A quasi-cluster randomized controlled trial of a classroom-based mental health literacy educational intervention to promote knowledge and help-seeking/helping behavior in adolescents.

INTRODUCTION: School-based education is a potentially effective approach for improving mental health literacy (MHL) in adolescents. This study evaluated the effects of the "Short MHL Program (SMHLP)", a brief (50 min), school teacher-led program, on MHL in adolescents in a quasi-cluster randomized controlled trial. METHODS: A total of 975 high school first graders (age 15-16) in Japan were allocated to classes such that gender and academic achievement ratios were almost equivalent at the time of admission to the high school. They were assigned at the class level to the SMHLP (n = 364 from 10 classes) or a control group (n = 611 from 17 classes). The program consisted of a 50-minute session and was delivered by a school teacher. The students completed a self-report questionnaire at 3 time points: pre-, (immediately) post- and 2-month follow-up. Outcomes included "Knowledge about mental health/illnesses", "Recognition of the necessity to seek help", "Intention to seek help", and "Intention of helping peers". Mixed effects modeling was employed for analyses. RESULTS: Scores of all outcomes were significantly improved in the intervention group compared to the control group post-intervention (p < .001). These improvements were maintained at 2-months follow-up for all outcomes (p < .001-.05). Questionnaire scores did not differ between groups at baseline. CONCLUSIONS: The effect of the SMHLP was confirmed in grade 10 students. Brief, yet effective programs can be a viable option to promote understanding of mental health problems and have the potential to be incorporated into regular school curriculum. ".

Effects of a school teacher-led 45-minute educational program for mental health literacy in pre-teens.

AIM: A concise teacher-led program for mental health literacy (MHL), suitable for schools with tight schedules was developed, and its effects were examined in pre-teens. METHODS: Participants comprised 662 grade 5 to 6 students from nine Japanese elementary schools. The program consisted of a 45-minute session, delivered by school teachers using a 10-minute animated film. Program focuses included: mental health problems are common, can be associated with lifestyle and that seeking help from reliable adults is a key to finding solutions. Participants filled out self-report questionnaires before, immediately after and 3 months post-intervention. Changes in MHL were analyzed using multilevel models. RESULTS: Knowledge about mental health/illnesses, recognition of mental health state and intention to help peers/seek help when suffering from mental health problems, were significantly improved immediately and 3 months post-intervention. CONCLUSIONS: Concise teacher-led programs administered in schools can have positive and lasting effects on MHL in pre-teens.

Relationship between violent behavior and repeated weight-loss dieting among female adolescents in Japan.

PURPOSE: To examine whether interpersonal violence perpetration and violence toward objects are associated with body mass index (BMI), body weight perception (BWP), and repeated weight-loss dieting in female adolescents. METHODS: A cross-sectional survey using a self-report questionnaire was performed evaluating interpersonal violence perpetration, violence toward objects, the number of diets, BMI, BWP, the 12-item General Health Questionnaire (GHQ-12), victimization, substance use, and other psychosocial variables among 9,112 Japanese females aged between 12-18 years. Logistic regression analysis was conducted to analyze the contribution of BMI, BWP, and weight-control behavior to the incidence of violent behavior, while controlling for potential confounding factors. RESULTS: The number of diets was associated with both interpersonal violence perpetration (OR = 1.18, 95% CI 1.08-1.29, p<0.001) and violence toward objects (OR = 1.34, 95% CI 1.24-1.45, p<0.001), after adjusting for age, BMI, BWP, the GHQ-12 total score, victimization, and substance use. In terms of BMI and BWP, the "overweight" BWP was associated with violence toward objects (OR = 1.29, 95% CI 1.07-1.54, p<0.05). On the other hand, the "Underweight" and "Slightly underweight" BMI were related to violence toward objects [(OR = 1.28, 95% CI 1.01-1.62, p<0.05) and (OR = 1.27, 95% CI 1.07-1.51, p<0.05), respectively]. The "Underweight" BWP was related to interpersonal violence perpetration (OR = 2.30, 95% CI 1.38-3.84, p<0.05). CONCLUSIONS: The cumulative number of diets is associated with violent behavior in female adolescents. In addition, underweight BMI and extreme BWP are associated with violent behavior.

A greater number of somatic pain sites is associated with poor mental health in adolescents: a cross-sectional study.

BACKGROUND: Identifying indicators of poor mental health during adolescence is a significant public health issue. Previous studies which suggested an association between the number of somatic pains and depression have mainly focused on adults or have employed samples with a narrow age range. To date, results from previous studies have been inconsistent regarding the association between somatic pain and academic impairment. Therefore, the main aims of the present study were to 1) investigate the association between the number of somatic pain sites and poor mental health using a community sample of adolescents aged 12 to 18 years and employing a simple method of assessment, and 2) examine the association between the number of somatic pain sites and perceived academic impairment. METHODS: Data analysis was conducted using a large cross-sectional survey of adolescents in grades 7 to 12. The one-month prevalence rates for three sites of somatic pain including head, neck and shoulders, and abdomen were examined. Poor mental health was evaluated using the General Health Questionnaire, and perceived academic impairment was measured using a self-report questionnaire. RESULTS: A total of 18,104 adolescents participated in the survey. A greater number of pain sites was associated with poor mental health, and this association was consistent across age and gender. There was no difference in effect on mental health between any of the pain sites. Although there was an association between the number of somatic pain sites and perceived academic impairment, the results suggested that the association was mediated by poor mental health. CONCLUSIONS: Simple reporting methods for assessing the number of pain sites may be a feasible indicator of poor mental health in adolescents. Professionals working with adolescents should consider the possibility of poor mental health, especially when students report multiple somatic pains.

Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents.

BACKGROUND: The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help. METHODS: A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors. RESULTS: A total of 18,104 students (8620 aged 12-15 years, 9484 aged 15-18 years), accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and seventy-six (3.3%) junior and 396 (4.3%) senior high school students reported having self-harmed. Of these, 40.6% of adolescents in junior and 37.6% in senior high schools were classified as poor help-seeking. Poor help-seeking with regard to self-harm was significantly more common in those who reported not having consulted anyone about psychological problems (odds ratio 9.2, 95% confidence interval 4.6-18.4 in juniors; odds ratio 9.9, confidence interval 5.5-17.9 in seniors) and in those with current suicidal ideation (odds ratio 2.0, confidence interval 1.0-3.7 in juniors; odds ratio 1.9, confidence interval 1.1-3.4 in seniors). Family members were approached significantly less often as a resource for help by students who self-harmed than by those who did not, and school nurses were more often consulted by those who did self-harm. CONCLUSION: Around 40% of adolescents who self-harmed in the previous year did not seek help. School-based mental health should screen students at risk of self-harm, and educate school nurses about preventative care.

Irregular bedtime and nocturnal cellular phone usage as risk factors for being involved in bullying: a cross-sectional survey of Japanese adolescents.

PURPOSE: A number of studies have tried to identify risk factors for being involved in bullying in order to help developing preventive measures; however, to our knowledge, no study has investigated the effect of nocturnal lifestyle behavior such as sleep pattern or cellular phone usage. In the present study, we aimed to investigate the relationship between school bullying and sleep pattern or nocturnal cellular phone usage in adolescents. The effect of school size on school bullying was also examined. METHODS: Data from the cross-sectional survey of psychopathologies conducted for 19,436 Japanese students from 45 public junior high schools (7(th)-9(th) grade) and 28 senior high schools (10(th)-12(th) grade) were analyzed. RESULTS: Bullying status was significantly associated with irregular bedtime (OR = 1.23 and 1.41 for pure bullies and bully-victims, respectively) and e-mail exchange or calling after lights-out (OR = 1.53 and 1.31 for pure bullies and bully-victims, respectively) after controlling domestic violence and substance usage. In addition, school size was significantly associated with the increased risk of bullying in junior high school students (OR = 1.13 for bully-victims). CONCLUSIONS: The present results suggested that sleep pattern and nocturnal cellular phone usage might be risk factors for being involved in school bullying in adolescents. Although further accumulation of data is needed, progressive trend towards nocturnal lifestyle and increasing usage of cellular phone might impair the well-being of adolescents. School-based interventions for lifestyle including sleep pattern and cellular phone usage may be encouraged to reduce school bullying.

Deliberate self-harm in adolescents aged 12-18: a cross-sectional survey of 18,104 students.

Little is known about accurate prevalence and associated factors of deliberate self-harm (DSH) among adolescents in Asian countries. In this study, the prevalence and associated factors of DSH among adolescents in Japan were examined. Data were derived from a cross-sectional survey using an anonymous self-report questionnaire and enrolling 8,620 adolescents aged 12-15 and 9,484 aged 15-18. DSH in the previous 12 months was reported by 3.3% (95% CI, 2.9-3.7) of junior and 4.3% (3.9%-4.7%) of senior high school respondents. The prevalence was more than four times as high among girls as among boys for both age groups. DSH was further strongly associated with having suicidal thoughts, having depression/anxiety symptoms, and having used recreational drugs. These associated factors were similar for both sexes and for both older and younger teenagers. A substantial minority of adolescents present with DSH, even among those aged 12-15. The prevalence of DSH in Japan was in the lower ranges of those reported for Western countries. The identified associated factors were not dissimilar from those reported in the West.

The suicidal feelings, self-injury, and mobile phone use after lights out in adolescents.

OBJECTIVE: To study association between nocturnal mobile phone use and mental health, suicidal feelings, and self-injury in adolescents. METHODS: Associations of mobile phone use after lights out with mental health, suicidal feelings, and self-injury were cross-sectionally examined in 17,920 adolescents using a self-report questionnaire. A series of logistic regression analyses were separately conducted for early (grades 7-9) and late (grades 10-12) adolescents. RESULTS: Sleep length was significantly associated with the mobile phone use only in early adolescents. Logistic regression showed significant associations of the nocturnal mobile phone use with poor mental health, suicidal feelings, and self-injury after controlling for sleep length and other confounders. CONCLUSIONS: Mobile phone use after lights out may be associated with poor mental health, suicidal feelings, and self-injury in both early and late adolescents. Association between reduced sleep and the mobile phone use was confined to early adolescents.

Not only body weight perception but also body mass index is relevant to suicidal ideation and self-harming behavior in Japanese adolescents.

Whether a low body mass index (BMI) is directly associated with a high risk of suicidal ideation or self-harming behavior in adolescents is still inconclusive. This study has, therefore, evaluated the relevance of BMI to suicidal ideation and self-harming behavior after controlling for body weight perception (BWP) and other potential confounding factors. BMI, BWP, suicidal ideation, and self-harming behavior were all assessed using a self-report questionnaire administered to 18,104 Japanese adolescents. Potential confounding factors were also evaluated. The data were then analyzed using bivariate and multivariate logistic regression. Low BMI was associated with suicidal ideation and deliberate self-harm when controlling for sex, age, drug use, emotional distress, and BWP. Low BMI may be an independent risk factor for suicidal ideation and deliberate self-harming behavior in Japanese adolescents.

Psychotic-like experiences are associated with violent behavior in adolescents.

OBJECTIVE: The diagnosis of psychotic disorder is associated with a risk of violence. Psychotic-like experiences (PLEs) in the general population may share an etiological background with psychotic disorders. The present study has evaluated the association between PLEs and violent behavior in adolescents. METHODS: PLEs and violent behavior were assessed using a self-report questionnaire administered to 18,104 Japanese adolescents. Potential confounding factors were also evaluated. RESULTS: After controlling for the effects of age, gender, GHQ-12 total score, victimization, and substance use, the existence of PLEs was significantly associated with both interpersonal violence (odds ratio (OR)=1.36, 95% confidence interval (CI): 1.23 to 1.51) and violence towards objects (OR=1.46, 95%CI: 1.33 to 1.61). The greater the number of such psychotic experiences, the higher the risk of violence. Particular types of PLEs ('spied-upon' and 'voice hearing') are significantly associated with interpersonal violence, while all of the types of PLEs assessed in this study were significantly associated with violence towards objects. CONCLUSION: PLEs may be a risk factor for violent behavior in adolescents. Violent acts by individuals with schizophrenia may not be a direct consequence of the disease itself, but may instead share an etiological background with such behavior in the general population.

Psychotic-like experiences (PLEs) and mental health status in twin and singleton Japanese high school students.

AIM: Studying what factors and behaviours to work on may be a key to develop the effective prevention of future mental disorder in both high-risk and general young subjects. This study aimed to investigate whether twins are more vulnerable to mental health problems including psychotic-like experiences (PLEs) than singletons and what factors on lifestyle and social environment are associated with poor mental health. METHODS: Subjects comprised 341 Japanese high-school students (173 males and 168 females) including 62 twins. We examined PLEs, general psychological distress, length and regularity of sleep, domestic violence, being bullied and other environmental factors using questionnaires including the 12-item General Health Questionnaire (GHQ-12). The variables were compared between twins and singletons. Whether variables on lifestyle and social environment affect PLEs and GHQ-12 scores were studied by logistic regression. RESULTS: Significant difference was observed in PLEs and GHQ-12 between twins and singletons. Experiencing PLEs was negatively associated with being a twin (OR = 0.293, 95% CI = 0.101-0.847) and length of sleep (OR = 0.685, 95% CI = 0.519-0.903). GHQ-12 > 4 was significantly associated with irregular sleep schedule (OR = 3.042, 95% CI = 1.818-5.090), being bullied (OR = 3.677, 95% CI = 1.317-10.266) and having no people to confide in (OR = 2.615, 95% CI = 1.249-5.475). CONCLUSION: Poor mental health status including experiencing PLEs might be less frequent in twins than in singletons. Problems in sleep length, its schedule and human relationships were significantly associated with mental health in high-school students as we hypothesized. Early identification programmes and mental health education focused on these factors may be helpful.