Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities

<p>Abstract</p> <p>Background</p> <p>In both developing countries and in relation to cultural minorities there have been calls to scale up mental health services and for evidence-informed policy and practice.</p> <p>Evidence based medicine</p> <p>The evidence based medicine movement has had a major influence in improving practice. However, implementation of this approach has some major difficulties. One that has been neglected is the situation where there is no relevant evidence. This situation is more likely to occur for healthcare decisions in developing countries or for cultural minorities within developed countries, because resources do not exist for expensive research studies.</p> <p>Consensus methods</p> <p>Consensus methods, such as the Delphi process, can be useful in providing an evidence base in situations where there is insufficient evidence. They provide a way of systematically tapping the expertise of people working in the area and give evidence that is readily applicable for a particular country and culture. Although consensus methods are often thought of as low in the hierarchy of evidence, consensus is central to the scientific process. We present four examples where the Delphi method was used to assess expert consensus in situations where no other evidence existed: estimating the prevalence of dementia in developing countries, developing mental health first aid guidelines in Asian countries, mental health first aid guidelines for Australian Aboriginal people, and modification of the concept of 'recovery' for Australian immigrant communities.</p> <p>Conclusion</p> <p>Consensus methods can provide a basis for decision-making and considered action when there is no evidence or when there are doubts about the applicability of evidence that has been generated from other populations or health system settings.</p

Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia

<p>Abstract</p> <p>Background</p> <p>The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.</p> <p>Methods</p> <p>Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.</p> <p>Results</p> <p>Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.</p> <p>Conclusion</p> <p>A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.</p

Teachers’ Experiences with and Helping Behaviour Towards Students with Mental Health Problems

The aim of the current study was to examine secondary school teachers&rsquo; experiences with and helping behaviour towards students with mental health problems. Data from 176 teachers were analysed. Altogether, 91.5% of participating teachers reported that they already had students with a mental health problem (particularly mood disorders) in their classes. About &frac34; of teachers (74.7%) were also willing to help a student with a mental health problem, particularly by listening attentively or by recommending professional help. The self-rated mental health literacy of teachers was significantly and positively associated with help provision and with the assessment that &lsquo;asking students about suicidal thoughts&rsquo; is helpful. In contrast, the perception of not having the necessary experience/training to help or that other people are better suited to help were seen as barriers to providing help. Based on the results, it is concluded that increasing teachers&rsquo; mental health literacy and the confidence in their ability to help (including asking students about suicidal thoughts) might increase their helping behaviour directed towards students with mental health problems

The Swiss Youth Mental Health Literacy and Stigma Survey: Study methodology, survey questions/vignettes, and lessons learned

Background and objectives Mental health literacy and stigma towards mentally ill people have hitherto mainly been studied in relation to depression and schizophrenia and in adult samples. The Swiss Youth Mental Health Literacy and Stigma Survey (SYMHLSS) was planned and carried out to address these gaps. The aims of this article are to (1) outline and reflect on the methodology of the SYMHLSS in order to build a sound methodological foundation for preparing and conducting similar future surveys; and (2) advance school-based survey methods more generally. Methods The Australian National Survey of Youth Mental Health Literacy and Stigma (telephone survey) served as basis for the Swiss survey. As in the Australian survey, vignettes describing a person with a mental disorder were the core element to which most subsequent survey questions referred. Five vignettes were used in the online-based Swiss survey that used a representative school-based sample of roughly 5000 students: (1) depression; (2) alcohol abuse; (3) depression and alcohol abuse combined; (4) schizophrenia, and (5) social anxiety disorder. Results and conclusions The current paper describes (1) the aims and research questions of the SYMHLSS against the backdrop of some essential research gaps in the field; (2) the rationale for selecting the particular vignettes mentioned above; (3) the adaption and development process of the SYMHLSS (including pilot testing); (4) the reasoning for using a school-based online survey with in situ guidance of research staff; (5) and methodological insights gained during data collection. The provided information might be used as guiding references for other researchers who aim to adapt and develop vignette-based surveys in the field of mental health literacy or stigmatizing attitudes or who are planning a school-based online survey with in situ presence of research staff

Age differences in mental health literacy

BACKGROUND: The community's knowledge and beliefs about mental health problems, their risk factors, treatments and sources of help may vary as a function of age. METHODS: Data were taken from an epidemiological survey conducted during 2003–2004 with a national clustered sample of Australian adults aged 18 years and over. Following the presentation of a vignette describing depression (n = 1001) or schizophrenia (n = 997), respondents were asked a series of questions relating to their knowledge and recognition of the disorder, beliefs about the helpfulness of treating professionals and medical, psychological and lifestyle treatments, and likely causes. RESULTS: Participant age was coded into five categories and cross-tabulated with mental health literacy variables. Comparisons between age groups revealed that although older adults (70+ years) were poorer than younger age groups at correctly recognising depression and schizophrenia, young adults (18–24 years) were more likely to misidentify schizophrenia as depression. Differences were also observed between younger and older age groups in terms of beliefs about the helpfulness of certain treating professionals and medical and lifestyle treatments for depression and schizophrenia, and older respondents were more likely to believe that schizophrenia could be caused by character weakness. CONCLUSION: Differences in mental health literacy across the adult lifespan suggest that more specific, age appropriate messages about mental health are required for younger and older age groups. The tendency for young adults to 'over-identify' depression signals the need for awareness campaigns to focus on differentiation between mental disorders

Predictors of refusal to participate: a longitudinal health survey of the elderly in Australia

BACKGROUND: The loss of participants in longitudinal studies due to non-contact, refusal or death can introduce bias into the results of such studies. The study described here examines reasons for refusal over three waves of a survey of persons aged ≥ 70 years. METHODS: In a longitudinal study involving three waves, participants were compared to those who refused to participate but allowed an informant to be interviewed and to those who refused any participation. RESULTS: At Wave 1 both groups of Wave 2 non-participants had reported lower occupational status and fewer years of education, had achieved lower verbal IQ scores and cognitive performance scores and experienced some distress from the interview. Those with an informant interview only were in poorer physical health than those who participated and those who refused. Depression and anxiety symptoms were not associated with non-participation. Multivariate analyses found that verbal IQ and cognitive impairment predicted refusal. Results were very similar for refusers at both Waves 2 and 3. CONCLUSIONS: Longitudinal studies of the elderly may over estimate cognitive performance because of the greater refusal rate of those with poorer performance. However, there is no evidence of bias with respect to anxiety or depression

Predictors of depression stigma

BACKGROUND: To investigate and compare the predictors of personal and perceived stigma associated with depression. METHOD: Three samples were surveyed to investigate the predictors: a national sample of 1,001 Australian adults; a local community sample of 5,572 residents of the Australian Capital Territory and Queanbeyan aged 18 to 50 years; and a psychologically distressed subset (n = 487) of the latter sample. Personal and Perceived Stigma were measured using the two subscales of the Depression Stigma Scale. Potential predictors included demographic variables (age, gender, education, country of birth, remoteness of residence), psychological distress, awareness of Australia's national depression initiative beyondblue, depression literacy and level of exposure to depression. Not all predictors were used for all samples. RESULTS: Personal stigma was consistently higher among men, those with less education and those born overseas. It was also associated with greater current psychological distress, lower prior contact with depression, not having heard of a national awareness raising initiative, and lower depression literacy. These findings differed from those for perceived stigma except for psychological distress which was associated with both higher personal and higher perceived stigma. Remoteness of residence was not associated with either type of stigma. CONCLUSION: The findings highlight the importance of treating the concepts of personal and perceived stigma separately in designing measures of stigma, in interpreting the pattern of findings in studies of the predictors of stigma, and in designing, interpreting the impact of and disseminating interventions for stigma

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

<p>Abstract</p> <p>Background</p> <p>Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.</p> <p>Methods</p> <p>To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12–25 years and 2005 of their parents, which included questions about the same strategies.</p> <p>Results</p> <p>A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.</p> <p>Conclusion</p> <p>Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.</p

Is telomere length a biomarker of aging? A review

Telomeres, the DNA-protein structures located at the ends of chromosomes, have been proposed to act as a biomarker of aging. In this review, the human evidence that telomere length is a biomarker of aging is evaluated. Although telomere length is implica

Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.</p> <p>Methods</p> <p>Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.</p> <p>Results</p> <p>Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.</p> <p>Conclusion</p> <p>The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.</p