RESUMO
Action learning is a promising approach for building mental health promotion (MHP) capacity. The aim of this study is to explore how action learning processes can strengthen MHP capacity within and across organizations in a community setting. We applied an embedded case study design and a realist evaluation framework to explore key combinations of mechanisms and contextual factors that generated the emergent MHP capacity outcomes of an action learning program, i.e. context-mechanism-outcome-configurations (CMO-configurations). Data consisted of 18 semi-structured face-to-face interviews, 10 telephone interviews, two group interviews, observations, and documents. Interviewees (n = 21) were participants and management employees. Our analytical provision of CMO-configurations provides insights into how contextual factors, such as participant motivation, organizational support, and existing task descriptions, in combination with certain program mechanisms, such as legitimization of specific agendas, learning-by-doing, and collaborations across organizational boundaries, explain the identified outcomes. Outcomes ranged across implementation of MHP initiatives, personal development among participants, and relational and collaborative development. Taken together, our results strengthen the notion that mechanisms of action learning hold the potential to build MHP capacity on an individual, organizational, and community level. This study, also, illustrates that realist evaluation offers a relevant methodology for investigating the underlying workings of capacity building programs.
Assuntos
Fortalecimento Institucional , Promoção da Saúde , Coleta de Dados , Promoção da Saúde/métodos , Humanos , Motivação , Avaliação de Programas e Projetos de SaúdeRESUMO
While there has been increased attention worldwide on mental health promotion over the past two decades, what is lacking in many countries around the globe is practical knowledge of what constitutes a population-wide mental health promotion campaign, and how such a campaign can be implemented. This paper provides such knowledge based on the development, implementation and evaluation of the Act-Belong-Commit campaign, the world's first comprehensive population-wide public mental health promotion campaign which was launched in 2008 in Western Australia. Given the learnings from the full-scale implementation and evaluation of the campaign in Western Australia and its expansion nationally and internationally, along with the continuing and expanding evidence base for the campaign constructs, we crystallise 21 reasons why jurisdictions who wish to achieve the goals of the WHO and adopt the recommendations of the European framework on mental health and wellbeing should consider adopting or adapting Act-Belong-Commit when considering implementing a public mental health promotion campaign.
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Promoção da Saúde , Saúde Mental , Austrália OcidentalRESUMO
BACKGROUND: Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this study, a prospective analysis was conducted on Danish data to determine 1) the association between mental well-being (measured in 2016) and government expenditure in 2017, specifially healthcare costs and sickness benefit transfers. METHODS: Data stem from a Danish population-based survey of 3,508 adults (aged 16 + years) in 2016, which was linked to Danish registry data. A validated scale (WEMWBS) was used for the assessment of mental well-being. Costs are expressed in USD PPP. A two-part model was applied to predict costs in 2017, adjusting for sociodemographics, health status (including psychiatric morbidity and health behaviour), as well as costs in the previous year (2016). RESULTS: Each point increase in mental well-being (measured in 2016) was associated with lower healthcare costs ($- 42.5, 95% CI = $- 78.7, $- 6.3) and lower costs in terms of sickness benefit transfers ($- 23.1, 95% CI = $- 41.9, $- 4.3) per person in 2017. CONCLUSIONS: Estimated reductions in costs related to mental well-being add to what is already known about potential savings related to the prevention of mental illness. It does so by illustrating the savings that could be made by moving from lower to higher levels of mental well-being both within and beyond the clinical range. Our estimates pertain to costs associated with those health-related outcomes that were included in the study, but excluding other social and economic outcomes and benefits. They cover immediate cost estimates (costs generated the year following mental well-being measurement) and not those that could follow improved mental well-being over the longer term. They may therefore be considered conservative from a societal perspective. Population approaches to mental health promotion are necessary, not only to potentiate disease prevention strategies, but also to reduce costs related to lower levels of mental well-being in the non-mental illness population. Our results suggest that useful reductions in both health care resource use and costs, as well as in costs due to sick leave from the workplace, could be achieved from investment in mental well-being promotion within a year.
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Custos de Cuidados de Saúde , Saúde Mental , Adulto , Análise Custo-Benefício , Dinamarca , Humanos , Estudos Prospectivos , Licença MédicaRESUMO
INTRODUCTION: Previous studies have shown that engaging in formal social participation may protect against declining mental health, but social network size (the number of close social ties a person has) may moderate the relationship. We assessed the potential moderating role of social network size using longitudinal data. METHODS: Nationally representative data from two consecutive waves (2011, 2013) of the SHARE survey were analyzed. The data consisted of 38,300 adults from 13 European countries aged 50 years and older in 2011. Measures pertaining to formal social participation, social network size, quality of life, and depression symptoms were used. Multivariable linear regression models were conducted. RESULTS: The majority of participants (over 70% of the sample) had a social network size of four or less close social ties. We identified significant moderations in both models. Individuals with relatively few close social ties may have benefitted from formal social participation both in terms of reductions in depression symptoms and increases in quality of life, while formal social participation among those with many social ties did not appear to be beneficial, and may even to some extent have been detrimental. CONCLUSIONS: Declines in mental health specifically among those with relatively few close social ties could potentially be prevented through the promotion of formal social participation. It is possible that such strategies could have a greater impact by specifically targeting individuals that are otherwise socially isolated. High levels of formal participation among those with relatively many close social ties may not be pragmatically beneficial.
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Aposentadoria , Participação Social , Idoso , Envelhecimento , Europa (Continente) , Humanos , Saúde Mental , Pessoa de Meia-Idade , Qualidade de Vida , Rede SocialRESUMO
BACKGROUND: The Mental Health Continuum-Short Form (MHC-SF) is a measure of positive mental health and flourishing, which is widely used in several countries but has not yet been validated in Denmark. This study aimed to examine its qualitative and quantitative properties in a Danish population sample and compare scores with Canada and the Netherlands. METHODS: Three thousand five hundred eight participants aged 16-95 filled out an electronic survey. Both the unidimensional and multidimensional aspects of the Danish MHC-SF were studied through bifactor modelling. Cognitive interviews examined face validity and usability. RESULTS: The general score of the Danish MHC-SF was reliable for computing unit-weighted composite scores, as well as using a bifactor model to compute general factor scores or measurement models in an SEM context. Nonetheless, subscale scores were unreliable, explaining very low variance beyond that explained by the general factor. The participants of the qualitative interviews observed problems with wording and content of the items, especially from the social subscale. The general score correlated with other scales as expected. We found substantial variation in flourishing prevalence rates between the three cultural settings. CONCLUSIONS: The Danish MHC-SF produced reliable general scores of well-being. Most of the issues observed regarding the subscale scores have been shown in previous research in other contexts. The further analysis of indices of the bifactor model and the inclusion of qualitative interviews allowed for a better understanding of the possible sources of problems with the questionnaire's subscales. The use of subscales, the substantive understanding of the general score, as well as the operationalization of the state of flourishing, require further study.
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Saúde Mental , Psicometria/instrumentação , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Comparação Transcultural , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida/psicologia , Adulto JovemRESUMO
Treatment and prevention alone are unlikely to make a significant difference in reducing the burden of poor mental health and mental illness. Therefore, mental health promotion (MHP) initiatives are advocated. In 2014, the ABCs of mental health (ABCs) partnership was established in Denmark; in the partnership, partner organisations, e.g., municipalities and NGOs, use a research-based framework for MHP, the ABC-framework, to develop and implement MHP initiatives. This paper has two aims: (1) to outline the overall characteristics of these MHP initiatives; and (2) to explore local coordinator and stakeholder perceptions of the implementation processes and the impact of the MHP initiatives. Questionnaire surveys, individual interviews and group interviews were conducted during 2017-2020. The MHP initiatives were grouped according to three strategies: building MHP capacity, campaign activities to promote mental health awareness and knowledge and establishing and promoting opportunities to engage in mentally healthy activities. The ABC-framework was positively received and viewed as providing relevant knowledge for working with MHP as well as fostering intersectoral and interprofessional collaborations. However, using a bottom-up approach to develop and implement MHP initiatives can be time-consuming and resource demanding, and it requires a deliberate balancing of local adaptability and concrete guidance when engaging stakeholders and implementers. Overall, using the ABC-framework to develop and implement MHP initiatives holds great promise for advancing and promoting MHP practice.
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Promoção da Saúde/organização & administração , Transtornos Mentais/prevenção & controle , Saúde Mental , Dinamarca/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Mental well-being is fundamental for a good life. Previous literature has examined the predictors of mental disorders and continuous measures of positive mental health. Very few studies have specifically focused on the predictors of different levels of mental well-being, but those that have suggest a different picture. This study aimed to compare socioeconomic and relational/recreational behaviour predictors of different levels of mental well-being as well as common mental disorders (CMDs). METHODS: Data from 3508 adults aged 16+ years old from the Danish Mental Health and Well-Being Survey 2016 were linked to Danish national register-based data. Mental well-being was assessed using the Warwick-Edinburgh Mental Well-being Scale, and information on CMDs was assessed using the Patient Health Questionnaire (PHQ-4). Regression analyses were conducted to estimate the predictors of low and high mental well-being compared to moderate mental well-being and also of CMDs. RESULTS: Lower socioeconomic position (education, income and employment status) was associated with increased odds of low mental well-being and the presence of CMDs, but did not significantly predict high mental well-being. Relational/recreational behaviours (informal and formal social participation, social support and recreational activity) were associated with reduced odds of low mental well-being and CMDs, and also with increased odds of high mental well-being. CONCLUSIONS: Socioeconomic predictors of high mental well-being do not mirror those of low mental well-being and CMDs, whereas relational/recreational predictors of high mental well-being do mirror those of low mental well-being and CMDs. These findings have important implications for public mental health strategies.
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Transtornos Mentais , Saúde Mental , Adolescente , Adulto , Dinamarca/epidemiologia , Escolaridade , Humanos , Transtornos Mentais/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Research indicates that social isolation and loneliness increase the risk of mental disorders, but less is known about the distinct contributions of different aspects of isolation. We aimed to distinguish the pathways through which social disconnectedness (eg, small social network, infrequent social interaction) and perceptions of social isolation (eg, loneliness, perceived lack of support) contribute to anxiety and depression symptom severity in community-residing older adults aged 57-85 years at baseline. METHODS: We did a longitudinal mediation analysis with data from the National Social Life, Health, and Aging Project (NSHAP). The study included individuals from the USA born between 1920 and 1947. Validated measures on social disconnectedness, perceived isolation, and depression and anxiety symptoms were used. Structural equation modelling was used to construct complete longitudinal path models. FINDINGS: Using data from 3005 adults aged 57-85 years, we identified two significant longitudinal mediation patterns with symptoms of depression, and two with anxiety symptoms. Overall, social disconnectedness predicted higher subsequent perceived isolation (ß=0·09; p<0·0001), which in turn predicted higher depression symptoms (ß=0·12; p<0·0001) and anxiety symptoms (ß=0·12; p<0·0001). The reverse pathways were statistically supported as well, suggesting bi-directional influences. INTERPRETATION: Social network structure and function are strongly intertwined with anxiety and depression symptoms in the general population of older adults. Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders. FUNDING: Nordea-fonden.
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Ansiedade/epidemiologia , Depressão/epidemiologia , Isolamento Social/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
Background: Previous research has suggested that leisure activity may benefit mental health and protect against substance use among adolescents, but more research is needed to asses associations with a wide range of outcomes. The aim of this study was to assess associations between multiple leisure activities and (1) mental health outcomes and (2) substance use outcomes in a sample of Danish adolescents. Methods: Using data from the Danish part of the European School Survey Project on Alcohol and Other Drugs (ESPAD) collected in 2019, nation-wide cross-sectional data from 2,488 participants aged 15 or 16 in Denmark were analyzed to assess associations between number of leisure activity types and outcomes pertaining to mental health and substance use. Results: Our results show that engaging in multiple activity types at least once a week-as compared to one single type of activity-is associated with increased odds for high mental well-being, and reduced odds for mental health problems. Engaging in multiple activity types is also associated with reduced odds for overall substance use and for using substances as a coping method. Among those using substances, engaging in multiple activity types is associated with reduced odds of above average substance use. Conclusion: Increasing opportunities for adolescents to engage in leisure activities is suggested to be useful in enhancing mental health and preventing substance use and promoting mental health. Promoting and increasing access to leisure activities among adolescents could be a promising avenue for policy and practice.
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This study examined the psychometric properties of the Danish WEMWBS and its short version (SWEMWBS) in a Danish population sample, and compared scores in Denmark with scores representative of three other European settings. A total of 3,508 Danish men and women aged 16-95 filled out an electronic survey. Face validity was examined by cognitive interviews. Content validity was assessed by examining response distributions and construct validity by confirmatory factor analysis, measurement invariance, and relations to other or similar measures. Overall mental well-being scores were calculated, as well as stratified by sex and age. Support was found for the single-factor hypothesis, yielding good model fits for both versions of the scale. Both scales have high internal consistency. Correlations with mental health measures were largely in line with expectations. The highest mental well-being scores were reported for Catalonia, followed by Denmark, Iceland, and England. The (S)WEMWBS appear to be appropriate instruments to measure mental well-being in the Danish population. The present findings encourage the use of the scales, particularly SWEMWBS, in epidemiological, intervention and evaluation studies in research and practice. Cross-cultural comparisons like the one reported here may be essential to inform international mental health policy.
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Comparação Transcultural , Saúde Mental/estatística & dados numéricos , Satisfação Pessoal , Psicometria/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Inglaterra/epidemiologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Islândia/epidemiologia , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Espanha/epidemiologia , Adulto JovemRESUMO
Objective Act-Belong-Commit is the world's first population-wide, community-based mental health promotion campaign. We assessed the associations between baseline indicators of Act-Belong-Commit behavioral domains and wellbeing at 2-year follow-up in a population-based sample of Irish older adults. MethodsData from 2 waves of the Irish Longitudinal Study on Ageing were analyzed. The sample consisted of 6098 adults. Outcomes were quality of life (QoL), life satisfaction (LS) and self-rated mental health (SRMH). Multivariable regression analyses were conducted. ResultsThe adjusted model showed that each increase in the number of social/recreational activities (Act) predicted better QoL and SRMH, but the positive association with LS did not reach statistical significance. Both social network integration (Belong) and frequency of participation in social/recreational activities (Commit) significantly promoted QoL, LS, and SRMH. These associations were apparent regardless of baseline common mental disorders. ConclusionsAct-Belong-Commit indicators are shown to promote wellbeing among Irish older adults, providing further support for the campaign's potential.
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Envelhecimento , Saúde Mental/estatística & dados numéricos , Satisfação Pessoal , Qualidade de Vida , Recreação , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
The Act-Belong-Commit campaign is the world's first comprehensive, population-wide, community-based program to promote mental health. However, its potential for preventing substance use disorders is unknown. Further, a literature gap is evident concerning behavioral modification strategies to prevent such disorders. The aim of this study was to prospectively assess the association between indicators of the Act-Belong-Commit behavioral domains and the development of problem drinking. Data from two waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The sample consisted of 3950 adults aged ≥50years. A validated scale for problem drinking was used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act-Belong-Commit and the development of problem drinking at two-year follow-up. Each increase in the number of social/recreational activities (Act) inversely predicted the onset of problem drinking. Similarly, being well integrated into social networks (Belong) was negatively associated with the development of problem drinking. Finally, frequency of participation in social/recreational activities (Commit) also inversely predicted the onset of problem drinking. These associations were apparent regardless of the presence of baseline common mental disorders. Act-Belong-Commit indicators are shown to be associated with a reduced risk for problem drinking. This lends further support to the Act-Belong-Commit domains and has wide-ranging implications for preventing substance use disorders in the aging community.