Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents.

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13-17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.

Engaging adolescent mothers in a longitudinal mental health intervention study: challenges and lessons learned.

Little is known about recruiting and retaining adolescent mothers in research studies. Investigators who study adolescent mothers have been guided by trial and error, clinical experience, qualitative inquiry, literature of special populations, or the advice of stakeholders. This paper describes the challenges and lessons learned in engaging adolescent mothers in a longitudinal community-based mental health intervention study. Audio-recorded data that describes the circumstances of five adolescent mothers lost to attrition were extracted from a longitudinal mental health intervention study. Adolescent mothers described a chaotic home environment with multiple demands, family conflict, health issues, limited access to a telephone, transportation, financial, and social support. Utilizing a multidisciplinary community advisory group, dedicated telephone, and free electronic media may assist in overcoming modifiable barriers to recruitment and retention of adolescent mothers. Exploring a waiver of informed consent and the engagement of mothers of adolescents in research are indicated.

How Adolescent Girls Understand and Manage Depression Within Their Peer Group: A Grounded Theory Investigation.

Depression is prevalent among adolescent girls, but few receive mental health treatment. Adolescent girls often forgo needed mental health treatment because they fear responses of peers about depression. Understanding the processes of how adolescent girls respond to peers with depression is an important first step to improve access to mental health treatment. This qualitative study describes the knowledge, perceptions, and behaviors of adolescent girls about depression and mental health treatment within their peer group. The investigators conducted two focus groups, with adolescent girls (n=21), in a public high school in the southern U.S. Grounded theory methods were utilized to identify a beginning substantive theory about perceptions and behaviors of adolescent girls related to depression in their peers. Participants cognitively processed mental health concepts similarly to adults. However, their affective responses to peers with mental illness fluctuated between adult and child perspectives. Participants expressed concerns about individuals with depression that have previously been identified in adults, but expressed unique perspectives that reflect their transitional stage of development. Findings provide new information about how adolescent girls respond to peers with depression, define areas for further investigation, provide directions for constructing developmentally appropriate mental health educational interventions for adolescent girls, and elucidate the need to provide guidance to women with whom adolescent girls have sustained contact.

Conceptual model of research to reduce stigma related to mental disorders in adolescents.

The purpose of this paper was to explicate an initial conceptual model that is amenable to testing and guiding anti-stigma interventions with adolescents. Multidisciplinary research and theoretical articles were reviewed and a conceptual model was developed. The conceptual model can guide anti-stigma interventions and should undergo testing and refinement in the future to reflect scientific advances in stigma reduction among adolescents. Use of a conceptual model enhances empirical evaluation of anti-stigma interventions, yielding a casual explanation for the intervention effects and enhancing clinical applicability of interventions across settings.

Reducing stigma related to mental disorders: initiatives, interventions, and recommendations for nursing.

Twenty percent of Americans suffer from mental disorders, but most do not receive treatment. Stigma is an important barrier to mental health treatment and recovery. This article aims to summarize current national initiatives to reduce stigma, clarify the current knowledge of stigma-reducing interventions, and provide recommendations to nurses on implementing and investigating stigma-reducing interventions.

Intention to seek depression treatment in adolescent mothers and a comparison group of adolescent girls.

The aims of the study were (a) to determine the efficacy of the theory of reasoned action in predicting intention to seek depression treatment in adolescent mothers (n = 64) and a comparison group of adolescent girls (n = 65) and (b) to explore the role of empirically suggested variables (e.g., social support and current symptoms of depression) in increasing the explanatory power of the model. Findings between the two groups differed. Subjective norms, but not attitude, was a significant predictor of intention to seek depression treatment in adolescent mothers (F = 4.82, P = .00; R(2) = .14). In the comparison group of adolescent girls, both attitude and subjective norms predicted intention to seek depression treatment (F = 8.56, P = .00, R(2) = .22). The addition of depressive symptoms and social support increased the explanatory power of the model in the comparison group of adolescent girls (R(2) change = 0.10, P = .02) but resulted in the deletion of subjective norms from the regression equation. Implications for further research and practice are discussed.

Analysis of popular press articles concerning postpartum depression: 1998-2006.

The purpose of the study was to analyze the content of popular press magazine articles that focused on postpartum depression, published from 1998-2006. Replicating earlier research by Martinez, Johnson-Robledo, Ulsh, and Chrisler, 2000, 47 articles were identified and their content analyzed in the areas of etiology, symptoms, treatment, resources, and demographic assumptions about readers. Popular press magazines contained contradictory information about the definition, prevalence, onset, duration, symptoms, and treatment of postpartum mood disorders. Health care providers should be proactive in directing childbearing women to factual sources of information on postpartum depression.

Testing a bioecological model to examine social support in postpartum adolescents.

PURPOSE: The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression. DESIGN: Cross-sectional design with convenience sampling (n=85) of adolescents at 4-6 weeks postpartum, recruited from two community hospitals. METHODS: Approval was received from the university's IRB (institutional review board), each recruitment site, the adolescent mothers, and their parents or guardians. Data were collected by a research assistant during home visits using a battery of self-report instruments to measure macro, meso, and microsystems of social support. Demographics, exposure to community violence (macrosystem), social support, social network (mesosystem), and perceived stress, mastery, and self-esteem (microsystem) were predictor variables. Depressive symptoms were measured by using the Center for Epidemiologic Studies of Depression (CES-D) Scale. FINDINGS: Variables from each system were significant predictors of depressive symptoms but perceived stress was the strongest predictor. Many postpartum adolescents reported that they had been victims of violence. Significant symptoms of depression were identified in 37% of the postpartum adolescents. CONCLUSIONS: Context is important to consider in comparing international studies of social support. Researchers and clinicians should investigate variables associated with the low incidence of treatment for depressive symptoms in postpartum adolescents. CLINICAL RELEVANCE: Feelings of high self-esteem and mastery should be fostered in nursing interventions with postpartum adolescents and routine screening for symptoms of depression should be considered in relevant healthcare settings.

Stigma towards mental illness: a concept analysis using postpartum depression as an exemplar.

Stigma towards mental illness is poorly understood, often unrecognized by nurses, and impacts both treatment seeking behavior and treatment adherence. Stigma towards mental illness is a serious issue in all cultures and ethnicities, and has a detrimental impact on an individual's functioning in all life domains. The aim of this analysis is to clarify the modern use of the concept of stigma towards mental illness, using the Walker and Avant concept analysis method, with postpartum depression as the exemplar. The second aim is to promote further dialogue about stigma in nursing. This analysis provides a foundation for further concept exploration in nursing, and generates hypotheses to be tested in various populations and circumstances. Nursing interventions, implications for research, and further concept development are discussed.

The impact of postpartum depression on mothering.

As a rule, mothers are the primary caregivers of infants regardless of employment or marital status. Thus, any factors that impact mothering affect the infant and have public health significance. National attention is now focused on postpartum depression, a major variable affecting mothering. The impact of postpartum depression on the various components of the maternal role is described. Recommendations for health care practice include screening for depression across the first postpartum year and developing a strong network for mental health referrals.