Development of a participatory arts intervention to promote mental health and wellbeing among men ‘at risk’ of suicide

Abstract

Introduction:
Male mental health is a growing public health concern. The male suicide rate is three times higher than the female rate in Northern Ireland. Men living in areas of high social disadvantage in Northern Ireland are considered a particularly vulnerable group to suicide. Men are often reticent to seek support for mental health issues. However, mental health promotion interventions that adopt gender-sensitive approaches have reported positive mental health outcomes among men. Participatory arts interventions (PAI) have been found to reduce anxiety and depression and promote social connectedness, autonomy and self-esteem. However, the acceptability and effectiveness of PAIs to promote mental health among men remains underexplored. Moreover, there are limited opportunities for the refinement or optimisation of current PAIs due to the lack of clear intervention descriptions in the field. Therefore, the aim of the thesis was to develop a PAI to promote mental health among men in areas of high social disadvantage in Northern Ireland.

Methods:
The study design aligned with Phase 1 Development of the MRC guidance for developing complex interventions. Stage 1 – Systematic Review consisted of a mixed methods systematic review to assess the acceptability, effectiveness and gender-responsiveness of PAIs to promote mental health among men. Stage 2(a) – Understanding Experiences included focus groups and interviews with men in areas of high social disadvantage in Northern Ireland (n=41) to explore the issues that contributed to psychological distress, the impact of extant PAIs on their mental health, and barriers and facilitators to engagement in PAIs. Finally, Stage 2(b) – Design of Intervention consisted of online consultations with men in areas of high social disadvantage in Northern Ireland (n=5) and service providers with a remit for mental health, men’s health and/or digital arts (n=11). This served to identify preferences for intervention features, content, approaches to delivery, and outcomes in order to develop an outline description of a PAI.

Results:
Stage 1 highlighted that PAIs are acceptable among adults but methodological issues limit the conclusions that can be drawn with regard to evidence of effectiveness. There is a dearth of studies in the literature that focus on men. Stage 2(a) identified that isolation, a lack of meaningful occupation, difficult life transitions and childhood experiences were the key factors contributing to psychological distress among the target population. However, PAIs can address some of these issues by enhancing connectedness, self-efficacy and personal growth, and emotional processing. Findings also elucidated a number of gender-sensitive approaches to enhance male engagement in PAIs. It was determined digital storytelling (DST) would be an appropriate art form for consideration by key stakeholder for further development. Findings from Stage 2(b) elucidated a number of preferences and practical considerations to make DST more acceptable among men. This resulted in the development of the Living Legacy Intervention. The proposed intervention and logic model are presented.

Conclusion:
The work undertaken in this thesis has made several contributions to knowledge in the fields of participatory arts, men’s health and mental health. It has provided a summary of the international literature in relation to the acceptability, effectiveness and gender-responsiveness of PAIs to promote mental health among men. It has identified a number of issues that contribute to psychological distress among men in areas of high social disadvantage in Northern Ireland. It has elucidated mechanisms of action that underpin positive mental health outcomes among men that engage in PAIs and a number of gender-sensitive approaches to enhance male engagement. Finally, it has developed an evidence-based, user-informed, gender-sensitive DST intervention. Recommendations for future research and practice are discussed.

Date of Award	Jul 2021
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	EC-Horizon 2020 & Northern Ireland Department for the Economy
Supervisor	Karen Galway (Supervisor), Maria Lohan (Supervisor), David Grant (Supervisor) & John L. Oliffe (Supervisor)