A Systematic Review of the Impacts of Media Mental Health Awareness Campaigns on Young People

This systematic review has been preregistered in the PROSPERO database (CRD42021220186).

This systematic review explored the characteristics and impacts of media mental health campaigns directed toward young people. We found that the goal of these campaigns focused primarily on raising awareness about suicide, encouraging help-seeking behaviors, promoting mental health literacy, and reducing stigma. The most popular method of evaluating the effects of media mental health campaigns for youth were self-reported measures of attitudes, beliefs, and behaviors followed by randomized control trials. These campaign evaluations show that exposure to campaigns has largely positive effects on proximal and intermediate outcomes. Proximal impacts included increased positive attitudes toward people experiencing mental health issues, reduced stigma toward oneself and others, awareness, and traffic of promoted resources, and increased intention and ability to seek help for oneself and others. Intermediate impacts included decreased mental health related outcomes such as depressive mood, increased health-seeking behaviors, and increased discussions about mental health. With only two studies reporting null results, existing media campaigns about mental health demonstrated a largely positive impact on their audience.

None of the campaign evaluations found negative impacts or harms. This finding contrasts with previous research on suicide prevention campaigns, where potential negative impacts were identified (Pirkis et al., 2019; Torok et al., 2017). Harmful campaign impacts may occur if contents of the campaign are triggering for individuals struggling with mental illness. For instance, growing evidence suggests a positive association between media coverage of suicidal behaviors and subsequent suicide rates (termed the “Werther” effect), especially when suicide reports are large-scale and sensationalized (Domaradzki, 2021). However, content related to suicide that emphasize its negative characteristics (e.g., as a wrong and painful act) or portray individuals who contemplated suicide but later coped through their difficulties can have a preventive effect, called the “Papageno effect” (Domaradzki, 2021). Thus, it is important that campaign content related to suicide are strategically designed to avoid elements associated with the Werther effect and emphasize elements associated with the Papageno effect.

This review found evaluations of campaigns disseminated primarily in Western countries. This may be partly due to our inclusion criteria of English papers only but may also reflect cultural differences in beliefs and attitudes toward mental health. A significant body of research demonstrates cross-cultural differences in beliefs about the cause of mental illness. Nakane et al. (2005) have shown that Japanese people are more likely to endorse “weakness of character” while Australians are more likely to endorse biological factors as a cause for depression and schizophrenia. Beliefs about mental illness as a weakness or character flaw are also prominent in Taiwan (Kurumatani et al., 2004) and Turkey (Taskin et al., 2003), and less common in Australia (Nakane et al., 2005) and the United States (Link et al., 1999) by comparison. Associating mental illness with character flaws implies moral judgment of mental illness, which promotes stigma around help-seeking and creates barriers to public discussions of these topics. With this in mind, it would not be unexpected to observe fewer media mental health campaigns in non-Western countries that hold more stigmatizing beliefs in comparison to Western countries. After a rigorous and systematic search of the literature, the inclusion of only 18 studies indicates the need for further evaluations specific in this area. In alignment with this sample size, the search found increasing numbers of published evaluations through the years, notably after 2019, indicating a recent upward trend in efforts to systematically evaluate the impacts of media mental health campaigns on young people.

We identified a lack of harmonization in the instruments and measures used for evaluation. Most evaluations measured campaign impacts using questionnaires, with some employing validated scales such as the General Help-Seeking Questionnaire (McTernan et al., 2023; Wilson et al., 2005)—however, there is a general lack of consensus on whether the contents of these questionnaires are designed to yield insights in the context of mass campaigns. Thus, there is a pressing need for a standardized tool to measure the impact of mental health campaigns that would allow for the comparison of campaigns across platforms.

Evaluations to inform best practices in the development and distribution of campaigns are essential to their successful dissemination and to maximize their impact. Evaluations can determine which methods of dissemination are most engaging for the population of interest, how the campaign affects them, and effective approaches of assessing the outcomes. An evaluation exploring the feasibility of a short-term anti-stigma campaign found that outcomes related to knowledge were easier to influence in comparison to those related to attitudes or behavior (Evans-Lacko et al., 2010). An evaluation of a student-led mental health awareness campaign discussed the need for further research in survey administration as a method of evaluation and recommendations for incentives depending on the intended audience (Giroux & Geiss, 2019). This systematic review assessed the outcomes of media mental health campaigns for young people that varied in their scope, mental health focus, evaluation designs, and outcomes measured. Conducting ongoing evaluations with rigorous methodologies assessing both short- and long-term effects of mental health campaigns will provide valuable insights not only on the existing campaigns, but also for future campaign development and dissemination.

We acknowledge the limitations of the present review. Only English articles were included in the study, which may have led to the exclusion of important evaluations of media mental health campaigns for youth in other languages and cultures. Given that most of the included evaluations relied on quantitative data, this review does not include rich data on the experiences and subjective appraisals of young people who are exposed to media mental health campaigns.

The present review reports positive effects of mass media campaigns on individuals’ awareness, beliefs, and behaviors around mental health. These findings support the benefits of using mass media to disseminate mental health messages to reach specific groups that are otherwise difficult to engage such as the youth population. This strategy should be utilized to reach other groups such as those from various cultural backgrounds where mental health stigma may be experienced. Given cross-cultural variations in historical attitudes, beliefs, and treatments of mental illness, mental health campaigns that are effective in Western countries may not have the same effect in other regions of the world. Different factors play a role in the way mental health is characterized and managed. In many Eastern countries, mental health disorders are considered a taboo, where it is shameful to discuss the topic with others, and there is a lack of resources (Madina & Ahmad, 2023). In Western countries, media representation of mental health disorders and the presence of advocacy initiatives are more common and have raised awareness around the issue (Madina & Ahmad, 2023). This highlights a pressing need for cultural competency in the design and implementation of mental health campaigns, such that they are aligned with the cultural needs and values of the intended audience. Studies included in this review also emphasize the importance of involving intended audiences in the design and implementation of mental health campaigns. A participatory design approach allows individuals to be an integral part of the design process and to contribute their perspectives and ideas toward the final product. Through design approaches that engage members of target communities, campaign messages become more relatable, can increase reach and engagement, and create a larger impact. A campaign included in the review focused on connecting boys and young men to mental health supports consulted various young people about the concepts used to share this message (Zenone et al., 2020). The authors emphasized the importance of speaking with the populations that campaigns are intended to reach, as relying on literature and statistics limits the ability to engage those of interest (Zenone et al., 2020). In addition, consulting specific audiences during the developmental stages of campaigns can mitigate harmful effects of sharing sensitive content related to mental health and suicide. A study engaging young people in the development of suicide prevention messages on social media found that it was feasible to safely involve them during the design process and as a result increase traction of the final campaign in a meaningful way (Robinson et al., 2017). Future media mental health campaigns should identify and focus on groups where mental health stigma is most prevalent and involve these individuals in the design and implementation processes to foster more authentic and impactful mental health promotion strategies. The involvement of audience members ensures that their specific needs are addressed and appropriate language is used so that the messages can resonate and influence change.

Channels and methods for disseminating mental health information are ever-changing. Earlier evaluations in this review focused on campaigns disseminated through channels such as radio and Facebook advertisement, while more recent evaluations focus on newer platforms such as Twitter, Instagram, and Snapchat. This presents a challenge to effective campaigns and evaluation research, as they must keep pace with the emergence of new social media platforms. Future campaign evaluations may benefit from comparing the effectiveness of previous efforts across media types (e.g., television, print advertisements, and online social media) to identify which platforms might generate a greater effect. In addition, further research in this area should consider identifying specific features of the platform that are most effective for dissemination (e.g., dissemination through direct message versus posting on a feed), thereby making evaluations more generalizable across platforms, and providing helpful information for mental health campaigns to keep up with the continuous advancement of the digital landscape. Gaining a more in-depth understanding of which messaging formats attract engagement can help realize the full potential of the platforms in reaching and engaging with target audiences effectively. Findings from these lines of research, combined with analyses such as the one presented here, can inform the development of specific guidelines or frameworks for the design and implementation of campaigns that are not only effective, but also uphold ethical and cultural considerations. These guidelines can include the language used in messages that are most effective on specific platforms, the format of messages that invite increased engagement and retention, and optimal strategies to influence proximal or intermediate changes. Harnessing the strengths of each platform feature can be advantageous in engaging the target population.

This review included media campaigns directed toward young people focusing on emotional disorders such as depression and anxiety, self-harm, and/or suicide and presented favorable impacts on their attitudes, beliefs, and behaviors. The WHO also identifies behavioral disorders as common in young adolescents, along with risk-taking behaviors starting during adolescence and psychosis commonly emerging in late adolescence. Future research should expand on the present work and assess media campaigns dedicated to these different issues to complete the evaluation landscape. Currently in the literature are evaluations of online advertisements to promote help-seeking for youth with early-stage psychotic disorders (Arigo et al., 2018) and of online resources available to information-seeking youth with psychotic symptoms (Birnbaum et al., 2016), as well as evaluations of existing campaigns to raise awareness and support for young people with attention deficit hyperactivity disorder (ADHD) (Craven et al., 2015). Additional systematic reviews of the impacts of campaigns pertaining to these issues would help aggregate results to improve future initiatives.

This systematic review presents the impacts of media mental health campaigns, more specifically around anxiety, depression, self-harm, and suicide, on young people. Mental health campaigns were found on various media outlets such as television, web pages, billboards, print ads, and social media platforms such as Twitter, Facebook, and YouTube. Quantitative methods were the most common form of evaluation to measure campaign impacts. Proximal and intermediate changes were reported by studies evaluating the media mental health campaigns focusing on depression, anxiety, self-harm, and/or suicide. Increase in positive attitudes and awareness and decrease in stigma around mental health are among some of the reported proximal impacts. Intermediate impacts included increase in help-seeking behaviors. The results demonstrate the potential of utilizing media campaigns as a tool for mental health promotion, particularly for a youth demographic group, but also underscore the importance of ongoing, rigorous evaluations of these campaigns to clearly characterize their short- and long-term effects. Engaging in thorough and ongoing evaluation processes ensures that campaign strategies can be optimized and adapted to meet the needs of the target audience. Future directions in this field should focus on developing a standardized evaluation tool that would allow for impact measurement and comparison, evaluate campaigns focused on other important mental health related issues, explore qualitative evaluation methods, and conduct longitudinal evaluations to measure long-term effects.