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Evaluating the benefits of a youth mental health curriculum for students in Nicaragua: a parallel-group, controlled pilot investigation

  • Arun V. Ravindran (a1), Andres Herrera (a2), Tricia L. da Silva (a1), Joanna Henderson (a1), Magda Esther Castrillo (a2) and Stan Kutcher (a3)...



High rates of mental illness and addictions are well documented among youth in Nicaragua. Limited mental health services, poor mental health knowledge and stigma reduce help-seeking. The Mental Health Curriculum (MHC) is a Canadian school-based program that has shown a positive impact on such contributing factors. This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua.


High school and university students (aged 14–25 years) were assigned to intervention (12-week MHC; n  =  567) and control (wait-list; n  =  346) groups in a non-randomized design. Both groups completed measures of mental health knowledge, stigma and function at baseline and 12 weeks. Multivariate analyses and repeated measures analyses were used to compare group outcomes.


At baseline, intervention students showed higher substance use (mean difference [MD]  =  0.24) and lower perceived stress (MD = −1.36) than controls (p  <  0.05); there were no other group differences in function. At 12 weeks, controlling for baseline differences, intervention students reported significantly higher mental health knowledge (MD  =  1.75), lower stigma (MD  =  1.78), more adaptive coping (MD  =  0.82), better lifestyle choices (MD  =  0.06) and lower perceived stress (MD = −1.63) (p  <  0.05) than controls. The clinical significance as measured by effect sizes was moderate for mental health knowledge, small to moderate for stigma and modest for the other variables. Substance use also decreased among intervention students to similar levels as controls (MD  =  0.03) (p > 0.05).


This pilot investigation demonstrates the benefits of the MHC in a low-and-middle-income youth population. The findings replicate results found in Canadian student populations and support its cross-cultural applicability.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: Dr. Arun V. Ravindran, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada. (Email:


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Banks, M (1983). Validation of the General Health Questionnaire in a young community sample. Psychological Medicine 13, 349353.
Barry, MM, Clarke, AM, Jenkins, R, Patel, V (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health 13, 835.
Bonhauser, M, Fernandez, G, Püschel, K, Yaňez, F, Montero, J, Thompson, B, Coronado, G (2005). Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promotion International 20, 113122.
Brady, SS, Tschann, JM, Pasch, LA, Flores, E, Ozer, EJ (2009). Cognitive coping moderates the association between violent victimization by peers and substance use among adolescents. Journal of Pediatric Psychology 34, 304310.
Burckhardt, CS, Woods, SL, Schultz, AA, Ziebarth, DM (1989). Quality of life of adults with chronic illness: a psychometric study. Research in Nursing and Health 12, 347354.
Burger, K, Samuel, R (2017). The role of perceived stress and self-efficacy in young people's life satisfaction: a longitudinal study. Journal of Youth and Adolescence 46, 7890.
Caldera Aburto, JT (2004). Mental health in Nicaragua with special reference to psychological trauma and suicidal behaviour. UMEA University, Medical Dissertations. ( Accessed 24 March 2017.
Canadian Centre on Substance Abuse (2007). Substance Abuse in Canada: Youth in Focus. Canadian Centre on Substance Abuse: Ottawa, ON. Accessed 24 March 2017.
Carver, CS (1997). You want to measure coping but your protocol's too long: consider the brief COPE. International Journal of Behavioral Medicine 4, 92100.
Central Intelligence Agency (CIA) (2016). The World Factbook: Nicaragua. ( Accessed 24 March 2017.
Chua, LW, Milfont, TL, Jose, PE (2015). Coping skills help explain how future-oriented adolescents accrue greater well-being over time. Journal of Youth and Adolescence 4, 20282041.
Cohen, S, Kamarck, T, Mermelstein, R (1983). A global measure of perceived stress. Journal of Health and Social Behavior 24, 385396.
Debnam, K, Milam, AJ, Furr-Holden, CD, Bradshaw, C (2016). The role of stress and spirituality in adolescent substance use. Substance Use and Misuse 51, 733741.
Fazel, M, Patel, V, Thomas, S, Tol, W (2014). Mental health interventions in schools in low-income and middle-income countries. Lancet Psychiatry 1, 388398.
Fernandez, A, Howse, E, Rubio-Valera, M, Thorncraft, K, Noone, J, Luu, X, Veness, B, Leech, M, Llewellyn, G, Salvador-Carulla, L (2016). Setting-based interventions to promote mental health at the university: a systematic review. International Journal of Public Health 61, 797807.
Ganasen, KA, Parker, S, Hugo, CJ, Stein, DJ, Emsley, RA, Seedat, S (2008). Mental health literacy: focus on developing countries. African Journal of Psychiatry (Johannesburg) 11, 2328.
Griffin, K, Botvin, G, Scheier, L, Epstein, J, Doyle, M (2002). Personal competence skills, distress, and well-being as determinants of substance use in a predominantly minority urban adolescent sample. Prevention Science 3, 2333.
Gulliver, A, Griffiths, K M, Christensen, H (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10, 113.
Jacob, KS, Sharan, P, Mirza, I, Garrido-Cumbrera, M, Seedat, S, Mari, JJ, Sreenivas, V, Saxena, S (2007). Mental health systems in countries: where are we now? The Lancet 370, 10611077.
Joint Consortium for School Health (2009). What is comprehensive school health? ( Accessed 24 March 2017.
Jorm, AF (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychology 67, 231243.
Jorm, AF, Reavley, NJ, Ross, AM (2012). Belief in the dangerousness of people with mental disorders: a review. The Australian and New Zealand Journal of Psychiatry 46, 10291045.
Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S, Ormel, J, Ustün, TB, Wang, PS (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc Epidemiologia E Psichiatria Sociale 18, 2333.
Kessler, RC, Foster, CL, Saunders, WB, Stang, PE (1995). Social consequences of psychiatric disorders, I: educational attainment. American Journal of Psychiatry 152, 10261032.
Knight, J, Sherritt, L, Shrier, LA, Harris, SK, Chang, G (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics and Adolescent Medicine 156, 607614.
Kumakech, E, Cantor-Graae, E, Maling, S, Bajunirwe, F (2009). Peer-group support intervention improves the psychosocial well-being of AIDS orphans: cluster randomized trial. Social Science and Medicine 68, 10381043.
Kurspahić-Mujčić, A, Hadžagić-Ćatibušić, F, Sivić, S, Hadžović, E (2014). Association between high levels of stress and risky health behavior. Medicinski Glasnik (Zenica) 11, 367372.
Kutcher, S (2015). Mental Health & High School Curriculum Guide: Understanding Mental Health and Mental Illness. CreateSpace Independent Publishing Platform. ( Accessed 24 March 2017.
Kutcher, S, Gilberds, H, Morgan, C, Greene, R, Hamwaka, K, Perkins, K (2015 a). Improving Malawian teachers’ mental health knowledge and attitudes: an integrated school mental health literacy approach. Global Mental Health 2, e1.
Kutcher, S, Wei, Y (2013). Educator mental health literacy: a programme evaluation of the teacher training education on the mental health & high school curriculum guide. Advances in School Mental Health Promotion 6, 8393.
Kutcher, S, Wei, Y, Gilberds, H, Ubuguyu, O, Njau, T, Brown, A, Sabuni, N, Magimba, A, Perkins, K (2016). A school mental health literacy curriculum resource training approach: effects on Tanzanian teachers’ mental health knowledge, stigma and help-seeking efficacy. International Journal of Mental Health Systems 10, 50.
Kutcher, S, Wei, Y, Morgan, C (2015 b). Successful application of a Canadian mental health curriculum resource by usual classroom teachers in significantly and sustainably improving student mental health literacy. Canadian Journal of Psychiatry 60, 580586.
Mcluckie, A, Kutcher, S, Wei, Y, Weaver, C (2014). Sustained improvements in students’ mental health literacy with use of a mental health curriculum in Canadian schools. BMC Psychiatry 14, 379.
Milin, R, Kutcher, S, Lewis, SP, Walker, S, Wei, Y, Ferrill, N, Armstrong, MA (2016). Impact of a mental health curriculum on knowledge and stigma among high school students: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry 55, 383391.
Nair, JM, Nemeth, LS, Sommers, M, Newman, S, Amella, E (2016). Alcohol use, misuse, and abuse among nursing students: a photovoice study. Journal of Addictions Nursing 27, 1223.
Ndetei, DM, Khasakhala, LI, Kuria, MW, Mutiso, VN, Ongecha-Owuor, FA, Kokonya, DA (2009). The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study. Annals of General Psychiatry 8, 1.
Neil, AL, Christensen, H (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical Psychology Review 29, 208215.
Obando Medina, C, Kullgren, G, Dahlblom, K (2014). A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Family Practice 15, 129.
Ojio, Y, Yonehara, H, Taneichi, S, Yamasaki, S, Ando, S, Togo, F, Nishida, A, Sasaki, T (2015). Effects of school-based mental health literacy education for secondary school students to be delivered by school teachers: a preliminary study. Psychiatry and Clinical Neurosciences 69, 572579.
Quinlan-Davidson, M, Sanhueza, A, Espinosa, I, Escamilla-Cejudo, JA, Maddaleno, M (2014). Suicide among young people in the Americas. Journal of Adolescent Health 54, 262268.
Roberts, LW (2010). Stigma, hope, and challenge in psychiatry: trainee perspectives from five countries on four continents. Academic Psychiatry 34, 14.
Roberts, R, Roberts, C, Chan, W (2009). One-year incidence of psychiatric disorders and associated risk factors among adolescents in the community. Journal of Child Psychology and Psychiatry and Allied Disciplines 50, 405415.
Rodríguez, AH, Caldera, T, Kullgren, G, Renberg, ES (2006). Suicidal expressions among young people in Nicaragua: a community-based study. Social Psychiatry and Psychiatric Epidemiology 41, 692697.
Rodríguez, JJ (2010). Mental health care systems in Latin America and the Caribbean. International Review of Psychiatry 22, 317324.
Skre, I, Friborg, O, Breivik, C, Johnsen, LI, Arnesen, Y, Wang, CEA (2013). A school intervention for mental health literacy in adolescents: effects of a non-randomized cluster controlled trial. BMC Public Health 13, 873.
Srikala, B, Kumar, KV (2010). Empowering adolescents with life skills education in schools – school mental health program: does it work. Indian Journal of Psychiatry 52, 344349.
UNIDOS Nicaragua (2016). Life in Nicaragua. ( Accessed 24 March 2017.
United Nations Economic Scientific and Cultural Organization (UNESCO) (n.d.). Health Education. ( Accessed 24 March 2017.
United Nations Office on Drugs and Crime (UNODC) (2010). Nicaragua: Drug abuse and drug dependence treatment situation. ( Accessed 24 March 2017.
United Nations Population Fund (UNFPA) (2014). The state of the world population 2014. ( Accessed 24 MarchJan 2017).
University of California Los Angeles (UCLA) School Mental Health Project: Center for Mental Health in Schools (2009). Mental health in schools: Program and policy analysis. ( Accessed 24 March 2017.
Wagnild, GM, Young, HM (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement 1, 165178.
Walker, SN, Sechrist, KR, Pender, NJ (1987). The health-promoting lifestyle profile: development and psychometric characteristics. Nursing Research 36, 7681.
Weare, K, Nind, M (2011). Mental health promotion and problem prevention in schools: what does the evidence say? Health Promotion International 26, i29i69.
Wei, Y, Kutcher, S (2012). International school mental health: global approaches, global challenges and global opportunities. Child and Adolescent Psychology 21, 1127.
Wilson, CJ, Deane, FP, Ciarrochi, J, Rickwood, D (2005). Measuring help-seeking intentions: properties of the general help-seeking questionnaire. Canadian Journal of Counseling 39, 1528.
World Bank (2011). Project appraisal document on a proposed credit in the amount of SDR15.8 million (US$25 million equivalent) to the Republic of Nicaragua for the second support to the education sector project. ( Accessed 24 March 2017.
World Bank (2016). GNI per capita, Atlas method (current US$). ( Accessed 24 March 2017.
World Health Organization (WHO) (2009). Discussion Paper: Mental health, poverty and development, July 2009. ( Accessed 24 March 2017.
World Health Organization (WHO) (2015). Mental health atlas 2014. ( Accessed 24 March 2017.
World Health Organization (WHO) (2016). Child and adolescent mental health. ( Accessed 24 Jan March 2017).


Evaluating the benefits of a youth mental health curriculum for students in Nicaragua: a parallel-group, controlled pilot investigation

  • Arun V. Ravindran (a1), Andres Herrera (a2), Tricia L. da Silva (a1), Joanna Henderson (a1), Magda Esther Castrillo (a2) and Stan Kutcher (a3)...


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