First aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth
Introduction
Mental health first aid has been defined as ‘the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves’ (Jorm et al., 2007, Jorm et al., 2008a, Langlands et al., 2008). Given the high prevalence of mental disorders (especially mood and anxiety disorders) in the community, most people will at some time have close contact with someone who is developing a mental disorder and their responses to this person may affect the person for better or worse. Furthermore, adolescence and early adulthood is the peak age of onset for many mental disorders (Oakley-Browne et al., 2006), and young people show a strong preference for getting initial help from their family and friends (Wright et al., 2005, Jorm and Wright, 2007). Hence young people are an important, potential source of first aid for mental disorders.
Several community surveys have now examined the beliefs of young people about the helpfulness of a range of responses to mental disorder in a close other, as well as young people's ability to respond in a supportive manner (Dunham, 2004, Kelly et al., 2006, Jorm et al., 2007). Overall, these findings demonstrated that young people's mental health first aid skills are not optimal. In a national survey of young Australians aged 12–25 years, young people were presented with a vignette (depression, psychosis, social phobia, or depression with alcohol abuse) and asked how they would respond to a peer with the problem. Only a minority of young people mentioned that they would encourage professional help-seeking, even for the vignette portraying a young person with psychosis. Only a minority of young people mentioned listening to the person's problems and few mentioned asking about suicidal thoughts (Jorm et al., 2007). In a survey of high school students, Kelly et al. (2006) examined how they would respond to a peer portrayed in a vignette of either depression or conduct disorder. Around half the sample gave positive social support as their response, but only a minority reported that they would engage the help of an adult such as a parent, teacher or school counselor. Other research has examined how young adults would respond to a suicidal peer and found that many would not tell a responsible adult about it (Dunham, 2004). In a study comparing the beliefs of health professionals and young people about the helpfulness or harmfulness of various first aid strategies, some clear discrepancies were found (Jorm et al., 2008a). Specifically, young people were less likely than health professionals to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. Young people were also less likely than health professionals to believe that talking to the person firmly would be harmful. Insofar as these young people's actual first aid actions reflect their beliefs, these findings indicate a need to improve young people's mental health first aid skills.
Existing research suggests that characteristics of young people themselves, such as age and gender, as well as the characteristics of the recipient of help, such as the type of mental health problem, may influence young people's first aid knowledge and beliefs. For example, Jorm et al. (2007) found that adolescents (aged 12–17) had less sophisticated first aid knowledge and beliefs than young adults (aged 18–25), but were paradoxically more confident about providing help to a peer. Kelly et al. (2006) found that while female adolescents tended to answer differently to the conduct disorder and depression vignettes, male adolescents responded similarly to both the vignettes. In addition, adolescents responding to the conduct disorder vignette (compared to the depression vignette) were more likely to describe engaging an adult to help, while males were more likely to say they would do nothing. Less is known about the influence of age and gender of the recipient on first aid beliefs, given that studies to-date have focused on first aid for age- and gender-matched peers (Jorm et al., 2007) or controlled for these factors (Kelly et al., 2006).
To date, however, there have been no published studies on the actual first aid actions taken by young people to help someone who is experiencing a mental disorder. The current study was designed to address this gap by following up a national sample of Australian young people who had been previously assessed for their first aid beliefs (Jorm et al., 2007). In particular, we examined the first aid actions taken by young people and evaluated their quality against the beliefs of health professionals. In post hoc exploratory analyses, we also examined whether the characteristics of the first aid provider (respondent) and the recipient (close friend or family member) influenced which first aid actions were taken. In this study, prompted (close-ended) measures of first aid actions were used to complement spontaneously reported (open-ended) measures because the former provides a higher rate of responses while the latter provides a more qualitative report from young people's experience. The list of prompted actions used is a standard list which has also been used in other studies (e.g., Jorm et al., 2007, Jorm et al., 2008a) and hence facilitates comparisons across samples (e.g., between health professionals and youth). Both measures are of interest separately in this study because of its primary aim to describe the first aid actions taken by Australian young people.
Section snippets
Participants
In 2006, a national computer-assisted telephone survey was carried out via random digit dialing on a sample of 3746 young Australians aged 12–25 years (61.5% response rate) (see Jorm and Wright, 2008 for more details of the sample). At the completion of the interview, 3005 respondents consented to being recontacted for a similar interview. About 2 years later, 2005 (66.7%) of these respondents completed the follow-up interview. Of these, there were 479 males and 449 females in the 12–17 year old
Frequencies and characteristics of respondents and recipients
Of the 2005 young people interviewed at follow-up, 609 (30.4%) reported having a family member or close friend with a problem similar to that described in the vignette since January 2007. One of the 609 respondents declined to give further information about this person, and was hence excluded from further analyses. Given that the problem occurred in the preceding 12 months for most of the 608 respondents (86%), further analyses were conducted for this full subsample. As shown in Table 1,
Discussion
A noteworthy finding from this survey is that many young people knew and tried to support a peer with a mental health problem. This is consistent with past research (Offer et al., 1991, Deane et al., 2002) where peers were found to be an important source of support for young people with mental health problems. In particular, most respondents reported taking some actions that are considered to be generally helpful, such as encouraging professional help-seeking, supportive listening and providing
Acknowledgements
This work was supported by funding from a National Health and Medical Research Council Project Grant, beyondblue: the national depression initiative, and the Colonial Foundation.
We would also like to thank Stefan Cvetkovski for his assistance with data analyses.
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