Improving support for people with mental health problems in China: a cluster randomised controlled trial of culturally adapted Mental Health First Aid training
Date
2025
Authors
Reavley, N.
Morgan, A.J.
Jorm, A.F.
Kitchener, B.
Wang, Y.
Lu, S.
Li, W.
Kelly, C.
Oldenburg, B.
Zhao, M.
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Journal article
Citation
The Lancet Regional Health. Western Pacific, 2025; 63:101698-1-101698-10
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Nicola Reavley, Amy J. Morgan, Anthony F. Jorm, Betty Kitchener, Yan Wang, Shurong Lu, Wenjing Li, Claire Kelly, Brian Oldenburg, Min Zhao, Yanling He
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Abstract
Background Culturally appropriate interventions that teach members of the public to provide early help towards a person developing a mental health problem or in a mental health crisis may improve access to services, social support, and mental health outcomes. This is the first study to evaluate the effectiveness of culturally adapted Mental Health First Aid (MHFA) Training for China. Methods A two-arm wait-list pilot cluster randomised controlled trial (cRCT) was conducted in 3 settings in Shanghai (health services, workplaces and community settings). Intervention settings were paired according to type and one of each pair was randomly allocated to the intervention (MHFA Training for China) or the wait-list control group, with a 1:1 allocation. Participants were invited by the trial coordinators in each setting. They were asked to complete questionnaires at baseline (T1) and 1 month (T2) and 7 months after training (T3). Control group participants were asked to complete questionnaires at corresponding times. The primary outcome was participant intended actions (recommended or not recommended) towards a person experiencing a mental health problem or in a mental health crisis. Secondary outcomes included recognition of depression in a vignette; beliefs about the helpfulness of health professionals and interventions; helping actions; confidence in providing mental health first aid; and stigmatising attitudes. Findings Between April and May 2024, 6 clusters were recruited and randomised, with 3 in each of the intervention and control arms. Following exclusion of participants who did not provide data, 146 participants were included at baseline: 67 in the intervention group and 79 in the control group. For the primary outcome (recommended actions subscale), the intervention group showed a significantly larger improvement than the control group at T2 (8.19 [95% CI 4.05–12.34]; p < 0.001) and T3 (3.08 [95% CI −1.02 to 7.18]; p = 0.034). Differences in changes in non-recommended actions were non-significant. At T2, significant differences favouring the intervention group were observed in confidence to provide support, perceiving the person as dangerous or unpredictable and in recognition of depression in a vignette. There were no significant differences in secondary outcomes at T3. Interpretation Delivering culturally adapted MHFA Training for China more widely could improve support for people experiencing mental health problems in the community.
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© 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).