Understanding mental health promotion in organized leisure communities for young people: a realist review.

Introduction: A large proportion of young people reports poor mental health, which is a major public health concern. Positive mental health is important for young people's development, quality of life, functioning in everyday life, and long-term possibilities. Thus, there is a great need to develop and implement mental health-promoting initiatives and activities in young people's lives. Participating in organized leisure communities has a positive impact on mental health and wellbeing. However, more knowledge is still needed about why and how participating in organized leisure communities targeting young people can promote mental health. The aim of this study was to gain knowledge about the mental health-promoting potential of organized leisure communities for young people by exploring the active ingredients that contribute to mental health promotion. Method: Given the complexity of the subject, this study implemented a realist review approach to explore the interaction between context, mechanism, and outcome. The study follows Pawsons' five key steps for conducting a realist review: (1) clarify scope, (2) search for evidence, (3) study selection criteria, and procedures, (4) data extraction, and (5) data synthesis and analysis. The literature was systematically searched in the four databases PsycINFO, Scopus, Embase, and SocIndex. Results: In the literature search, a total of 11,249 studies were identified, of which 52 studies met the inclusion criteria. Based on the 52 studies, seven different contexts i.e., types of organized leisure communities for young peoples were identified. Across the seven different types of organized leisure communities, five active ingredients that promoted the mental health of young people were identified: social connectedness, development of skills, development of self-confidence, pleasure-driven participation, and safety and trust. Conclusion: This review contributes important knowledge about how to promote young people's mental health when participating in organized leisure communities. Moving forward, an important task consists of establishing and maintaining the five active ingredients in organized leisure communities through e.g., education and training that strengthens the skills and knowledge of those responsible for facilitating the leisure communities, such as sports coaches or music teachers, as these adults play a central role in supporting the active ingredients.

Implementing a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark.

BACKGROUND: Depressive and anxiety disorders share major risk factors and can often be effectively prevented or treated with similar interventions. However, less than half of young people with mental health problems seek professional help and hence innovative approaches to support this group are needed. To this end Coping with Anxiety and Depression shows promise. The aim of this paper was to evaluate the implementation of Coping with Anxiety and Depression for young people aged 15-25 years showing symptoms of anxiety and/or depression in a Danish community setting. METHODS: The programme was implemented in 39 Danish municipalities. To evaluate the implementation of the programme, we collected quantitative and qualitative data simultaneously and subsequently we triangulated it in the data analysis. The qualitative data collection comprised semi-structured interviews in seven case municipalities. In each municipality we conducted interviews with a local municipality coordinator of the program, a group interview with two voluntary instructors facilitating the program and a group interview with two to seven participants in the programme. In total, seven local coordinators, 14 voluntary instructors and 23 participants (8 men and 15 women) were interviewed. We also carried out a baseline and post-intervention survey. Interview data was coded via an inductive and deductive analysis approach. Survey data was analysed via descriptive statistics in the statistical software programme STATA 16. RESULTS: The evaluation showed that the implementation of the programme is feasible, and that most participants (83%) were satisfied with the programme to a high/very high extent. In total, 84% of the participants strongly agreed/agreed that it was advantageous that instructors themselves had experience with anxiety and depression. Qualitative data showed that the participants were very positive about the group format. It also showed that recruitment and retention of participants and especially young instructors were challenging but doable. Thus our findings suggest that the programme can be implemented in a way that is perceived as useful and satisfying to young people. CONCLUSIONS: Coping with Anxiety and Depression constitutes a feasible peer-to-peer, group-based community programme that is well-received by its target group. Recruitment and retention of participants and instructors is challenging but doable.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review.

BACKGROUND: Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS: We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS: A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS: The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

The Satisfaction with Life Scale: Philosophical Foundation and Practical Limitations.

Research and policymaking on positive mental health and well-being have increased within the last decade, partly fueled by decreasing levels of well-being in the general population and among at-risk groups. However, measurement of well-being often takes place in the absence of reflection on the underlying theoretical conceptualization of well-being. This disguises the fact that different rating scales of well-being often measure very different phenomena because rating scales are based on different philosophical assumptions, which represent radically different foundational views about the nature of well-being. The aim of this paper is to examine the philosophical foundation of the Satisfaction with Life Scale (SWLS) in order to clarify the underlying normative commitments and the psychometric compromises involved in the translation of theory into practice. SWLS is widely used by psychologists, public health professionals, economists, and is popular in national and international surveys of well-being. This paper introduces the philosophical theory of life satisfaction and explores how three central discussions within life satisfaction theory are reflected in the construction of the SWLS; (1) Whether we should be equally satisfied with our past, present and future, (2) Whether we should be satisfied with all the various domains of our lives, and (3) How to avoid the trap of "false consciousness", i.e. that people fail to recognize the injustice or misfortune of their lives. In the end, life satisfaction theory is contrasted with affective foundational theories of well-being, to explore the magnitude and limits of SWLS as a rating scale based on life satisfaction theory.

The Well-Being Index WHO-5: hedonistic foundation and practical limitations.

Research and policymaking on positive mental health and well-being have increased within the last decade, partly fueled by decreasing levels of well-being in the general population and among at-risk groups. However, measurement of well-being often takes place in the absence of reflection on the underlying theoretical conceptualisation of well-being. This disguises the fact that different rating scales of well-being often measure very different phenomena because rating scales are based on different philosophical assumptions, which represent radically different foundational views about the nature of well-being. The aim of this paper is to examine the philosophical foundation of the Well-Being Index WHO-5 in order to clarify the underlying normative commitments and the psychometric compromises involved in the translation of philosophical theory into practice. WHO-5 has been introduced as a rating scale that measures the affective and hedonistic dimensions of well-being. It is widely used within public health and mental health research. This paper introduces the philosophical theory of Hedonism and explores how two central assumptions that relate to hedonistic theory are reflected in the construction of WHO-5. The first concerns 'the hedonic balance', that is the relation between positive and negative emotions. The second assumption concerns 'the value of emotions', that is, how to determine the duration and intensity of emotions. At the end, Hedonism is contrasted with Life Satisfaction Theory, an alternative foundational theory of well-being, in order to clarify that the outlook of WHO-5 is more a rating system of positive affect than a cognitive judgement of overall life satisfaction. We conclude that it is important to examine the philosophical foundation of rating scales of well-being, such as WHO-5, in order to be fully able to assess the magnitude as well as the limits of their results.

Addressing organizational barriers to continuity of care in the Danish mental health system - a comparative analysis of 14 national intervention projects.

BACKGROUND: Continuity of mental health care is central to improve the conditions of people with enduring mental disorders. In Denmark, several government-funded projects on the improvement of continuity of mental health care have been initiated since 2009. AIM: The aim of this study was to investigate how national intervention projects on continuity of mental health care have addressed major barriers for continuity of care and extract general learning points from the projects on the improvement of continuity of care. METHOD: The study was designed as a thematic document analysis of external evaluations of 14 major national projects on the improvement of continuity of routine mental health care from 2009 to 2017. The data material was processed through thematic coding and comparative analysis. RESULTS: The analysis was organized around four main barriers for continuity: Lack of models for collaboration, different professional cultures and methods, lack of channels of communication, and intersectoral differences in management, economy, and legislation. The first three barriers were addressed in a predominant part of the projects through development of collaborative models, common tools and communication systems. The latter structural barrier was not addressed in any of the projects. CONCLUSION: There is an ongoing need to address barriers for continuity of mental health care. So far, there has been a much larger focus on organizational, cultural and communicational aspects of continuity than on structural aspects. The study calls for an increased focus on how changes in existing managerial, economic and legislative structures can improve continuity of care.