Background
Methods
Study design
Participants
Randomisation
Interventions
Youth mental health first aid course
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recognise the early signs of a mental health problem, e.g. depression, anxiety, psychosis, substance use problems or eating disorders;
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identify potential mental health-related crises, e.g. suicidal thoughts and behaviours, non-suicidal self-injury (sometimes called deliberate self-harm), panic attacks, traumatic events, severe psychotic states, acute effects of drug or alcohol use and aggressive behaviours, and
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assist adolescents to get appropriate professional help as early as possible.
Red cross provide first aid course
Outcomes
Primary outcomes
Outcome | Survey measure | Response | Scoring | Psychometrics |
---|---|---|---|---|
Outcomes completed by both parents and adolescents | ||||
Social Distance [26] | 5 questions assessing desire for social distance from the person in the psychosis vignette. E.g. Would you be happy for your child / Would you be happy…to develop a close friendship with X? | 4-point Likert scale 1 = Yes definitely 2 = Yes, probably 3 = Probably not 4 = Definitely not | Mean score of 5 questions, range 1–4. | Parent ω = .90 Adolescent ω = .88 |
Stigma: Weak-not-sick [26] | 4 questions assessing that the person in the psychosis vignette is weak not sick. E.g. X could snap out of it if (he/she) wanted | 5-point Likert scale 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree | Mean score of 4 questions, range 1–5, dichotomised to low stigma (=1) or not (> 1). | Parent ω = .81 Adolescent ω = .56 |
Stigma: Dangerous/Unpredictable [26] | 4 questionsa assessing that the person in the psychosis vignette is dangerous or unpredictable. E.g. X’s problem makes (him/her) unpredictable | 5-point Likert scale 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree | Mean score of 4 questions, range 1–5. | Parent ω = .46 Adolescent ω = .45 |
K6 psychological distress (12-month version) [27] | 6 questions assessing the frequency of psychological distress in the worst month during the past 12 months | 5-point Likert scale 1 = None of the time 2 = A little of the time 3 = Some of the time 4 = Most of the time 5 = All of the time | Total scores of 19 or above indicate a high level of psychological distress | Parent ω = .91 Adolescent ω = .93 |
Outcomes completed by parents only | ||||
Problem recognition |
What, if anything, do you think is wrong with X?
Question in response to each of 4 vignettes: depression, social phobia, EDNOS, psychosis | Verbatim responses were scored for correct/incorrect, blinded to group allocation and timepoint. | 1 point for correct recognition if the following were mentioned: Depression (depression, depressed), social phobia (anxiety/anxious, social anxiety, social phobia, anxiety disorder, performance anxiety), EDNOS (Eating disorder, EDNOS, bulimia/bulimic/bulimia nervosa/mia, binge eating/loss of control eating, binge eating disorder, anorexia/anorexia nervosa/anorexic/ana, disordered eating), psychosis (schizophrenia/paranoid schizophrenia, psychosis/psychotic, schizophrenic, schizoaffective disorder, precursor to schizophrenia). Mean score of 4 responses, range 0–1. | ω = 0.82 |
Quality of MHFA intentions |
Imagine X is your child. You want to help (him/her). What would you do?
Question in response to each of 4 vignettes: depression, social phobia, EDNOS, psychosis | Verbatim responses were scored for consistency with the ALGEE action plan in the Youth MHFA manual, [8] blinded to group allocation and timepoint. | Mean score of 4 responses, range 0–12. | Inter-rater reliability (ICC) for 4 vignettes ranged from 0.74–0.84. ω = 0.56 |
Confidence to help |
How confident would you be in your ability to help X?
Question in response to each of 4 vignettes: depression, social phobia, EDNOS, psychosis | 4-point Likert scale 1 = Very confident 2 = Fairly confident 3 = Slightly confident 4 = Not confident at all | Mean score of 4 responses, range 1–4. | ω = 0.84 |
Knowledge about mental health problems | 18 questions on knowledge about mental health problems, derived from the Youth MHFA manual. [8] E.g. If a teenager has a traumatic experience, it is best to make them talk about it as soon as possible | Agree, Disagree, Don’t know | 1 point for a correct response to each question, range 0–18. | Test-retest r = 0.67 (PFA group) |
Quality of MHFA support towards other person |
Over the last 12 months, has anyone else you know had any sort of mental health problem?...Have you done anything to help the person with this problem?...What did you do?
| Verbatim responses were scored for consistency with the ALGEE action plan, blinded to group allocation and timepoint. | Scores range 0–12. | Inter-rater reliability ICC = 0.76 |
Appropriate help-seeking for mental health problem |
Over the last 12 months, have you yourself had any sort of mental health problem?...Have you done anything to deal with this mental health problem?...What did you do?
| Verbatim responses were scored for the presence of an appropriate source of help. | Scored a 1 if mentioned any of the following professionals or treatments: taking medication, antidepressant, anxiolytic, counselling, counsellor, GP, psychologist, psychiatrist, CBT, hospital, other medical (mental health practitioner or specialist, professional for alcohol misuse, maternal & child health nurse), professional organisation (Centre Against Sexual Assault, Drummond Family Services). | |
Outcomes completed by adolescents only | ||||
Perceived general social support from parent [28] | Communication subscale of Parent Attachment from the People in My Life Questionnaire (5 questions). E.g. My parents can tell when I am upset about something. | 4-point Likert scale 1 = Almost never or never true 2 = Sometimes true 3 = Often true 4 = Almost always or always true | Scores range 5–20. | ω = 0.82 |
Intended help-seeking from parent |
If you had a problem right now like X would you ask for help?...Where would you go?
Question in response to each of 4 vignettes: depression, social phobia, EDNOS, psychosis | Verbatim responses. | Scored 1 point per vignette if mentioned seeking help from a parent. Sum score of 4 responses, range 0–4. | ω = 0.71 |
Actual help-seeking from parent |
Over the last 12 months, have you had any sort of mental health problem?... Did you get help from family?... Who in the family?
| Verbatim responses. | Scored a 1 if adolescent reported seeking help from either or both parents. | |
Help-seeking from a health professional |
Over the last 12 months, have you had any sort of mental health problem?... Did you get help from a health professional or counsellor?
| Verbatim responses. | Scored a 1 if adolescent responded with yes. |
Sample size estimation
Adverse events
Ethics
Statistical analysis
Results
Participant flow and numbers analyzed
Participant characteristics
YMHFA (n = 170) | PFA (n = 152) | p | |
---|---|---|---|
Parent | |||
Family situation % | .675 | ||
Child living with both parents | 71.8 | 75.7 | |
Parents separated but both involved in care of child | 12.9 | 9.2 | |
Parents separated but only respondent involved in care of child | 7.1 | 5.3 | |
Sole parent | 6.5 | 6.6 | |
Other (e.g. grandparents) | 1.8 | 3.3 | |
Married/defacto % | 74.1 | 80.9 | .146 |
Female % | 89.4 | 86.8 | .476 |
Tertiary education % | 56.6 | 50.7 | .294 |
Speaks only English at home % | 85.9 | 79.6 | .135 |
Not Aboriginal or Torres Strait Islander % | 99.4 | 98.7 | .209 |
Employed full or part time % | 66.5 | 71.7 | .310 |
Studying status % | .185 | ||
Full-time | 2.9 | 3.9 | |
Part-time | 16.5 | 11.2 | |
Not studying | 11.2 | 18.4 | |
Unknown | 69.4 | 66.4 | |
Age M (SD) | 45.2 (5.54) | 45.1 (5.69) | .867 |
Number of children M (SD) | 2.2 (0.8) | 2.3 (1.0) | .282 |
Child | |||
Female % | 58.8 | 52.0 | .217 |
Health issue % | 26.5 | 27.0 | .919 |
Age M (SD) | 13.3 (1.11) | 13.3 (1.08) | .949 |
Primary outcomes
Change over time between YMHFA and PFA | ||||||||||||||
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Baseline | 1 year follow-up | 2 year follow-up | Baseline to 1-year follow-up | Baseline to 2-year follow-up | ||||||||||
PFA | YMHFA | PFA | YMHFA | PFA | YMHFA | |||||||||
n/N | % | n/N | % | n/N | % | n/N | % | n/N | % | n/N | % | OR (95% CI) | OR (95% CI) | |
Adolescent with mental health problem – parent reporteda | 19/151 | 12.6 | 31/168 | 18.5 | 8/96 | 8.33 | 15/109 | 13.8 | 10/80 | 12.5 | 14/98 | 14.3 | 2.03 (0.23 to 17.54) | 0.44 (0.05 to 4.14) |
Adolescent with mental health problem – adolescent reportedb | 11/142 | 7.75 | 20/159 | 12.6 | 6/86 | 6.98 | 12/100 | 12.0 | 5/69 | 7.25 | 5/81 | 6.17 | 0.80 (0.12 to 5.33) | 0.24 (0.02 to 2.26) |
Mother supported adolescent very wellc | 14/26 | 53.9 | 17/30 | 56.7 | 6/10 | 60.0 | 8/22 | 36.4 | 2/11 | 18.2 | 8/20 | 40.0 | 0.21 (0.01 to 6.07) | 6.55 (0.12 to 343.44) |
Father supported adolescent very wellc | 7/23 | 30.4 | 7/29 | 24.1 | 3/8 | 37.5 | 2/21 | 9.52 | 2/10 | 20.0 | 5/19 | 26.3 | 0.34 (0.01 to 9.71) | 3.65 (0.12 to 111.62) |
PFA (n = 38) | MHFA (n = 54) | PFA (n = 24) | MHFA (n = 28) | PFA (n = 18) | MHFA (n = 34) | Baseline to 1-year follow-up | Baseline to 2-year follow-up | |||||||
M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | Mdiff (95% CI), d (95% CI) | Mdiff (95% CI), d (95%CI) | |
Quality of parental support towards adolescents with mental health problem | 2.55 | 1.18 | 2.41 | 1.19 | 2.29 | 1.08 | 2.46 | 1.00 | 2.61 | 1.09 | 2.82 | 1.45 | 0.37 (− 0.42 to 1.15), 0.17 (− 0.38 to 0.71) | 0.37 (− 0.44 to 1.18). 0.16 (− 0.41 to 0.73) |
Secondary outcomes
Baseline | 1 year follow-up | 2 year follow-up | Change over time between MHFA and PFA | |||||||||||||||||
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PFA | MHFA | PFA | MHFA | PFA | MHFA | Baseline to 1-year follow-up | Baseline to 2-year follow-up | |||||||||||||
Variable | n | M | SD | n | M | SD | n | M | SD | n | M | SD | n | M | SD | n | M | SD | Mdiff (95% CI), d# (95% CI) | Mdiff (95% CI), d# (95% CI) |
MHFA knowledge | 152 | 9.77 | 2.76 | 170 | 10.28 | 2.71 | 97 | 10.01 | 2.75 | 111 | 11.90 | 2.44 | 80 | 10.31 | 2.52 | 98 | 11.82 | 2.36 | 1.25 (0.62 to 1.87)***, 0.43 (0.15 to 0.70) | 0.84 (0.17 to 1.51)*, 0.26 (−0.03 to 0.56) |
Problem recognition | 152 | 0.63 | 0.35 | 170 | 0.66 | 0.31 | 96 | 0.66 | 0.35 | 111 | 0.75 | 0.30 | 80 | 0.67 | 0.33 | 98 | 0.77 | 0.28 | 0.05 (−0.03 to 0.12), 0.11 (− 0.16 to 0.39) | 0.03 (− 0.04 to 0.11), 0.12 (− 0.18 to 0.41) |
Quality of MHFA intentions | 152 | 2.24 | 0.62 | 170 | 2.34 | 0.73 | 96 | 2.20 | 0.77 | 111 | 2.57 | 0.83 | 80 | 2.34 | 0.81 | 98 | 2.66 | 0.90 | 0.23 (− 0.01 to 0.47)*, 0.22 (− 0.05 to 0.50) | 0.20 (− 0.05 to 0.45), 0.15 (− 0.14 to 0.45) |
Confidence | 151 | 2.25 | 0.68 | 169 | 2.36 | 0.61 | 96 | 2.10 | 0.70 | 110 | 2.05 | 0.56 | 80 | 2.18 | 0.69 | 98 | 2.17 | 0.59 | −0.17 (− 0.34 to -0.00)*, 0.26 (− 0.01 to 0.53) | −0.10 (− 0.28 to 0.07), 0.23 (− 0.06 to 0.53) |
Quality of MHFA support towards other person | 86 | 2.23 | 1.16 | 113 | 2.29 | 1.14 | 46 | 2.35 | 1.08 | 70 | 2.40 | 1.01 | 45 | 2.16 | 1.30 | 67 | 2.30 | 1.15 | −0.02 (−0.52 to 0.48), − 0.08 (− 0.52 to 0.36) | 0.06 (− 0.44 to 0.56), -0.02 (− 0.46 to 0.42) |
Social distance (parent) | 145 | 2.16 | 0.66 | 160 | 2.08 | 0.63 | 91 | 2.04 | 0.64 | 107 | 1.88 | 0.61 | 78 | 1.87 | 0.68 | 96 | 1.86 | 0.48 | −0.11 (−0.26 to 0.04), 0.18 (− 0.11 to 0.46) | 0.08 (− 0.08 to 0.24), −0.12 (− 0.43 to 0.19) |
Dangerous/ unpredictable stigma (parent) | 147 | 2.48 | 0.52 | 164 | 2.44 | 0.56 | 93 | 2.46 | 0.54 | 110 | 2.37 | 0.56 | 78 | 2.40 | 0.50 | 95 | 2.29 | 0.52 | −0.04 (−0.20 to 0.12), 0.15 (− 0.12 to 0.43) | −0.06 (− 0.23 to 0.11), 0.22 (− 0.08 to 0.52) |
Social distance (adolescent) | 140 | 2.23 | 0.61 | 157 | 2.20 | 0.66 | 85 | 2.12 | 0.60 | 99 | 2.17 | 0.63 | 69 | 2.13 | 0.62 | 81 | 2.15 | 0.60 | 0.09 (−0.07 to 0.25), -0.08 (− 0.37 to 0.21) | −0.02 (− 0.19 to 0.15), 0.03 (− 0.35 to 0.29) |
Weak not sick stigma (adolescent) | 142 | 2.33 | 0.65 | 157 | 2.29 | 0.75 | 85 | 2.04 | 0.65 | 100 | 1.93 | 0.75 | 68 | 1.86 | 0.64 | 81 | 1.75 | 0.69 | 0.01 (−0.18 to 0.19), -0.07 (− 0.36 to 0.22) | 0.04 (− 0.16 to 0.24), -0.18 (− 0.51 to 0.14) |
Dangerous/ unpredictable stigma (adolescent) | 133 | 2.63 | 0.67 | 148 | 2.56 | 0.67 | 80 | 2.44 | 0.72 | 96 | 2.54 | 0.59 | 67 | 2.46 | 0.58 | 80 | 2.50 | 0.54 | 0.19 (0.01 to 0.38)*, -0.36 (−0.67 to 0.05) | 0.06 (− 0.14 to 0.26), -0.04 (− 0.37 to 0.30) |
Perceived general social support from parent | 142 | 16.26 | 3.11 | 159 | 15.74 | 3.50 | 86 | 16.03 | 3.20 | 100 | 15.22 | 3.48 | 69 | 15.58 | 3.43 | 81 | 15.94 | 3.12 | −0.25 (−1.12 to 0.62), − 0.08 (− 0.37 to 0.20) | 0.54 (− 0.40 to 1.49), 0.15 (− 0.17 to 0.48) |
Adolescent intended help-seeking from parent | 140 | 2.95 | 1.21 | 158 | 2.84 | 1.29 | 86 | 2.95 | 1.21 | 100 | 2.87 | 1.29 | 68 | 2.78 | 1.43 | 80 | 2.64 | 1.39 | 0.04 (−0.35 to 0.43), 0.06 (− 0.23 to 0.35) | −0.11 (− 0.54 to 0.32), − 0.15 (− 0.48 to 0.18) |
n | % | n | % | n | % | n | % | n | % | n | % | OR (95% CI) | OR (95% CI) | |||||||
Weak not sick stigma (parent) – median or below | 0.94 (0.34 to 2.60) | 0.59 (0.19 to 1.80) | ||||||||||||||||||
K6 above cut-off (parent) | 28 | 18.5 | 37 | 21.9 | 14 | 14.6 | 17 | 15.6 | 10 | 12.5 | 19 | 19.4 | 0.81 (0.20 to 3.28) | 1.68 (0.38 to 7.48) | ||||||
K6 above cut-off (adolescent) | 33 | 23.4 | 42 | 26.6 | 15 | 17.4 | 36 | 36.0 | 22 | 32.8 | 26 | 32.1 | 4.00 (1.09 to 14.71)* | 0.62 (0.16 to 2.34) | ||||||
Parent sought appropriate help for own mental health problem | 36 | 81.8 | 49 | 69.0 | 16 | 72.7 | 23 | 69.7 | 10 | 58.8 | 28 | 66.7 | 42.0 (0.38 to 4622.42) | 189.52 (0.61 to 58,672.80) | ||||||
Adolescent sought help from parent for mental health problem | 22 | 75.9 | 24 | 77.4 | 6 | 60.0 | 11 | 50.0 | 6 | 54.6 | 14 | 66.7 | 0.56 (0.01 to 26.25) | 0.49 (0.01 to 28.48) | ||||||
Adolescent sought help from health professional for mental health problem | 19 | 65.5 | 23 | 74.2 | 8 | 80.0 | 12 | 54.6 | 4 | 36.4 | 16 | 76.2 | 0.21 (0.02 to 1.83) | 4.52 (0.57 to 35.75) |