Skip to main content
Top
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Research

The effectiveness of a “EspaiJove.net”- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial

Authors: Rocío Casañas, Pere Castellvi, Juan-José Gil, María Torres-Torres, Jesica Barón, Mercè Teixidó, Hernán María Sampietro, Marta Díez, Raúl Fernández, Raquel Sorli, Patricia Siñol, Francisca Jurado, Regina Carreras-Salvador, Davinia Vazquez, Sandra Gonzalez, Maria Isabel Fernandez-San Martín, Antonia Raya-Tena, Rosa Alvarez, Isaac Amado-Rodriguez, Luis Miguel Martín- López, Jordi Alonso, Lluís Lalucat-Jo

Published in: BMC Public Health | Issue 1/2022

Login to get access

Abstract

Background

The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention “EspaiJove.net” in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity. 

Methods

A clustered school-based randomised controlled trial (cRCT) design. Subjects: 1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018. Intervention: Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list. Outcome measures: 1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ. Analysis: The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling.

Results

One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p < 0.005).

Conclusions

The three interventions of the EspaiJove.net programme (SP, MHL and MHL + SR) seem not to be effective in terms MHL, Stigma and help-seeking behaviours. The contact with a person who has experimented mental illness first-hand did not reduce stigma attitudes. Further research should deal with the heterogeneity of MHL interventions (concept, duration and measures) and identify which components of stigma interventions are effective.

Trial registration

ClinicalTrials.gov identifier: NCT03215654 (registration date 12 July 2017).
Appendix
Available only for authorised users
Literature
2.
go back to reference Kessler RC, Berglund P, Demler O, Ma R, Jin MA, Merikangas KR, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. 2005.CrossRef Kessler RC, Berglund P, Demler O, Ma R, Jin MA, Merikangas KR, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. 2005.CrossRef
4.
go back to reference Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–64.CrossRef Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–64.CrossRef
6.
go back to reference Aguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20(1):293.CrossRef Aguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020;20(1):293.CrossRef
7.
go back to reference Gulliver A, Griffiths KM, Christensen H, Brewer JL. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry. 2012;12:81.CrossRef Gulliver A, Griffiths KM, Christensen H, Brewer JL. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry. 2012;12:81.CrossRef
8.
go back to reference Jorm AF. Mental health literacy; empowering the community to take action for better mental health. Am Psychol. 2012;67(3):231–43.CrossRef Jorm AF. Mental health literacy; empowering the community to take action for better mental health. Am Psychol. 2012;67(3):231–43.CrossRef
9.
go back to reference Zachrisson HD, Rödje K, Mykletun A. Utilization of health services in relation to mental health problems in adolescents: A population based survey. BMC Public Health. 2006;6(1):34.CrossRef Zachrisson HD, Rödje K, Mykletun A. Utilization of health services in relation to mental health problems in adolescents: A population based survey. BMC Public Health. 2006;6(1):34.CrossRef
11.
go back to reference European Commission. European Pact for Mental Health and Well-being. EU High-level conference together for mental health and wellbeing. 2008. European Commission. European Pact for Mental Health and Well-being. EU High-level conference together for mental health and wellbeing. 2008.
13.
go back to reference Kutcher S, Wei Y, Morgan C. Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy. Can J Psychiatry. 2015;60(12):580–6.CrossRef Kutcher S, Wei Y, Morgan C. Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy. Can J Psychiatry. 2015;60(12):580–6.CrossRef
15.
go back to reference Comisión Europea. El Pacto Europeo para la Salud y el Bienestar Mental: Resultados y actuación futura. 2011. Comisión Europea. El Pacto Europeo para la Salud y el Bienestar Mental: Resultados y actuación futura. 2011.
16.
go back to reference Wei Y, Kutcher S. International School Mental Health: Global Approaches, Global Challenges, and Global Opportunities. Child Adolesc Psychiatr Clin N Am. 2012;21(1):11–27.CrossRef Wei Y, Kutcher S. International School Mental Health: Global Approaches, Global Challenges, and Global Opportunities. Child Adolesc Psychiatr Clin N Am. 2012;21(1):11–27.CrossRef
17.
go back to reference Wyn J, Cahill H, Holdsworth R, Rowling L, Carson S. MindMatters, a Whole-School Approach Promoting Mental Health and Wellbeing. Aust New Zeal J Psychiatry. 2000;34(4):594–601.CrossRef Wyn J, Cahill H, Holdsworth R, Rowling L, Carson S. MindMatters, a Whole-School Approach Promoting Mental Health and Wellbeing. Aust New Zeal J Psychiatry. 2000;34(4):594–601.CrossRef
18.
go back to reference Chisholm K, Patterson P, Torgerson C, Turner E, Jenkinson D, Birchwood M. Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial. BMJ Open. 2016;6:9435.CrossRef Chisholm K, Patterson P, Torgerson C, Turner E, Jenkinson D, Birchwood M. Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial. BMJ Open. 2016;6:9435.CrossRef
19.
go back to reference Ojio Y, Mori R, Matsumoto K, Nemoto T, Sumiyoshi T, Fujita H, et al. Innovative approach to adolescent mental health in Japan: School-based education about mental health literacy. Early Interv Psychiatry. 2021;15(1):174–82.CrossRef Ojio Y, Mori R, Matsumoto K, Nemoto T, Sumiyoshi T, Fujita H, et al. Innovative approach to adolescent mental health in Japan: School-based education about mental health literacy. Early Interv Psychiatry. 2021;15(1):174–82.CrossRef
20.
go back to reference Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust febrero de. 1997;166(4):182–6.CrossRef Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust febrero de. 1997;166(4):182–6.CrossRef
21.
go back to reference Kutcher S, Wei Y, Coniglio C. Mental Health Literacy. Can J Psychiatry. 2016;61(3):154–8.CrossRef Kutcher S, Wei Y, Coniglio C. Mental Health Literacy. Can J Psychiatry. 2016;61(3):154–8.CrossRef
22.
go back to reference Seedaket S, Turnbull N, Phajan T, Wanchai A. Improving mental health literacy in adolescents: systematic review of supporting intervention studies. Trop Med Int Heal. 2020;25(9):1055–64.CrossRef Seedaket S, Turnbull N, Phajan T, Wanchai A. Improving mental health literacy in adolescents: systematic review of supporting intervention studies. Trop Med Int Heal. 2020;25(9):1055–64.CrossRef
23.
go back to reference Wei Y, Hayden JA, Kutcher S, Zygmunt A, McGrath P. The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth. Early Interv Psychiatry. 2013;7:109–21.CrossRef Wei Y, Hayden JA, Kutcher S, Zygmunt A, McGrath P. The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth. Early Interv Psychiatry. 2013;7:109–21.CrossRef
24.
go back to reference Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatr Serv octubre de. 2012;63(10):963–73.CrossRef Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatr Serv octubre de. 2012;63(10):963–73.CrossRef
25.
go back to reference Freţian AM, Graf P, Kirchhoff S, Glinphratum G, Bollweg TM, Sauzet O, et al. The Long-Term Effectiveness of Interventions Addressing Mental Health Literacy and Stigma of Mental Illness in Children and Adolescents: Systematic Review and Meta-Analysis. Int J Public Health. 2021;66:1604072.CrossRef Freţian AM, Graf P, Kirchhoff S, Glinphratum G, Bollweg TM, Sauzet O, et al. The Long-Term Effectiveness of Interventions Addressing Mental Health Literacy and Stigma of Mental Illness in Children and Adolescents: Systematic Review and Meta-Analysis. Int J Public Health. 2021;66:1604072.CrossRef
26.
go back to reference Deb T, Lempp H, Bakolis I, Vince T, Waugh W, Henderson C, et al. Responding to experienced and anticipated discrimination (READ): Anti -stigma training for medical students towards patients with mental illness - Study protocol for an international multisite non-randomised controlled study. BMC Med Educ. 2019;19(1):41.CrossRef Deb T, Lempp H, Bakolis I, Vince T, Waugh W, Henderson C, et al. Responding to experienced and anticipated discrimination (READ): Anti -stigma training for medical students towards patients with mental illness - Study protocol for an international multisite non-randomised controlled study. BMC Med Educ. 2019;19(1):41.CrossRef
27.
go back to reference Casañas R, Gil JJ, Castells G, Pujol A, Torres M, Lalucat-Jo LL. Evaluación de un programa de alfabetización en salud mental para adolescentes. Rev Psicopatología y Salud Ment. 2017;30:105–14. Casañas R, Gil JJ, Castells G, Pujol A, Torres M, Lalucat-Jo LL. Evaluación de un programa de alfabetización en salud mental para adolescentes. Rev Psicopatología y Salud Ment. 2017;30:105–14.
28.
go back to reference Casañas R, Arfuch VM, Castellví P, Gil JJ, Torres M, Pujol A, et al. A school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial. BMC Public Health. 2018;18(1):939 «EspaiJove.net».CrossRef Casañas R, Arfuch VM, Castellví P, Gil JJ, Torres M, Pujol A, et al. A school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial. BMC Public Health. 2018;18(1):939 «EspaiJove.net».CrossRef
29.
go back to reference Hemming K, Taljaard M, McKenzie JE, Hooper R, Copas A, Thompson JA, et al. Reporting of stepped wedge cluster randomised trials: extension of the CONSORT 2010 statement with explanation and elaboration. BMJ. 2018;363:k1614.CrossRef Hemming K, Taljaard M, McKenzie JE, Hooper R, Copas A, Thompson JA, et al. Reporting of stepped wedge cluster randomised trials: extension of the CONSORT 2010 statement with explanation and elaboration. BMJ. 2018;363:k1614.CrossRef
30.
go back to reference Naylor PB, Cowie HA, Walters SJ, Talamelli L, Dawkins J. Impact of a mental health teaching programme on adolescents. Br J Psychiatry abril de. 2009;194(4):365–70.CrossRef Naylor PB, Cowie HA, Walters SJ, Talamelli L, Dawkins J. Impact of a mental health teaching programme on adolescents. Br J Psychiatry abril de. 2009;194(4):365–70.CrossRef
31.
go back to reference Castellvi P, Casañas R, Arfuch VM, Moreno JJG, Torres MT, García-Forero C, et al. Article development and validation of the espaijove.Net mental health literacy (EMHL) test for spanish adolescents. Int J Environ Res Public Health. 2020;17(1):72.CrossRef Castellvi P, Casañas R, Arfuch VM, Moreno JJG, Torres MT, García-Forero C, et al. Article development and validation of the espaijove.Net mental health literacy (EMHL) test for spanish adolescents. Int J Environ Res Public Health. 2020;17(1):72.CrossRef
32.
go back to reference Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al. Development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci. 2011;20(3):263–71.CrossRef Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al. Development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci. 2011;20(3):263–71.CrossRef
33.
go back to reference Taylor SM, Dear MJ. Scaling Community Attitudes Toward the Mentally Ill. Schizophr Bull. 1981;7(2):225–40.CrossRef Taylor SM, Dear MJ. Scaling Community Attitudes Toward the Mentally Ill. Schizophr Bull. 1981;7(2):225–40.CrossRef
34.
go back to reference Ochoa S, Martínez-Zambrano F, Vila-Badia R, Arenas O, Casas-Anguera E, García-Morales E, et al. Validación al castellano de la escala de estigma social: Community Attitudes towards Mental Illness en población adolescente. Rev Psiquiatr Salud Ment julio de. 2016;9(3):150–7.CrossRef Ochoa S, Martínez-Zambrano F, Vila-Badia R, Arenas O, Casas-Anguera E, García-Morales E, et al. Validación al castellano de la escala de estigma social: Community Attitudes towards Mental Illness en población adolescente. Rev Psiquiatr Salud Ment julio de. 2016;9(3):150–7.CrossRef
35.
go back to reference Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring Help-Seeking Intentions: Properties of the General Help-Seeking Questionnaire. Can J Couns. 2005;39:15–28. Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring Help-Seeking Intentions: Properties of the General Help-Seeking Questionnaire. Can J Couns. 2005;39:15–28.
36.
go back to reference Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173.CrossRef Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173.CrossRef
38.
go back to reference Ben-Shachar M, Lüdecke D, Makowski D. effectsize: Estimation of Effect Size Indices and Standardized Parameters. J Open Source Softw. 2020;5(56):2815.CrossRef Ben-Shachar M, Lüdecke D, Makowski D. effectsize: Estimation of Effect Size Indices and Standardized Parameters. J Open Source Softw. 2020;5(56):2815.CrossRef
39.
go back to reference Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Routledge; 1988. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Routledge; 1988.
40.
go back to reference Rubin D. Multiple Imputation for Nonresponse in Surveys. Hoboken: John and Wiley & Son; 2004. p. 258. Rubin D. Multiple Imputation for Nonresponse in Surveys. Hoboken: John and Wiley & Son; 2004. p. 258.
41.
go back to reference Pinto-Foltz MD, Logsdon MC, Myers JA. Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents. Soc Sci Med junio de. 2011;72(12):2011–9.CrossRef Pinto-Foltz MD, Logsdon MC, Myers JA. Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents. Soc Sci Med junio de. 2011;72(12):2011–9.CrossRef
42.
go back to reference Perry Y, Petrie K, Buckley H, Cavanagh L, Clarke D, Winslade M, et al. Effects of a classroom-based educational resource on adolescent mental health literacy: A cluster randomised controlled trial. J Adolesc. 2014;37(7):1143–51.CrossRef Perry Y, Petrie K, Buckley H, Cavanagh L, Clarke D, Winslade M, et al. Effects of a classroom-based educational resource on adolescent mental health literacy: A cluster randomised controlled trial. J Adolesc. 2014;37(7):1143–51.CrossRef
43.
go back to reference Milin R, Kutcher S, Lewis SP, Walker S, Wei Y, Ferrill N, et al. Impact of a Mental Health Curriculum on Knowledge and Stigma among High School Students: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2016;55(5):383-391.e1.CrossRef Milin R, Kutcher S, Lewis SP, Walker S, Wei Y, Ferrill N, et al. Impact of a Mental Health Curriculum on Knowledge and Stigma among High School Students: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2016;55(5):383-391.e1.CrossRef
44.
go back to reference Campos L, Dias P, Duarte A, Veiga E, Dias C, Palha F. Is It Possible to “Find Space for Mental Health” in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program. Int J Environ Res Public Health. 2018;15(7):1426.CrossRef Campos L, Dias P, Duarte A, Veiga E, Dias C, Palha F. Is It Possible to “Find Space for Mental Health” in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program. Int J Environ Res Public Health. 2018;15(7):1426.CrossRef
45.
go back to reference Mansfield R, Patalay P, Humphrey N. A systematic literature review of existing conceptualisation and measurement of mental health literacy in adolescent research: Current challenges and inconsistencies. BMC Public Health. 2020;20(1):607.CrossRef Mansfield R, Patalay P, Humphrey N. A systematic literature review of existing conceptualisation and measurement of mental health literacy in adolescent research: Current challenges and inconsistencies. BMC Public Health. 2020;20(1):607.CrossRef
46.
go back to reference American Psychiatric Association. Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-5. 5a. ed. --.Madrid: Editorial Médica Panamericana; 2014. American Psychiatric Association. Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-5. 5a. ed. --.Madrid: Editorial Médica Panamericana; 2014.
47.
go back to reference Kusan S. Dialectics of Mind, Body, and Place. SAGE Open. 2013;3(4):215824401351213.CrossRef Kusan S. Dialectics of Mind, Body, and Place. SAGE Open. 2013;3(4):215824401351213.CrossRef
48.
go back to reference Jorm A. We need to move from ‘mental health literacy’ to ‘mental health action.’ Ment Heal Prev junio de. 2020;18:200179.CrossRef Jorm A. We need to move from ‘mental health literacy’ to ‘mental health action.’ Ment Heal Prev junio de. 2020;18:200179.CrossRef
50.
go back to reference Mansfield R, Humphrey N, Patalay P. Psychometric validation of the Reported and Intended Behavior Scale (RIBS) with adolescents. Stigma Heal agosto de. 2020;5(3):284–93.CrossRef Mansfield R, Humphrey N, Patalay P. Psychometric validation of the Reported and Intended Behavior Scale (RIBS) with adolescents. Stigma Heal agosto de. 2020;5(3):284–93.CrossRef
51.
go back to reference Lindow JC, Hughes JL, South C, Minhajuddin A, Gutierrez L, Bannister E, et al. The Youth Aware of Mental Health Intervention: Impact on Help Seeking, Mental Health Knowledge, and Stigma in U.S. Adolescents. J Adolesc Heal. 2020;67(1):101–7.CrossRef Lindow JC, Hughes JL, South C, Minhajuddin A, Gutierrez L, Bannister E, et al. The Youth Aware of Mental Health Intervention: Impact on Help Seeking, Mental Health Knowledge, and Stigma in U.S. Adolescents. J Adolesc Heal. 2020;67(1):101–7.CrossRef
52.
go back to reference Olivari C, Mellado C, Casañas R, Espinosa-Díaz N, Fuster-Villaseca J. Preferred sources of help for mental health problems among Chilean adolescents: a descriptive study. Bol Med Hosp Infant Mex. 2021;78(3):207–15. Olivari C, Mellado C, Casañas R, Espinosa-Díaz N, Fuster-Villaseca J. Preferred sources of help for mental health problems among Chilean adolescents: a descriptive study. Bol Med Hosp Infant Mex. 2021;78(3):207–15.
Metadata
Title
The effectiveness of a “EspaiJove.net”- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial
Authors
Rocío Casañas
Pere Castellvi
Juan-José Gil
María Torres-Torres
Jesica Barón
Mercè Teixidó
Hernán María Sampietro
Marta Díez
Raúl Fernández
Raquel Sorli
Patricia Siñol
Francisca Jurado
Regina Carreras-Salvador
Davinia Vazquez
Sandra Gonzalez
Maria Isabel Fernandez-San Martín
Antonia Raya-Tena
Rosa Alvarez
Isaac Amado-Rodriguez
Luis Miguel Martín- López
Jordi Alonso
Lluís Lalucat-Jo
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-14558-y

Other articles of this Issue 1/2022

BMC Public Health 1/2022 Go to the issue