Students’ mental health issues are a common concern on college campuses and are often addressed via prevention programming called mental health literacy. This dissertation consists of two studies regarding mental health literacy programming for college students at a western university in the United States. In study one, the Mental Health Awareness and Advocacy Assessment Tool (MHAA-AT) was created and evaluated for its utility in assessing college students’ mental health literacy. This assessment tool is unique in that it is built upon a process-based approach to mental health literacy. The assessment tool demonstrated adequate psychometric properties and it was deemed an appropriate tool to assess college students’ mental health literacy, specifically their declarative knowledge, self-efficacy, and behaviors. In study two the Mental Health Awareness and Advocacy (MHAA) curriculum was created and evaluated in a college student population. The MHAA curriculum is unique in that is taught in-person or online in a degree seeking program at a college or university. Results from study two suggest that the MHAA curriculum was effective in increasing college students’ mental health literacy scores, specifically their declarative knowledge and self-efficacy. The benefit of this two-study dissertation is that it provides a unique way to deliver and evaluate effective mental health literacy prevention programming on a larger scale via a degree-seeking program to college students.

The University of Ottawa (UO) has been dealing with a mental health crisis. The purpose of this study was to evaluate UO students’ knowledge, awareness, and use of mental health services (MHS) and to address limited research on knowledge of on-campus MHS. A cross-sectional online, bilingual, survey was administered to 235 UO students over 18 years old and registered at the university since Fall 2019. Data analysis included descriptive data, categorical analysis, and inductive thematic analysis. Awareness and use of services varied depending on the services in question. 48.9% of students only heard about the services but could not explain them. 57.4% would use a service if in distress and those who would not mainly point to Use of other methods and Lack of information as their reasons. This study contributes to the ongoing efforts of improving UO community’s mental wellbeing.

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Coaches' knowledge, attitudes, and beliefs about mental health – the construct of mental health literacy (MHL) – affects teams' mental health (MH) climates and the early detection, referral, and treatment of athletes' MH concerns. Thus, assessing collegiate coaches' MHL, and the factors related to its presence, is critical. Using the Mental Health Literacy Scale, I surveyed 1,571 NCAA coaches (Mage = 37.5 years, SD = 11.8; 51.4% cisgender female; 85.9% White) regarding their MHL and related demographic and MH-experience factors, including their belief regarding MH and sport performance. Overall, 99.9% of the coaches believed that athletes' MH affected their sport performances. Through hierarchical regression analyses, I found that coaches' exposure to MH treatment, their perceived helpfulness of MH treatment, their gender (i.e., woman), number of years coaching (i.e., fewer years), and NCAA Division in which they currently coach (i.e., DIII) were related significantly to their MHL, explaining 15.5% of variance. Coaches' race/ethnicity was not related to MHL. These findings provide insight on hiring and educating coaches, and hiring appropriately trained and licensed MH and sport psychology professionals. Specifically, coach education should be focused and practical: signs and symptoms of common MH concerns disorders; the ubiquity of MH concerns among athletes; how to talk to athletes about MH and suicide; and how to make timely, efficient, and respectful referrals following that system's specific procedures. Such education would be particularly beneficial for male coaches or those who have been coaching longer.

The mental health literacy (MHL) rates of Christian clergy in the United States remains underinvestigated in the current literature. This gap of knowledge is problematic for the large numbers of individuals with mental illness who seek assistance from clergy and may receive inadequate care for their concerns. As theoretically designated by the behavioral models of health care and MHL research, denomination-type, educational variables, and demographic characteristics were investigated as potential predictors of MHL. A sample of 238 Christian clergy from throughout the United States completed the web-based Mental Health Literacy Scale and demographic questionnaire. Results of analysis of variance (ANOVA) revealed no significant differences among MHL scores of Evangelical Protestant, Mainline Protestant, Catholic, and Historically Black Protestant groups. Results of the multiple linear regressions showed that number of years of postsecondary school, degree-type, age, and geographical location were not significant predictors of MHL scores. Higher numbers of clinical MH training courses and female gender did significantly predict higher levels of MHL scores. The findings provided the first parametric measure of a diverse, national sample of Christian clergy and indicated a need for increasing MHL trainings. Results also provided counselors and counselor educators with information useful for initiating and modeling interprofessional trainings, collaborations, and referral partnerships with clergy who currently serve as front-line mental health workers to millions of U.S. residents. The results may also inform social justice initiatives to reduce mental health care disparities in underserved populations.

School settings are increasingly being targeted as ideal entry points for youth mental health initiatives and naturally, educators have been identified as playing a critical role in supporting youth in distress. The current study set out to investigate how to strengthen the ability of educators to support youth experiencing bullying and mental health difficulties. The study was conducted in two phases: an initial phase in which a mental health literacy and communication skills workshop for educators was developed and refined, and a second phase in which the workshop was pilot-tested. The 2-hour workshop was delivered to two groups of students (N = 35) in a Teacher’s Education (B.Ed.) program at a Canadian university. Participants completed a questionnaire following the workshop to assess their satisfaction with the workshop experience and their degree of change in knowledge and awareness of bullying and mental health difficulties, as well as self-efficacy and perceived confidence in communicating with young people in distress. Results showed that participant satisfaction with the workshop was high and that most participants would recommend the workshop for pre-service and in-service teachers. In addition, participant knowledge, awareness, self-efficacy, and self-confidence in communicating with youth in distress increased from pre- to post-workshop. Taken together, the results of the pilot study provide support for further development and delivery of this workshop to pre-service and in-service teachers to help prepare educators for the complex, demanding, and vital role of supporting young people in distress due to bullying and mental health difficulties.

Bakgrund: Psykisk ohälsa ökar bland ungdomar. Skolan har en unik möjlighet att bidra i det hälsofrämjande och förebyggande arbetet. Lärare har, genom en slags gatekeeperfunktion, möjlighet att tidigt upptäcka och initiera åtgärder för elever med psykiska besvär. Syfte: Att undersöka dels lärares självskattade kunskap om, dels lärares upplevda förutsättningar att agera och initiera åtgärder vid misstanke om, psykisk ohälsa hos elever. Metod: En kvantitativ enkätundersökning med tvärsnittsdesign genomfördes bland 96 grundskolelärare. Data redovisades deskriptivt samt som skillnader (Fischers exakta test) ochsamband (Spearman’s Rho). Resultat: Knappt hälften av respondenterna (n=43) angav sig ha kunskap i form av specifik utbildning gällande psykisk ohälsa hos unga, medan en större andel angav goda kunskaper i att upptäcka elever i risk (n=64) och att bedöma tecken på psykisk ohälsa (n=75). Majoriteten av lärarna upplevde goda förutsättningar att agera och initiera åtgärder vid befarad psykisk ohälsa. Vid jämförelse mellan grupperna med respektive utan specifik utbildning framkom statistiskt signifikanta skillnader avseende både förmåga att upptäcka och upplevda förutsättningar att agera vid befarad psykisk ohälsa hos elever. Sambandsanalyser visade att variabler för kunskaper hade statistiskt signifikanta positiva samband med variabler för upplevda förutsättningar. Slutsatser: Även om majoriteten av lärarna upplever sig ha såväl kunskaper som förutsättningar att agera och initiera åtgärder så stödjer föreliggande studie teorin om att specifik utbildning om psykisk ohälsa hos unga ökar lärares förmåga att både upptäcka elever med psykisk ohälsa och förutsättningarna att agera och initiera åtgärder. / Background: Mental illness increases among adolescents. The school has a unique opportunity to contribute to promotion and prevention. Through a gatekeeper function, teachers can detect and initiate measures for students with mental health problems early on. Aim: To investigate partly teachers’ self-estimated knowledge of, partly teachers' perceived conditions to act and initiate measures in case of suspicion of, mental illness in students.  Method: A quantitative survey with cross-sectional design was conducted among 96elementary school teachers. Data were reported descriptively, as differences (Fischer’s exact test) and as correlations (Spearman’s Rho).  Results: About half of the respondents (n=43) indicated possessing knowledge in form of specific education, slightly more indicated possessing knowledge to spot students at risk (n=64) and to assess signs of mental illness (n=75). The majority indicated experiences of good conditions to act and initiate measures in case of suspected mental illness. When comparing the groups with and without specific education, statistically significant differences emerged regarding both abilities to detect and perceived conditions to act in the event of suspected mental illness in students. Correlation analyzes showed that variables for knowledge had statistically significant positive correlations with variables for perceived conditions.  Conclusions: Although most teachers indicate having both the knowledge and the conditions to act and initiate measures, the present study supports the theory that specific education on mental illness in young people increases teachers’ ability to both detect students with mental illness and the conditions to act and initiate measures.

Despite high rates of suicide and mental health concerns (Duldulao, Takeuchi, & Hong, 2009; Kisch, Leino, & Wilverman, 2005; Lee, Park, Lee, Oh, Choi, & Oh, 2018; World Health Organization, 2019), many Asian Americans including Koreans and Korean Americans do not seek mental health services (Lam & Zane, 2004; Lee, Hanner, Cho, Han, & Kim, 2008; Markus & Kitayama, 1991; Sue, Cheng, Saad, & Chu, 2012). Especially for Koreans and Korean Americans, stigma (Masuda & Latzman, 2011) as well as cultural values (e.g., Cheng, Leong, & Geist, 1993; Cheong & Snowden, 1990; Kim & Omizo, 2003; Tracey, Leong, & Glidden, 1986) can prevent them from seeking appropriate services. The current study compares Korean, Korean American, and non-Korean emerging and young adults’ mental health literacy (Jorm, Korten, Jacomb, Christensen, Rodgers, & Pollitt, 1997), specifically mental health knowledge, confidence in finding appropriate mental health services, and attitudes towards mental disorders and treatment. A pilot study was conducted to tailor the Mental Health Literacy Scale (O’Connor & Casey, 2015) to answer the main research questions and examine internal consistency and validity. Analysis of variance (ANOVA) was used to assess the differences among the sociocultural groups (i.e., Koreans, Korean Americans, and non-Asians) and investigate individual and contextual influences (e.g., age, gender, citizenship). The results demonstrated that (1) non-Asians have significantly higher mental health knowledge scores, higher self-efficacy, and less negative attitudes towards mental disorders compared to Koreans and Korean Americans and (2) there were no significant differences in the scores between Koreans and Korean Americans. The discussion section describes the importance of enhancing mental health literacy and increasing help seeking behavior for Koreans and Korean Americans and suggests cultural factors to consider in creating culturally appropriate outreach programs.

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Background: School-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge. Methods: Participants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12–18 years (M = 13.88, SD = 1.00; grade levels 7–10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included. Results: In the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher. Conclusion: Psychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.