Effects of a classroom‐based educational resource on adolescent mental health literacy: A cluster randomised controlled trial
Abstract
Evidence suggests that poor mental health literacy is a key barrier to help‐seeking for mental health difficulties in adolescence. Educational programs have shown positive effects on literacy, however, the evidence base remains limited and available studies have many methodological limitations. Using cluster Randomised Control Trial (RCT) methodology, the current study examines the impact of ‘HeadStrong’, a school‐based educational intervention, on mental health literacy, stigma, help‐seeking, psychological distress and suicidal ideation. A total of 380 students in 22 classes (clusters) from 10 non‐government secondary schools was randomised to receive either HeadStrong or Personal Development, Health and Physical Education (PDHPE) classes. Participants were assessed pre‐ and post‐intervention, and at 6‐month follow‐up. Literacy improved and stigma reduced in both groups at post‐intervention and follow‐up, relative to baseline. However, these effects were significantly greater in the HeadStrong condition. The study demonstrates the potential of HeadStrong to improve mental health literacy and reduce stigma.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Five studies developed programmes based on the notion that promoting mental health awareness could enhance mental health literacy and promote help-seeking.
“Five studies developed programmes based on the notion that promoting mental health awareness could enhance mental health literacy and promote help-seeking [84–88].”
Teacher's support and engagement with the intervention were also described as a barrier in the implementation process for some studies.
“Teacher’s support and engagement with the intervention were also described as a barrier in the implementation process for some studies [85, 93, 114].”
Educational settings have a central role in promoting mental health, recognising warning signs of mental ill health, and delivering prevention and intervention programmes.
“Educational settings have a central role in promoting mental health, 329,330 recognising the warning signs of mental ill health, 331 and delivering prevention and intervention programmes.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [329]
Cites
Lovibond, P. F., & Lovibond, S. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00075-u · Cited by 14,523 · see citing works
Cohen, J. (1992) · Psychological Bulletin · doi:10.1037//0033-2909.112.1.155 · Cited by 8,771 · see citing works
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-113 · Cited by 3,292 · see citing works
Self-citationJorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997) · Medical Journal of Australia · doi:10.5694/j.1326-5377.1997.tb140071.x · Cited by 2,585 · see citing works
Self-citationMental health literacy: Public knowledge and beliefs about mental disorders
Jorm, A. F. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.5.396 · Cited by 2,114 · see citing works
Challenging the public stigma of mental illness: a meta-analysis of outcome studies
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100529 · Cited by 1,680 · see citing works
Social consequences of psychiatric disorders, I: Educational attainment
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.7.1026 · Cited by 1,370 · see citing works
On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change
Corrigan, P. W., & Rao, D. (2012) · The Canadian Journal of Psychiatry · doi:10.1177/070674371205700804 · Cited by 1,208 · see citing works
Mackenzie, C. S., Gekoski, W. L., & Knox, V. J. (2006) · Aging & Mental Health · doi:10.1080/13607860600641200 · Cited by 878 · see citing works
Griffiths, K. M., Christensen, H., Jorm, A. F., Evans, K., & Groves, C. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.185.4.342 · Cited by 789 · see citing works
Self-citationImproving mental health literacy as a strategy to facilitate early intervention for mental disorders
Kelly, C. M., Jorm, A. F., & Wright, A. (2007) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2007.tb01332.x · Cited by 598 · see citing works
Psychoeducation for depression, anxiety and psychological distress: a meta-analysis
Donker, T., Griffiths, K. M., Cuijpers, P., & Christensen, H. (2009) · BMC Medicine · doi:10.1186/1741-7015-7-79 · Cited by 542 · see citing works
Self-citationEvans-Lacko, S. E., Brohan, E., Mojtabai, R., & Thornicroft, G. (2011) · Psychological Medicine · doi:10.1017/s0033291711002558 · Cited by 433 · see citing works
Stigma and discrimination limit access to mental health care
Thornicroft, G. (2008) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00002621 · Cited by 432 · cited 1× · see citing works
“Poor literacy is associatedwith lower rates of help-seeking and service use, as well as societal stigma and discriminatory behaviour (Evans-Lacko, Brohan, Mojtabai, & Thornicroft, 2012; Rusch, Evans-Lacko, Henderson, Flach, & Thornicroft, 2011; Thornicroft, 2008).”
BackgroundReducing the treatment gap for mental disorders: a WPA survey
PATEL, V., MAJ, M., FLISHER, A. J., DE SILVA, M. J., KOSCHORKE, M., PRINCE, M., WPA Zonal and Member Society Representatives, Tempier, R., Riba, M., Sanchez, M., et al. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00305.x · Cited by 420 · see citing works
Szabó, M. (2010) · Journal of Adolescence · doi:10.1016/j.adolescence.2009.05.014 · Cited by 400 · see citing works
Adolescent mental health literacy: Young people's knowledge of depression and help seeking
Burns, J. R., & Rapee, R. M. (2005) · Journal of Adolescence · doi:10.1016/j.adolescence.2005.05.004 · Cited by 395 · see citing works
Mackenzie, C. S., Knox, V. J., Gekoski, W. L., & Macaulay, H. L. (2004) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2004.tb01984.x · Cited by 368 · see citing works
Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M., & O'Kearney, R. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0017391 · Cited by 327 · see citing works
Self-citationHow Adolescents Perceive the Stigma of Mental Illness and Alcohol Abuse
Corrigan, P. W., Lurie, B. D., Goldman, H. H., Slopen, N. B., Medasani, K., & Phelan, S. M. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.5.544 · Cited by 309 · see citing works
Reavley, N. J., & Jorm, A. F. (2011) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2011.621061 · Cited by 298 · see citing works
Preventing adolescent depression: An evaluation of the Problem Solving For Life program.
Spence, S. H., Sheffield, J. K., & Donovan, C. L. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.1.3 · Cited by 282 · see citing works
Knowledge and Attitudes as Predictors of Intentions to Seek Help for and Disclose a Mental Illness
Rüsch, N., Evans-Lacko, S. E., Henderson, C., Flach, C., & Thornicroft, G. (2011) · Psychiatric Services · doi:10.1176/ps.62.6.pss6206_0675 · Cited by 246 · see citing works
Sample size calculator for cluster randomized trials
Campbell, M., Thomson, S., Ramsay, C. R., MacLennan, G., & Grimshaw, J. (2003) · Computers in Biology and Medicine · doi:10.1016/s0010-4825(03)00039-8 · Cited by 221 · see citing works
Pinto, M. D., Logsdon, M. C., & Myers, J. A. (2011) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.04.006 · Cited by 203 · see citing works
Reavley, N. J., Cvetkovski, S., Jorm, A. F., & Lubman, D. I. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003705458 · Cited by 185 · see citing works
Esters, I. G., Cooker, P. G., & Ittenbach, R. F. (1998) · PubMed · Cited by 138 · see citing works
Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan
Rahman, A., Mubbashar, M. H., Gater, R. A., & Goldberg, D. (1998) · The Lancet · doi:10.1016/s0140-6736(98)02381-2 · Cited by 138 · see citing works
Yap, M. B. H., Mackinnon, A. J., Reavley, N. J., & Jorm, A. F. (2014) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1433 · Cited by 135 · see citing works
Personal and perceived depression stigma in Australian adolescents: Magnitude and predictors
Calear, A. L., Griffiths, K. M., & Christensen, H. M. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.08.019 · Cited by 130 · see citing works
Self-citationRitterfeld, U., & Jin, S. A. (2006) · Journal of Health Psychology · doi:10.1177/1359105306061185 · Cited by 119 · see citing works
Conner, K. O., Lee, B. A., Mayers, V., Robinson, D., Reynolds, C. F., Albert, S. M., & Brown, C. (2010) · Journal of Aging Studies · doi:10.1016/j.jaging.2010.05.007 · Cited by 113 · see citing works
Thoughts of Death and Suicide in Early Adolescence
Stoep, A. V., McCauley, E., Flynn, C., & Stone, A. L. (2009) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2009.39.6.599 · Cited by 88 · see citing works
HAN, D., CHEN, S., HWANG, K., & WEI, H. (2006) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2006.01580.x · Cited by 76 · see citing works
Yap, M. B. H., & Jorm, A. F. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.039 · Cited by 68 · see citing works
Yap, M. B. H., Reavley, N. J., & Jorm, A. F. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.08.029 · Cited by 68 · see citing works
Evaluation of a Mental Illness Awareness Week program in public schools
Battaglia, J., Coverdale, J., & Bushong, C. P. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.3.324 · Cited by 63 · see citing works
(2009)
Flagged first, then by citations
Cited by
Sorted by citations
Aguirre Velasco, A., Cruz, I. S. S., Billings, J., Jimenez, M., & Rowe, S. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02659-0 · Cited by 736 · see citing works
“Teacher’s support and engagement with the intervention were also described as a barrier in the implementation process for some studies [85, 93, 114].”
The Lancet Psychiatry Commission on youth mental health
McGorry, P. D., Mei, C., Dalal, N., Alvarez-Jimenez, M., Blakemore, S.-J., Browne, V., Dooley, B., Hickie, I. B., Jones, P. B., McDaid, D., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00163-9 · Cited by 663 · see citing works
Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., Amray, A. N., Shah, Z., & Naveed, S. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09751-4 · Cited by 176 · see citing works
Kutcher, S., Wei, Y., & Morgan, C. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506001209 · Cited by 145 · see citing works
‘teen Mental Health First Aid’: a description of the program and an initial evaluation
Hart, L. M., Mason, R. J., Kelly, C. M., Cvetkovski, S., & Jorm, A. F. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0034-1 · Cited by 118 · see citing works
Amado-Rodríguez, I. D., Casañas, R., Mas-Expósito, L., Castellví, P., Roldan-Merino, J. F., Casas, I., Lalucat-Jo, L., & Fernández-San Martín, M. I. (2022) · Children · doi:10.3390/children9040480 · Cited by 112 · see citing works
Patafio, B., Miller, P., Baldwin, R., Taylor, N., & Hyder, S. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13109 · Cited by 84 · see citing works
Help-Seeking Measures and Their Use in Adolescents: A Systematic Review
Divin, N., Harper, P., Curran, E., Corry, D., & Leavey, G. (2018) · Adolescent Research Review · doi:10.1007/s40894-017-0078-8 · Cited by 83 · see citing works
Johnco, C., & Rapee, R. M. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.08.062 · Cited by 84 · see citing works
Gijzen, M. W. M., Rasing, S. P. A., Creemers, D. H. M., Engels, R. C. M. E., & Smit, F. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.062 · Cited by 61 · see citing works
Walsh, E. H., Herring, M. P., & McMahon, J. (2023) · Prevention Science · doi:10.1007/s11121-022-01449-2 · Cited by 50 · see citing works
Werlen, L., Gjukaj, D., Mohler-Kuo, M., & Puhan, M. A. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000544 · Cited by 45 · see citing works
Clough, B. A., Nazareth, S. M., & Casey, L. M. (2020) · British Journal of Guidance & Counselling · doi:10.1080/03069885.2019.1673312 · Cited by 30 · see citing works
- Authors
- Perry, Y., Petrie, K., Buckley, H., Cavanagh, L., Clarke, D., Winslade, M., Hadzi‐Pavlovic, D., Manicavasagar, V., & Christensen, H.
- Affiliations
- Prince of Wales Hospital (AU)
- Charles Sturt University (AU)
- Black Dog Institute Hospital Rd Prince of Wales Hospital Randwick NSW 2031 Australia
- Corresponding author
- Perry, Yael
- ORCID
- Venue
- Journal of Adolescence
- Publisher
- Wiley
- Published
- 2014-08-25
- Volume
- 37
- Issue
- 7
- Pages
- 1143-1151
- ISSN
- 0140-1971 (ISSN-L)
- 1095-9254
- OpenAlex
- W2109557614
- Cited by
- 167
- References
- 38
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 14 · 2023: 22 · 2022: 22 · 2021: 22 · 2020: 24 · 2019: 13 · 2018: 10 · 2017: 7 · 2016: 5 · 2015: 9
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Adolescence (publishedVersion)
- PubMed (publishedVersion)
- Funders
- nib Foundation
- National Health and Medical Research Council (1056964)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- mental health literacy, adolescent mental health, school-based educational intervention, mental health stigma, help-seeking, psychological distress, suicidal ideation, high school students, mental health education
- MeSH terms
- Adolescent, Attitude to Health, Female, Health Education, Humans, Male, Mental Health, Patient Acceptance of Health Care, Stereotyping, Health Literacy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
