JULIA SCHLEIMER 1 AND BETTINA FRIEDRICH 2 OVERCOMING BARRIERS IN MINDS AND SOCIETY 8 TH TOGETHER AGAINST STIGMA CONFERENCE COPENHAGEN, DENMARK SEPTEMBER 20, 2017 Talk About Change: An Evaluation of a Mental Health Intervention in a Californian School 1 Columbia University s Mailman School of Public Health, NY, USA 2 Department for Clinical, Educational and Health Psychology, University College London
Program Creator unable to attend conference Julia P. Schleimer Developed this intervention with support from the Mental Health Association of San Francisco and with mentorship from Bettina Friedrich, PhD Currently a Master of Public Health candidate in epidemiology at Columbia University s Mailman School of Public Health
What is Talk About Change? A secondary school-based mental health intervention for 9 th grade students in one Northern Californian school (Davis) Specific aims were to improve: 1. Mental health literacy 2. Attitudes towards others with mental illness 3. Behaviors towards others with mental illness Stigma Main aim: young people should be able to understand their own and other people s mental health (problems), to detect issues and to be knowledgeable and comfortable acting on the issues! -getting early help for self or others if needed
The intervention osix lessons over one semester (4 months) led by UC Davis college students, alumni, and mental health professionals o Participant inclusion criteria: -being an enrolled 9 th grade student of the host teacher at the host school and - turning in a parent-signed consent form approving participation (consent form specified what topics would be discussed on particular days and gave students and parents the opportunity to opt out of one or more days)
Curriculum o PowerPoint presentations with information about mental health o Interactive classroom activities o Personal stories of mental health challenges and recovery shared by college students otopics covered: general mental health/why it s important, anxiety, depression, substance abuse, eating disorders, bipolar disorder, and self-care (you can email Julia or me for the material)
Intervention development Informed by: Extant literature on adolescent mental health education and existing secondary school-based mental health programs Contact-based approach in combination with education 7 Social Ecological Model framework ( interactive effects of personal and environmental factors that determine behaviors )
Participants Total N = 107 ninth grade students 52 males and 55 females Ages ranged from age 13 to 15 Treatment group: 1 st and 2 nd periods (n=51) Control group: 5 th and 7 th periods (n=56) At the host school, students are not assigned to class periods by any systematic criteria; as such, this study employed a clustered randomized control trial design
Clustered randomized control trial Intervention Group: Pre Knowledge (MAKS) Attitudes (2 subscales) Behavior (RIBS) Post Knowledge (MAKS) Attitudes (2 subscales) Behavior (RIBS) Positive score changes should be bigger/more positive in the intervention group if intervention has a positive impact Pre Post Control Group: Knowledge (MAKS) Knowledge (MAKS) Attitudes (2 subscales) Attitudes (2 subscales) Behavior (RIBS) Behavior (RIBS)
Evaluation clustered randomisedcontrol trip (pre and post test measures) Mental Health Knowledge Scale 8 measures mental health-related knowledge Attitudes Toward Mental Illness and Its Treatment Scale 9 (two subscales) negative stereotypes towards those with mental illness recovery and outcome attitudes towards those with mental illness Reported and Intended Behavior Scale 10 measures current, past, and future behaviors (i.e. discrimination) towards individuals with mental illness
MAKS
Attitudes Toward Mental Illness and Its Treatment Scale 9 (two subscales)
RIBS
Statistical Analyses ot-tests and chi-squared test: differences between treatment and control group at baseline? Significant different for attitudes toward mental health issues (higher in control) owe calculated regressions so see whether score improvements could be significantly predicted by group membership (control vs. treatment). o Control variables: gender, age, baseline scores
Results Table 1. Predictors of Mental Health-Related Knowledge Improvements at Post-Test (linear regression) Coef. Std. Error t-statistic Sig. Treatment (1) vs. Control (0) Knowledge Score at Baseline 2.068 0.506 4.09 0.000* -0.541 0.100-5.42 0.000* Age -0.483 0.598-0.81 0.421 Gender, male (1) vs. female (0) -0.831 0.511-1.62 0.107 *p < 0.05 Higher scores indicate improvement for knowledge R squared: 0.314 Number of observations: 103
Table 2. Predictors of Mental Health-Related Reported and Intended Behavior Improvements at Post-Test (linear regression) Coef. Std. Error t-statistic Sig. Treatment (1) vs. Control (0) Behavior Score at Baseline 0.856 0.454 1.89 0.062-0.505 0.070-7.64 0.000* Age -0.095 0.539-0.18 0.860 Gender, male (1) vs. female (0) -0.076 0.490-0.15 0.877 *p < 0.05 Higher scores indicate improvement for behavior R squared: 0.412 Number of observations: 103
Table 3. Predictors of Negative Attitudes Towards Others with Mental Illness Improvements at Post-Test (linear regression) Coef. Std. Error t-statistic Sig. Treatment (1) vs. Control (0) Negative Attitudes Score at Baseline -1.362 0.424-3.21 0.002* -0.573 0.097-5.91 0.000* Age -0.044 0.495-0.09 0.929 Gender, male (1) vs. female (0) 0.205 0.425 0.48 0.631 *p < 0.05 Lower scores indicate improvement for attitudes R squared: 0.288 Number of observations: 103
Table 4. Predictors of Recovery Attitudes Towards Others with Mental Illness Improvements at Post-Test (linear regression) Coef. Std. Error t-statistic Sig. Treatment (1) vs. Control (0) Recovery Attitudes Score at Baseline -2.03 0.513-3.95 0.000* -0.682 0.094-7.25 0.000* Age -0.349 0.611-0.57 0.569 Gender, male (1) vs. female (0) 0.075 0.530 0.14 0.887 *p < 0.05 Lower scores indicate improvement for attitudes R squared: 0.440 Number of observations: 103
Conclusions ocompared to the control group, membership to the treatment group significantly (p < 0.05) predicted improvements in mental health related knowledge, negative attitudes towards those with mental illness, and recovery attitudes towards mental illness -intervention effective for those measures! othere was no significant difference between treatment and control for reported and intended behavior
Limitations 1. Significant difference between the treatment and control groups at baseline for negative attitudes towards people with mental health problems - controlled 2. Treatment and control group took place at different times during the day (alertness, interest, mood)? 3. Control group was not entirely isolated from the treatment group 4. Evaluation done by facilitator (but: surveys anonymous, ID numbers)
Future Directions Long term follow-up assessments Replicating research with this designusing larger samples of different groups of students across settings and ages Alternative measures: checking help-seeking at school psychologists (control vs intervention group)
Thank you! Special thanks to: Bettina Friedrich, PhD; the Mental Health Association of San Francisco; Pam Eimers, Holmes Junior High HealthTeacher; Natalie Zehnder, DJUSD Prevention & Crisis Manager; DanenAdelson, PsyD;Professors Nolan Zane, PhD; Eva Schepeler, PhD; Active Minds at UC Davis, Out of the Darkness at UC Davis, and NAMI at UC Davis for their support and involvement!
References 1. University of Washington. Mental Illness Reporting: Facts about the Prevalence of Mental Illness. Retrieved from http://depts.washington.edu/mhreport/facts_prevalence.php 2. National Institute of Mental Health, Prevalence Any Mental Illness. https://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-amongus-adults.shtml 3. Kelly, C. M., Jorm, A. F., & Wright, A. (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust, 187(7 Suppl), S26-30. 4. National Alliance on Mental Illness, Facts on Children s Mental Health in America. http://www.namihelps.org/assets/pdfs/fact-sheets/children-and- Adolescents/Facts-on-Childrens-Mental-Health--in-America.pdf 5. Gestsdottir, A. (2010). Evaluation of school-based mental health promotion for adolescents Focus on knowledge, stigma, help-seeking behaviourand resources.(master of Public Health Sciences), University of Iceland School of Health Sciences. 6. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62(6), 593-602. doi:10.1001/archpsyc.62.6.593 7. Patrick W. Corrigan, Scott B. Morris, Patrick J. Michaels, Jennifer D. Rafacz, & Nicolas Rüsch. (2012). Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatric Services, 63(10), 963-973. doi:10.1176/appi.ps.201100529 8. Evans-Lacko, S., Little, K., Meltzer, H., Rose, D., Rhydderch, D., Henderson, C., & Thornicroft, G. (2010). Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry, 55(7), 440-448. doi:10.1177/070674371005500707 9. Kobau, R., Diiorio, C., Chapman, D., & Delvecchio, P. (2010). Attitudes about mental illness and its treatment: validation of a generic scale for public health surveillance of mental illness associated stigma. Community Ment Health J, 46(2), 164-176. doi:10.1007/s10597-009-9191-x 10. Evans-Lacko, S., Rose, D., Little, K., Flach, C., Rhydderch, D., Henderson, C., & Thornicroft, G. (2011). Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci, 20(3), 263-271.