The aim of this study was to investigate the child labor caregivers’ beliefs and attitudes about first aid and stigma of mental health problems. Most people are often aware of their physical health problems while mental health problems are often overlooked. This issue along with the stigma about mental disorders prevents people from seeking early help for their mental health problems (10). They also often do not know how to properly support other persons around with mental problems (18). In order to improve this aspect of mental health literacy, Mental Health First Aid (MHFA) training courses were prepared and implemented. Its 5 main steps include assess risk of suicide or harm; listen non-judgmentally; give reassurance and information; encourage person to get appropriate professional help; encourage self-help strategies (10).
Mental health first aid emphasizes that people with mental health problems can be identified and supported similarly to physical health problems by community members who can play a useful primary role. On the other hand, due to the high prevalence of mental health problems, community members are more likely to encounter with someone experiencing a mental health crisis than a physical health crisis such as coronary artery event, so it will be important for them to know how to help their loved ones using first aid.
In this regard, the responsibility for caring of community members' mental health goes beyond specialized mental health services and even beyond health services in general (19). In line with above explanation, one of the first important questions in the field of first aid for mental health is “How confident would you be in your ability to help vignette”. The findings of the present study showed that only 30% of caregivers were confident that they could help a child with a problem reported in Vignette. In comparison with this result, a study conducted in adults in Tehran showed that 6% were completely and 75% were somewhat confident in helping (12). In the Yoshioka study (20), 3% of Japanese youth and in the Jorm study, 30% of Australian youth were completely confident (21).
Regarding the appropriate behavior for first aid, the majority of caregivers (94.5%) believed that listening to the child with problem is helpful when in the study of Tehran, the majority (about 60%) considered listening to vignette appropriate (12).
While according to studies, asking about suicidal ideation is one of the mental health first aid measures (10, 22), the majority of participants (84.5%) believed that asking this question from a person with mental health problem would be detrimental.
That this belief can be due to the stigma associated with suicide and the avoidance of any reference to it, as well as the fear of possible encouragement to attempt suicide. Only 30% of participants believed that visiting a general practitioner or counselor was helpful that was almost similar to the findings of Tehran survey (12). This finding may be due to the lack of knowledge about the effectiveness of professional interventions for psychiatric disorders that in this case, providing the necessary trainings in order to increase the awareness and the ability to provide mental health first aid for the child labor caregivers can help to raise awareness in this area.
A meta-analysis study showed that MHFA training programs could be a promising public health intervention to combat stigma and taboos for mental disorders and prevent suicide (6). Stigma is also one of the biggest barriers to receiving specialized services by people with psychiatric disorders who refuse to accept the disease and do not seek services from experts in this field (23).
Based on the findings of this study, 57% of caregivers believed that depression, like any other disorder can be treated, in Ghadirian study it was 88% in Tehran residents and in Sayarifard study it was 75% in students in Tehran University of Medical Sciences (5, 16). In the present study, similar to the findings of the Yeap study in Malaysia (24) about 25% of caregivers believed that depressive disorder was not a real medical illness when it was 8.6% in the Reavley study in Australia (25).
This finding is important because first aid training, by correcting this wrong belief that depression is not a real illness, can affect their willingness to seek care and receive related assistance (26).
In this study 39% of participants agreed that the vignette was not dangerous for others, which showed a more negative attitude compared to similar studies (5, 16, 25).
More than half of the participants responded negatively about staying away from the person with depressive disorder and not talking about this problem with others. This negative attitude can affect the request for help, initial diagnostic and care measures as other studies that have shown the relationship between stigma and help-seeking (27). Findings of Jung study has indicated the need to strengthen social support to promote a positive attitude towards psychological issues.
Mental health education can be useful for people at risk for mental illness and for families who are likely to influence on helping attitudes of people with mental illness (28). On the other hand, Yoshioka's study showed that perceived stigma is significantly associated with various biogenetic, psychosocial and personality factors (29).
Other studies have reported that despite many anti-stigma programs and extensive researches in this area, it is still difficult to find effective ways to combat stigma against mental illness in the population and to determine community-based interventions, more research is needed in this area (30–32).
The present study was conducted only on a group of caregivers of child labor covered by an NGO in Tehran and is not generalizable to the whole community, however, due to the fact that no study has been conducted on the mental health literacy in this target group in Iran so far, conducting this study is a strength to start further studies in this target group in order to improve their mental health and ultimately improve the mental health of child labor who are from disadvantaged groups in society.