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

Surveys were posted to all 1710 psychiatrists listed on the Medicare Provider File (Medicare is Australia's national health insurance scheme), a random sample of 2000 GPs listed on the File, all 1628 Australian members of the Australian and New Zealand College of Mental Health Nurses, and a random sample of 2000 psychologists listed in the Victorian Psychologists Registration Board's online database of registered psychologists. Surveys were completed anonymously and separate response cards with identification numbers were used to determine participation or refusal. GPs, psychiatrists and psychologists were sent one reminder letter to encourage participation. Completed surveys were received from 470 GPs, 591 psychiatrists, 522 mental health nurses and 736 psychologists. Response rates were 24.0% (GPs), 35.4% (psychiatrists), 32.3% (mental health nurses) and 40.3% (psychologists).

The details of these samples have been previously published [14], so are only described briefly here. In 2006, a telephone survey was carried out with a national sample of young Australians aged 12–25 years. If the young person lived at home with a parent, then one parent was randomly invited to be interviewed as well. Interviews were completed for 3746 young people out of 6087 who could be contacted and were confirmed as in scope, giving a response rate of 61.5%. There were 2925 youth respondents with a co-resident parent, of which 2005 completed interviews, giving a response rate of 68.5%.

The survey was based on a vignette of a young person with a mental disorder [14]. Participants were randomly given a vignette describing a 15 or 21 year old with depression, depression with alcohol misuse, social phobia or psychosis. The vignettes were written to satisfy DSM-IV criteria and were validated by asking the professionals in the current study what was wrong with the person described. (Over 80% of each professional group diagnosed the psychosis vignette with schizophrenia or other psychotic disorder, the depression vignette with a mood disorder and the social phobia vignette with an anxiety disorder. However, diagnosis of comorbid substance-related disorder was lower, ranging from 26% up to 60% depending on the professional group and the age of the person in the vignette [19]). Vignettes were matched to the gender of youth participants, whereas professionals received only male vignettes due to the smaller sample size and the fact that previous research had shown that gender of the vignette had very little effect on responses [20]. After being presented with the vignette, professionals were asked a series of questions to assess their recognition of the disorder in the vignette, beliefs about first aid, interventions, and prevention, and sociodemographic characteristics. The present paper presents data only on the first aid questions, so these are described in detail here. Professionals were asked whether it would be helpful if a friend or family member were to do various first aid actions, youth were asked whether it would be helpful if they provided the first aid to someone they knew and cared about, and parents were asked whether it would be helpful if they provided the first aid to their child. The first aid actions were: 'Listen to his problems in an understanding way. Talk to him firmly about getting his act together. Suggest he seek professional help. Make an appointment for him to see a GP. Ask him whether he is feeling suicidal. Suggest he have a few drinks to forget his troubles. Rally friends to cheer him up. Ignore him until he gets over it. Keep him busy to keep his mind off problems. Encourage him to become more physically active.' Participants could respond 'helpful', 'harmful', 'neither', 'depends' or 'don't know'. These 10 potential first aid strategies were based on previous work on what members of the public report they would do to help someone with a mental disorder [13] and strategies that are described as either helpful or not helpful by a mental health first aid training manual [21].

Previous publications on these data sets have covered young people's and parent's beliefs about help-seeking [22], treatments [18], the effect of substance use on mental disorders [23], mental health first aid strategies [14], stigmatizing attitudes [24], and awareness of a national depression initiative [25]. There have also been publications on clinicians' beliefs about treatments for depression and psychosis [26, 27], their recognition of mental disorders in young people [19], and their beliefs about intervention to reduce smoking in people with mental disorders [28].

Responses were dichotomized in two ways: helpful versus all other responses, or harmful versus all other responses. For descriptive purposes, the percent rating each strategy as helpful and as harmful was calculated by vignette and professional group. To examine differences in ratings according to profession and vignette, multiple logistic regressions were carried out predicting helpful or harmful ratings in the combined professional sample. The predictors were profession (with GP as the reference category), type of disorder in the vignette (with depression as the reference category) and age group in the vignette (with 15 years as the reference category). Because of the large sample size and the number of comparisons examined, the 99% CI was used for odds ratios.

Data on the youth and parent samples have been reported previously [14], but are reproduced here to allow comparison with the professional data. The major interest is in how youth and parents rate those first aid strategies about which there is professional consensus on helpfulness or harmfulness. A strategy was classified as recommended by professionals if the mean helpful rating across the four professions and the two vignette ages was >70%. Similarly, a strategy was classified as harmful where the mean harmful rating was >70%. These cutoffs were chosen because they well exceed a majority support for either using or avoiding a first aid strategy. Because of the large sample size of youth and parents, even very small differences in ratings of helpfulness could be statistically significant. Therefore comparisons of public with professionals were made in terms of effect sizes, with medium and large effect sizes noted. Following Rosenthal [29], a medium effect size was defined as a difference in percentages of at least 18 points and a large effect size as a difference of at least 30 points.

Approval was given by the University of Melbourne Human Research Ethics Committee.

Additional file 1 shows the results when multiple logistic regression was used in the combined professional sample to examine predictors of rating each strategy as likely to be helpful. The additional file also shows the results when examining predictors of rating each strategy as likely to be harmful.

A number of significant differences were found for helpful ratings. Listen to problems in an understanding way was recommended less for psychosis than for depression and less for 21-year-olds than 15-year-olds. Suggest seek professional help was recommended less by mental health nurses than GPs and more for 21-year-olds than 15-year-olds. Make an appointment for person to see GP was recommended more for psychosis than depression, less for social phobia than depression, and less by either psychologists or mental health nurses than GPs. Ask whether feeling suicidal was recommended less for social phobia than for depression and less by psychologists than GPs. Rally friends to cheer up was generally not seen as a helpful strategy, but was seen as less helpful for psychosis or social phobia than depression, and was recommended less by psychologists and mental health nurses than by GPs. Keep busy to keep mind off problems was not generally seen as a helpful strategy, but was recommended less for psychosis than for depression. Encourage to become more physically active was recommended less for psychosis than for depression and less by psychiatrists or nurses than GPs.

There were also a number of significant differences for harmful ratings. Talk to firmly about getting act together was rated as harmful more by psychologists than GPs, less for depression with alcohol misuse than for depression alone, and for less for 21-year-olds than 15-year olds. Make an appointment for person to see GP and ask whether feeling suicidal were rated as harmful more for social phobia than for depression. Suggest have a few drinks to forget troubles was rated as harmful less for social phobia than depression and less for 21-year-olds than 15-year-olds. Rally friends to cheer up was more often rated as harmful by nurses than GPs and more often for psychosis and social phobia than for depression. Ignore until gets over it was more often rated as harmful by nurses than by GPs and less often for social phobia than depression. Keep busy to keep mind off problems was more often rated as harmful for psychosis than for depression.

While there are many statistically significant differences, it can be seen from the percentages in Tables 1 and 2 that the differences are comparatively small in magnitude and that there is considerable agreement across professions about what are helpful strategies. There were also few differences between what was recommended for adolescents and young adults. Table 3 lists the strategies for which there is substantial agreement that the strategy is likely to be helpful or likely to be harmful. Looking across the disorders in Table 3, it can be seen that there is a lot of overlap in recommendations. The main difference is that social phobia received fewer firm recommendations for helpful strategies.

The asterisks in Tables 1 and 2 indicate where there were medium or large differences between public and professional ratings. However, some of these differences are with strategies for which there is not professional agreement. The main interest is where there is a difference from the professional beliefs about first aid strategies summarized in Table 3. With strategies recommended by professionals, the major discrepancy is for ask whether feeling suicidal which was less frequently rated as helpful and more frequently as harmful by both young people and parents. Young people were also less positive about make an appointment for person to see GP, whereas parents were positive about this strategy, consistent with professionals.