556908 research-article2014
JHI0010.1177/1460458214556908Health Informatics JournalMontagni et al.
Article
Spanish students’ use of the Internet for mental health information and support seeking
Health Informatics Journal 1–22 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1460458214556908 jhi.sagepub.com
Ilaria Montagni
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Italy; INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Isabelle Parizot
CNRS, UMR 8097, Centre Maurice Halwbachs, France; INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Aine Horgan
School of Nursing and Midwifery, University College Cork, Ireland
Juan-Luis Gonzalez-Caballero
Department of Statistics and Operational Research, University of Cádiz, Spain
José Almenara-Barrios
Area of Preventive Medicine and Public Health (Biostatistics), University of Cádiz, Spain
Carolina Lagares-Franco and Juan-Luis Peralta-Sáez Department of Statistics and Operational Research, University of Cádiz, Spain
Pierre Chauvin
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Francesco Amaddeo
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Italy
Corresponding author: Ilaria Montagni, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. Email: [email protected]
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
2
Health Informatics Journal
Abstract The Internet is a growing source of information for health in general, with university student being online almost daily. Evaluating their use of the Internet for mental health information and support can help understanding if online tools and websites should be used for mental health promotion and, to some extent, care. A survey was conducted with more than 600 students of Law, Nursing and Computer Science of the University of Cadiz in Spain to determine their general use of the Internet and their perceptions and trust in using this medium for mental health information. Data were collected using a 25-item-questionnaire and findings indicated that students had a strong distrust in online mental health information, notwithstanding their daily use of the Internet. The frequency and methods of their research on the Internet correlated with their health status, their medical consultations and with certain socio-demographic characteristics.
Keywords Internet, mental health, online information, Spain, university students
Introduction The Internet plays a significant role in health information seeking, with an increasing number of web users looking for news and advice concerning mental health.1 The confidential and privacyprotection-oriented nature of the Internet is an incentive for searching sensitive topics such as mental health which are often a source of stigmatization. Furthermore, the Internet has also the advantage of widespread accessibility at low or no cost.2 In this sense, the accessibility offered by the Internet could promote social inclusion for those people who are isolated due to geography, immobility or illness. At present, the Internet is ranked higher as a source to use than a source to trust, with health professionals remaining the most trusted sources of information for mental health problems.3 However, given the frequent use of the Internet and related technology, it is possible that in the near future online mental health services will represent a further therapeutic support for mental health care. Adolescents and young adults could benefit from the use of the Internet as a provider of mental health care, and online mental health promotion. Prevention and early intervention strategies at a population level are already delivered by some national mental health care systems (e.g. in Australia, the Young and Well Cooperative Research Centre website www.yawcrc.org.au and the Orygen Youth Health website www.oyh.org.au; in Ireland, the Youth SpunOut website www.spunout.ie; in France the Fil Santé Jeunes website www.filsantejeunes.com). Young people represent a big portion of the Internet public and they are, at the same time, a vulnerable group where presence of mental distress is frequently observed. Indeed an Australian study reports that issues such as anxiety, depression, psychosis, suicide and eating disorders have actually their peak onset in the 12–25-year period.4 Among Spanish students, aged 18–24 years, Serrano-Blanco et al.5 reported that there is a high odds ratio of them experiencing a substance use or misuse problem. Another Spanish survey6 showed that 7.8 percent of young adults aged 18– 24 years suffered from anxiety disorders. For this reason, concerns regarding the mental health of young people have become increasingly pressing,7 and against this background, it is necessary to evaluate the use of the Internet by young people specifically for mental health information and support seeking. An understanding of their behavior on the web and their feelings about the support and news they find online will help in defining the quality of the contents of websites and aid in the design of new methods for searching information needed. Numerous studies have been conducted on the way people of all ages use the Internet for general health information seeking,8–10 but a few have focused exclusively on both young
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
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Montagni et al.
people and mental health.11–15 As such, the use of the Internet for mental health information is less certain and little is known about what types of mental health information young people search for and how they view using the Internet for mental health support. Among these few studies, Gould et al.12 estimated that in the United States, one-fifth of young adults had used the Internet as a source of mental health information. In Australia, a national survey investigated the perceived helpfulness of websites for mental health information13 and a similar study was conducted in the United States14 showing that mental health–related websites enhance knowledge about mental health issues and increase help seeking. By contrast, in Europe, resources and surveys in this domain are still really scarce, with some exceptions of national studies like the Health Barometer15 in France, which however did not exclusively focus on e-health. In one of the few studies identified, Horgan and Sweeney11 in a quantitative study with Irish students aged between 18 and 24 years showed that 68 percent of participants indicated that they would use the Internet for mental health support if they needed to, and considered the Internet as a viable source of support. Young adults’ and adolescents’ frequent engagement with the Internet for health information can change and affect their relationships with health professionals.16 Indeed, the introduction of information and communication technology has already represented a radical shift in the health domain in general and in the mental health one in particular. However, to the best of our knowledge, there is not yet a complete understanding of how the Internet is used by students in relation to medical advice. In general, it seems that the relationship between patients and physicians has become less hierarchical and more client-provider oriented.17 The main objective of this research was to address the gap in European and International literature about the use of the Internet for mental health information and support seeking by young people and their relationship with the health care system. This article presents findings from a survey conducted in the University of Cadiz in Spain. The survey investigated Spanish students’ use of the Internet by taking into account the links with their health status and their medical consultations. Students’ socio-demographic characteristics and their trust in mental health information found online were also determined.
Methods Data were collected using a self-administered questionnaire based on a tool developed for a study in Ireland.11 The original questionnaire was modified and updated with new items from a French survey18 (Baromètre Santé 2010) and two French Studies (WHIST19 and Fil Santé Jeunes20 surveys). The final questionnaire (see Appendix 1) also took into account the major themes identified from the literature on the use of the Internet by young adults for mental health information and advice and the most searched words on this issue.21 The Spanish version of the questionnaire was then composed of items translated into Spanish from either French or English. Counter-translations were provided by three professional translators and native Spanish speakers for a final Spanish questionnaire which was approved and validated by one psychiatrist, one psychologist and one social worker. They determined whether the questionnaire addressed the topic overall (content validation), and tried to detect whether subjects’ answers on the questionnaire could predict certain aspects or behaviors of the subjects (predictive validation). The questionnaire consisted of 25 items divided into three sets: General Information, that is, demographic details of age, gender, subject of academic study, type of accommodation, place of living, employment and health condition (9 questions); General Usage of Internet (4 questions); and Use of Internet for Health and Mental Health (12 questions). The questionnaire contained different types of questions such as multiple choice questions, polar questions and Likert scales.
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
4
Health Informatics Journal
Data were collected from students of the University of Cadiz which is a public university located in the province of Cadiz, Spain, and founded in 1979. The population of Cadiz in 2012 was 123,948 with a density of 27,000 per square mile. The University’s main schools include Modern Languages, Health, Engineering, Labor Relations, Legal and Economic Studies, Pedagogy. The three courses selected for this study, Computer Science, Law and Nursing, belonged respectively to the school of Engineering, Legal and Economic Studies and Health. In the academic year 2012–2013 when this survey was carried out, the total number of students of the University of Cadiz was 19,802. The survey was conducted in the second week of June 2013. Students from all five years of the Bachelor’s degree and Master’s degree of Computer Science, Law and Nursing were included in the study. These three courses were selected in order to cover both the fields of Letters and Sciences (one of our hypotheses being that students of these fields could have different relationships with Internet). Moreover, we opted for this choice in order to have the same number of males and females, since males were very numerous in the Sciences field, and females in the Nursing course. Nursing students were chosen also in order to represent the medical field without any specific reference to mental health issues. The questionnaire was distributed in class and re-collected after 10–15 min. The protocol of this study was strictly followed in accordance with the Social Research Ethics Committee of the University of Cadiz. The Head of School of each course was contacted to seek access to participants. Once access was granted, the investigators studied the timetables to pick appropriate classes and approached individual lecturers to seek permission to distribute the questionnaire during class time. For Computer Science, 10 classes participated in the survey with the consensus of 7 lecturers. For Law, four classes participated in the survey with the consensus of 4 lecturers. For Nursing, 3 classes participated in the survey with the consensus of 2 lecturers. Lecturers refusing the distribution of the questionnaire during their classes stated that this would have delayed their academic program. All students attending these 17 classes participated to the study and their questionnaires were included in the final analysis with a refusal rate of 0 percent. Not all participants answered every question, but they were all included in the sample because they had answered at least to 50 percent of the items. Among the variables here analyzed, missing rates go from 0 to 20.2 percent. They are reported for each studied variable. Students were informed that the participation was voluntary, that no personal sensitive health data would be collected and that the questionnaires were anonymous. To maintain confidentiality of the records, no personal details like name, address, phone number or e-mail were requested. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) v20.0 software (SPSS Inc.; Chicago, IL, USA). The chi-square test was used for comparisons of proportions, p
JHI0010.1177/1460458214556908Health Informatics JournalMontagni et al.
Article
Spanish students’ use of the Internet for mental health information and support seeking
Health Informatics Journal 1–22 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1460458214556908 jhi.sagepub.com
Ilaria Montagni
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Italy; INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Isabelle Parizot
CNRS, UMR 8097, Centre Maurice Halwbachs, France; INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Aine Horgan
School of Nursing and Midwifery, University College Cork, Ireland
Juan-Luis Gonzalez-Caballero
Department of Statistics and Operational Research, University of Cádiz, Spain
José Almenara-Barrios
Area of Preventive Medicine and Public Health (Biostatistics), University of Cádiz, Spain
Carolina Lagares-Franco and Juan-Luis Peralta-Sáez Department of Statistics and Operational Research, University of Cádiz, Spain
Pierre Chauvin
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, France; Sorbonne Universités, UPMC Univ Paris 06, France
Francesco Amaddeo
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Italy
Corresponding author: Ilaria Montagni, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. Email: [email protected]
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
2
Health Informatics Journal
Abstract The Internet is a growing source of information for health in general, with university student being online almost daily. Evaluating their use of the Internet for mental health information and support can help understanding if online tools and websites should be used for mental health promotion and, to some extent, care. A survey was conducted with more than 600 students of Law, Nursing and Computer Science of the University of Cadiz in Spain to determine their general use of the Internet and their perceptions and trust in using this medium for mental health information. Data were collected using a 25-item-questionnaire and findings indicated that students had a strong distrust in online mental health information, notwithstanding their daily use of the Internet. The frequency and methods of their research on the Internet correlated with their health status, their medical consultations and with certain socio-demographic characteristics.
Keywords Internet, mental health, online information, Spain, university students
Introduction The Internet plays a significant role in health information seeking, with an increasing number of web users looking for news and advice concerning mental health.1 The confidential and privacyprotection-oriented nature of the Internet is an incentive for searching sensitive topics such as mental health which are often a source of stigmatization. Furthermore, the Internet has also the advantage of widespread accessibility at low or no cost.2 In this sense, the accessibility offered by the Internet could promote social inclusion for those people who are isolated due to geography, immobility or illness. At present, the Internet is ranked higher as a source to use than a source to trust, with health professionals remaining the most trusted sources of information for mental health problems.3 However, given the frequent use of the Internet and related technology, it is possible that in the near future online mental health services will represent a further therapeutic support for mental health care. Adolescents and young adults could benefit from the use of the Internet as a provider of mental health care, and online mental health promotion. Prevention and early intervention strategies at a population level are already delivered by some national mental health care systems (e.g. in Australia, the Young and Well Cooperative Research Centre website www.yawcrc.org.au and the Orygen Youth Health website www.oyh.org.au; in Ireland, the Youth SpunOut website www.spunout.ie; in France the Fil Santé Jeunes website www.filsantejeunes.com). Young people represent a big portion of the Internet public and they are, at the same time, a vulnerable group where presence of mental distress is frequently observed. Indeed an Australian study reports that issues such as anxiety, depression, psychosis, suicide and eating disorders have actually their peak onset in the 12–25-year period.4 Among Spanish students, aged 18–24 years, Serrano-Blanco et al.5 reported that there is a high odds ratio of them experiencing a substance use or misuse problem. Another Spanish survey6 showed that 7.8 percent of young adults aged 18– 24 years suffered from anxiety disorders. For this reason, concerns regarding the mental health of young people have become increasingly pressing,7 and against this background, it is necessary to evaluate the use of the Internet by young people specifically for mental health information and support seeking. An understanding of their behavior on the web and their feelings about the support and news they find online will help in defining the quality of the contents of websites and aid in the design of new methods for searching information needed. Numerous studies have been conducted on the way people of all ages use the Internet for general health information seeking,8–10 but a few have focused exclusively on both young
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
3
Montagni et al.
people and mental health.11–15 As such, the use of the Internet for mental health information is less certain and little is known about what types of mental health information young people search for and how they view using the Internet for mental health support. Among these few studies, Gould et al.12 estimated that in the United States, one-fifth of young adults had used the Internet as a source of mental health information. In Australia, a national survey investigated the perceived helpfulness of websites for mental health information13 and a similar study was conducted in the United States14 showing that mental health–related websites enhance knowledge about mental health issues and increase help seeking. By contrast, in Europe, resources and surveys in this domain are still really scarce, with some exceptions of national studies like the Health Barometer15 in France, which however did not exclusively focus on e-health. In one of the few studies identified, Horgan and Sweeney11 in a quantitative study with Irish students aged between 18 and 24 years showed that 68 percent of participants indicated that they would use the Internet for mental health support if they needed to, and considered the Internet as a viable source of support. Young adults’ and adolescents’ frequent engagement with the Internet for health information can change and affect their relationships with health professionals.16 Indeed, the introduction of information and communication technology has already represented a radical shift in the health domain in general and in the mental health one in particular. However, to the best of our knowledge, there is not yet a complete understanding of how the Internet is used by students in relation to medical advice. In general, it seems that the relationship between patients and physicians has become less hierarchical and more client-provider oriented.17 The main objective of this research was to address the gap in European and International literature about the use of the Internet for mental health information and support seeking by young people and their relationship with the health care system. This article presents findings from a survey conducted in the University of Cadiz in Spain. The survey investigated Spanish students’ use of the Internet by taking into account the links with their health status and their medical consultations. Students’ socio-demographic characteristics and their trust in mental health information found online were also determined.
Methods Data were collected using a self-administered questionnaire based on a tool developed for a study in Ireland.11 The original questionnaire was modified and updated with new items from a French survey18 (Baromètre Santé 2010) and two French Studies (WHIST19 and Fil Santé Jeunes20 surveys). The final questionnaire (see Appendix 1) also took into account the major themes identified from the literature on the use of the Internet by young adults for mental health information and advice and the most searched words on this issue.21 The Spanish version of the questionnaire was then composed of items translated into Spanish from either French or English. Counter-translations were provided by three professional translators and native Spanish speakers for a final Spanish questionnaire which was approved and validated by one psychiatrist, one psychologist and one social worker. They determined whether the questionnaire addressed the topic overall (content validation), and tried to detect whether subjects’ answers on the questionnaire could predict certain aspects or behaviors of the subjects (predictive validation). The questionnaire consisted of 25 items divided into three sets: General Information, that is, demographic details of age, gender, subject of academic study, type of accommodation, place of living, employment and health condition (9 questions); General Usage of Internet (4 questions); and Use of Internet for Health and Mental Health (12 questions). The questionnaire contained different types of questions such as multiple choice questions, polar questions and Likert scales.
Downloaded from jhi.sagepub.com at UCSF LIBRARY & CKM on March 2, 2015
4
Health Informatics Journal
Data were collected from students of the University of Cadiz which is a public university located in the province of Cadiz, Spain, and founded in 1979. The population of Cadiz in 2012 was 123,948 with a density of 27,000 per square mile. The University’s main schools include Modern Languages, Health, Engineering, Labor Relations, Legal and Economic Studies, Pedagogy. The three courses selected for this study, Computer Science, Law and Nursing, belonged respectively to the school of Engineering, Legal and Economic Studies and Health. In the academic year 2012–2013 when this survey was carried out, the total number of students of the University of Cadiz was 19,802. The survey was conducted in the second week of June 2013. Students from all five years of the Bachelor’s degree and Master’s degree of Computer Science, Law and Nursing were included in the study. These three courses were selected in order to cover both the fields of Letters and Sciences (one of our hypotheses being that students of these fields could have different relationships with Internet). Moreover, we opted for this choice in order to have the same number of males and females, since males were very numerous in the Sciences field, and females in the Nursing course. Nursing students were chosen also in order to represent the medical field without any specific reference to mental health issues. The questionnaire was distributed in class and re-collected after 10–15 min. The protocol of this study was strictly followed in accordance with the Social Research Ethics Committee of the University of Cadiz. The Head of School of each course was contacted to seek access to participants. Once access was granted, the investigators studied the timetables to pick appropriate classes and approached individual lecturers to seek permission to distribute the questionnaire during class time. For Computer Science, 10 classes participated in the survey with the consensus of 7 lecturers. For Law, four classes participated in the survey with the consensus of 4 lecturers. For Nursing, 3 classes participated in the survey with the consensus of 2 lecturers. Lecturers refusing the distribution of the questionnaire during their classes stated that this would have delayed their academic program. All students attending these 17 classes participated to the study and their questionnaires were included in the final analysis with a refusal rate of 0 percent. Not all participants answered every question, but they were all included in the sample because they had answered at least to 50 percent of the items. Among the variables here analyzed, missing rates go from 0 to 20.2 percent. They are reported for each studied variable. Students were informed that the participation was voluntary, that no personal sensitive health data would be collected and that the questionnaires were anonymous. To maintain confidentiality of the records, no personal details like name, address, phone number or e-mail were requested. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) v20.0 software (SPSS Inc.; Chicago, IL, USA). The chi-square test was used for comparisons of proportions, p
