Addressing Mental Health Literacy in a UK university campus population: Positive replication of a Canadian intervention

Abstract

Objectives:

Mental health concerns on university campuses are increasing in the UK. Improving mental health literacy (MHL) for students may be a useful part of an integrated approach to effectively address these concerns. This study evaluated a previously demonstrated effective Canadian campus MHL resource in a UK student sample.

Design:

This cross-sectional study conducted on one UK campus reports on student’s opinions about the impact of the Transitions (2nd edition) resource as well as applying a standard measure of MHL.

Methods:

Online survey using a convenience sample of students during semester 1 conducted over a 1-week period at a large UK university.

Results:

Use of Transitions (2nd edition) improved student self-reported mental health knowledge, decreased stigma and increased help-seeking intent. Significant (p < .05) improvement in a standard MHL assessment was also found.

Conclusions:

These results suggest that the Transitions resource may be a helpful intervention in addressing student mental health in a UK university campus setting.

Keywords

Mental health literacy mental health promotion UK university

Background

Addressing mental health–related concerns on post-secondary campuses has been of recent global interest. In North America, the National Survey of Counselling Directors (Gallagher, 2015) identified increasing rates of self-reported symptoms related to anxiety and depression. These findings are consistent with self-reported increases of stress and related negative emotions reported in the American College Health Association [ACHS], 2018) Assessment. Similar findings have been reported in Canada (ACHS, 2016) and in Australia (Storrie et al., 2010).

In the UK, similar concerns regarding mental health on campus have been acknowledged (Macaskill, 2012; Royal College of Psychiatrists, 2011). The importance of addressing these issues during the first semester on campus year has also been recognised (All Party Parliamentary Group on Mental Health, 2015; Bewick et al., 2010; Nelson et al., 2012; Worfel et al., 2016). For example, Student Minds, a new organisation focused on campus mental health has begun operation in response (see http://www.studentminds.org.uk) and both the popular (e.g. Wakeford, 2017) and special interest press (e.g. Chaffin, 2018) have brought national attention to this issue.

As a result, various suggestions for addressing these concerns in the student population have been put forward, and several barriers have been identified, including the presence of stigma, lack of knowledge and poor perceived need for help (Eisenberg et al., 2012; MacKean, 2011; Thorley, 2017).

One of the key domains to be addressed around mental health on campus is the enhancement of mental health literacy (MHL). As the foundation for mental health promotion, prevention and care, MHL has been recently defined as having four separate but related components: (1) obtaining and maintaining good mental health, (2) understanding mental disorders and their treatments, (3) decreasing stigma and (4) enhancing help-seeking efficacy (Kutcher et al., 2014, 2016a, 2016b). While increasing awareness of the need to address student MHL in post-secondary institutions is growing (Reavley and Jorm, 2010), there is a lack of evidence-based resources available to help address this need (Vasquez, 2016).

Transitions (2nd edition) (Kutcher, 2014) was created to provide a resource for post-secondary students who were making the adjustment from secondary to post-secondary education. It embeds MHL into a comprehensive life-skills resource specifically designed to meet the needs of incoming post-secondary students. Developed in consultation with hundreds of post-secondary students, faculty and campus based mental health care providers, it contains sections addressing common challenges faced by university students, including: budgeting, study skills, sexual health, social media use and so on. It also integrates information about mental health (such as understanding the stress response) and information about common mental illnesses and substance use.

A previous study of the resource undertaken in Canada has demonstrated a substantial positive impact in self-reported improvements on knowledge and help-seeking intentions as well as decreasing stigma (Kutcher et al., 2016c). Similar findings were reported in a study of an earlier version of Transitions (Potvin-Boucher et al., 2010). These results suggest that it may be a useful resource to be deployed on campus; however, its utility within this context has not been determined. To consider implementation in the UK, it is useful to attempt to replicate the Canadian studies in a UK university setting. This study provides such a replication.

Methods

Following approval from the University of Leicester Psychology ethics committee, a pre-post measures online survey design was applied at the University of Leicester. The University of Leicester is a public research-led university based in central England. Between the measurement points (1 week apart) first year students in semester 1 were provided with an emailed PDF copy of the Transitions resource and asked to read it. All survey responses were completed online. The study was advertised to 100 students, 71 volunteers signed up to participate and completed the pre–post survey comprising the sample evaluated herein.

The primary outcome variable was the Transitions evaluation measurement tool used in a previous publication (Potvin-Boucher et al., 2010: see online Appendix 1). This was applied at the second measurement point. The secondary outcome variable was the Mental Health Literacy Scale (MHLS) (O’Conner and Casey, 2015) with this being administered at Times 1 and 2. The MHLS assess many attributes of MHL, for example, knowledge on mental health disorders, recognition of mental health disorders and attitudes towards mental health and help seeking (Jorm et al., 1997).

The MHLS was modified for the present study and comprised 31 items (minimum score 31–highest score 146). Modifications included the removal of questions 9 and 10 due to the cultural specificity of these questions (which relate to Australian demographics which would not be appropriate for the UK). Questions 33 and 35, as they refer to having your own family and being an employer, were similarly deemed inappropriate to the sample population and so were removed. Items 10, 12, 15, 20 and 28 were reversed scored. The modified version used in the present study was re-tested and found to have good internal consistency with a Cronbach’s alpha coefficient of .86 (see online Appendix 2).

Analysis

The sample size recommended for the paired samples t-test comparisons was a total sample of n = 34 to detect a significant difference at the p < .05 level of significance (two-tailed), with power of .8, assuming a medium effect size of (d = .5) (Cohen, 1988, 1992; Faul et al., 2007). The sample of n = 71 exceeded this criterion.

Statistical analysis of the data was performed using the Statistical Software for Social Sciences (SPSS) version 24 with the alpha level set at .05. The Kolmogorov-Smirnov test of normality was performed and demonstrated no violation of assumptions. Student surveyed responses ‘strongly agree’ and ‘agree’ were collapsed into one ‘positive’ category. Student surveyed opinions of Transitions were analysed using BOS online survey (www.onlinesurveys.ac.uk/). A matched pairs t-test was used to examine differences between participants’ mean MHLS scores at Time 1 and Time 2.

Results

In total, 71 first year undergraduate psychology students at the University of Leicester participated in the study. Almost all (96%) were between the age of 18 and 20 years, the remainder (4%) were between the age of 21 and 23 years. Of this sample, 60 (84%) participants were female and 11 (15.5%) were male.

Almost all students (94.4%) reported that they found Transitions to be helpful and the majority (88.7%) reported that they would recommend the resource to someone they know. Over 80% reported an increase in knowledge about mental health and mental illness, and 84.5% reported that their knowledge about treatment for mental illnesses had improved. The resource also produced a positive effect on student attitudes with the majority of students (83.1%) reporting that, as a result of reading Transitions, they would be more comfortable having someone with a mental illness in their class. Furthermore, 87.3% of students reported that after having read Transitions they understood that most people with a mental illness could live a productive life. Regarding help seeking intentions, over three-quarters (76.1%) reported that they would feel more comfortable seeking help for a mental health concern if they needed to. Furthermore, 21.2% of students reported that as a result of what they had read in Transitions, they planned to get help for a mental health concern or were thinking about it. Almost three quarters of students (73.2%) reported that they did not have a mental health concern and a small number of students (5.6%) reported that they did not plan to seek help although they had a mental health concern.

Importantly, the majority (80.3%) of students reported that as a result of reading Transitions, they would suggest someone they know get help for a mental health concern (Table 1).

Table 1.

Feedback on the resource.

Statement	Positive (%)	Neutral (%)	Negative (%)
General considerations
Overall, I found Transitions (2nd edition) helpful	94.4	4.2	1.4
I would recommend Transitions (2nd edition) to someone I know	88.7	9.9	1.4
Impact on knowledge
As a result of reading Transitions (2nd edition) my knowledge about mental health and mental illness has improved	81.7	11.3	7
Impact on attitudes
As a result of reading Transitions (2nd edition), I am comfortable having someone in my class with a mental illness	83.1	16.9	0
As a result of reading Transitions (2nd edition), I understand most people with a mental illness can live a productive life	87.3	12.7	0
Impact on help-seeking efficacy
As a result of reading Transitions (2nd edition), my knowledge about treatment of mental illness has improved	84.5	14.1	1.4
As a result of reading Transitions (2nd edition), I would suggest someone I Know get help for a mental health concern	80.3	18.3	1.4
As a result of reading Transitions (2nd edition), I feel more comfortable seeking help for a mental health concern if I need to	76.1	22.5	1.4

Students indicated that they talked about Transitions with others. Almost one third of students (32.4%) talked about Transitions with their friends, about a quarter (21.9%) talked about it with their roommates and (18.1%) discussed the resource with their classmates. Few (11.4%) talked about the resource with their parents.

Applying the paired samples t-test revealed a statistically significant increase in MHL scores from Time 1 (M = 118.3, SD = 9.60) to Time 2 (M = 122.4, SD = 9.99; t(70) = 2.46, p = .016 (two-tailed). The computed effect size, due to a within-subjects comparison, Morris and DeShon’s (2002) equation 8, was applied to correct for dependence among means (r = –.08); was d = .289; meaning a small effect size; achieving a power level (two-tailed, p < .05) of .66 (t = 1.99, df = 70). Mental health literacy scores measured at Time 1 and Time 2 are illustrated in Figure 1.

Figure 1.

An evaluation of a Mental Health Literacy (MHL) resource ‘Transitions’ (II).

Discussion

This replication study of a MHL resource, in a UK university student population, showed very similar positive results to outcomes previously reported in studies conducted with Canadian samples (Kutcher et al., 2016c; Potvin-Boucher et al., 2010). In the UK sample, students who engaged with Transitions self-reported improved knowledge, improved attitudes (i.e. via a decrease in stigma towards others) and increased help-seeking intent, all core components of MHL (Kutcher et al., 2014, 2016a, 2016b). To our knowledge, this is the first report applying this resource in a first year UK university population. However, whether similar results would be found in students in other years that engage with this resource cannot be extrapolated from this study.

Of additional interest is that one-third of the students also reported that they had discussed what they had read with a friend, suggesting horizontal dissemination of the resource beyond its original target audience. It is not known, however, if those with whom the resource was discussed engaged with the material or not, and if so, what the impact of that engagement was. Further research is needed to address this issue but the wider distribution of the resource suggests that students considered it worthy enough to inform their friends about it. Such peer-to-peer transmission of MHL resources may be important in increasing acceptance of their use.

The application of a secondary outcome measure, using a standardised MHL measure showed significant improvement in both knowledge and stigma related to the student’s reading of the Transitions material. This finding independently supports the results reported in the primary outcome measure, thus providing greater comfort in the robustness of that outcome. Taken together, these results suggest that the Transitions resource may be a useful intervention that could be introduced on UK campuses to help address growing concerns related to campus mental health. However, studies using this intervention as part of an integrated approach to campus mental health (Broglia et al., 2017) will be needed to determine potential wider impact.

Of note is that these results were achieved in the absence of adaptation of the materials to the UK context. Such adaptation of mental health–related information should be considered (Chu and Leino, 2017). Although Canadian and UK culture share some similarities, it should not be assumed that Canadian resources should be applied in the UK context without being modified to better reflect UK realities. Future work should include a proper adaptation of Transitions for the UK student population and a more robust evaluation of that modified resource with larger samples of students across numerous campuses conducted.

Future research might also address different vehicles for applying Transitions on university campuses. For example, peer led application may be a promising implementation strategy. A recent report by a Canadian investigator suggested that this delivery method may be effective (Gilham et al., 2018) and a similar approach for UK universities may demonstrate similar results. In addition, consideration of constructing and then evaluating the impact of this resource presented in an online interactive format may enhance potential for uptake and scale up of the intervention.

Limitations

This study has several limitations that should be addressed in future work. The sample was a relatively small (n = 71) cross-sectional study conducted with a convenience sample and may not be reflective of the larger university population. The university in which the study was conducted may also not be similar enough to all universities in the UK to provide comfort for generalisability of results. Thus studies with larger samples and across different campuses are needed to confirm or reject these initial findings. In addition, longitudinal studies are needed to determine if the results found herein are maintained over time and if reported help-seeking intent is translated into appropriate action. Evaluations addressing these issues are currently being planned and the third version of the Transitions resource is currently being adapted for use on UK campuses by Student Minds UK.

Conclusion

This study of Transitions (2nd edition) applied in a UK university demonstrated a positive impact on enhancing MHL: improving knowledge, decreasing stigma and increasing help-seeking intent. Although further studies in larger and more diverse samples are needed, these results suggest that use of the resource could be considered as part of an integrated mental health intervention in UK universities.

Supplemental Material

0226_online_only_appendices_(2) – Supplemental material for Addressing Mental Health Literacy in a UK university campus population: Positive replication of a Canadian intervention

Supplemental material, 0226_online_only_appendices_(2) for Addressing Mental Health Literacy in a UK university campus population: Positive replication of a Canadian intervention by Sarah Hunt, Yifeng Wei and Stan Kutcher in Health Education Journal

Footnotes

Acknowledgements

Sarah Hunt would like to thank Panos Vostanis for sharing his knowledge and providing assistance in this study. The authors would also like to thank Mina Hashish from the Sun Life Financial Chair in Adolescent Mental Health team for her assistance in the preparation of this manuscript.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Sarah Hunt conducted this research in partial fulfilment of undergraduate dissertation thesis at the University of Leicester, Stan Kutcher led the development of the Transitions resource, and Yifeng Wei participated in the writing of the resource.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

References

All Party Parliamentary Group on Mental Health. (2015) Parity in progress? The all party parliamentary group on mental health’s inquiry into parity of esteem for mental health. Available at: https://www.mind.org.uk/media/1939983/appg-parity-in-progress-final.pdf

American College Health Association. (2016) American College Health Association-national College Health Assessment II: Canadian Reference Group Executive Summary Spring 2016. Hanover, MD: American College Health Association.

American College Health Association. (2018) American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2018. Silver Spring, MD: American College Health Association.

Bewick

Koutsopoulou

Miles

et al . (2010) Changes in undergraduate students’ psychological well-being as they progress through university. Studies in Higher Education 35(6): 633–645.

Broglia

Millings

Barkham

(2017) Challenges to addressing student mental health in embedded counselling services: A survey of UK higher and further education institutions. British Journal of Guidance & Counselling 46(4): 441–445.

Chaffin

(2018) UK universities act to tackle student mental health crisis. Financial Times. Available at: https://www.ft.com/content/8e53ee5a-1e13-11e8-aaca-4574d7dabfb6

Chu

Leino

(2017) Advancement in the maturing science of cultural adaptations of evidence-based interventions. Journal of Consulting and Clinical Psychology 85(1): 45–57.

Cohen

(1988) Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum.

Cohen

(1992) A power primer. Psychological Bulletin 112(1): 155–159.

10.

Eisenberg

Hunt

Speer

(2012) Help seeking for mental health on college campuses: Review of evidence and next steps for research and practice. Harvard Review of Psychiatry 204: 222–232.

11.

Faul

Erdfelder

Lang

et al . (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39(2): 175–191.

12.

Gallagher

(2015) National Survey of College Counseling Centers 2014. Project Report, The International Association of Counseling Services (IACS), Alexandria, VA.

13.

Gilham

Austen

Wei

et al . (2018) Improving mental health literacy in post-secondary students: Field testing the feasibility and potential outcomes of a peer-led approach. Canadian Journal of Community Mental Health 37(1): 1–12.

14.

Jorm

Korten

Jacomb

et al . (1997) Mental health literacy: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia 166: 182–186.

15.

Kutcher

(2014) Transitions. 2nd edn. Available at: https://teenmentalhealth.org/transitions

16.

Kutcher

Bagnell

Wei

(2014) Mental health literacy in secondary schools: A Canadian Approach. Child and Adolescent Psychiatric Clinics of North America 24(2): 233–244.

17.

Kutcher

Wei

Coniglio

(2016a) Mental health literacy: Past, present and future. The Canadian Journal of Psychiatry 61(13): 144–148.

18.

Kutcher

Wei

Morgan

(2016c) Mental health literacy in post-secondary students. Health Education Journal 75: 689–697.

19.

Kutcher

Wei

Costa

et al . (2016b) Enhancing mental health literacy in young people. European Child & Adolescent Psychiatry 25(6): 567–569.

20.

Macaskill

(2012) The mental health of university students in the United Kingdom. British Journal of Guidance & Counselling 41(4): 426–441.

21.

MacKean

(2011) Mental health and well-being in postsecondary education settings: A literature and environmental scan to support planning and action in Canada. In: CACUSS pre-conference workshop: Student mental health: A call to action, Toronto, ON, Canada, June. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.737.6978&rep=rep1&type=pdf

22.

Morris

DeShon

(2002) Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods 7: 105–125.

23.

Nelson

Quinn

Marrington

et al . (2012) Good practice for enhancing the engagement and success of commencing students. Higher Education 63(1): 83–96.

24.

O’Conner

Casey

(2015) The Mental Health Literacy Scale (MHLS): A new scale-based measure of mental health literacy. Psychiatry Research 229: 511–516.

25.

Potvin-Boucher

Szumilas

Sheikh

et al . (2010) Transitions: A mental health literacy program for postsecondary students. Journal of College Student Development 51(6): 723–727.

26.

Reavley

Jorm

(2010) Prevention and early intervention to improve mental health in higher education students: A review. Early Intervention in Psychiatry 4(2): 132–142.

27.

Royal College of Psychiatrists (2011) Mental health of students in higher education. London: RCP. Available at: https://www.rcpsych.ac.uk/publications/collegereports/cr/cr166.aspx

28.

Storrie

Ahern

Tuckett

(2010) A systematic review: Students with mental health problems–A growing problem. International Journal of Nursing Practice 16: 1–6.

29.

Thorley

(2017) Not by degrees: Improving student mental health in the UK’s universities. IPPR, London. Available at: https://www.ippr.org/publications/not-by-degrees

30.

Vasquez

(2016) Mental health literacy among college students: Conceptualizations of mental and emotional health. Social Sciences Capstone Projects 40. Available at: https://commons.pacificu.edu/cassoc/40

31.

Wakeford

(2017) It’s time for universities to put student mental health support first. The Guardian. Available at: https://www.theguardian.com/higher-education-network/2017/sep/07/its-time-for-universities-to-put-student-mental-health-first

32.

Worfel

Gusy

Lohmann

et al . (2016) Mental health problems among university students and the impact of structural conditions. Journal of Public Health 24: 125–133.

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