Youth Well being in China & Central America: Implementation of an integrated prevention and intervention program

Background

Mental illnesses and addictions often have onset in childhood and adolescence, with greatest frequency in the 15-24 year age group. Global estimates are that 10-20% of youth under age 25 years will experience a mental illness or addiction. Depression, anxiety and substance use disorders are among the most common of these conditions, and are often complicated by increased risk of suicidality. Left untreated, these conditions tend to become chronic conditions in adulthood, and are associated with higher rates of impaired academic, occupational and interpersonal functioning, job loss, physical illness, poor quality of life, morbidity and mortality.

Honduras and El Salvador are LMICs with populations of 8.8 and 6.1 million, respectively. About 50% of the inhabitants in both countries are under the age of 25-35. Like many Central American countries, Honduras and El Salvador have long histories of political instability, civil wars, frequent natural disasters, high rates of violence, and poverty. The collective impact of these factors on mental health is significant, particularly in youth. Although prevalence studies are few, high rates of depression (32%) and suicidality (13%) have been reported in adolescents in El Salvador, and significant psychological distress and stress in Honduran youth affected by political repression and natural disasters.

High rates of mental illness and addiction (often associated with self-harm) have been reported in China and Central America. Stigma, poor mental health knowledge, and limited awareness and/or accessibility to health services lead to low help-seeking, further compounding the problem. Thus, there is an urgent need for strategies to promote mental health knowledge to enable early identification and treatment and to improve help-seeking behaviour.

Aims

The aim of this 5-year project was to implement and evaluate a multi-level, integrated mental health education, screening, and intervention program to improve functioning and well-being in youth in China, Honduras and El Salvador.

Project plan

About 5000 students in China, 2000 students in Honduras and 2000 students in El Salvador were recruited. Participants received a 12-week mental wellness and leadership program (MWL) online (at universities) or in class (at vocational/technical schools). Curriculum topics will include mental health education (illness and stigma, help-seeking, stress management), social responsibility (prejudice, violence, gender-based violence), and leadership (values, skills). Students were to be assessed on psychosocial function (e.g. distress, coping, stress, academic performance) and physiological measures of stress (saliva and hair cortisol) before and after MWL completion.

An open-access phone app was to be created to screen for emotional difficulties and addictive behaviours and will be available to MWL and non-MWL students. Those students who screen positive for significant emotional difficulties, as well as those with depression, anxiety and/or addictive behaviours who are referred by health professionals, were yp receive one of two forms of an 8-week internet-based cognitive-behavioural therapy (iCBT) program. The iCBT emotional well-being program targeted mood and anxiety symptoms, and the iCBT addictions program targeted substance abuse (including alcohol and tobacco) and problematic internet use. Students were to be assessed on symptom and functional improvement as well as on physiological measures of stress before and after program completion.

This project offered the opportunity to implement and evaluate the broad benefits of a novel integrated prevention and psychological intervention program for youth in culturally differing regions. The program as to be adapted and incorporated into existing postsecondary institutions in the three countries with measurement of cross-cultural acceptability, efficacy, fidelity of implementation, and sustainability. It is proposed that the project will improve the mental wellness of transitional youth with good sustainability in two distinct global regions, and furthermore, it offers an opportunity to objectively evaluate to cost and benefit of this implementation.

Impact

The project implemented a peer-based approach, training senior university students to deliver the intervention to first year students and help identify those who may need additional mental health support. Peer-to-peer teaching and mentoring has proven to be beneficial, as students are more inclined to seek advice from peers with similar life experiences versus seeking professional help. Evidence from the project showed that peer-to-peer teaching and mentoring is relatively easy to implement and sustain since it is contained within the university environment.

Funding organisations

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