Many adolescents do not seek appropriate help when they experience mental health problems (MHP). Especially during the COVID-19 pandemic, this has become an increasingly pressing public health problem as more adolescents experience MHP due to social isolation, problematic home environments, and lack of future outlooks. Strengthening adolescents' competencies to cope with MHP (so called mental health literacy (MHL)) has the potential to prevent worsening of problems and delayed help-seeking. However, the implementation of MHL interventions remains absent or short-lived. To stimulate its implementation, this study explored attitudes of adolescents regarding mental health, help-seeking, and MHL interventions. We used a mixed-methods design including online focus group discussions and interviews, and surveys. Data collection took place since April ‘20. Participants were recruited online, through social media. So far, 58 adolescents (ages 13 and 19) attending secondary school in the Netherlands participated in this study. The data collected includes mental health status pre-, during, and post-lockdown as well as attitudes on mental health support and education. Our qualitative data analysis follows the principles of thematic analysis. We found that adolescents experience a lack of attention for mental health in secondary education as well as stigma and negative attitudes towards mental health treatment and help-sources, in general and during COVID-19. The participants voiced that they would like to know more about mental health and illness, help-sources and normalize the conversation of mental health. The attitudes of adolescents aided in shaping ideas for the implementation of mental health education. Our preliminary findings suggest that MHL and its related competencies are necessary to be able to (self-)manage one's own and others mental health especially in situations of crisis (e.g. COVID). This may decrease the disadvantageous characteristics of long-term MHP.
Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (β = − 1.70, 95% CI [− 2.72, − 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care.
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