The impact of the COVID-19 pandemic on hospital-treated self-harm in Sydney (Australia).

OBJECTIVES: This study investigated trends in hospital-treated self-harm and hospital presenting suicidal ideation in the period before and after COVID-19 public health responses by key socio-demographic groups among those presenting to hospitals in the Western Sydney (Australia) population catchment. METHODS: Emergency department presentations for the period January 2016 to June 2021 were used to specify a series of interrupted time-series models to compare the observed and expected event rates of (1) hospital-treated self-harm and (2) hospital presenting suicidal ideation in the period following the onset of COVID-19 public health measures in March 2020. Rate differences between observed and expected rates in the post-implementation period were also estimated in models stratified by sex, age group, country of birth and socio-economic status. RESULTS: There was no significant increase in hospital-treated self-harm in the period post-implementation of public health orders (March 2020) compared to the previous period, although there were lower than expected rates of emergency department presentations among non-Australian-born males, males aged 0-14 years and 25-44 years, and females aged 45-64 years. In contrast, there was a significant increase in hospital presenting suicidal ideation, particularly among women (rate difference per 100,000 = 3.91, 95% confidence interval = [1.35, 6.48]) and those aged 15-24 years (both males and females, rate differences ranging from 8.91 to 19.04), and among those residing in lower socio-economic status areas (both males and females, rate differences ranging from 0.90 to 2.33). CONCLUSION: There was no increase in hospital-treated self-harm rates in the 15 months post-implementation of COVID-19 public health orders in Western Sydney; however, there was a significant increase in hospital presenting suicidal ideation. The limited change in suicidal behaviour may reflect the success of social and economic supports during this period, the benefits of which may have been different for young people, and those of lower socio-economic status.

The Impact of Mental Health Literacy Training Programs on the Mental Health Literacy of University Students: a Systematic Review.

Student mental health is of growing concern for the university education sector. Supporting opportunities to increase mental health literacy of students is one strategy in which universities and colleges are actively investing to support students build their capacity to be well. This study is a systematic review of mental health literacy training (MHLT) programs, other than Mental Health First Aid training, to examine their impact on the mental health literacy of university students. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Online Resource 1) and A Measurement Tool to Assess Systematic Reviews (AMSTAR2) guidelines. Search terms related to mental health literacy concepts, mental health literacy training and university students were used in four major databases (i.e. EBSCOhost, Ovid, ProQuest and Web of Science), retrieving a total of 1219 articles, with 44 studies selected for full-text review, and a final number of 24 studies included for review based on pre-determined eligibility criteria. Results were reported against three main themes: types of MHLT offered; common practices, processes and implementation elements; and effectiveness of intervention. Results indicate a high level of variability in approaches to mental health literacy interventions and measures of assessment and reporting. Additionally, reported benefits to mental health literacy failed to report on comparable units of improvement or the sustainability of benefits. Although it is in the best interest of universities to prioritise early intervention programs to address mental health and improve wellbeing, more robust data is required to establish the effectiveness of MHLT programs in achieving this aim.

Students as leaders in supporting campus well-being: Peer-to-peer health promotion in higher education.

ISSUE ADDRESSED: This study aimed to analyse the relationship between peer-delivered health promotion programmes and student well-being and to expand the limited body of research examining peer-to-peer mental health promotion as experienced by student leaders. METHODS: The study was cross-sectional and focused on the experience of participants of a Sydney-based University Mental Health Day event, including student leaders, student participants, university staff and industry partners. It adopted a mixed-method approach to data collection, including a quantitative and a qualitative phase. RESULTS: Results from the quantitative phase demonstrate the benefits of peer-delivered health promotion programmes to students who receive the event. Results from the qualitative phase of the study provide a deeper insight into the delivery of the event, from both a student leader perspective, and also from the perspective of other stakeholders, who worked closely with student leaders. Two main themes emerged from the qualitative material and are explored in detail: enabling leadership and creating a sense of purpose. CONCLUSION: The study concludes that, while there is mounting evidence of the benefits of student-led mental health programmes for both leaders and their peers, more research needs to be carried out to better understand how to optimise these experiences and unlock their full potential with reference to student mental health. SO WHAT?: With the ongoing pressure on university student services to support student well-being not being met with appropriate resourcing, peer-to-peer programmes, like the Mental Health and Well-being Student Ambassador Programme, have a real opportunity to make strides in supporting and promoting student mental health.

A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil.

BACKGROUND: Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS: Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS: A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS: This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.

Creating Healthy Universities: The role of campus-based health promotion events in supporting student well-being.

ISSUE ADDRESSED: University students have been increasingly recognised as a population with a high prevalence of mental ill health, with research suggesting that psychological distress is higher among tertiary education students than nonstudents. The purpose of this study was to assess students' perceptions of the effectiveness of student-led, campus-based mental health promotion events on their well-being. METHODS: The cross-sectional study included six campus-based events, and collected data from 700 university students using a survey tool that included quantitative and qualitative measures. A multivariate logistic regression model was developed to investigate the association among explanatory variables and the response variable. A log-likelihood ratio test was used to assess the goodness of fitness of the final model. Qualitative data were thematically analysed. RESULTS: Results showed that the majority of students (84%) agreed the event promoted and supported student well-being, with three variables being statistically related to this agreement: (a) respondents' decision to spend more time on campus due to the event; (b) how respondents felt about receiving health information from student peers; and (c) the number of activities in which they took part. CONCLUSIONS: Our findings suggest that campus-based mental health promotion events need to be designed with emphasis on activities that attract, retain and educate students about mental health, and are delivered with the benefits of peer-to-peer health promotion in mind, in order to reach their full potential in supporting improved student mental health. SO WHAT?: The findings highlight the opportunities that can be created by university events to promote and support student mental health by building peer relationships and creating a sense of community.

Physical activity levels of economically disadvantaged women living in the Olympic city of Rio de Janeiro.

The objective of this study was to analyze the physical activity patterns of women living in a low-income community located in close proximity to the 2016 Rio de Janeiro Olympic Park. Data (N = 140) were collected in June and July 2012 using the International Physical Activity Questionnaire. Findings indicated that the majority (54.8%) of participants reported high levels of physical activity. The domains that contributed the most to this pattern were occupational and household physical activity. Significantly, 88.1% of participants reported low physical activity levels during their leisure-time. In the transport-related domain, participants were relatively more active, but more than half of them (57%) spent less than 600 MET-minutes/week in this domain. The results highlighted the discrepancies between different physical activity domains. In addition, the findings also suggested that low-income women in our study engaged little in physical activity during their leisure time. Therefore, the proposed commitments found in the Rio de Janeiro Candidature File to host the 2016 Olympic Games to increase sport/physical activity participation within low-income communities in Rio de Janeiro need to be implemented effectively if this physical activity behavior during self-directed time is to be changed.

A qualitative approach to explore the cognitive processes used by members of an adult learn-to-cycle program.

Introduction: Attaining movement proficiency under various constraints is well-researched; of particular interest here is how conscious processing and self-consciousness influence learning and performance. Current research relevant to these variables e.g., reinvestment, tends to utilize quantitative methods and thus overlooks a potentially rich source of understanding. Therefore, the purpose of this study was to apply a qualitative approach to explore the cognitive processes and self-consciousness within a less practiced population of adults participating in a non-competitive leisure activity. Methods: To achieve this, eleven semi-structured interviews were conducted with adult women learning or relearning to ride a bicycle. Results: Using thematic analysis, two distinct themes were evident and corroborated those illustrated in scales such as the movement-specific reinvestment scale. These themes included Conscious Processing, Recalling Experiences and Movement Analysis, in addition to Style of Movement, and Self-Consciousness. Anxiety also emerged as an additional and relevant theme to learning a new complex movement skill. Discussion: The findings indicated that participating women attuned to their movements to the extent that there was a conscious attempt to control their movements, but less so regarding movements being altered by self-awareness. Whilst further research is required, qualitative methods provide a promising basis for exploring the cognitive process involved with the conscious process involved in learning.

An analysis of the suitability of public spaces to physical activity practice in Rio de Janeiro, Brazil.

OBJECTIVES: To assess the physical characteristics of public spaces designed for sport/physical activity/leisure in Rio de Janeiro, Brazil, and their relationship to the socioeconomic indicators. METHODS: Public spaces (n = 38) spread across the city were evaluated between December 2011 and January 2012 using the Physical Activity Resource Assessment (PARA) instrument. Based on PARA results, a Quality Indicator (QI) was prepared and the sample was grouped into "High QI" and "Low QI" using a k-means clustering algorithm. The association between QI and the local Social Development Index (SDI) was tested using a Chi-square test. RESULTS: The average QI was 13.6 ± 4.91 and the median was equal to 13 points. The High QI group, composed of sites with a QI above median, reached 17.9 ± 2.35 points, while the Low QI group reached 9.3 ± 2.16 points. Pearson's Chi-square tests identified a significant association between QI and SDI when the value of SDI 0.7 was used as a criterion for separation (χ(2) = 17.84, p < 0.001). In neighborhoods with lower levels of SDI, public spaces usually had a lower QI. CONCLUSIONS: Policies to encourage physical activity need to focus attention on the built environment also, particularly in socially vulnerable areas.

Exploring experiences of a telephone crisis support workplace training program in Australia.

Telephone crisis support (TCS) is considered by the World Health Organization to be an integral part of an effective suicide prevention framework. However, as TCS lines worldwide are primarily staffed by volunteers, they frequently experience high staff turnover impacting on their ability to provide crucial crisis counselling to the population. One group that has been identified as potentially lessening staff shortages is university students, who may be attracted to TCS as a way to gain professional experience and qualifications. However, challenges are associated with the recruitment of this cohort, due to the potential impacts working in crisis support may have on the well-being of a group that is identified as being at higher risk of poor mental health. This study used semi-structured interviews, conducted between March and May 2020, to explore university students' experiences of a Crisis Support Workplace Training Program. It included 16 university students who completed (fully or partially) the training programme. Thematic analysis was used to identify patterns across the dataset. NVivo 12© was used throughout the analysis to assist with organisation and coding of data. Two overarching themes were identified: 1) Becoming and being the role, and 2) Experiencing and managing barriers to helping. Results illustrate how students experienced varying levels of distress due to empathetic engagement with callers, while also highlight the impact of students' experiences on the development of their professional identities. This study is amongst the first to examine the perceptions and experiences of training for and delivering TCS, and the first to focus specifically on university students as volunteer workers. The study's findings highlight the challenges participants face in undertaking crisis support training and our discussions provide a range of recommendations for future practice and research.

How I cope at university: Self-directed stress management strategies of Australian students.

Universities across the world remain under-resourced and frequently unequipped to provide the required support to the increasing demand of students experiencing mental health problems. While there is a considerable amount of research focusing on university student stress levels, interventions to address them, and coping strategies adopted by students, little research has reported on the strategies students choose to manage their stress and how that relates to their self-identified sources of stress as well as to what universities are offering to support their mental health and wellbeing. The present study provides a contribution in this direction, reporting on a study that surveyed over 3200 students from three large Australian metropolitan universities and interviewed three groups of university staff who provide student wellbeing services. Results highlight differences between what students and staff perceive as main sources of stress and best strategies to address them. In addition, students recommend task-oriented, pro-active coping strategies more often to their peers than engage in them themselves. The findings of the study further reinforce the need to develop an understanding of student coping strategies with a lens considerate of students' perspectives and preferences to authentically support their wellbeing, better informing planning and service delivery.

In search of a "vocabulary for recreation": Leisure-time physical activity among humanitarian migrants in regional Australia.

This study provides an exploration of the meanings of leisure for humanitarian migrants in regional Australia and these meanings' implications for health. It uses mixed-methods to explore leisure-time physical activity participation and day-to-day experiences of leisure and health. A sample representing approximately one third of the Coffs Coast adult humanitarian migrant population completed the survey, as well as 32 individuals who participated in interviews and focus groups. Findings were organised into three themes and explored issues around mental health and time for leisure, cultural differences in experiencing leisure, and the connections with experiences of other disadvantaged groups. We conclude by arguing that leisure needs to be brought to the fore of discussions around service provision and policy making concerned with the wellbeing of the refugee migrant population, particularly focusing on support for the (re)development of a vocabulary for recreation, as a step forward in the journey to healing and belonging.

Does being an Olympic city help improve recreational resources? Examining the quality of physical activity resources in a low-income neighborhood of Rio de Janeiro.

OBJECTIVES: To assess the quality of public physical activity resources (PARs) in a low socio-economic community in the Olympic city of Rio de Janeiro. METHODS: The Physical Activity Resource Assessment (PARA) instrument was used to assess all 29 public PARs located in this community. A quality indicator (QI) was developed based on PARA results. RESULTS: The average QI of the areas assessed was 1.3 ± 6.40 and the median 1 point, a considerably low score if compared to scores of public PARs across the city (13.6 ± 4.91 and 13 points). CONCLUSIONS: The urban regeneration necessary for hosting mega-sport events is frequently promoted as an opportunity to enhance PARs and therefore to improve health through physical activity (PA) participation. Findings indicate that the high number of elements that can discourage the use of these spaces may help explain the low level of PA during leisure time that has been previously reported of residents of the same neighborhood. Whether using the Olympic Games as catalyst or not, policies designed to encourage PA should focus also on the built environment.

Adherence to physical activity in an unsupervised setting: Explanatory variables for high attrition rates among fitness center members.

OBJECTIVES: To evaluate the attrition rate of members of a fitness center in the city of Rio de Janeiro and the potential explanatory variables for the phenomenon. DESIGN: An exploratory, observational study using a retrospective longitudinal frame. METHODS: The records of 5240 individuals, members of the fitness center between January-2005 and June-2014, were monitored for 12 months or until cancellation of membership, whichever occurred first. A Cox proportional hazard regression model was adjusted to identify variables associated to higher risk of 'abandonment' of activities. This study was approved by Southern Cross University's Human Research Ethics Committee (approval number: ECN-15-176). RESULTS: The general survival curve shows that 63% of new members will abandon activities before the third month, and less than 4% will remain for more than 12 months of continuous activity. The regression model showed that age, previous level of physical activity, initial body mass index and motivations related to weight loss, hypertrophy, health, and aesthetics are related to risk of abandonment. Combined, those variables represent an important difference in the probability to abandon the gym between individuals with the best and worse combination of variables. Even individuals presenting the best combination of variables still present a high risk of abandonment before completion of 12 months of fitness center membership. CONCLUSIONS: Findings can assist in the identification of high risk individuals and therefore help in the development of strategies to prevent abandonment of physical activity practice.

Physical activity overcomes the effects of cumulative work time on hypertension prevalence among Brazilian taxi drivers.

BACKGROUND: The aim of this study was to assess the physical activity profile of taxi drivers and its relationship with hypertension prevalence in this group of workers. METHODS: Cross sectional exploratory study. Between November 2008 and April 2009, 491 taxi drivers from Rio de Janeiro, Brazil, answered a questionnaire focusing on previous hypertension diagnosis, occupational characteristics and physical activity habits. Two logistic models were developed to determine risk factors related to hypertension and to find variables associated with a higher probability of sedentarism. RESULTS: Hypertension prevalence was 22.6%. The workload of the group investigated was high. Results indicate that 'age', 'Body Mass Index', 'physical activity', and 'years as a taxi driver' are related to the probability of hypertension. Physical activity was shown to be a protection factor for hypertension, even considering the deleterious effect of time as a taxi driver. Our results also determined that the practice of physical activity is influenced by age, level of education and workload. CONCLUSIONS: It is recommended that programs to combat sedentary lifestyles as well as measures to reduce workloads be developed as strategies to prevent hypertension.