Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Black Dog Institute, University of New South Wales, Sydney, Australia.
Epidemiol Psychiatr Sci. 2019 Aug 9;29:e46. doi: 10.1017/S2045796019000404.
The prevalence of common mental disorders has not declined in high-income countries despite substantial increases in service provision. A possible reason for this lack of improvement is that greater willingness to disclose mental disorders might have led to increased reporting of psychiatric symptoms, thus masking reductions in prevalence. This masking hypothesis was tested using data from two trials of interventions that increased willingness to disclose and that also measured symptoms. Both interventions involved Mental Health First Aid (MHFA) training, which is known to reduce stigma, including unwillingness to disclose a mental health problem.
A cross-lagged panel analysis was carried out on data from two large Australian randomised controlled trials of MHFA training. The first trial involved 1643 high school students in Year 10 (mean age 15.87 years), who were randomised to receive either teen MHFA training or physical first aid training as the control. The second trial involved 608 Australia public servants who were randomised to receive either eLearning MHFA, blended eLearning MHFA or eLearning physical first aid as the control. In both trials, willingness to disclose a mental disorder as described in vignettes and psychiatric symptoms (K6 scale) were measured pre-training, post-training and at 12-month follow-up.
Both trials found that MHFA training increased willingness to disclose. However, a cross-lagged panel analysis showed no effect of this change on psychiatric symptom scores.
Greater willingness to disclose did not affect psychiatric symptom scores. Because the trials increased willingness to disclose through a randomly assigned intervention, they provide a strong causal test of the masking hypothesis. It is therefore unlikely that changes in willingness to disclose are masking reductions in prevalence in the population.
尽管高收入国家的服务提供有了实质性的增加，但常见精神障碍的患病率并未下降。这种改善不足的一个可能原因是，更愿意公开精神障碍可能导致精神症状的报告增加，从而掩盖了患病率的降低。使用两项旨在增加公开意愿并测量症状的干预措施的试验数据检验了这种掩蔽假说。这两项干预措施都涉及心理健康急救（MHFA）培训，这种培训已知可以减少耻辱感，包括不愿意公开心理健康问题。
对两项澳大利亚大型随机对照 MHFA 培训试验的数据进行了交叉滞后面板分析。第一项试验涉及 1643 名 10 年级的高中生（平均年龄 15.87 岁），他们被随机分配接受青少年 MHFA 培训或身体急救培训作为对照组。第二项试验涉及 608 名澳大利亚公务员，他们被随机分配接受电子学习 MHFA、混合式电子学习 MHFA 或电子学习身体急救作为对照组。在这两项试验中，都在培训前、培训后和 12 个月随访时，根据情景描述评估了公开精神障碍的意愿和精神症状（K6 量表）。
两项试验都发现 MHFA 培训增加了公开意愿。然而，交叉滞后面板分析显示，这种变化对精神症状评分没有影响。
更大的公开意愿并没有影响精神症状评分。由于这些试验通过随机分配的干预措施增加了公开意愿，因此它们对掩蔽假说提供了强有力的因果检验。因此，改变公开意愿不太可能掩盖人群中患病率的降低。
