"EspaiJove.net"- a school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial

Rocío Casañas, Victoria-Mailen Arfuch, Pere Castellví, Juan-José Gil, Maria Torres, Angela Pujol, Gemma Castells, Mercè Teixidó, Maria Teresa San-Emeterio, Hernán María Sampietro, Aleix Caussa, Jordi Alonso, Lluís Lalucat-Jo, Rocío Casañas, Victoria-Mailen Arfuch, Pere Castellví, Juan-José Gil, Maria Torres, Angela Pujol, Gemma Castells, Mercè Teixidó, Maria Teresa San-Emeterio, Hernán María Sampietro, Aleix Caussa, Jordi Alonso, Lluís Lalucat-Jo

Abstract

Background: One half of adults who develop any mental disorder do so during adolescence. Previous literature showed that Mental Health Literacy (MHL) interventions impact mental health knowledge, reduce the associated stigma, and promote help-seeking among the adolescent population. However, evidence for the effectiveness and cost-effectiveness of these programmes remains inconclusive. The aim of this paper is to present a study protocol that evaluates the effectiveness of the " EspaiJove.net " programme. " EspaiJove.net " consists of a universal MHL intervention designed to promote mental health knowledge, increase help-seeking, reduce the stigma associated with mental illness, and prevent mental disorders in Spanish school settings.

Methods: A school-based clustered randomised controlled trial (cRCT) design with 12 months of follow-up.

Subjects: At least 408 secondary school students who attend the 3rd year of E.S.O (Compulsory secondary education for 13- to 14-year- olds) will be recruited from 8 schools within Barcelona city, Catalonia (Spain).

Intervention: A dose-response intervention will be delivered with 4 arms: 1) Sensitivity Programme (SP) in Mental Health (1 h); 2) Mental Health Literacy (MHL) Programme (6 h); 3) MHL plus first-person Stigma Reduction (MHL + SR) (7 h); 4) Control group: waiting list. Primary outcomes: 1) MHL: EspaiJove.net MHL Test (EMHLT); 2) Stigma: Reported and Intended Behaviour Scale (RIBS) and Community Attitudes toward the Mentally Ill (CAMI). Others outcomes: 1) Acceptability of intervention; 2) Mental health symptoms and emotional well-being (SDQ); 3) States of Change Scale (SCS); 4) Bullying and Cyberbullying; 5) Quality of life (EQ-5D); 6) Help seeking and use of treatment; 7) Health benefits.

Discussion: Results would be informative for efforts to prevent mental disorders and promote mental wellbeing in secondary school students.

Trial registration: NCT03215654 (date registration July 12, 2017).

Keywords: Adolescence; Intervention; Mental health; Mental health literacy; Prevention; Promotion; School; Stigma.

Conflict of interest statement

Ethics approval and consent to participate

The Independent Ethics Committee at the Fundació Unio Catalana Hospitals in Barcelona, Spain has approved the trial study protocol. The trial has also been registered on the Clinical.Trial.gov register NCT03215654 (date registration July 12, 2017).

Written informed consent of the parents and guardians of all students participating in the study will be requested.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schematic Illustration of the research design
Fig. 2
Fig. 2
Flow chart of participants

References

    1. World Health Organization. Adolescent mental health: mapping actions of nongovernmental organizations and other international development organizations. World Health Organization; 2012. Report No.: ISBN 978 92 4 150364 8.
    1. Merikangas KR, Nakamura EF. Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci. 2009;11(1):7–20.
    1. McGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Curr Opin Psychiatry. 2011;24(4):301–306. doi: 10.1097/YCO.0b013e3283477a09.
    1. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379(9820):1056–1067. doi: 10.1016/S0140-6736(11)60871-4.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Jones PB. Adult mental health disorders and their age at onset. Br J Psychiatry. 2013;202(s54):s5–10. doi: 10.1192/bjp.bp.112.119164.
    1. Kessler R, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: a review of recent literature. Current Opinion Psychiatry. 2007;20(4):359–364. doi: 10.1097/YCO.0b013e32816ebc8c.
    1. Mojtabai R, Olfson M, Han B. National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults. Pediatrics. 2016; Available from:; 10.1542/peds.2016-1878.
    1. Jorm AF. Mental health literacy: empowering the community to take action for better mental health. Am Psychol. 2012;67(3):231–243. doi: 10.1037/a0025957.
    1. Zachrisson HD, Rödje K, Mykletun A. Utilization of health services in relation to mental health problems in adolescents: a population based survey. BMC Public Health. 2006;6:34. doi: 10.1186/1471-2458-6-34.
    1. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113. doi: 10.1186/1471-244X-10-113.
    1. Chisholm K, Patterson P, Torgerson C, Turner E, Jenkinson D, Birchwood M. Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial. BMJ Open. 2016;6(2):e009435. doi: 10.1136/bmjopen-2015-009435.
    1. Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv. 2012;63(10):963–973. doi: 10.1176/appi.ps.201100529.
    1. Jorm AF, Korten AE, Jacomb PA, Rodgers B, Pollitt P, Christensen H, et al. Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public. Br J Psychiatry. 1997;171(03):233–237. doi: 10.1192/bjp.171.3.233.
    1. Whitley J, David Smith J, Vaillancourt T. Promoting mental health literacy among educators. Can J Sch Psychol. 2013;28(1):56–70. doi: 10.1177/0829573512468852.
    1. Sanders LM, Federico S, Klass P, Abrams MA, Dreyer B. Literacy and child health: a systematic review. Arch Pediatr Adolesc Med. 2009;163(2):131–140. doi: 10.1001/archpediatrics.2008.539.
    1. Kutcher S, Wei Y, Weist MD. School Mental Health. Global Challenges and Opportunitie. 1st. ed. Cambridge University Press; 2015.
    1. Wei Y, Kutcher S. International school mental health: global approaches, global challenges, and global opportunities. Child Adolesc Psychiatr Clin N Am. 2012;21(1):11–27. doi: 10.1016/j.chc.2011.09.005.
    1. Weist MD, Lowie JA, Flaherty LT, Pruitt D. Collaboration among the education, mental health, and public health systems to promote youth mental health. Psychiatr Serv. 2001;52(10):1348–1351. doi: 10.1176/appi.ps.52.10.1348.
    1. Wyn J, Cahill H, Holdsworth R, Rowling L, Carson S. MindMatters, a whole-school approach promoting mental health and wellbeing. Aust N Z J Psychiatry. 2000;34(4):594–601. doi: 10.1080/j.1440-1614.2000.00748.x.
    1. Muir, K., Powell, A., Patulny, R., Flaxman, S., McDermott, S., Oprea, I., Gendera, S., Vespignani, J., Sitek, T., Abello, D., Katz, I. Independent Evaluation of headspace: the National Youth Mental Health Foundation. Available from:
    1. Birchwood M, Singh SP. Mental health services for young people: matching the service to the need. Br J Psychiatry Suppl. 2013;54:s1–s2. doi: 10.1192/bjp.bp.112.119149.
    1. Schulze B, Richter-Werling M, Matschinger H, Angermeyer MC. Crazy? So what!? Effects of a school project on mental health and illness on students’ attitudes. Eur Psychiatry. 2002;17:81. doi: 10.1016/S0924-9338(02)80370-4.
    1. Schulze B, Richter-Werling M, Matschinger H, Angermeyer MC. Crazy? So what! Effects of a school project on students’ attitudes towards people with schizophrenia. Acta Psychiatr Scand. 2003;107(2):142–150. doi: 10.1034/j.1600-0447.2003.02444.x.
    1. Wei Y, Hayden JA, Kutcher S, Zygmunt A, McGrath P. The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth. Early Interv Psychiatry. 2013;7(2):109–121. doi: 10.1111/eip.12010.
    1. Milin R, Kutcher S, Lewis SP, Walker S, Wei Y, Ferrill N, et al. Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2016;55(5):383–91.e1. doi: 10.1016/j.jaac.2016.02.018.
    1. Kiviruusu O, Björklund K, Koskinen H-L, Liski A, Lindblom J, Kuoppamäki H, et al. Short-term effects of the “Together at School” intervention program on children’s socio-emotional skills: a cluster randomized controlled trial. BMC Psychology. 2016;4(1) 10.1186/s40359-016-0133-4.
    1. Mehta N, Clement S, Marcus E, Stona A-C, Bezborodovs N, Evans-Lacko S, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry. 2015;207(5):377–384. doi: 10.1192/bjp.bp.114.151944.
    1. Mellor C. School-based interventions targeting stigma of mental illness: systematic review. Psychiatr Bull. 2014;38(4):164–171. doi: 10.1192/pb.bp.112.041723.
    1. Casañas R, Gil JJ, Castells G, Pujol A, Torres M, Lalucat-Jo LL. Evaluación de un programa de alfabetización en salud mental para adolescentes. Rev Psiquiatr Salud Ment. 2017;30:105–114.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Wei Y, McGrath PJ, Hayden J, Kutcher S. Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review. BMC Psychiatry. 2015;15:291. doi: 10.1186/s12888-015-0681-9.
    1. Casañas R, Arfuch Mailen V, Castellvi P, Gil JJ, Torres M, Pujol A et al. Development and validation of a mental health knowledge questionnaire from the content of the school-based mental health literacy "" program [poster presentation]. In: 4rt International Conference On Youth Mental Health: Future- Proofing Youth Mental Health. Internacional Association for Youth Mental Health (IAYMH), 24-27 September 2017, Dublin.
    1. Website. Available from: Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C et al. Epidemiol. Psychiatr. Sci., 2011.
    1. Website. Available from: Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial Chisholm K, Patterson P, Torgerson C, Turner E, Jenkinson D, Birchwood M BMJ Open, 2016.
    1. Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophr Bull. 1981;7(2):225–240. doi: 10.1093/schbul/7.2.225.
    1. Ochoa S, Susana O, Francisco M-Z, Regina V-B, Oti A, Emma C-A, et al. Validación al castellano de la escala de estigma social: Community Attitudes towards Mental Illness en población adolescente. Rev Psiquiatr Salud Ment. 2016;9(3):150–157. doi: 10.1016/j.rpsm.2015.02.002.
    1. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x.
    1. Goodman R, Meltzer H, Bailey V. The strengths and difficulties questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry. 1998;7(3):125–130. doi: 10.1007/s007870050057.
    1. Goodman R. The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 1999;40(5):791–9.
    1. Niclasen J, Dammeyer J. Psychometric properties of the strengths and difficulties questionnaire and mental health problems among children with hearing loss. J Deaf Stud Deaf Educ. 2016;21(2):129–140. doi: 10.1093/deafed/env067.
    1. DiClemente CC, Prochaska JO. Self-change and therapy change of smoking behavior: a comparison of processes of change in cessation and maintenance. Addict Behav. 1982;7(2):133–142. doi: 10.1016/0306-4603(82)90038-7.
    1. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–395. doi: 10.1037/0022-006X.51.3.390.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Janssen MF, Simon Pickard A, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2012;22(7):1717–1727. doi: 10.1007/s11136-012-0322-4.
    1. Rickwood DJ. The effectiveness of seeking help for coping with personal problems in late adolescence. J Youth Adolesc. 1995;24(6):685–703. doi: 10.1007/BF01536951.
    1. Rickwood DT. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;173
    1. IBM Corp. Released 2010. IBM SPSS statistics for windows, version 19.0. Armonk: IBM Corp.

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