Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial

Amelia Gulliver, Kathleen M Griffiths, Helen Christensen, Andrew Mackinnon, Alison L Calear, Alison Parsons, Kylie Bennett, Philip J Batterham, Rosanna Stanimirovic, Amelia Gulliver, Kathleen M Griffiths, Helen Christensen, Andrew Mackinnon, Alison L Calear, Alison Parsons, Kylie Bennett, Philip J Batterham, Rosanna Stanimirovic

Abstract

Background: Mental disorders are more common in young adults than at any other life stage. Despite this, young people have low rates of seeking professional help for mental health problems. Young elite athletes have less positive attitudes toward seeking help than nonathletes and thus may be particularly unlikely to seek help. Interventions aimed at increasing help-seeking in young elite athletes are warranted.

Objective: To test the feasibility and efficacy of three Internet-based interventions designed to increase mental health help-seeking attitudes, intentions, and behavior in young elite athletes compared with a control condition.

Methods: We conducted a randomized controlled trial (RCT) of three brief fully automated Internet-based mental health help-seeking interventions with 59 young elite athletes recruited online in a closed trial in Australia. The interventions consisted of a mental health literacy and destigmatization condition, a feedback condition providing symptom levels, and a minimal content condition comprising a list of help-seeking resources, compared with a control condition (no intervention). We measured help-seeking attitudes, intentions and behavior using self-assessed surveys. Participation was open to elite athletes regardless of their mental health status or risk of mental illness.

Results: Of 120 athletes initially agreeing to participate, 59 (49%) submitted a preintervention or postintervention survey, or both, and were included in the present study. Adherence was satisfactory, with 48 (81%) participants visiting both weeks of assigned intervention material. None of the interventions yielded a significant increase in help-seeking attitudes, intentions, or behavior relative to control. However, at postintervention, there was a trend toward a greater increase in help-seeking behavior from formal sources for the mental health literacy/destigmatization condition compared with control (P = .06). This intervention was also associated with increased depression literacy (P = .003, P = .005) and anxiety literacy (P = .002, P = .001) relative to control at postintervention and 3-month follow-up, respectively, and a reduction in depression stigma relative to control at postintervention (P = .01, P = .12) and anxiety stigma at 3-month follow-up (P = .18, P = .02). The feedback and help-seeking list interventions did not improve depression or anxiety literacy or decrease stigmatizing attitudes to these conditions. However, the study findings should be treated with caution. Due to recruitment challenges, the achieved sample size fell significantly short of the target size and the study was underpowered. Accordingly, the results should be considered as providing preliminary pilot data only.

Conclusions: This is the first RCT of an Internet-based mental health help-seeking intervention for young elite athletes. The results suggest that brief mental health literacy and destigmatization improves knowledge and may decrease stigma but does not increase help-seeking. However, since the trial was underpowered, a larger trial is warranted.

Trial registration: 2009/373 (www.clinicaltrials.gov ID: NCT00940732), cited at http://www.webcitation.org/5ymsRLy9r.

Conflict of interest statement

The present study authors developed the TEAMS online interventions but derived no personal or financial benefit from their operation.

Figures

Figure 1
Figure 1
Flow of participants through the trial. AIS = Australian Institute of Sport; CEO = chief executive officer; RCT = randomized controlled trial.

References

    1. Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety. 2002;16(4):162–71. doi: 10.1002/da.10065.
    1. Andrews G, Issakidis C, Carter G. Shortfall in mental health service utilisation. Br J Psychiatry. 2001 Nov;179:417–25.
    1. Anonymous Australian Bureau of Statistics. 2008. Oct 23, [2012-04-25]. 4326.0: National Survey of Mental Health and Wellbeing: Summary of Results, 2007 .
    1. King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, Bellón-Saameño JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, de Almeida MC, Correa B, Torres-Gonzalez F. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry. 2008 May;192(5):362–7. doi: 10.1192/bjp.bp.107.039966. 192/5/362
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617–27. doi: 10.1001/archpsyc.62.6.617. 62/6/617
    1. Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust. 2007 Oct 1;187(7 Suppl):S35–9. ric10279_fm
    1. Yang J, Peek-Asa C, Corlette JD, Cheng G, Foster DT, Albright J. Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clin J Sport Med. 2007 Nov;17(6):481–7. doi: 10.1097/JSM.0b013e31815aed6b.00042752-200711000-00008
    1. Watson J. College student-athletes’ attitudes toward help-seeking behavior and expectations of counseling services. J Coll Stud Dev. 2005;46(4):442–9.
    1. Komiti A, Judd F, Jackson H. The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context. Soc Psychiatry Psychiatr Epidemiol. 2006 Sep;41(9):738–45. doi: 10.1007/s00127-006-0089-4.
    1. Kushner M, Sher K. The relation of treatment fearfulness and psychological service utilization: an overview. Prof Psychol Res Pr. 1991 Sep;22(3):196–203. doi: 10.1037/0735-7028.22.3.196.
    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. 1471-244X-10-113
    1. Buckley GI, Malouff JM. Using modeling and vicarious reinforcement to produce more positive attitudes toward mental health treatment. J Psychol. 2005 May;139(3):197–209.
    1. Donohue B, Dickens Y, Lancer K, Covassin T, Hash A, Miller A, Genet J. Improving athletes' perspectives of sport psychology consultation: a controlled evaluation of two interview methods. Behav Modif. 2004 Mar;28(2):182–93. doi: 10.1177/0145445503259399.
    1. Sharp W, Hargrove D, Johnson L, Deal W. Help-seeking and mental health education: an evaluation of a classroom-based strategy to modify help-seeking for mental health problems. J Coll Stud Dev. 2006;47(4):419–38.
    1. Han DY, Chen SH, Hwang KK, Wei HL. Effects of psychoeducation for depression on help-seeking willingness: biological attribution versus destigmatization. Psychiatry Clin Neurosci. 2006 Dec;60(6):662–8. doi: 10.1111/j.1440-1819.2006.01580.x.PCN1580
    1. Christensen H, Leach LS, Barney L, Mackinnon AJ, Griffiths KM. The effect of web based depression interventions on self reported help seeking: randomised controlled trial [ISRCTN77824516] BMC Psychiatry. 2006;6:13. doi: 10.1186/1471-244X-6-13. 1471-244X-6-13
    1. Costin DL, Mackinnon AJ, Griffiths KM, Batterham PJ, Bennett AJ, Bennett K, Christensen H. Health e-cards as a means of encouraging help seeking for depression among young adults: randomized controlled trial. J Med Internet Res. 2009;11(4):e42. doi: 10.2196/jmir.1294. v11i4e42
    1. Rickwood D, Deane F, Wilson C, Ciarrochi J. Young people’s help-seeking for mental health problems. Adv Ment Health. 2005;4(3):218–51. doi: 10.5172/jamh.4.3.218.
    1. Gerhards SA, de Graaf LE, Jacobs LE, Severens JL, Huibers MJ, Arntz A, Riper H, Widdershoven G, Metsemakers JF, Evers SM. Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Br J Psychiatry. 2010 Apr;196(4):310–8. doi: 10.1192/bjp.bp.109.065748. 196/4/310
    1. Mihalopoulos C, Kiropoulos L, Shih ST, Gunn J, Blashki G, Meadows G. Exploratory economic analyses of two primary care mental health projects: implications for sustainability. Med J Aust. 2005 Nov 21;183(10 Suppl):S73–6. mih10602_fm
    1. Napolitano MA, Marcus BH. Targeting and tailoring physical activity information using print and information technologies. Exerc Sport Sci Rev. 2002 Jul;30(3):122–8.
    1. Muñoz RF. Using evidence-based internet interventions to reduce health disparities worldwide. J Med Internet Res. 2010;12(5):e60. doi: 10.2196/jmir.1463. v12i5e60
    1. Fridrici M, Lohaus A, Glass C. Effects of incentives in web-based prevention for adolescents: Results of an exploratory field study. Psychol Health. 2009 Jul;24(6):663–75. doi: 10.1080/08870440802521102.905683267
    1. Christensen H, Griffiths K, Groves C. MoodGYM Training Program: Clinician's Manual. Canberra: Centre for Mental Health Research; 2004.
    1. Jorm AF, Dear KB, Rodgers B, Christensen H. Interaction between mother's and father's affection as a risk factor for anxiety and depression symptoms--evidence for increased risk in adults who rate their father as having been more affectionate than their mother. Soc Psychiatry Psychiatr Epidemiol. 2003 Apr;38(4):173–9. doi: 10.1007/s00127-003-0620-9.
    1. Dijkstra A. Working mechanisms of computer-tailored health education: evidence from smoking cessation. Health Educ Res. 2005 Oct;20(5):527–39. doi: 10.1093/her/cyh014. cyh014
    1. Bewick BM, West R, Gill J, O'May F, Mulhern B, Barkham M, Hill AJ. Providing web-based feedback and social norms information to reduce student alcohol intake: a multisite investigation. J Med Internet Res. 2010;12(5):e59. doi: 10.2196/jmir.1461. v12i5e59
    1. Burgess SW, Sly PD, Devadason SG. Providing feedback on adherence increases use of preventive medication by asthmatic children. J Asthma. 2010 Mar;47(2):198–201. doi: 10.3109/02770900903483840.
    1. Rinfret S, Lussier MT, Peirce A, Duhamel F, Cossette S, Lalonde L, Tremblay C, Guertin MC, LeLorier J, Turgeon J, Hamet P, LOYAL Study Investigators The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care. Circ Cardiovasc Qual Outcomes. 2009 May;2(3):170–7. doi: 10.1161/CIRCOUTCOMES.108.823765. CIRCOUTCOMES.108.823765
    1. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction. 1993 Mar;88(3):315–35.
    1. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002 Aug;32(6):959–76.
    1. Wilson C, Deane F, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: properties of the General Help-Seeking Questionnaire. Can J Couns. 2005;39(1):15–28.
    1. Fischer EH, Farina A. Attitudes toward seeking professional psychological help: a shortened form and considerations for research. J Coll Stud Dev. 1995;36(4):368–73.
    1. Elhai JD, Schweinle W, Anderson SM. Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form. Psychiatry Res. 2008 Jun 30;159(3):320–9. doi: 10.1016/j.psychres.2007.04.020.S0165-1781(07)00144-8
    1. Hackler A. Attitudes toward seeking professional help for an eating disorder: the role of stigma and anticipated outcomes. J Couns Dev. 2010;88(4):424–31.
    1. Chang HW. Help-seeking for stressful events among Chinese college students in Taiwan: roles of gender, prior history of counseling, and help-seeking attitudes. J Coll Stud Dev. 2008;49(1):41–51.
    1. Deane FP, Wilson CJ, Ciarrochi J. Suicidal ideation and help-negation: Not just hopelessness or prior help. J Clin Psychol. 2001 Jul;57(7):901–14.10.1002/jclp.1058
    1. Deane FP, Wilson CJ. University of Wollongong. 2007. Oct 2, [2009-06-09]. Considerations for Specifying Problem-Types, Help-Sources and Scoring the General Help-seeking Questionnaire (GHSQ) .
    1. Rickwood D, Cavanagh S, Curtis L, Sakrouge R. Educating young people about mental health and mental illness: evaluating a school-based programme. Int J Ment Health Promot. 2004;6(4):23–32.
    1. Rickwood DJ, Braithwaite VA. Social-psychological factors affecting help-seeking for emotional problems. Soc Sci Med. 1994 Aug;39(4):563–72.
    1. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004 Oct;185:342–9. doi: 10.1192/bjp.185.4.342. 185/4/342
    1. Kiropoulos LA, Griffiths KM, Blashki G. Effects of a multilingual information website intervention on the levels of depression literacy and depression-related stigma in Greek-born and Italian-born immigrants living in Australia: a randomized controlled trial. J Med Internet Res. 2011;13(2):e34. doi: 10.2196/jmir.1527. v13i2e34
    1. Griffiths KM, Batterham PJ, Barney L, Parsons A. The Generalised Anxiety Stigma Scale (GASS): psychometric properties in a community sample. BMC Psychiatry. 2011;11:184. doi: 10.1186/1471-244X-11-184. 1471-244X-11-184
    1. Griffiths KM, Christensen H, Jorm AF. Predictors of depression stigma. BMC Psychiatry. 2008;8:25. doi: 10.1186/1471-244X-8-25. 1471-244X-8-25
    1. Gueorguieva R, Krystal JH. Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry. 2004 Mar;61(3):310–7. doi: 10.1001/archpsyc.61.3.310.61/3/310
    1. Hamer RM, Simpson PM. Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials. Am J Psychiatry. 2009 Jun;166(6):639–41. doi: 10.1176/appi.ajp.2009.09040458.166/6/639
    1. Hedges L, Olkin I. Statistical Methods for Meta-Analysis. Orlando, FL: Academic Press; 1985.
    1. Mackenzie CS, Gekoski WL, Knox VJ. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health. 2006 Nov;10(6):574–82. doi: 10.1080/13607860600641200.M0222V7376P5M826
    1. Kelly CM, Jorm AF, Wright A. Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust. 2007 Oct 1;187(7 Suppl):S26–30. kel10278_fm
    1. Barney LJ, Griffiths KM, Christensen H, Jorm AF. Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma. BMC Public Health. 2009;9:61. doi: 10.1186/1471-2458-9-61. 1471-2458-9-61
    1. Barney LJ, Griffiths KM, Jorm AF, Christensen H. Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry. 2006 Jan;40(1):51–4. doi: 10.1111/j.1440-1614.2006.01741.x. ANP1741

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever