IMPRES: Improving mental health literacy in children and adolescents to reduce stigma

Wahl P, Fretian A, Bauer U. IMPRES: Improving mental health literacy in children and adolescents to reduce stigma. In: EUROPEAN JOURNAL OF PUBLIC HEALTH. Vol 28. OXFORD UNIV PRESS; 2018: 259-260

Mental health literacy of students: evaluation of school-based intervention in Germany

Fretian A, Kirchhoff S, Okan O. Mental health literacy of students: evaluation of school-based intervention in Germany. European Journal of Public Health . 2023;33(Suppl. 2): ckad160.604

Addressing stigma and mental health literacy in childhood and adolescence

Wahl P, Fretian A, Bauer U. Addressing stigma and mental health literacy in childhood and adolescence. In: EUROPEAN JOURNAL OF PUBLIC HEALTH. Vol 28. OXFORD UNIV PRESS; 2018: 122

Improving students' mental health literacy: evaluation of an adapted school intervention in Germany

Kirchhoff S, Fretian A, Okan O. Improving students' mental health literacy: evaluation of an adapted school intervention in Germany. European Journal of Public Health . 2023;33(Suppl. 2): ckad160.320

Evaluation of a school-based intervention to promote mental health literacy. Preliminary results

Kirchhoff S, Fretian A, Graf P, Bauer U. Evaluation of a school-based intervention to promote mental health literacy. Preliminary results. European Journal of Public Health . 2021;31(Suppl. 3):56.Background Mental illness is one of the leading causes of ill-health and disability. The current COVID-19 pandemic poses an additional challenge on mental health, e.g., through increased levels of anxiety, depression and fears about the future. As most mental illnesses develop before the age of 25, young people are a critical target group for prevention. Mental health literacy (MHL) is considered to be a key determinant of positive mental health, thus, being crucial for mental health promotion and dealing with the aftermath of the pandemic. This project aims at (i) adapting an evidence-based MHL curriculum for German schools, as school-based interventions are suitable in reaching most young people, and (ii) evaluating its acceptance and effectiveness regarding MHL and stigmatizing attitudes. Methods An interdisciplinary team including representatives from self-help groups for mental health translated and adapted the Canadian “TeenMentalHealth” curriculum for German schools. The evaluation design includes a pre, post, follow-up assessment of MHL, stigmatizing attitudes, and help-seeking efficacy. Results For better applicability of the curriculum, the original program was shortened, while keeping its core contents such as knowledge and myths around mental health and illness. Written and digital material was developed and distributed to teachers, which were trained to deliver the intervention. Preliminary results show high acceptability, a significant increase in MHL and a decrease in stigmatizing attitudes, while help-seeking efficacy remained unchanged. Conclusions An MHL intervention was successfully adapted for the German school setting. While evaluation is ongoing, first results indicate its effectiveness in promoting MHL among students, decreasing stigmatizing attitudes and high acceptability, even during the times of the pandemic. Further evaluation is necessary to confirm the preliminary findings and to gain insight into the missing effect on help-seeking efficacy

Promoting mental health literacy in schools

Fretian A, Kirchhoff S, Graf P, Bauer U. Promoting mental health literacy in schools. In: 16th World Congress on Public Health 2020. Public Health for the future of humanity: analysis, advocacy and action. European Journal of Public Health. Vol 30. Oxford: Oxford Univ Press; 2020: V103

Evaluating the effect of an adapted mental health literacy intervention on mental health related stigma among secondary students in Germany: results of a pre-post evaluation study

Kirchhoff S, Fretian A, Okan O, Bauer U. Evaluating the effect of an adapted mental health literacy intervention on mental health related stigma among secondary students in Germany: results of a pre-post evaluation study. BMC Public Health . 2023;23(1): 1959.BackgroundMost mental health problems develop during youth, with about three quarter emerging before age 25. In adolescence, stigmatizing attitudes related to mental illness become more nuanced and consolidate into one's belief system. As the stigma of mental illness is still one of the leading barriers to help-seeking, intervention measures should explicitly address it before it becomes entrenched over time. Preventive measures, for example, based on promoting mental health literacy (MHL), can be used to address and tackle stigmatizing attitudes. The Canadian MHL-based intervention "the Guide" was translated and adapted for the use in German schools. The present study evaluates the effect of the German version of the Guide on attitudes towards mental illness among students in Germany.MethodsThe first-time application of the Guide (German version) was evaluated with a pre-post-evaluation study with an intervention and a control group. The evaluation data of 188 students (intervention group n = 106, control group n = 82) were statistically analyzed focusing on the outcomes social stigma, social distance, and self-stigma.ResultsThe analysis showed that participants do not tend to hold stigmatizing attitudes even before the intervention. Nevertheless, the intervention was effective in reducing social stigma, but not in reducing social distance and self-stigma. Neither gender, pre-existing experience with mental illness, nor the delivery modality of the contact element within the intervention (speaker vs. video) seemed to influence the outcomes.ConclusionsThe German version of the MHL-based intervention, the Guide, seems to be a suitable intervention to improve attitudes towards mental illness among students in Germany. More extensive research is necessary to confirm the findings and further explore factors that influence the program's effects on attitudes short- and long-term

Asylum seeking and refugee adolescents’ mental health service use and help-seeking patterns: a mixed-methods study

Namer Y, Fretian A, Podar MD, Razum O. Asylum seeking and refugee adolescents’ mental health service use and help-seeking patterns: a mixed-methods study. npj Mental Health Research. 2022;1(1): 18.**Abstract** Almost a third of all people who entered Germany to seek protection since 2010 were under the age of 18. Asylum-seeking and refugee (ASR) adolescents in Germany face reduced entitlements to healthcare and experience barriers in accessing mental healthcare, despite documented mental health needs. This mixed-methods study aims to describe the mental health needs and service use of ASR adolescents in Germany and identify the predictors of their help-seeking patterns. Here we report findings of cross-sectional data collected between February 2019 and November 2020 in schools and refugee accommodations in three German federal states. Our subsample consists of ASR between the ages of 11 and 18, coming from Syria, Afghanistan, and Iraq (N = 216). Cross-sectional data are supplemented by semi-structured interviews with nine mental health professionals in one region of the study. Our findings reveal an underutilization of mental health services relative to the emotional difficulties reported. Perceived and experienced access barriers, age, and externalizing and internalizing symptoms predict different help-seeking patterns. Psychotherapy-related social resources, as well as reporting of emotional difficulties, are predictors of actual or intended psychotherapeutic service utilization. Based on our quantitative and qualitative findings, we highlight the need for widespread, accessible, and low-threshold mental health initiatives designed to work with ASR adolescents, for additional assistance in navigating the mental healthcare system, as well as for support to important people in ASR adolescents’ lives who fill the gap between mental health needs and accessible mental healthcare services

Stressful life events as predictors of refugee adolescents’ subjective mental health need

Namer Y, Fretian A, Podar MD, Razum O. Stressful life events as predictors of refugee adolescents’ subjective mental health need. In: European Journal of Public Health. Vol 32. Oxford University Press (OUP); 2022.**Background** Asylum seeking and refugee (ASR) adolescents fleeing armed conflict have lived through stressful events. Although not all stressful life events are experienced as post-traumatic stress, they may still lead to subjective need for mental health support. In this study, we assessed which stressful events predicted subjective need. **Methods** We collected and analysed cross-sectional data (February 2019-November 2020) from ASR adolescents aged 11-18, coming from Syria, Afghanistan and Iraq (n = 216). Subjective mental health need was measured with the question “Do you think you have emotional difficulties that you need help with?” and stressful life events (SLE) by the SLE Checklist, a self-report screening tool that asks if participants experienced stressful events in three categories: separation from family, witnessing armed conflict, experiencing violence. Binary logistic regression was run to assess the relative contribution of stressful life events to subjective need. **Results** 30.1% of participants reported subjective need for mental health support. Most commonly encountered events were witnessing armed conflict (53.2%) and experiencing the death of a loved one (51.9%). Only one stressful event significantly predicted subjective need for mental health support: separation from family or relatives against one's will (e.g., by police or military) [OR = 6.32, 95%CI(1.79,22.31)]. **Conclusions** ASR adolescents who have been separated from their family by force report subjective need for mental health support. It is important to supplement diagnostic tools with subjective report of needing mental health care. ASR adolescents who have experienced separation from famil by force should be given spaces to talk about their need for mental health support. Public health interventions could focus on creating or utilising such spaces where mental health support is available. Crucially, bureaucratic and legal burdens that impede speedy family reunification should be reduced. **Key messages** • ASR adolescents who have been separated from their families by force are more likely to report subjective need for mental health support. • The higher reported need highlights the importance of reducing bureaucratic and legal burdens that impede fast family reunification

Describing the objective and subjective mental health care needs of minor refugees in Germany

Fretian A, Podar MD, Razum O, Namer Y. Describing the objective and subjective mental health care needs of minor refugees in Germany. In: 16th World Congress on Public Health 2020. Public Health for the future of humanity: analysis, advocacy and action. European Journal of Public Health. Vol 30. Oxford: Oxford Univ Press; 2020