Background and Rationale:
Mental health problems among adolescents represent a significant public health burden worldwide and in Egypt. Studies among Egyptian secondary school and university students show high prevalence of depression (32.5%), anxiety (45.2%), and psychological distress (65-70%). Despite this burden, most adolescents do not seek professional help due to low mental health literacy, stigma, and lack of awareness of available services. Existing Egyptian research focuses primarily on urban university students, leaving a critical evidence gap for younger school-aged adolescents, particularly in underserved regions like Upper Egypt.
Study Design:
This is a two-phase study combining cross-sectional assessment and a randomized controlled trial.
Phase 1 - Cross-Sectional Assessment (n=270):
Four preparatory/secondary schools in Assiut city will be randomly selected using cluster sampling stratified by educational stage and school gender composition. All eligible students aged 13-18 years will be invited to complete validated Arabic questionnaires assessing mental health literacy (MHLS - 35 items covering six domains), peer stigmatization (PMHSS - 16 items), help-seeking intentions (GHSQ), attitudes toward professional help (ATSPPH - 10 items), and mental health difficulties (SDQ - 25 items). Sociodemographic data will also be collected. This phase establishes baseline prevalence and identifies factors associated with mental health literacy, stigma, and help-seeking patterns.
Phase 2 - Randomized Controlled Trial (n=150):
Two secondary schools (one male, one female) will be selected. Within each school, 75 students will be randomly assigned to the intervention group and 75 to the control group, matched for age and sex. The intervention consists of three weekly structured classroom sessions (40-50 minutes each) delivered by trained researchers:
Session 1 (Mental Health Literacy): Basic concepts of mental health and mental illness; common adolescent mental health problems including stress, anxiety, and depression; key signs and symptoms; myths versus facts about mental health; understanding that mental health problems are real, treatable conditions.
Session 2 (Stigma Reduction): Definition and impact of stigma; how negative labels and stereotypes harm people with mental health problems; distinction between public stigma (others' attitudes) and self-stigma (internalized shame); recognition of stigma in adolescent contexts (mocking, exclusion, gossip); activities promoting respectful language and empathy.
Session 3 (Help-Seeking Behavior): Recognizing when problems require professional help; differences between informal sources (family, friends, religious leaders) and formal/professional sources (school counselors, physicians, psychiatrists, youth health centers); common barriers to help-seeking including shame, fear, and confidentiality concerns; information about realistic, accessible mental health resources in Assiut; role-play exercises on approaching trusted adults and guiding peers to help.
All sessions use interactive teaching methods with clear examples, group discussions, and brief activities. The control group continues regular school activities without receiving intervention sessions during the study period. Both groups complete identical questionnaires at baseline and one month post-intervention.
Assessment Tools:
All instruments are validated Arabic versions: Mental Health Literacy Scale (MHLS), Peer Mental Health Stigmatization Scale (PMHSS), General Help-Seeking Questionnaire (GHSQ), Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH), and Strengths and Difficulties Questionnaire (SDQ).
Expected Outcomes:
This study will provide the first comprehensive data on mental health literacy, stigma, and help-seeking among school-aged adolescents in Assiut and Upper Egypt. It will test whether a brief, feasible school-based intervention can improve knowledge, reduce stigma, and promote help-seeking behaviors, potentially informing scalable mental health promotion strategies for Egyptian schools.
