.84), yielding an ICER of €-29 (savings) per unit improvement. From a health care perspective, the incremental health benefits were achieved at additional direct costs of €181 for prevention participants (95% CI [40, 318], p = 0.01) with an ICER of €91 per unit improvement on the HADS. Willingness-to-pay for the prevention program to achieve a 95% probability of being cost-effective compared to usual-care, was estimated at €225 per unit improvement on the HADS score from a societal, and €191 from a health care perspective respectively. Sensitivity analyses suggested differential cost-effect-ratios depending on the initial distress of participants.LimitationsDue to the complexity of the field trial, it was not feasible to randomize participants and offer an active control condition. This limitation was met by applying a rigorous matching procedure.ConclusionsOur results indicate that universal mental health promotion programs in community settings might be a cost-effective strategy to enhance well-being. Differences between the societal and health care perspective underline the call for joint funding in the dissemination of preventive services.Trial registrationGerman Clinical Trials Registration ID: DRKS00006216 (2014/06/11, retrospective registration).

Depression Education As Primary Prevention

Major depression is a treatable and common mental health disorder for youth. Untreated depression is a major risk factor for youth who become suicidal and die by suicide. Recent focus in the school-based literature on creating universal mental health promotion programs have recognized the need for effective depression awareness education programs to assist youth in identifying symptoms of depression in themselves and their peers, and to encourage those youth to seek trusted adults for help. A quasi-experimental design (QED) was employed in two suburban Chicago high schools (n=652) to evaluate the intervention, Real Teenagers Talking About Adolescent Depression (RTTAAD), a video-based universal classroom discussion intervention created by clinical social workers, parents, and youth. The analysis showed that RTTAAD led to statistically significant changes in adolescent knowledge about depression and their stated willingness to seek help from trusted adults at 6-week follow-up compared to a control classroom condition. This study supports the notion that school social workers and other school mental health professionals need to allocate more time to primary prevention work to help build mental health awareness in their school communities and to help prevent depression and suicidal behavior.

A Single-Session Universal Mental Health Promotion Program in Japanese Schools: A Pilot Study

A program based on cognitive behavioral therapy was developed for Japanese junior high school students aged 12–15 years. It consists of a single 50-minute session that targets a reduction in irrational beliefs, which is related to the improvement of psychological distress, such as anxiety and depression. The students were assigned to an intervention group (n = 238) and a control group (n = 277); the latter received an assertiveness training program. Students completed questionnaires including scales addressing irrational beliefs and self-esteem at pre- and post-program. The results revealed that, despite its short length, the OKS program significantly reduced irrational beliefs in the intervention group, in comparison to the control group. Moreover, both programs increased self-esteem. These findings imply the feasibility of a single-session universal mental health promotion program in Japanese schools.

Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience.

The Youth Aware of Mental health (YAM) experienceYouth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences.Conversations about mental healthThirty-two semi-structured interviews were conducted with 15–17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: “interested”, “foot in the door”, “respect for authority”, “careful”, and “not my topic”. Corresponding labels were devised for their YAM experience: “engaged”, “initially hesitant”, “cautious”, “eager to please”, or “disengaged”. We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: “favoritism”, “familiarity”, “frustration”, “out of sync”, and “insecurity”. Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM.Youth and mental health professionals: Noticing the dynamics at playAs mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.

Preventing Internalizing Problems in 6-8 Year Old Children: A Universal School-Based Program.

The Aussie Optimism Program: Feelings and Friends (AOP-FF) is a 10 week, universal mental health promotion program based on social/emotional and cognitive and behavioral strategies. The aim of the current study was to evaluate the efficacy of a universal Cognitive Behavioral Therapy based program in preventing and reducing internalizing problems in 6–8 year olds (Years 1–3 in Australia). Year 1–3 students from a low SES primary school (N = 206) were randomly assigned in classes to either an intervention or a control group and assessed at baseline and post-test. Results showed a significant (p = 0.009) and small to moderate (partial eta-squared = 0.034) pre-post decrease in parent-reported anxiety symptoms for the intervention group, in conjunction with a non-significant (p = 0.708) and negligible (partial eta-squared = 0.001) pre-post increase for the control group. A larger randomized controlled trial assessing longer term effects is needed. In addition the program needs to be simplified for year 1–2 students with a separate more developmentally appropriate program for year 3 students.

Feeling Good and Doing Well? —Testing Efficacy of a Mental Health Promotive Intervention Program for Indian Youth

The need for moving beyond a narrow focus on diagnosis, treatment and rehabilitation is well recognized in thefield of mental health literature. However, there is a dearth of interventions for mental health promotion testedfor use in the developing nations. The present study aimed at examining the efficacy of a mental healthpromotive intervention program, “Feeling Good and Doing Well” for Indian college youth. One hundred andseventy one college youth in a metropolitan city registered for the intervention trial, in response to programannouncements. Eighty five and eighty six participants were assigned to the intervention and waitlist groupsrespectively. These groups were comparable on almost all the study variables at baseline. The interventionprogram (with three core themes, namely application of strengths, goal pursuit and emotional regulation) wasconducted in the form of eight interactive group sessions. The waitlisted group also underwent the intervention atthe end of the waiting period. Multiple outcomes were examined including wellbeing (positive and negativeaffect, life satisfaction, positive states of mind and psychological well-being), psychological distress and ratingson self-efficacy. Significant gains on well-being and self-efficacy ratings as well as decline in psychologicaldistress were noted one month following intervention and these gains remained stable at four month follow up.This is one of the first multi-component interventions with potential utility to serve as a universal mental healthpromotion program for Indian youth.

Impact of a mental health promotion program on substance use in young adolescents

This cluster randomized controlled trial evaluated the impact of a universal mental health promotion program, the Aussie Optimism Program (AOP), on adolescent tobacco and alcohol use. Students aged 10–13 years (N = 3288) from 63 government primary schools were recruited from an urban population area in Western Australian. Schools were randomized to a usual school health curriculum control group (21 schools), an AOP group with teacher training (20 schools), or AOP with teacher training plus coaching (22 schools). The intervention was implemented in primary school Grades 6 and 7, with follow-up in secondary school Grade 8. Students completed confidential questionnaires relating to consumption of cigarettes and alcohol over the past month. The intervention program contained activities relating to social skills, social problem solving and challenging unhelpful thoughts. The intervention was associated with lower levels of alcohol use at post-test and lower levels of both alcohol and tobacco use at a 12-month secondary school follow-up, but only when AOP was implemented by teachers who received training and coaching in the program. Hence, mental health promotion programs that focus on general life skills may also impact upon health risk behaviors such as alcohol and tobacco use in young adolescents.

The fickle fates of push and pull in the dissemination of mental health programs for children.

As the demand for evidence-based programs has increased, considerable research has concentrated on the development and testing of innovative and promising prevention and treatment programs. However, a knowledge gap remains between research in children's mental health and the educational and health services providers who could use the programs produced. In contrast to the elaborate national system set up for monitoring and disseminating medications, the infrastructures to support the evaluation and dissemination of prevention and treatment programs targeting children's mental health have only begun to be developed. Based on my experiences in a community-based research project that has worked for the last decade to develop and evaluate the WITS (Walk away, Ignore, Talk it out, and Seek help) programs for the prevention of peer victimization, I illuminate obstacles to the dissemination of evidence-based prevention programs for children and solutions that are beginning to address these obstacles. In particular, I argue that enduring, integrated community, provincial and federal infrastructures are needed to improve program dissemination and to monitor their effects on children's well-being. Keywords: knowledge transfer, diffusion of innovation, mental health, children adolescence The reality that children and adolescents suffer from mental health problems is no longer questioned. There is also no doubt that the social, emotional and behavioural problems that are symptomatic of their mental health problems can have pervasive consequences for healthy child development: childhood and adolescent mental illnesses can disrupt school readiness and academic achievement; compromise relationships with family, teachers and peers; undermine attention; exacerbate physical complaints, and even damage the architecture of the developing brain (Gunner, 2007; Shonkoff & Phillips, 2000; Tolan & Dodge, 2005). The fact that few children who have mental health problems receive the care that they need is also widely recognised. Canadian and United States data indicates that only 5-18% of children with a diagnosable psychological problem receive any form of treatment (Kirby & Keon, 2006; Tolan & Dodge, 2005). Two widely circulated reports Out of the Shadows at Last: Highlights and Recommendations of the Final Report on Mental Health, Mental Illness and Addiction (Kirby & Keon, 2006) and Mental Health: A Report of the Surgeon General (U.S. Department of Health & Human Services, 1999) make clear that early detection of childhood mental health concerns can help to prevent school failure, poor employment opportunities and criminal activities. Considerable research also shows that even prodromal or subclinical symptoms, those that do not meet criteria for diagnosis of a disorder, can affect children's development and their relationships with their parents, peers, teachers, and so forth. However, universal mental health promotion programs or secondary prevention programs addressing these concerns are not widely available. What role can prevention programs play in the gathering momentum to improve children's mental health? Prevention of mental health problems in children shows benefits in reducing treatment costs in the United States (Weissberg, Kumpfer, & Selligman, 2003), but in Canada universal and even secondary prevention programs - particularly involving mental health concerns typically are not widely distributed and their effectiveness and cost savings are not monitored. Indeed, despite extensive research on the development and evaluation of innovative programs, only a few are adopted, often only locally, and typically for only short periods. In this paper, I argue that there are serious obstacles embedded in our traditional reliance on relationships between individual researchers and service providers for the development and dissemination of evidence-based programs to promote children's mental health and prevent illness. …