Mental Health Literacy to Promote Help-Seeking in Adolescent Male Sport Participants

Background: Mental illness is a serious concern among adolescent males, as many disorders have their onset during adolescence and males are particularly reluctant to seek help. Increasing the rate of help-seeking amongst adolescent males is necessary to reduce the global burden of mental illness and protect the future health of this population. Organised sport may be an ideal vehicle for the delivery of mental health promotion to adolescent males. Aims: The aims of the research presented within this thesis are to: a) survey and describe current approaches to mental health promotion by sporting organisations in Australia; b) design, implement and evaluate a targeted mental health literacy intervention delivered through community sport clubs (‘Help Out a Mate’; HOAM); c) validate a measure of attitudinal factors related to mental illness and help-seeking, and d) explore the sub-group variability in help-seeking preferences that may facilitate more effective mental health literacy education. Method: Study 1 involved a review of sporting organisations’ websites to catalogue the current approaches to addressing mental health in sport. Study 2 reports on the design, implementation, and evaluation of a sports-based mental health literacy intervention via a cluster-randomised control trial (c-RCT) (N=102). Study 3 involved confirmatory and exploratory factor analysis of a tool to measure attitudes about mental illness and help-seeking (N=361). This is followed by a re-analysis of Study 2 data using the validated measure from Study 3 (N=102). Study 4 reports the results of a Latent Profile Analysis of help-seeking intentions (N=1038). Four distinct latent profiles were then compared across mental health measures. Results: Study 1 revealed that many of the sport organisations reviewed acknowledged the importance of mental components of their sport to increase competitiveness (32.3%), but few explicitly noted mental health problems or the potential of their sport to promote positive mental health (11.3%). Study 2 results indicated that compared to the wait-list control, participants in the HOAM condition reported significant increases in knowledge of signs and symptoms of mental illness, intentions to provide help to a friend who may be experiencing a mental health problem, and attitudes that promote problem recognition and help-seeking. There were no between group differences in confidence to provide help, personal help-seeking intentions, and psychological distress. Study 3 revealed a distinct four-factor structure: social distance, stigmatising attitudes, confidence accessing information about mental illness, and negative help-seeking attitudes, each with satisfactory levels of internal consistency and construct validity. When these newly identified subscales were re-analysed with the c-RCT data, findings resulted in more robust evidence for the effectiveness of HOAM on societal and self-stigma. Study 4 revealed four latent profiles of help-seeking intentions: Low general help-seekers, Moderate general help-seekers, High general help-seekers, and High family and friends help-seekers. Low general help-seekers showed a substantial discrepancy in their willingness to seek help from parents (M = 2.42) from all other profiles (M range 5.96-6.77), even when controlling for age. They also had significantly lower perceived family support and higher psychological distress. Those in the High family and friends profile displayed a unique profile that had high intentions to seek help from family and friends but low intentions for other help sources. Conclusion: The lack of mental health promotion identified through peak sports body websites suggested that there is potential to better address mental health through sports. The brief mental health literacy program (HOAM) was able to be successfully delivered through a community sports club. As a result of HOAM, adolescents will likely be more able to accurately recognise an emerging problem, would have some knowledge of what to do to assist someone, have attitudes that are more accepting of people with mental illness, and have some confidence in acting. HOAM offers a solution to the gap in mental health promotion approaches by providing a context-specific, brief, accessible, targeted program. The measure validated in Study 3 is brief and is likely to have high utility in measuring attitudes about mental illness and help-seeking amongst adolescent males. This may have implications for understanding the processes that could influence or improve help-seeking amongst this vulnerable group. The Low general help-seekers identified in Study 4 were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Overall, the program of research highlights the potential benefits of targeting interventions to improve help-seeking for subgroups of adolescent males with needs and interests through the novel setting of community youth sport clubs.