Ensuring that teachers have high mental health literacy (MHL) is paramount, particularly because the prevalence rate for mental illness among children and adolescents is 10-20% (Mental Health Commission of Canada, 2013). Currently, there are few programs designed to increase the MHL of teachers, and the research base examining these is scant. As a result, more research is required to find effective methods of improving MHL among teachers. The current study explored the influence of a new, interactive MHL learning module on the MHL levels of B.Ed. candidates. A questionnaire largely adapted from existing measures was developed and factor analysis was conducted. Pre- and post-module MHL scores were analyzed using descriptive approaches and a repeated-measures MANOVA. Results indicate that pre-service teachers have high knowledge and non-stigmatizing beliefs in relation to MHL which did not change post- module completion; self-efficacy levels did show a small, non-significant increase.

Although the prevalence of mental pathology is high, public’s mental health literacy (i.e. knowledge about mental disorders) has not been examined to a great extent. The main purpose of this study was to examine mental health literacy concerning depression and schizophrenia in a setting of adolescents in Sweden. A secondary aim was to explore stigmatizing attitudes towards mentally ill and levels of altruism among adolescents regarding help-seeking behavior. The present study employed qualitative methodology and data were collected through vignettes. A total of 426 high school students living in Stockholm formed the respondents and content analysis showed that among teenagers recognition of both depression and schizophrenia was poor. Moreover, friends and informal sources of help were regarded as best types of help. Furthermore, results indicated stigmatizing beliefs about mental disorders and low levels of altruistic behavior. These results are supported from other similar studies and suggest awareness campaigns to increase mental health literacy among adolescents. Recommendations for future research are also discussed.

As suicide is a leading cause of death for young people, child and youth care professionals are likely to encounter adolescents who are contemplating ending their lives. Recognizing and responding to the needs of a suicidal adolescent is challenging for the professional as they attempt to balance their relationship with the young person while simultaneously following customary rules of engaging in situations involving suicide. The need for theory to deepen understanding of child and youth care professionals’ mental health literacy practices with suicidal adolescents led to this grounded theory study. Derived from interviews with 19 participants including child and youth care professionals, supervisors at youth-serving agencies, educators in schools of child and youth care, and textual analysis of policies, assessment tools, and curricula, the Balancing Perimeter and Proximity process was identified as the core category in the analysis. The Balancing process suggests professionals’ mental health literacy practices fluctuate between circling care and circling defensively. Circling defensively refers to the professional taking up literacy practices that establish a perimeter of protection; whereas literacy practices within circling care position the professional in relational proximity where they connect and attend to the adolescent holistically. The theory extends current conceptualizations of mental health literacy, and contextualizes professionals’ practice in identifying the conditions influencing the Balancing process, thereby providing an understanding for how existing structures (e.g., suicide education, agency policies) influence child and youth care professionals’ mental health literacy practices with suicidal adolescents. / Graduate

While there is extensive research on adult conceptualisations of mental illness, as well as on children’s understanding of physical health and illness, research on children’s conceptualisations of mental illness is limited. The primary aim of this thesis is to provide a detailed account of children’s and adolescents’ conceptualisations of depression. In the first study, individual semi-structured interviews with primary school pupils (N=105) from two age groups (mean ages: 8.9 and 11.8 years) were conducted, with the use of depression and control vignettes, to elicit children’s depression concepts, help-seeking intentions and desired social distance. Children’s depression conceptualisations were organised according to the common-sense model of illness representations (CSM). Quantitative content analysis was performed to allow for descriptive analysis; in turn, inferential statistics were used to examine age, gender and self-reported direct and indirect experience differences. Children differentiated between depression and control vignettes, however did not spontaneously label depression or recognised the mental health nature of difficulties. Children provided a wide variety of possible causes that reflected common risk factors for depression, primarily referring to interpersonal factors. Children considered negative consequences of untreated depression, and identified that depressed characters need help. They suggested numerous sources of help, which were mainly informal. Children considered depression to be curable and would seek help primarily from parents if depressed. Older children showed more sophisticated conceptualisations of depression. No substantial gender or experience differences were found. Subsequently, a single session school-based mental health literacy intervention on adolescent depression, adapted from an intervention created by NHS mental health professionals, was developed, using the mental health literacy and CSM frameworks. The second study consists of a pilot evaluation of the intervention, using a controlled before and after design, to examine the effect of the intervention on young people’s depression literacy, help-seeking and help-providing intentions as well as social distance. Young people’s depression literacy was measured by the Adolescent Concepts of Depression Questionnaire (ACDQ), developed for the purposes of this study. Exploratory factor analysis was conducted to indicate the factor structure of the ACDQ, which was in turn used to examine participants’ baseline depression literacy and the effect of age, gender, current depressive symptomatology and direct/ indirect experience with depression and other mental illness (Study 2a). In turn, the effectiveness of the intervention is presented (Study 2b). 339 adolescents (mean age: 13.4 years, 168 female) were allocated to either the intervention (N=171) or a control group (N=168), and completed the ACDQ one week before and following the intervention. Mixed results were found for gender, depressive symptoms and experience differences. Mixed ANOVA was conducted between time and group; the results show that the intervention was effective in informing young people’s depression literacy (ACDQ total score), and specifically in young people’s knowledge of treatment options for depression (treatment subscale), perceived curability of depression (curability subscale), symptom recognition, help-seeking and help-providing intentions. No significant improvements were found for social distance, perceived helpfulness of sources of help, and two of the ACDQ subscales. The contribution of this thesis lies upon the detailed examination of children and adolescent depression conceptualisations, adding to the limited evidence base, especially in children’s mental health literacy. The pilot evaluation of the intervention is promising, and upon re-evaluation could be standardised and implemented in Scottish schools. Implications for clinical practice and mental health literacy are also discussed.

Depression är ett psykiatriskt tillstånd som påför individen lidande och kräver samhällsekonomiska resurser. Med grund i depressionens höga prevalens är en effektiv behandling eftersträvansvärt. Internetbaserad kognitiv beteendeterapi (iKBT) har visats vara effektiv vid depression. Vetskap om vilka behandlingsfaktorer som predicerar behandlingsutfallet möjliggör att optimera behandlingen. Syfte med föreliggande studie var att undersöka om emotionell attityd till behandlingen och förståelse för behandlingens innehåll predicerar behandlingsutfallet i iKBT för depression och vilken som har starkast prediktionsvärde. Totalt 91 patienters arkiverade internetbehandlingar kodades med studiens framtagna kodningsmanual. Resultaten från två multipla regressionsanalyser visar att emotionell attityd till behandlingen signifikant predicerar 20,6% av behandlingsutfallet och att förståelse för behandlingens innehåll predicerar 3,9% men inte signifikant. Emotionell attityd till behandlingen utgör den starkaste prediktorn för behandlingsutfallet men inte en signifikant starkare prediktor. I praktiken innebär resultaten att patientens emotionella attityd till behandlingen kan användas som ett varningstecken gällande behandlingsutfallet. Framtida forskning behövs för att säkerställa konstrukten och för att vidareutveckla kodningsmanualen. / Depression is a psychiatric condition that causes the individual suffering and requires socio-economic resources. Due to high prevalence of depression, effective treatment is desirable. Internet-based cognitive behavioral therapy (ICBT) has been shown to be effective for depression. Knowledge of which treatment factors that predict treatment outcome makes it possible to optimize the treatment. The purpose of the present study was to investigate whether emotional attitude towards the treatment and understanding of the treatment content predicts the treatment outcome in ICBT for depression and which has the strongest predictive value. A total of 91 patients’ archived internet-based treatments were coded with the developed coding manual in the present study. The results from two multiple regression analyzes show that emotional attitude towards the treatment significantly predicts 20,6% of the treatment outcome and that understanding of the treatment content predicts 3,9% but not significantly. Emotional attitude towards the treatment constitutes the strongest predictor of the treatment outcome, but not a significantly stronger predictor. In practice the results imply that the patient's emotional attitude towards the treatment can be used as a warning sign regarding the treatment outcome. Future research is needed to ensure the constructs and to further develop the coding manual.

Psykisk ohälsa är ett globalt problem och unga vuxna är en särskilt utsatt grupp. Mental Health Literacy (MHL) är en modell som innefattar fyra komponenter avseende psykisk hälsa och ohälsa. God MHL bidrar till att stärka psykisk hälsa och kan vara en förutsättning för tidig upptäckt och behandling av psykisk ohälsa, det är därför viktigt med en större förståelse för unga vuxnas MHL ur ett omvårdnadsperspektiv. Syftet med studien var att undersöka specialistsjuksköterskors erfarenheter av unga vuxnas MHL. En kvalitativ metod med abduktiv ansats användes. Tio semistrukturerade intervjuer genomfördes på allmänpsykiatriska specialistmottagningar för vuxna och analyserades med kvalitativ innehållsanalys. I resultatet framkom fyra teman: erfarenheter av unga vuxnas förståelse att kunna uppnå och upprätthålla god psykisk hälsa, erfarenheter av unga vuxnas förståelse för psykiatriska tillstånd och hur de behandlas, erfarenheter av unga vuxnas upplevelse av stigma relaterat till psykisk ohälsa samt erfarenheter av unga vuxnas hjälpsökande. Unga vuxna har en ökad kunskapsnivå gällande psykiatriska tillstånd men en bristfällig förmåga att omsätta kunskapen till ett adekvat självomhändertagande. Vissa diagnoser var mer stigmatiserande och det fanns oklarheter angående hjälpsökande. Sjukvårdens kunskap om unga vuxnas MHL behöver förbättras för att främja god personcentrerad omvårdnad. Forskning inriktad på implementering av personcentrerad psykiatrisk vård behövs. / Mental illness is a global problem, and young adults is a vulnerable group. Mental Health Literacy (MHL) is a model that includes four components relating to mental health and illness. High levels of MHL contributes to strengthening mental health, can prerequisite early detection and treatment of mental illness, it´s therefore important to increase understanding of young adults’ MHL from a nursing perspective. The aim of the study was to explore mental health nurses’ experiences of MHL among young adults. Qualitative method with an abductive approach was used. The datamaterial was analyzed with qualitative content analysis. Ten semi-structured were conducted at psychiatric specialist clinics for adults. The results showed four themes: experiences of young people’s understanding for obtaining and retaining mental health, experiences of young people’s understanding of mental illness, experiences of young people and stigma in relation to psychiatric conditions, and experiences of young people’s help-seeking. Young adults have an increased knowledge regarding psychiatric conditions but lack ability to convert the knowledge into adequate self-care. Some diagnoses are more stigmatizing, and there´s uncertainty where the young adults can receive help for their mental illness. The health care organization needs better knowledge of young adults' MHL to promote psychiatric person-centred care.

Thesis advisor: Ramsay Liem / Underutilization of mental health services among Asian Americans is a pressing concern. It is possible that knowledge and beliefs about mental illness (a.k.a. “mental health literacy”) serve as barriers to seeking appropriate help, and that Asian cultural values plays a role in determining such attitudes. This study investigated the relationships among mental health literacy, attitudes towards mental health services, and adherence to Asian cultural values. A sample of 17 Caucasian and 22 Asian American college students completed a questionnaire including the Asian Values Scale, the Attitudes Toward Seeking Professional Psychological Help Scale – Shortened Version, and four vignettes portraying depression, schizophrenia, alcohol dependency, and anorexia. Results indicated that Caucasians were slightly more likely to correctly recognize and identify mental illnesses than were Asian Americans. Causal attributions varied greatly across different mental disorders, and Asian Americans showed less positive attitudes towards seeking professional psychological help, and preferred to solve problems on their own or seek help from family or friends. The greatest barriers to treatment for Asian Americans were a fear of showing personal weakness and concern about stigma. Adherence to Asian cultural values was inversely associated with willingness to seek professional help, and with willingness to take medication for psychological problems. / Thesis (BA) — Boston College, 2005. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Psychology. / Discipline: College Honors Program.

Canadian society continues to stigmatize individuals with mental illness, despite the prevalence of mental illness in the population, decades of advocacy to combat mental illness stigma, and known negative sequelae of experiences of stigma by people affected by a mental illness. One negative impact of stigma is internalization of negative connotations attached to mental illness. Although there is extensive research on the stigma of mental illness, there is little information specifically about how youth with mental illness perceive the stigma of mental illness and how they respond to it. The current research sought to understand how youth who self-identify as having a mental illness experienced, perceived and internalized the stereotypes, prejudice and discrimination of the stigma of mental illness. A simple content categorization method was used to identify key themes in the transcribed interviews of eleven youth in Vancouver Canada who identified as having mental illness. Qualitative analysis identified that the most frequent perpetrators of public stigma included casual acquaintances, family, friends, school staff, mental health professionals and authority figures. Youths’ accounts linked mental illness stigma with low mental health literacy, delayed mental health treatment and a low quality of life. The findings are considered with reference to implications for prevention of stigma, including enhanced mental health literacy for mental health professionals and the public aimed at increased understanding, sensitivity and empowerment of youth with mental illness and their families. / Graduate

New immigrants to Canada are identified as a vulnerable population in mental health and, as a result, organizations are signaling the need to enhance their mental health supports. The research uses focus groups and questions based on the messaging of a Canadian school mental health program to understand how new immigrant mothers interpret and develop key aspects of their mental health literacy and how they attain parent empowerment. A thematic assessment of the knowledge, interpretation, action and decision-making of the study participants (n=7), all recent immigrants to Canada and mothers of high school students, shows that new immigrant mothers are prepared to follow a path towards mental health literacy. At the same time, however, there are barriers that can block progression towards mental health literacy for this audience. These findings are supported by three umbrella themes: the first main theme “home as haven” espouses maternal roles in mental health maintenance such as protector and communicator, the second main theme “knowledge versus suspicions of mental health and mental illness” represents informed views and support of mental illness and myths and illusions of mental illness, and the third main theme, “additional barriers to mental health literacy” includes the hardships of immigration and fear of knowledge. The study concludes that new immigrant mothers appreciate the importance of fostering mental health understanding and discussion with their children at the same time that they encounter obstacles to the advancement of their mental health literacy. This study is relevant to the field of communication in that it demonstrates the experience of new immigrant mothers as a secondary audience in mental health programming. As the caregivers of their children, they are in position to enforce the messages and health maintenance behaviours of a school-based mental health program aimed at adolescents.

New immigrants to Canada are identified as a vulnerable population in mental health and, as a result, organizations are signaling the need to enhance their mental health supports. The research uses focus groups and questions based on the messaging of a Canadian school mental health program to understand how new immigrant mothers interpret and develop key aspects of their mental health literacy and how they attain parent empowerment. A thematic assessment of the knowledge, interpretation, action and decision-making of the study participants (n=7), all recent immigrants to Canada and mothers of high school students, shows that new immigrant mothers are prepared to follow a path towards mental health literacy. At the same time, however, there are barriers that can block progression towards mental health literacy for this audience. These findings are supported by three umbrella themes: the first main theme “home as haven” espouses maternal roles in mental health maintenance such as protector and communicator, the second main theme “knowledge versus suspicions of mental health and mental illness” represents informed views and support of mental illness and myths and illusions of mental illness, and the third main theme, “additional barriers to mental health literacy” includes the hardships of immigration and fear of knowledge. The study concludes that new immigrant mothers appreciate the importance of fostering mental health understanding and discussion with their children at the same time that they encounter obstacles to the advancement of their mental health literacy. This study is relevant to the field of communication in that it demonstrates the experience of new immigrant mothers as a secondary audience in mental health programming. As the caregivers of their children, they are in position to enforce the messages and health maintenance behaviours of a school-based mental health program aimed at adolescents.