Psychiatry and Psychology Commons^™

Maternal Mental Health Priorities, Help-Seeking Behaviors, And Resources In Post-Conflict Settings: A Qualitative Study In Eastern Uganda., Wietse A Tol, Breeona Ebrecht, Rebecca Aiyo, Sarah M Murray, Amanda J Nguyen, Brandon A Kohrt, Sheila Ndyanabangi, Stephen Alderman, Seggane Musisi, Juliet Nakku

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders' perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda.

METHODS: We employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = …

Psychosocial Correlates Of Post-Traumatic Stress Disorder Symptoms And Well-Being Among Hispanic World Trade Center Rescue And Recovery Workers, Dianne Ciro

Dissertations, Theses, and Capstone Projects

Thousands of first responders are estimated to have endured extremely distressing experiences during their recovery efforts at the 9/11 World Trade Center (WTC) site. While the effects of 9/11 continue to be studied, few studies have examined how rescue and recovery workers have been coping since 9/11 and how their coping is associated with their psychological well-being. Moreover, we do not know how distinct coping patterns may be associated with post-traumatic growth, experiences of positive emotion, or quality of life among WTC responders.

This study compared coping differences among Hispanic, Non-Hispanic White, and Non-Hispanic Black first responders. In addition, it …

Sensory, Motor And Process Skills As Compared To Symptom Severity In Adult Patients With Schizophrenia, Lola Halperin

Occupational Therapy Faculty Publications

Schizophrenia is a serious mental illness affecting millions of Americans. It is characterized by positive and negative symptoms; cognitive impairments; and sensory, motor, and process skill deficits; as well as compromised motor learning, functional difficulties, and diminished quality of life. Neuroscientists attribute the above deficits to abnormal brain development, exaggerated synaptic pruning, and neurodegenerative processes, causing disrupted connectivity and diminished plasticity in the brain, neurotransmitter dysfunction, and impaired sensory processing.

Presently, there is no cure for schizophrenia. Numerous medications and rehabilitation modalities exist; however, many of the affected individuals continue to struggle daily. Recovery of these individuals implies symptom management …

Objective Coding Of Content And Techniques In Workplace-Based Supervision Of An Ebt In Public Mental Health, Shannon Dorsey, Suzanne E U Kerns, Leah Lucid, Michael D Pullmann, Julie P Harrison, Lucy Berliner, Kelly Thompson, Esther Deblinger

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials.

METHODS: Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health …

Investigating Prosodic Accommodation In Clinical Interviews With Depressed Patients, Brian Vaughan, Carolina De Pasquale, Lorna Wilson, Charlie Cullen, Brian Lawlor

Conference Papers

Six in-depth clinical interviews, involving six elderly female patients (aged 60+) and one female psychiatrist, were recorded and analysed for a number of prosodic accommodation variables.

Our analysis focused on pitch, speaking time, and vowel-space ratio. Findings indicate that there is a dynamic manifestation of prosodic accommodation over the course of the interactions. There is clear adaptation on the part of the psychiatrist, even going so far as to have a reduced vowel-space ratio, mirroring a reduced vowel-space ratio in the depressed patients. Previous research has found a reduced vowel-space ratio to be associated with psychological distress; however, we suggest …

Reducing Stigma Among Healthcare Providers To Improve Mental Health Services (Reshape): Protocol For A Pilot Cluster Randomized Controlled Trial Of A Stigma Reduction Intervention For Training Primary Healthcare Workers In Nepal., Brandon A Kohrt, Mark J D Jordans, Elizabeth L Turner, Kathleen J Sikkema, Nagendra P Luitel, Sauharda Rai, Daisy R Singla, Jagannath Lamichhane, Crick Lund, Vikram Patel

Psychiatry and Behavioral Sciences Faculty Publications

Background

Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services …

Interpersonal Violence And Suicidality Among Former Child Soldiers And War-Exposed Civilian Children In Nepal., Anvita Bhardwaj, Christine Bourey, Sauharda Rai, Ramesh Prasad Adhikari, Carol M Worthman, Brandon A Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background: Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal.

Methods: A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and …

Neural Correlates Of Taste Reactivity In Autism Spectrum Disorder., Jason A Avery, John E Ingeholm, Sophie Wohltjen, Meghan Collins, Cameron D Riddell, Stephen J Gotts, Lauren Kenworthy, Gregory L Wallace, W Kyle Simmons, Alex Martin

Psychiatry and Behavioral Sciences Faculty Publications

Selective or 'picky' eating habits are common among those with autism spectrum disorder (ASD). These behaviors are often related to aberrant sensory experience in individuals with ASD, including heightened reactivity to food taste and texture. However, very little is known about the neural mechanisms that underlie taste reactivity in ASD. In the present study, food-related neural responses were evaluated in 21 young adult and adolescent males diagnosed with ASD without intellectual disability, and 21 typically-developing (TD) controls. Taste reactivity was assessed using the Adolescent/Adult Sensory Profile, a clinical self-report measure. Functional magnetic resonance imaging was used to evaluate hemodynamic responses …

Discerning Suicide In Drug Intoxication Deaths: Paucity And Primacy Of Suicide Notes And Psychiatric History, Ian Rh Rockett, Eric D. Caine, Hilary S. Connery, Gail D'Onofrio, David J. Gunnell, Ted R. Miller, Kurt B. Nolte, Mark S. Kaplan, Nestor D. Kapusta, Christa L. Lilly, Lewis S. Nelson, Sandra L. Putnam, Steven Stack, Peeter Varnik, Lynne R. Webster, Haomiao Jia

Faculty & Staff Scholarship

Objective

A paucity of corroborative psychological and psychiatric evidence may be inhibiting detec- tion of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods.

Methods

This observational multilevel (individual/county), multivariable study employed a general- ized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System …

Suicidal Ideation Assessment In Individuals With Premanifest And Manifest Huntington Disease., Melissa Wesson, Nicholas R Boileau, Joel S Perlmutter, Jane S Paulsen, Stacey K Barton, Michael K Mccormack, Noelle E Carlozzi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Huntington disease (HD) is associated with increased risk of suicide.

OBJECTIVE: This study compares suicide ideation in HD to the general population, assesses factors associated with increased prevalence of suicidal thoughts, and compares clinician-rated to self-reported assessments of suicidal ideation.

METHODS: We examined 496 participants with premanifest or manifest HD. Clinician-rated suicidal ideation was measured using the Problem Behaviors Assessment - short form. Self-reported ideation was measured using two items from the HDQLIFE Concern with Death and Dying item bank. Independent sample t-tests were conducted to compare the prevalence of suicidal thoughts between our HD sample and the U.S. …

Relationships Among Apathy, Health-Related Quality Of Life, And Function In Huntington's Disease., Nora E Fritz, Nicholas R Boileau, Julie C Stout, Rebecca Ready, Joel S Perlmutter, Jane S Paulsen, Kimberly Quaid, Stacey Barton, Michael K Mccormack, Susan L Perlman, Noelle E Carlozzi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Up to 90% of individuals with Huntington's disease (HD)-a progressive, inherited neurodegenerative disorder-experience apathy. Apathy is particularly debilitating because it is marked by a reduction in goal-directed behaviors, including self-care, social interactions, and mobility. The objective of this study was to examine relationships between variables of apathy, functional status, physical function, cognitive function, behavioral status/emotional function, and health-related quality of life. Clinician-rated measures of physical, cognitive, and behavioral function, including one clinician-rated item on apathy, and self-reported measures of physical function, health-related quality of life, and emotional, cognitive, and social function were collected in a single session from 487 persons …

Feasibility Study Of A Family- And School-Based Intervention For Child Behavior Problems In Nepal., Ramesh P Adhikari, Nawaraj Upadhaya, Emily N Satinsky, Matthew D Burkey, Brandon A Kohrt, Mark J D Jordans

Psychiatry and Behavioral Sciences Faculty Publications

Background: This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.

Methods: Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6-15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale-Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews …

Protocol For A Feasibility Study Of Group-Based Focused Psychosocial Support To Improve The Psychosocial Well-Being And Functioning Of Adults Affected By Humanitarian Crises In Nepal: Group Problem Management Plus (Pm+), M Sangrawla, E Van Hof, N Luitel, E Turner, K Marahatta, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background

The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individuallydelivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and …

Spotlight On Once-Monthly Long-Acting Injectable Aripiprazole And Its Potential As Maintenance Treatment For Bipolar I Disorder In Adult Patients., Vanessa Torres-Llenza, Pooja Lakshmin, Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

The lack of long-term medication adherence is a challenge in the treatment of bipolar disorder, particularly during the maintenance phase when symptoms are less prominent. The rate of nonadherence is ~20%-60% depending on how strict a definition is used. Nonadherence worsens the course of bipolar disorder and can add hundreds of thousands of dollars to the lifetime cost of treating the illness. Long-acting injectable (LAI) medication is an attractive alternative to daily dosing of oral medication, especially among patients who are ambivalent about treatment. The purpose of this paper is to review the evidence for the safety and efficacy of …

Shared Genetic And Environmental Influences On Fear, Anxiety, Posttraumatic Stress, And Brain Morphometry, Chelsea Sawyers

Theses and Dissertations

Anxiety disorders (ADs) and stress-related disorders are some of the most common psychiatric disorders in the United States. Like other c0mplex psychiatric illness, genetics and neuroimaging research has focused on understanding their underlying neurobiology. Areas within the fear-network play important roles in threat perception, fear conditioning/learning, cognitive processing, and modulation of fear responses including contextual modulation and extinction and have been implicated in ADs as well as stress disorders such as posttraumatic stress disorder (PTSD). The primary gap in the current search for underlying biological mechanisms is in whether biomarkers associated with disorders share genetic influences with the disorders they …

Relationship Of Physical Health Risk Screenings In Seriously Mentally Ill With Self-Efficacy For Health, Perception Of Health Risk, And Intention To Follow-Up With Medical Care., Dawn (Vanruler) Bos

Electronic Theses and Dissertations

Morbidity and mortality occur at higher rates in those with serious mental illness (SMI) than those without SMI. These higher rates are worsening in degree, despite known preventative strategies, such as physical health risk screening (HRS). This study evaluates the relationship of physical HRS with self-efficacy for health prevention behaviors, perception of level of risk of health consequences, and intention to follow up with medical care for identified health risks. The study considers Protection Motivation Theory (PMT) factors related to HRS in individuals with SMI. A HRS tool was administered to 54 adult ambulatory clients from the Midwestern United States …

Evaluating The Attitudes And Practices Of Exercise Prescription Among Psychotherapists, Igor Vasilj

Theses and Dissertations--Educational, School, and Counseling Psychology

Exercise has been shown to improve mood, anxiety, stress, and promote neuroplasticity (Conn, 2010; Donaghy, 2007; Josefsson, Lindwall, & Archer, 2014; Silveria et al., 2013; Stathopoulou et al., 2006). However, limited research on the topic suggests that many psychologists and mental health providers are not incorporating exercise into psychological treatment, and many lack the confidence to do so (Burton, Pakenham, & Brown, 2010; Weir, 2011). The purpose of this study was to evaluate current exercise prescription trends among practicing psychologists and trainees, including identifying their current beliefs, attitudes, training, and the perceived barriers hindering psychotherapists from recommending and prescribing exercise. …

Development And Preclinical Evaluation Of Long-Lasting Cocaine Hydrolases For Cocaine Overdose And Cocaine Use Disorder Treatment, Ting Zhang

Theses and Dissertations--Pharmacy

Cocaine is a plant-based illicit drug commonly involved in substance use disorder. Although cocaine overdose and cocaine use disorders cause adverse health consequences to individuals and the economic burden on their family and society, there are no FDA (Food and Drug Administration) approved medications for treatment. Recently, it has been recognized that delivery of cocaine hydrolase (CocH) is a promising therapeutic strategy. Human butyrylcholinesterase (hBChE), the primary enzyme involved in cocaine metabolism in human, have advantages over other candidates for the development of CocH. Previous studies in our laboratory have designed and characterized hBChE mutants that have ~4,000-fold improved catalytic …

Cocaine Choice: A Novel Procedure For Investigating Neuronal Activation Mediating Cocaine Preference, Jonathan Jenn-Sheng Chow

Theses and Dissertations--Psychology

Cocaine use disorder is a significant health problem, negatively impacting individuals afflicted. While preclinical self-administration research has provided invaluable insight into the neurobehavioral mechanisms that underlie cocaine abuse, cocaine use outside of the laboratory occurs within an environment where other goods are also available ubiquitously. Although there is an ever-increasing literature investigating drug vs. non-drug choice in rodent models and how alternative goods can compete with the subjective value of cocaine, the neurobiological mechanisms that are associated with cocaine preference remains largely unknown. Additionally, current drug vs. non-drug choice studies use procedures that confound preference with intake, such that preference …

A Sensory-Based Program To Enhance Occupational Performance For Dementia, Naomi Grace Wong, Jacob Joseph Gantan, Ivy Annahi Torres-Flores, Heather Anne August

Student Research Posters

Dementia is a neurological disease, causing behavioral and cognitive symptoms, that progressively impairs an individual’s ability to engage in meaningful activities. Progressive deterioration associated with dementia impacts occupational performance and independence and quality of life. Sensory based interventions, such as drumming groups, have been hypothesized to be a non-pharmacological intervention for individuals with dementia. The purpose of this study was to analyze the effects of a sensory based intervention program, in this case participation in a drumming group, on functional engagement during self-feeding for individuals with dementia. Researchers gathered data over the course of two days using the Functional Behavior …

Sexual Coercion, Drinking To Cope Motives, And Alcohol-Related Consequences Among Self-Identified Bisexual Women, Michelle L. Kelly, Sarah J. Ehlke, Robin J. Lewis, Abby L. Braitman, Wendy Bostwick, Kristin E. Heron, Cathy Lau-Barraco

Psychology Faculty Publications

Background: Given higher sexual victimization and greater alcohol use among bisexual women, a critical public health challenge is to understand within-group variation that may heighten or explain these associations in bisexual women. Objectives: The present study tested a moderated-mediation model in which sexual coercion was hypothesized to be associated with alcohol-related consequences via drinking to cope motives in self-identified bisexual women who reported at least occasional binge drinking. Negative affect was hypothesized to moderate the sexual coercion-drinking to cope motives association. Methods: Participants were a community sample of 107 self-identified bisexual women (age M = 20.97, SD = 2.11) who …

Six-Month Post-Release Outcomes For Inmates With Traumatic Brain Injury In Supported Community Programming, Elizabeth O. Ahlers

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Traumatic brain injury (TBI) is a serious public health issue. The incidence of TBI is much higher in the incarcerated population than in the general population, making this a uniquely vulnerable population. Methods: This study looks at data from the Jail Based Behavioral Health Services (JBBS) to examine recidivism rates among inmates participating in supportive programming. It also uses data from a state brain injury program to examine the impact of case management on community engagement in the justice-involved population with a history of brain injury. Results: Statewide data for a population of inmates who elect to participate …

A Comparison Of The Rey Auditory-Verbal Learning Test And The Wechsler Scales, Samantha Denhart

Murray State Theses and Dissertations

The present study was designed to determine the correlation between a commonly used cognitive ability test (i.e., Wechsler) and a verbal memory test (i.e., Rey Auditory-Verbal Learning Test) by analyzing archival data from a clinical sample of adults. Many researchers have continued to establish the relationship between cognitive ability, or IQ, and learning and memory skills; however, there is little research regarding when differences between IQ and memory scores are statistically significant. Results of this study indicated 17 of 20 IQ index/memory correlations were statistically significant and a series of simple regressions generated standardized residuals. These residuals generated confidence bands …

The Unspoken Psychological Issues With Lesson Horses And How We Need To Address Them, Casey Clark

Murray State Theses and Dissertations

Every day all over the world horses provide much needed therapy and treatment to people in need. They provide physical, emotional, and mental training and healing. Humans depend on them for so much and we have a moral and ethical obligation to be good stewards of our equine companions. This close proximity can take a toll on horses physically and psychologically even in the realm of experienced equine professionals. So many times though it is the small lesson facility that sees hundreds of people each year and makes a profound difference in people’s lives. This can be at a 4-H …

Clinical Utility Of The Dsm-5 Alternative Model For Borderline Personality Disorder: Differential Diagnostic Accuracy Of The Bfi, Scid-Ii-Pq, And Pid-5, J Christopher Fowler, Alok Madan, Jon G Allen, Michelle Patriquin, Carla Sharp, John M Oldham, B Christopher Frueh

Staff and Researcher Publications

Background: With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD).

Methods: Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n=653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) …

Amygdala-Frontal Connectivity Predicts Internalizing Symptom Recovery Among Inpatient Adolescents, Amanda Venta, Carla Sharp, Michelle Patriquin, Ramiro Salas, Elizabeth Newlin, Kaylah Curtis, Philip Baldwin, Christopher Fowler, B Christopher Frueh

Staff and Researcher Publications

Background: The possibility of using biological measures to predict the trajectory of symptoms among adolescent psychiatric inpatients has important implications. This study aimed to examine emotion regulation ability (measured via self-report) and a hypothesized proxy in resting-state functional connectivity [RSFC] between the amygdala and frontal brain regions as baseline predictors of internalizing symptom recovery during inpatient care.

Methods: 196 adolescents (61% female; Mage = 15.20; SD = 1.48) completed the Achenbach Brief Problem Monitor (BPM) each week during their inpatient care. RSFC (n = 45) and self-report data of emotion regulation (n = 196) were collected at baseline.

Results: The …

Stasi Brainwashing In The Gdr 1957 - 1990, Jacob H. Solbrig, Jacob Hagen Solbrig

LSU New Orleans Theses and Dissertations

This thesis examines the methods used by the Ministerium für Staatssicherheit (MfS), more commonly known as the Stasi, or East German secret police, for extraction of information from citizens of the German Democratic Republic for the purpose of espionage and covert operations inside East Germany, as it pertains to the deliberate brainwashing of East German citizens. As one of the most efficient intelligence agencies to ever exist, the Stasi’s main purpose was to monitor the population, gather intelligence, and collect or turn informants. They used brainwashing techniques to control the people of the GDR, keeping the populace paralyzed with fear …

Modifiable Lifestyle Risk Factors For Stroke Among A High Risk Hypertensive Population In Greater Kampala, Uganda; A Cross-Sectional Study, Carol Blixen, Elisabeth Welter, Martha Sajatovic

Faculty Scholarship

Objective: To describe the modifiable lifestyle risk factors for stroke among a high risk population for stroke. Africa suffers from rapid population growth, adoption of harmful western diets, and increased prevalence of hypertension and obesity. Results: A total of 440 study participants were screened and 87 individuals with hypertension plus at least one other known stroke risk factor were enrolled. The prevalence of hypertension and diabetes mellitus in the screened population was 19.7 and 1.8%, respectively. Among those with hypertension only 2.3% (2/87) had ever had serum lipid assessment. Seventy-two percent (68/87) had very high serum LDL-cholesterol, while 33.3% (29/87) …

Buspirone Maintenance Does Not Alter The Reinforcing, Subjective, And Cardiovascular Effects Of Intranasal Methamphetamine, Anna R. Reynolds, Justin Charles Strickland, William W. Stoops, Joshua A. Lile, Craig R. Rush

Pharmaceutical Sciences Faculty Publications

Background—Medications development efforts for methamphetamine-use disorder have targeted central monoamines because these systems are directly involved in the effects of methamphetamine. Buspirone is a dopamine autoreceptor and D3 receptor antagonist and partial agonist at serotonin 1A receptors, making it a logical candidate medication for methamphetamine-use disorder. Buspirone effects on abuse-related behaviors of methamphetamine have been mixed in clinical and preclinical studies. Experimental research using maintenance dosing, which models therapeutic use, is limited. This study evaluated the influence of buspirone maintenance on the reinforcing effects of methamphetamine using a self-administration procedure, which has predictive validity for clinical efficacy. The impact …

Differences In Mental Health Education Across Baby Boomers, Generation X, And Millennials, Ashlyn M. Avera

Honors College Theses

There is no denying that mental illness has gained a strong prevalence in the United States. According to the National Alliance on Mental Illness, approximately one in five adults in the United States experiences a mental illness in any given year. Although mental health stigmas have played a role in the past, it does not mean they must continue to play the same role in the future. Research is now looking toward ways to decrease mental health stigma through increasing mental health knowledge. This study examines the starting point for which a society becomes literate in mental health. Using a …