الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
Mental health is a vital component of overall health. The development of Mental Health Literacy (MHL) has arisen because of the fundamental domain of Health Literacy (HL). Mental Health Literacy (MHL) was defined as the ”knowledge and beliefs about mental disorders that facilitate their identification, management, or prevention.”
MHL was conceptualized to encompass six attributes: recognizing specific disorders, knowing how to access mental health information, understanding risk factors and causes, awareness of self-treatment options, knowledge of available professional help, and possessing attitudes that encourage recognition and appropriate help-seeking.
Several studies have been conducted to determine the factors that influence Mental Health Literacy (MHL). These studies have consistently found that MHL is higher among older individuals, those with higher levels of education, females, and higher-income families. However, it is important to note that most of these studies have focused on adult populations in developed nations. Therefore, it may not be appropriate to apply these conclusions to younger populations in developing countries due to differences in sociodemographic characteristics. A recent meta-analysis revealed that the prevalence of depression among adolescents between the ages of 13 and 18 is approximately 5.6%.
Treatment of teenage mental health disorders has been elevated as a worldwide health priority due to depression’s expanding scope and high potential of developing disastrous outcomes including suicide thoughts. Approximately one out of every five children and/or teenagers meet the criteria for a psychiatric disorder, but many of them with mental illnesses remain undiagnosed and untreated.
The aim of the present work was to study depression literacy, depressive symptoms, and help-seeking behavior among secondary school students in Alexandria.
A cross sectional design was used. The study was conducted in governmental and private secondary schools in Alexandria Governorate, the target population was first grade secondary school students. The minimum sample size needed was determined as 588 students. The total number of participants in the study was 639 students, with 324 males and 315 females selected randomly.
Three out of the eight educational districts in Alexandria governorate were selected randomly, namely; (El-Montazah, Middle and East). Each district was represented by 3 schools selected randomly: two public schools (one for boys and one for girls) and a mixed private school. A total of 9 schools were included. In each school one or more classes were selected at random from the first grade to recruit the predetermined allocated sample.
The data collection methods and tools included:
A pre-designed structured self-administered questionnaire (Appendix Ι ):
It was used to collect data from the students. This questionnaire included various sections, such as demographic and socio-economic data, relationship with family members, peers, and teachers, history of mental health problems and help-seeking behavior, and family history of mental illness.
Depression literacy (DL) assessment (Appendix ΙΙ ):
It was assessed based on the Australian National Survey of Mental Health Literacy and Stigma Youth Survey. In our study, only the depression vignette and the associated questions were adapted through forward backward translation technique. The details of the vignette were modified to be age-appropriate and gender-specific (Amir vignette for boys and Farah vignette for girls). After presentation of the vignette to adolescents, they were asked vignette-related questions that covered the following areas; recognition of the mental disorder, beliefs about potential sources of help, beliefs related to useful treatments and activities, help seeking intentions and first support actions, knowledge of helpful preventive practices for the depression case scenario model.
The Arabic version of the Center for Epidemiological Studies-Depression (CES-D) (Appendix ΙΙΙ ):
This scale consists of 20 items that assess symptoms of depression in adolescents and adults. Responses are coded on a Likert scale, and the total scores range from 0-60. A cut off score of 25 was determined to be the best for screening purposes.
The study revealed the following results:
The age of students ranged from 14 to 17 years, with a mean value of 15.4 ± 0.6 years. The highest percentage of students aged 15 years old (57.4%) followed by those aged 16 years old (38.5%), while the minority aged 14 or 17 years old (2.3% and 1.7%, respectively).
Over half of the students’ fathers held university degrees or higher (54.3%), and 29.1% acclaimed secondary school certificates. The remaining of students’ fathers were illiterate or just read and write (4.4%).
Most of the students’ mothers achieved university degrees or higher (49.7%), followed by secondary school graduates (34.1%). However, the remaining 5.9% of students’ mothers were illiterate or just read and write.
Regarding the socio-economic level, 45.4% of the students came from moderate standing, while 30.5% had a high standing, and 24.1% came from low socio-economic families.
More than three fifths of the students (62.3%) had an earlier history of psychological problems. However, the minority (12.1%) of them consulted a doctor and received treatment. Only 6% of the students with an earlier history of psychological problems sought help at school mental health services.
In terms of recognizing depression through the vignette-based approach, the current study found that approximately 41.5% of the participating adolescents correctly identified the depression case scenario. Meanwhile, around 18.2% believed there was nothing wrong with the case scenario or considered it to be just a typical teenage problem.
Regarding the recognition of depression in relation to gender differences, the findings of the present study indicated that female adolescents displayed a much higher likelihood of accurately identifying depression compared to their male counterparts (49.2% vs 34%).
According to the current study, it was revealed that adolescents possessed adequate knowledge regarding effective preventive practices. The practices that were most frequently mentioned included ”having a religious or spiritual belief” (97.6%), ”engaging in physical activity” (92.2%), and ”maintaining regular contact with friends” (89.2%). The correct response rates for these practices ranged from 78.7% to 97.6%.
A significant portion of sampled students, specifically 71.2% and 55.7%, expressed their belief in the effectiveness of consulting a psychiatrist or using mental health services as helpful activities.
Most of the adolescents surveyed expressed support for seeking assistance from both formal and informal sources. Psychiatrists were rated the highest (80.3%) among professionals, followed by family members and close friends (76.1% each), and then psychologists (61.0%).
According to the level of adequate Depression Literacy (DL), the sampled students with adequate DL (i.e., correct recognition of case scenario and intentions for help-seeking behavior) rated 24.6%.
In the current study, it was discovered that being female is a crucial factor when predicting the adequacy of Depression Literacy (DL). Furthermore, in addition to gender, a high socioeconomic status was also identified as a significant predictor of DL adequacy in adolescents.
Based on the results of the current study, the following recommendations are suggested:
There is a pressing need to increase awareness of depression and its impact directed to adolescents, their families, communities, and the whole population through special campaigns with the goal of promoting depression literacy.
Further studies are needed to study DL, and its determinants
Mental health training for school personnel to improve their knowledge, attitudes, and skills to facilitate and improve the help seeking behavior of all students at risk.
6.2. Conclusion
Findings of the current study have indicated that the majority of secondary school adolescents in Alexandria had satisfactory knowledge related to helpful activities to prevent depression. Moreover, most of them endorsed positive beliefs regarding helpful first aid activities and treatments for depression. Whilst both formal and informal sources of help (psychiatrists, psychologists, family members and friends) were supported by most of the students, school doctors/GPs, school nurses and teachers were perceived as harmful sources of help.
Despite the moderate rate of students’ expressing help seeking intentions (65.6%), they demonstrated a relatively low rate of recognition of depression (41%) and an overall low adequate depression literacy (DL) rate of (24.6%). Female gender and high socio-economic level predicted significantly adolescents’ recognition of depression, as well as adequate DL.
Though depressive symptoms were common among secondary school adolescents (39.3%), they were significantly associated with negative attitudes towards school health personnel as potential sources of help and low rates of help seeking intentions.
6.3. Recommendations:
I- For the Ministry of Health and the general population:
Health policy and decision makers should recognize the significance of mental health, and common mental disorders, in order to adopt mental health strategies that ensures promotion of adolescences’ mental health and prevention of mental illness in schools at all levels.
Educational campaigns through mass media and/or social media should be conducted to raise community awareness about depression, its symptoms, risk factors and impact, targeting adolescents, families, communities, and the entire population.
II- For schools:
Mental health should be recognized by school personnel as a crucial public health issue, with a focus on social and emotional well-being of the students.
Schools should support preventive mental health interventions that aim to manage high-risk behaviors such as substance abuse, and promote life skills training that enhance self-esteem and resilience to social pressures.
Provision of mental health literacy training program for school personnel (teachers, social workers, and school doctors) is urgently needed. School personnel can play a crucial role in raising mental health literacy of students as potential sources of help for students with depressive symptoms.
Tailored evidence based mental health literacy programs should be developed and implemented in schools to improve students’ knowledge, attitudes and help seeking behaviors towards mental illness particularly depression.
Regular screening for depression among school adolescents should be conducted to ensure early detection and referral for school mental health services.
III- For school health services:
Provision of easily accessible, efficient and satisfying school mental health services meet the needs of adolescents with mental disorders.
IV- For researchers:
Further studies targeting school students on different levels is needed to fill gaps in our knowledge concerning other determinants of adolescents’ help seeking behaviors.
Documenting evidence for effective mental health literacy interventions targeting school students in Egypt should be a priority.