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Response rates in epidemiological studies have generally been decreasing over the past decades. However, when the target group consists of adolescents and young adults, school-based surveys have hitherto been able to mitigate this problem: This age group can be reached relatively easy in the school context (e.g., as compared to reaching them by phone) with very low refusal rates at the student level. However, the present study used a mixed-methods approach and suggests that schools at the organizational level have meanwhile become the problematic bottleneck for school-based surveys, as they increasingly reject requests for study participation. The current article provides insights into promising means for counteracting this trend. Researchers are advised to offer flexible timeframes for schools’ participation and to involve institutional gatekeepers who are endorsing their study. Furthermore, researchers, funding agencies, and schools would benefit from joint regional survey coordination systems. Such means will be crucial for the representativeness of future school-based epidemiological surveys.

The aim of the current study was to examine secondary school teachers’ experiences with and helping behaviour towards students with mental health problems. Data from 176 teachers were analysed. Altogether, 91.5% of participating teachers reported that they already had students with a mental health problem (particularly mood disorders) in their classes. About ¾ of teachers (74.7%) were also willing to help a student with a mental health problem, particularly by listening attentively or by recommending professional help. The self-rated mental health literacy of teachers was significantly and positively associated with help provision and with the assessment that ‘asking students about suicidal thoughts’ is helpful. In contrast, the perception of not having the necessary experience/training to help or that other people are better suited to help were seen as barriers to providing help. Based on the results, it is concluded that increasing teachers’ mental health literacy and the confidence in their ability to help (including asking students about suicidal thoughts) might increase their helping behaviour directed towards students with mental health problems.

Background: Though Internet- and mobile-based interventions (IMIs) and mindfulness-based interventions (generally delivered in-situ) appear effective for people with substance use disorders, IMIs incorporating mindfulness are largely missing, including those targeting frequent cannabis use. Methods: This paper details the protocol for a three-arm randomized controlled trial comparing a mindfulness-based self-help IMI (arm 1) and cognitive-behavioral therapy (CBT)-based self-help IMI (arm 2) versus being on a waiting list (arm 3) in their effectiveness reducing cannabis use in frequent cannabis users. Predictors of retention, adherence and treatment outcomes will be identified and similarities between the two active intervention arms explored. Both active interventions last six weeks and consist of eight modules designed to reduce cannabis use and common mental health symptoms. With a targeted sample size of n = 210 per treatment arm, data will be collected at baseline immediately before program use is initiated; at six weeks, immediately after program completion; and at three and six months post baseline assessment to assess the retention of any gains achieved during treatment. The primary outcome will be number of days of cannabis use over the preceding 30 days. Secondary outcomes will include further measures of cannabis use and use of other substances, changes in mental health symptoms and mindfulness, client satisfaction, intervention retention and adherence, and adverse effects. Data analysis will follow ITT principles and primarily employ (generalized) linear mixed models. Discussion: This RCT will provide important insights into the effectiveness of an IMI integrating mindfulness to reduce cannabis use in frequent cannabis users. Trial registration: International Standard Randomized Controlled Trial Number Registry: ISRCTN14971662 ; date of registration: 09/09/2021. Keywords: Cannabis; Cognitive-behavioral therapy; Internet-based intervention; Mindfulness; Ra

Purpose: To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Methods: Parental reports about their 9- to 14-year-old children with mental (n=785) or physical health problems (n=475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Results: Mental health problems were perceived as being more severe (p<0.001) and exerting a larger impact upon the family (e.g., financial impact) than physical health problems. Furthermore, fewer parents of children with a mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p=0.004) and were satisfied with the health care services their child received (p<0.001). The odds of low health literacy was higher among parents with children suffering from mental health problems vs. parents of children with physical health problems (OR in the adjusted model=1.92; 95% CI 1.47-2.50; p<0.001); this finding held generally for mental health problem (although only a trend was observable for internalizing problems). Conclusions: The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.

Background: Previous research on public stigma towards people with mental disorders has mostly targeted adult samples and focused on depression, schizophrenia or mental disorders in general. Hence, the present study aimed to investigate predictors of stigmatizing attitudes towards different mental disorders (including less researched ones) in a representative sample of adolescents and young adults. Methods: Data from the Swiss Youth Mental Health Literacy and Stigma Survey were used (analytical sample: n = 4,932). Each participant was randomly presented with one of five vignettes (depression; alcohol abuse; depression and alcohol abuse combined; schizophrenia; social anxiety). The structure of stigmatizing attitudes was assessed using confirmatory factor analysis. Regression models, implemented within a structural equation framework, were used to study predictors for the identified latent variables. Results: A three-factor model for stigmatizing attitudes-consisting of 'dangerous/unpredictable', 'weak-no-sick', and 'social distance' factors-best fitted the data. Female gender was associated with less stigmatizing attitudes. Associations in opposite directions with different latent factors were found for educational and migration background. Exposure to mental disorders (being personally affected, personally having received professional help or knowing someone close who has received treatment for a mental disorder) was either not or was negatively associated with stigmatizing attitudes. In contrast, current mental health symptoms (heightened levels of psychological distress, problematic alcohol use) were generally not or were positively associated with stigmatizing attitudes. Even though the included predictors had some predictive value, the variance explained by the models was rather small (the adjusted R2 varied between 0.03 and 0.26). Conclusions: The current study indicates that contact with someone who has received treatment for a mental disorder might be an imp

Background and objectives Mental health literacy and stigma towards mentally ill people have hitherto mainly been studied in relation to depression and schizophrenia and in adult samples. The Swiss Youth Mental Health Literacy and Stigma Survey (SYMHLSS) was planned and carried out to address these gaps. The aims of this article are to (1) outline and reflect on the methodology of the SYMHLSS in order to build a sound methodological foundation for preparing and conducting similar future surveys; and (2) advance school-based survey methods more generally. Methods The Australian National Survey of Youth Mental Health Literacy and Stigma (telephone survey) served as basis for the Swiss survey. As in the Australian survey, vignettes describing a person with a mental disorder were the core element to which most subsequent survey questions referred. Five vignettes were used in the online-based Swiss survey that used a representative school-based sample of roughly 5000 students: (1) depression; (2) alcohol abuse; (3) depression and alcohol abuse combined; (4) schizophrenia, and (5) social anxiety disorder. Results and conclusions The current paper describes (1) the aims and research questions of the SYMHLSS against the backdrop of some essential research gaps in the field; (2) the rationale for selecting the particular vignettes mentioned above; (3) the adaption and development process of the SYMHLSS (including pilot testing); (4) the reasoning for using a school-based online survey with in situ guidance of research staff; (5) and methodological insights gained during data collection. The provided information might be used as guiding references for other researchers who aim to adapt and develop vignette-based surveys in the field of mental health literacy or stigmatizing attitudes or who are planning a school-based online survey with in situ presence of research staff.

AIMS: To examine the quality of life (QOL) of parents of children with a specific mental disorder (any age). METHODS: Relevant articles were searched using different databases. Articles were included that compared the QOL of parents with mentally-ill children to parents of healthy controls or norm values or provided the required data for this comparison. A meta-analysis was conducted to obtain an overall mean effect size estimate. Additional analyses were performed to assess publication bias and moderation. RESULTS: Twenty-six out of 10 548 articles met the pre-defined inclusion criteria. Most of these studies focused on attention-deficit/hyperactivity disorder or autism spectrum disorder, used clinical samples that mainly included males and young children and studied the QOL of mothers. The meta-analysis revealed that parents of mentally-ill children are experiencing a clinically relevant reduction in their QOL relative to parents of healthy children and norm values (g = -0.66). CONCLUSIONS: The compromised QOL of parents of mentally-ill children needs to be considered and addressed by health professionals who are in contact with them. The paper provides insights into existing research gaps and suggests improvements for subsequent work.

Purpose: To examine the associations between substance use and other health-risk behaviors and quality of life (QOL) among young men. Methods: The analytical sample consisted of 5,306 young Swiss men who participated in the Cohort Study on Substance Use Risk Factors. Associations between seven distinct self-reported health-risk behaviors (risky single-occasion drinking; volume drinking; cigarette smoking; cannabis use; use of any other illicit drugs; sexual intercourse without a condom; low physical activity) were assessed via chi-square analysis. Logistic regression analyses were conducted to study the associations between each particular health-risk behavior and either physical or mental QOL (assessed with the SF-12v2) while adjusting for socio-demographic variables and the presence of all other health-risk behaviors. Results: Most health-risk behaviors co-occurred. However, low physical activity was not or negatively related to other health-risk behaviors. Almost all health-risk behaviors were associated with a greater likelihood of compromised QOL. However, sexual intercourse without a condom (not associated with both physical and mental QOL) and frequent risky single-occasion drinking (not related to mental QOL after adjusting for the presence of other health-risk behaviors; positively associated with physical QOL) differed from this pattern. Conclusions: Health-risk behaviors are mostly associated with compromised QOL. However, sexual intercourse without a condom and frequent risky single-occasion drinking differ from this pattern and are therefore possibly particularly difficult to change relative to other health-risk behaviors.