Silence is Deadly
This scale consists of 5 items rated on a 5-point scale from 1 never to 5 always , with total scale scores ranging from 5 to Higher scores on the DQ-5 reflect greater psychological distress. Research indicates that the measurement of suicidal behaviours in adolescents is acceptable and does not pose an iatrogenic risk [ 32 ].
The sub-scale contains 9 items that are rated on a 6-point scale ranging from 1 strongly disagree to 6 strongly agree. Total scale scores can range from 9 to 54, with higher score indicative of greater conformity to gender norms regarding emotional restriction.
In addition to the measures above, participants in intervention schools will be asked to complete a number of open-ended evaluation questions at post-intervention. These qualitative data will provide insight into strengths and areas of improvement for the Silence is Deadly program. A sample of adolescents from 8 high schools students per school will be targeted for recruitment to the current study.
Assuming correlation between repeated measures of 0. Analyses of primary and secondary effectiveness outcomes will be conducted using a mixed-model repeated measures MMRM approach [ 35 ], the standard and most robust methodology for analysing randomised controlled trials. This approach is able to include participants with missing data without using biased imputation techniques, assuming that data are missing-at-random. Further, by incorporating appropriate random effects for each school, MMRM can accommodate and assess the strength and significance of clustering effects.
Analysis of binary outcomes will be undertaken using binary mixed models, analogous to linear MMRM. Qualitative analysis of the semi-structured interviews will be conducted using Framework Analysis. Framework Analysis was designed for addressing social policy research questions [ 36 ] and has been used frequently in health research [ 37 ].
It follows a systematic process of inductive coding, generating a table of findings across participants that is conducive to interpretation and input from multiple researchers. The need for effective and tailored interventions for personal and emotional problems in males is high, particularly given the rates of suicide and mental health difficulties observed in this population [ 1 , 2 ].
The current project represents an opportunity to evaluate a program specifically designed for males, which primarily aims to increase help-seeking intentions for personal and emotional problems. The targeting of help-seeking intentions, and help-seeking attitudes and behaviours as secondary outcomes, within this program is important given the low rates of help-seeking evident in this population for mental health problems and suicide [ 5 , 6 , 7 , 8 ].
ANZCTR - Registration
The intervention tested in this trial is also novel in its approach to targeting male gender-specific attitudes and obstacles that drive poor help-seeking intentions, attitudes and behaviours in this population. If found to be effective, it could provide a key solution to promoting help-seeking in young males, which is the cornerstone to preventing and reducing mental health problems, disengagement and suicide risk.
Mental health and suicide prevention systems are lacking in Australian schools and the program tested in this trial has the potential to significantly impact the help-seeking intentions, attitudes and behaviours of young Australian men and stimulate more high quality research in this critical area.
The mental health of Australians 2: report on the National Survey of mental health and wellbeing. Canberra: Department of Health and Ageing; Statistics ABo. Causes of death, Australia. Canberra: Australian Bureau of Statistics; Azjen I. The theory of planned behavior.
Organ Behav Hum Decis Process. What do we know about mens helpseeking and health service use?
Med J Aust. Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. Br J Psychiatry. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health.
Moller-Leimkuhler M. Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affect Disord. Wahto R, Swift JK. Labels, gender-role conflict, stigma, and attitudes toward seeking psychological help in men. Am J Mens Health. Masculinity and suicidal thinking. Soc Psychiatry Psychiatr Epidemiol. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry. Rochlen AB. Gender role conflict, attitudes toward career counseling, career decision-making, and perceptions of career counseling advertising brochures.
Psychol Men Masculinity. Couns Psychol. A preliminary examination of the "real men. Real depression" campaign. Blazina C. College men's affective reactions to individual therapy, psychoeducational workshops, and men's support group brochures: the influence of gender-role conflict and power dynamics upon help-seeking attitudes. Psychotherapy Chicago, Ill. McKelley RA. Conformity to masculine norms and preferences for therapy or executive coaching. Robertson JM. Overcoming the masculine mystique: preferences for alternative forms of assistance among men who avoid counseling. J Couns Psychol.
The relation of male gender role conflict and attitudes toward career counseling to interest in and preferences for different career counseling styles.
Silence is deadly
Responses to ethical challenges in conducting research with Australian adolescents. Aust J Psychol. Lewis JA. Statistical principles for clinical trials ICH E9 : an introductory note on an international guideline. Stat Med. Treatment allocation by minimisation. Taves DR.
The use of minimization in clinical trials. Contemporary Clinical Trials. Measuring help-seeking intentions: properties of the general help-seeking questionnaire. Can J Couns.
Silence is not Strength. Silence is Deadly.
Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. J Consult Clin Psychol. Predictors of help-seeking for suicidal ideation in the community: risks and opportunities for public suicide prevention campaigns. Psychiatry Res. Another employee entered the store and the first employee looked up to talk to them about lunch.