Effectiveness of a pragmatic school-based universal intervention targeting student resilience protective factors in reducing mental health problems in adolescents

School-based yoga and mindfulness interventions for young adolescents: A qualitative study in a disadvantaged area

OBJECTIVES

With raising rates of mental health problems, mind-body interventions are increasingly being integrated in schools to support children and adolescents' mental health and well-being. The aim of this study was to explore young adolescents' experiences of yoga and mindfulness and the acceptability of delivery within the school curriculum in an area of high deprivation.

DESIGN

Qualitative group interviews with young adolescents embedded within a larger feasibility study exploring the universal (class-wide) delivery of yoga and mindfulness interventions.

METHODS

After participation in separate 10-week yoga or mindfulness interventions, 45 adolescents (12-13 years old; 66.7% male) took part in semi-structured group interviews exploring perceptions, acceptability, and experiences of each intervention. Data was analysed using inductive thematic analysis.

RESULTS

Two overarching themes were identified, evident across both mindfulness and yoga groups. "Facilitators and barriers to engagement" outlined key factors impacting acceptability, including prior perceptions. Teacher qualities of non-reactivity and respect, an invitational approach to teaching, and interactive sessions were highly valued. Secondly, participants described a range of "psychosocial impacts", including increased emotional regulation, positive mindset and self-confidence, and greater focus and concentration. Physical benefits were also reported in the yoga group.

CONCLUSION

This is the first study to explore the acceptability and impact of universal yoga and mindfulness interventions with an ethnically diverse sample of disadvantaged young adolescents in the United Kingdom. The findings suggest mind-body interventions can help children and adolescents develop skills to better manage challenges in their everyday lives, but they require further integration into the curriculum for optimal benefit.

Systematic Review and Meta-analysis of the Effectiveness of Whole-school Interventions Promoting Mental Health and Preventing Risk Behaviours in Adolescence

Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Based on the Health-Promoting Schools Framework, whole-school interventions offer a promising strategy in this developmentally-sensitive cohort, through championing a systems-based approach to promotion and prevention that involves the key stakeholders in an adolescent's life. The evidence-base surrounding the effectiveness of whole-school interventions, however, remains inconclusive, partly due to the insufficient number of studies in previous meta-analyses. An updated systematic review and meta-analysis was thus conducted on the effectiveness of whole-school interventions promoting mental health and preventing risk behaviours in adolescence. From 12,897 search results, 28 studies reported in 58 publications were included. Study characteristics and implementation assessments were synthesized across studies, and quality appraisals and meta-analyses performed. Analyses identified a significant reduction in the odds of cyber-bullying by 25%, regular smoking by 31% and cyber-aggression by 37% in intervention participants compared to the control. Whole-school interventions thus offer substantial population health benefits through the reduction of these highly-prevalent issues affecting adolescents. The non-significant findings pertaining to the remaining eleven outcomes, including alcohol use, recreational drug use, anxiety, depression and positive mental health, are likely attributable to suboptimal translation of the Health-Promoting Schools Framework into practice and inadequate sensitivity to adolescents' local developmental needs. Given the ongoing challenges faced in the implementation and evaluation of these complex interventions, this study recommends that future evaluations assess the implementation of health-promoting activities in both intervention and control conditions and actively use this implementation data in the interpretation of evaluation findings.Preregistration: A pre-registered PROSPERO protocol (ID: CRD42023491619) informed this study.

Intolerance of Uncertainty as a Central Influence on Social Media Use: A School-Based Program for Adolescents

This study evaluated a classroom program to address Intolerance of uncertainty (IU) in secondary school students in Australia. IU is a transdiagnostic vulnerability factor for a range of psychological difficulties. A universal classroom program aimed to increase student understanding of feelings of uncertainty and explored socioemotional factors that could influence behaviors when facing uncertainty. Classroom teachers in two high schools were trained to deliver an 18-lesson program under naturalistic classroom conditions. Relative to the control group, the intervention lowered IU at post-test, but not at a later follow-up. The only socioemotional outcome measure to demonstrate a concurrent change was social media use. Limitations of the study were associated with the naturalistic classroom intervention, including the high level of attrition. Future studies may need to address broader factors in the students' context that could influence intolerance of uncertainty.

Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study

BACKGROUND

Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes.

OBJECTIVE

This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience.

METHODS

In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use.

RESULTS

Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback.

CONCLUSIONS

Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research.

Development and Evaluation of a Workplace Bullying Cognitive Rehearsal-Based Nursing Simulation Education Program: A Mixed-Methods Study

Bullying makes learning difficult for nursing students, and using real-life scenarios during training can improve the understanding of workplace bullying. Thus, to mitigate bullying experienced by nurses, this study developed and evaluated a cognitive rehearsal education program that constituted training nursing students through role-play simulations. A mixed-method research design was used to evaluate 39 nursing students from two universities. A quasi-experimental research design was applied to assess symptoms, knowledge, and perceptions of bullying, and a focus group interview was conducted with six participants. Quantitative analyses revealed that the program improved participants' knowledge and perceptions but not their symptoms. The focus group interview revealed that the program improved participants' coping skills and desire for education. This program could be effective in raising awareness of workplace bullying and increasing relevant coping skills. It can be further developed as part of an overall strategy to manage workplace bullying and its consequences in hospital settings.

Impact of adverse childhood experiences on educational achievements in young people at clinical high risk of developing psychosis

BACKGROUND

Adverse childhood experiences (ACE) can affect educational attainments, but little is known about their impact on educational achievements in people at clinical high risk of psychosis (CHR).

METHODS

In total, 344 CHR individuals and 67 healthy controls (HC) were recruited as part of the European Community's Seventh Framework Programme-funded multicenter study the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI). The brief version of the Child Trauma Questionnaire was used to measure ACE, while educational attainments were assessed using a semi-structured interview.

RESULTS

At baseline, compared with HC, the CHR group spent less time in education and had higher rates of ACE, lower rates of employment, and lower estimated intelligence quotient (IQ). Across both groups, the total number of ACE was associated with fewer days in education and lower level of education. Emotional abuse was associated with fewer days in education in HC. Emotional neglect was associated with a lower level of education in CHR, while sexual abuse was associated with a lower level of education in HC. In the CHR group, the total number of ACE, physical abuse, and neglect was significantly associated with unemployment, while emotional neglect was associated with employment.

CONCLUSIONS

ACE are strongly associated with developmental outcomes such as educational achievement. Early intervention for psychosis programs should aim at integrating specific interventions to support young CHR people in their educational and vocational recovery. More generally, public health and social interventions focused on the prevention of ACE (or reduce their impact if ACE occur) are recommended.

School-Based Nursing Interventions for Preventing Bullying and Reducing Its Incidence on Students: A Scoping Review

Incidents of bullying have increased on students in schools. This has a negative impact such as mental health problems and risk of suicide. Interventions related to bullying are still focused on being carried out independently. Meanwhile, collaborative interventions between nurses and the school are needed to acquire maximum results in preventing and reducing the incidence of bullying. The purpose of this study is to describe school-based nursing interventions in preventing and reducing the incidence of bullying among students at school. This study used scoping review with a search strategy using the PRISMA Extension for Scoping Review process to find the articles. The PubMed, CINAHL, and Scopus electronic databases were searched. We found 12 articles from 594 articles in 3 databases which discussed nursing interventions based on school to prevent and reduce incidence of bullying in students. The studies included are design randomized control trials and quasi experiments. The samples with the range of 40-7121 respondents. We classified the school-based nursing interventions being three methods, there are Game programs, physical activity programs, training programs, and peer-group programs. The content of interventions are psychoeducation, empathy training, counseling, and self-management. This study shows that school-based nursing interventions can be an option in preventing and reducing the incidence of bullying among students at school.

Magis - A magical adventure: Using a mobile game to deliver an ACT intervention for elementary schoolchildren in classroom settings

Studies of the effects of the COVID-19 pandemic have shown that this health emergency has affected especially young people. Supporting the well-being of children is thus particularly urgent. However, the high prevalence of ill-being among children requires novel approaches to providing help. Health care resources are limited, and many children did not receive support even before the pandemic. The current study presents a novel approach to delivering brief interventions for school-aged children. A mobile game based on acceptance and commitment therapy was used to increase psychological flexibility and well-being among 10 to 12-year-old schoolchildren. A sample of 106 students played the game in four weekly sessions as part of normal teaching practice in school. The effectiveness of the brief game intervention was examined as a universal intervention among the whole sample and among subgroups created on the basis of baseline psychological flexibility (i.e., based on the need for an intervention). The results show that higher psychological flexibility was associated with less emotional and behavioral problems, higher health-related quality of life, mood, and school satisfaction, and less loneliness (r = 0.46-0.63). While a significant effect was not detected in the whole sample, the subsample of children with initially high psychological inflexibility benefitted from participating in the intervention (Cohen's d = 0.35). These preliminary findings suggest that the brief game-based intervention can increase psychological flexibility among children when the need for an intervention is considered. Further research is necessary to examine the stability of improvements in psychological flexibility.

Emotional Intelligence and Resilience Outcomes in Adolescent Period, is Knowledge Really Strength?

Adolescence is possibly the most difficult period of life, because it is the beginning of a series of changes in both the internal and external aspects of the body. For this reason, we all have a series of psychological mechanisms, resilience and emotional intelligence, which allow us to adapt to these periods of change. In this way, the present study aims to analyse through a systematic review the results obtained in different studies to better understand the current situation. The methodology used in the systematic review was PRISMA, covering a period of the last 10 years. The results obtained show that the selected studies show a strong relationship between resilience and emotional intelligence when there are adequate levels of resilience and emotional intelligence. Therefore, it is necessary for young people to develop a series of internal mechanisms that act as protectors against the vicissitudes they may face in their lives, allowing them to fully adapt to the demands of the context.

Method of Nursing Interventions to Reduce the Incidence of Bullying and Its Impact on Students in School: A Scoping Review

The bullying of students in schools can have a negative impact on students. The impact of bullying can take the form of anxiety, low psychological well-being, low social adjustment, psychological distress, and risk of suicide. Incidents of bullying are still considered normal, and there has not been a focus on reducing their incidence and impact. The purpose of this study is to describe nursing interventions to reduce the incidence of bullying and its impact on students at school. This study used the scoping review method and literature reviews via CINAHL, PubMed, and ProQuest databases. The keywords used in English were "bullying OR cyberbullying OR aggression" AND "students OR school students" AND "school OR schools" AND "nursing intervention". The criteria for articles in this study were: full texts, student populations and samples, randomized control trials or quasi-experiment research designs, use of the English language, and the publication period of the last 10 years (2013-2022). We found 11 articles discussing nursing interventions to reduce the incidence of bullying and its impact on students in schools. There are four types of interventions that can be provided to students, namely, prevention programs, activities programs, peer group programs, and resilience programs. Most of the articles used randomized control trials and quasi-experiment designs. The samples in the articles analyzed were in the range of 50-7121 students. These four types of interventions can reduce the incidence of bullying and its impact on students at school, and in addition, they can improve the social skills and mental health of students, for example, by increasing their self-efficacy, resilience, and adaptive coping. There are four nursing interventions to reduce the incidence of bullying and its impact on students in schools, namely, the prevention program, activities program, peer group program, and resilience program.

Children's representations of the COVID-19 lockdown and pandemic through drawings

The COVID-19 pandemic and the measures to face it have placed children and their caregivers in front of many challenges that could represent sources of stress. This work aims to explore the point of view of children through drawing, as a spontaneous means of expression, relating it to parents' perceptions of children's difficulties, strengths, and mentalization skills. The sample consists of 18 children (mean age = 8.22, SD = 1.79). Parents were asked to complete: a socio-demographic questionnaire with information on the impact of COVID-19 on the family, the Strengths and Difficulties Questionnaire, and the Everyday Mindreading Scale. Children were asked to draw three moments: "Before" the pandemic, "During" the lockdown, and "After," when the COVID-19 will be passed. The drawings were coded by constructing a content and expressive analysis grid, adapting coding systems found in the literature. Data were collected at the beginning of the summer of 2020, just after the first lockdown period (from March to May 2020 in Italy). The results of the present work are in line with previous studies that reported experiences of wellbeing and tranquility of children in time spent at home with family during the pandemic. From the drawings emerges that children feel sufficiently able to master the situation, as reflected by including themselves in drawings and providing many details of the house in "During" drawings. The literature also reports a feeling of sadness/loneliness caused by the lack of friends, an element that we also find in the tendency to represent friends significantly more in the drawings concerning the future. Some contents of drawings (inclusion of friends, relatives, and parents) appeared associated with emotional, interpersonal, and mentalizing abilities of children, as perceived by parents. Exploring children's representations of a stressful event like the pandemic through drawings allows to focus both on their difficulties and on their resources, with useful implications for the educational support.

Non-Cooperation within a School-Based Wellness Program during the COVID-19 Pandemic-A Qualitative Research

This paper presents a qualitative analysis of COVID-19′s impact on the development, delivery, and uptake of “Favoring Myself”, a school-based interactive wellness program conducted via Zoom during 2020–2021. “Favoring Myself” targets resilience, self-esteem, body-esteem, self-care behaviors, and media literacy among 5th-grade preadolescents. Data were obtained from meetings, 23 semi-structured interviews with parents, teachers, and principals, and other modes of correspondence. All data were transcribed and thematically analyzed. The analysis highlighted the barriers faced when delivering external programs during COVID-19. Parents’ difficulties in cooperating with the program, distrustful relationships between parents and the education system, as well as teachers’ overload and stress, were identified as barriers to the external program’s sustainability. These challenges are discussed in light of previous studies of school-based programs, the psychological and social contexts of an ongoing crisis and the impact of neoliberalism on education. This study concludes that school-based prevention programs and accompanying research should be more flexible and focus on understanding and relating to parents’ and schools’ fears, uncertainties, and resistance. It is the hope of the authors that knowledge created through this exploration will be helpful in future coping vis-à-vis prevention program teams and recipients in times of unpredictable, unmanageable, and overpowering crises.

School educational models and child mental health among K-12 students: a scoping review

BACKGROUND

The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies.

METHODS

This scoping review followed the framework of Arksey and O'Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases.

RESULTS/FINDINGS

After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development.

CONCLUSIONS

The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.

What is the impact of structural and cultural factors and interventions within educational settings on promoting positive mental health and preventing poor mental health: a systematic review

Mental health (MH) difficulties are on the increase among children and young people (CYP). Evidence has shown that educational settings contain both risk and protective factors for MH. This review investigated which structural and cultural factors and interventions within educational settings promote positive MH and prevent poor MH in 4–18 year olds. Searches were conducted in PsychINFO, Embase, ERIC, ASSIA and British Education Index, and reference lists from key studies and relevant systematic reviews were hand-searched. Intervention, cohort, and qualitative studies were included. Of the 62 included papers, 36 examined cultural factors (30 social/relational and six value-related) while 12 studies examined structural factors (eight organisational and four physical) and 14 studies examined multiple factors. There was strong evidence for the impact of positive classroom management techniques, access to physical activity, and peer mentoring on student MH. Studies examining the impact of positive school culture, teacher training in MH and parent involvement in school MH activities also found predominantly positive results for student MH, albeit the evidence was of lower quality or from a low number of studies. Few studies explicitly examined the impact of interventions on MH inequalities; those that did indicated limited if any reduction to inequalities. A very small number of studies suggested that interventions targeting those at risk of poor MH due to socioeconomic factors could successfully improve wellbeing and reduce depression, anxiety and behavioural problems. Studies exploring the effect of management and leadership strategies within schools, policies, and aspects of the physical environment other than green space were scarce or absent in the literature. This review highlights the need to consider the ways in which educational settings are organised, the culture that is created and the physical space in order to improve the MH of CYP.

School-based Interventions to Improve Adolescent Resilience: A Scoping Review

BACKGROUND: Resilience can help adolescents to have positive adaptations in dealing with difficulties, stress, and trauma, as well as preventing mental disorders. School-based resilience improvement programs have been implemented internationally. However, there has been no specific review to examine the effectiveness of the application of resilience programs in adolescents. AIM: This review aimed to analyze the effectiveness of school-based interventions to increase resilience in adolescents. METHODS: Search articles using three electronic databases, namely CINAHL Ebsco, PubMed, and ProQuest. The keywords used are “resilience or resilient” AND “adolescents or teenagers or young adults” AND “school-based intervention or classroom-based intervention or teacher implemented.” There are 1206 research articles from 2014 to 2020, but only nine randomized controlled trials (RCT) studies match the inclusion criteria for analysis. RESULTS: Findings show that five school-based intervention programs have a significant effect on adolescent resilience levels, namely: enhancing resiliency among students experiencing-stress-prosocial, mindfulness training with learning to BREATH (mindfulness-based programs stress reduction), resilience and coping intervention (RCI), and girls first resilience curriculum. The shortest program duration is RCI, 3 weeks, while the most extended time is Girls first for 5 months. The duration of the program had no significant effect on increasing resilience. CONCLUSION: These findings encourage further research and development of school-based intervention programs to increase resilience in adolescents, especially in developing countries such as Indonesia.

The use of film-based interventions in adolescent mental health education: A systematic review

Film-based interventions have been embraced by adolescents as educational tools, but their efficacy in mental health education remains under-explored. In this review, we systematically examined the use of film-based interventions in adolescent mental health education. A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, Education Full Text [H.W. Wilson], CINAHL Plus with Full Text, Humanities Full Text [H.W. Wilson], MEDLINE, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, Social Sciences Full Text [H.W. Wilson], Soc Index, ERIC. Risk of Bias were assessed using Version 2 of the Cochrane RoB tool for randomised trials (RoB2) or the Cochrane Collaboration Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I). Ten peer-reviewed studies were included in this review. Film emerged as a promising education method for enhancing metal health literacy and reducing stigma. Mixed reports were found for improving attitudes towards help-seeking, with narrative-based films having a weaker effect on attitudes towards help-seeking when compared with more instructive approaches. No study focussed on resilience. This review highlights the utility and potential for film-based interventions in adolescent mental health education. Further research is warranted around how best to implement such interventions to engage adolescents.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

Effective interventions targeting the mental health of children and young adults: A scoping review

Aims: Children and young adults are in general characterised by good health, but evidence shows increasing mental-health problems. Numerous interventions have been developed to target their mental health, but the effectiveness of these interventions remains varied. In this scoping review, we investigated factors associated with the effectiveness of interventions. Methods: A scoping review based on a three-block search strategy was performed to review the current literature of effective interventions. Each block (interventions, mental health and children and young adults) were operationalised to search terms. Systematic searches were conducted in three electronic databases and supplemented with citation searches, resulting in 51 studies in total. All studies were critically analysed, and a standardised extraction chart was used to systemise the data. Results: Our scoping review revealed a range of factors influencing the effectiveness of interventions. These factors were (a) characteristics of the target group (age, sex and level of baseline symptoms), (b) factors linked to implementation (use of manuals, training of implementers and context) and (c) characteristics of the interventions (universal versus indicated delivery, multiple-domain approaches, level of theory and adjustment to age and socio-economic status). Elements are discussed for each factor. Conclusions: Based on this review, it can be concluded that the use of stepwise, multi-domain approaches incorporating the social networks of the target group, adjusting activities to specific age groups and the social context, training implementers well and using stringent implementation manuals will improve the effectiveness of interventions targeting the mental health of children and young adults.

Mental health difficulties, coping mechanisms and support systems among school-going adolescents in Ghana: A mixed-methods study

BACKGROUND

Although adolescents are highly vulnerable to mental health challenges, they receive little attention, especially in developing countries. We investigated the mental health difficulties (MHDs) faced by adolescent students in four senior high schools in Ghana, their coping strategies and support systems.

METHODS

In this convergent mixed-methods study, quantitative data was obtained using validated strengths and difficulties questionnaire to assess the mental health of 405 adolescents. Qualitative data was collected through in-depth interview with 18 teachers and seven focused group discussions with 35 students. Adjusted odds ratios (OR) for MHDs were estimated through ordinal logistic regression in Stata 14.2. Qualitative data was analyzed inductively and deductively using ATLAS.ti 7.1.

RESULTS

Over half (58.5%) experienced peer (20.5%), emotional (16.3%), conduct (13.3%) and hyperactivity (3.0%) problems, whereas 5.4% exhibited prosocial behaviours. MHDs were associated with females (OR = 2.27, 95% CI: 1.47-3.50), bullying (OR = 1.72, CI: 1.07-2.75), domestic violence (OR = 1.87, CI: 1.10-3.17), substance abuse (OR = 8.14, CI: 1.41-46.8), academic pressure (OR = 2.40, CI: 1.30-4.42) and self-perceived poor school performance (OR = 7.36 CI: 2.83-19.16). Qualitatively, we identified financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence as the main themes attributed to MHDs. Coping strategies included isolation, substance use and spiritual help. The main school-based support system was the guidance and counselling unit, but there were complaints of it been ineffective due to trust and confidentially issues, and non-engagement of qualified counsellors.

CONCLUSIONS

As many triggers of MHDs emanate in schools, we need mental health-friendly school environments where trained psychotherapists head counselling centres. We propose incorporating mental health education into school curricula and generating surveillance data on adolescent's mental health.

Health Literacy in Schools? A Systematic Review of Health-Related Interventions Aimed at Disadvantaged Adolescents

Socioeconomically disadvantaged populations are at greater risk of adopting unhealthy behaviours and developing chronic diseases. Adolescence has been identified as a crucial life stage to develop lifelong healthy behaviours, with schools often suggested as the ideal environment to foster healthy habits. Health literacy (HL) provides a possible solution to promote such healthy behaviours. The aim of this study was to review school-based HL-related interventions targeting socioeconomically disadvantaged adolescents and to identify effective intervention strategies for this population. Searches were performed in six databases. Inclusion criteria included age: 12–16; the implementation of a school-based intervention related to HL aimed at socioeconomically disadvantaged populations; an intervention focused on: physical activity (PA), diet, mental health, substance abuse or sleep. Forty-one articles were included, with the majority focusing on PA and diet (n = 13), PA (n = 9) or mental health (n = 7). Few interventions focused solely on substance abuse (n = 2) or sleep (n = 1), and none targeted or assessed HL as an outcome measure. There was huge heterogeneity in study design, outcomes measures and effectiveness reported. Effective intervention strategies were identified that can be used to guide future interventions, including practical learning activities, peer support and approaches targeting the school environment, the parents or that link the intervention to the community.

Psychological effects of the COVID-19 pandemic on Wuhan's high school students

OBJECTIVE

This study explored the protective mechanisms of resilience and positive emotion regulation against psychological trauma among Wuhan's high school students during the COVID-19 outbreak.

METHOD

We obtained 286 valid samples from four high schools in Wuhan, China. To construct a measurement model and a structural model, structural equation models using four measurement scales with valid items were adopted, including a scale of psychological trauma, a scale of resilience, a scale of positive emotional regulation, and a scale of mental health. Participants reported their answers to items on a 5-point Likert-like scale.

RESULTS

The results revealed that psychological trauma was a negative predictor of mental health, and resilience and positive emotion regulation mediated the relationship between psychological trauma and mental health.

CONCLUSIONS

Accordingly, we concluded that resilience and positive emotion regulation interrupted the direct impact of psychological trauma on mental health, thereby greatly protecting the mental health of Wuhan's high school students during the COVID-19 outbreak.

Contributing Factors in Adolescents’ Mental Well-Being—The Role of Socioeconomic Status, Social Support, and Health Behavior

Mental disorders are common in adolescents, and for effective interventions we should be aware of their determinants. However, there are only a small number of studies investigating the combined effect of multiple factors. Therefore, our aim is to assess the impact of socioeconomic status, social support, and health behavior on adolescents’ mental well-being. A cross-sectional health survey of 1641 children was carried out in accordance with the study protocol of the Hungarian Health Behavior in School-aged Children survey. Multivariate multiple regression was used to analyze the main determinants of mental well-being. The boys’ mental well-being was favorable compared to girls; lower subjective family wealth was associated with lower life satisfaction and depressive mood. Life satisfaction was positively related to healthy eating, social support, and physical activity. Unhealthy eating, sedentary lifestyle, and lower social support were associated with higher depression scores. Higher social support reduces psychosomatic symptoms, while unhealthy eating and spending a lot of time in front of the computer increase them. Both social support and healthy lifestyle seem to be protective against mental health problems among adolescents, and thus interventions should focus on these factors regardless of the socioeconomic status of the participants, with special attention given to girls.

Adolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections

OBJECTIVE

To analyze the association between vulnerabilities to Sexually Transmitted Infections (STIs/HIV/AIDS) of adolescents in poverty and their level of resilience.

METHOD

Cross-sectional study with 287 students between 11 and 17 years old in a school in the outskirts of Fortaleza-Ce. The study was conducted from August to October 2016. Three instruments related to characterization, vulnerability to STIs/HIV/AIDS and resilience were used. The association between the instruments was calculated using the Mann-Whitney and Kruskal-Wallis tests. Association between vulnerability to STIs/HIV/AIDS and resilience was assessed through the Spearman's correlation coefficient. Statistical significance was set at p<0.05.

RESULTS

There was a significant association between the factors "housing" (p=0.022), "family income" (p=0.037) and vulnerability to STIs/HIV/AIDS. Adolescents whose father has completed high school (p=0.043) have moderately high resilience.

CONCLUSION

Adolescents with low socioeconomic status and who live on less than a minimum wage tends to be more susceptible to vulnerabilities to STIs/HIV/AIDS and to have low resilience.

Sensory processing sensitivity and culturally modified resilience education: Differential susceptibility in Japanese adolescents

This study investigated the efficacy of a culturally modified resilience education program on Japanese adolescents’ well-being from a differential susceptibility perspective. First, a culturally modified resilience education intervention was developed by employing the SPARK resilience program and implemented with 407 Japanese high school students in Tokyo (age = 15–16, M = 192, F = 215). To test intervention efficacy, students’ level of resilience, self-esteem, self-efficacy, and depression were measured pre-, post-, and three months after intervention. Additionally, sensory processing sensitivity, using the Japanese version of the Highly Sensitive Child Scale for Adolescence, was measured as an index of individual sensitivity. Analysis of variance was used to examine the baseline differences and interaction effects of students’ gender and level of sensory processing sensitivity. Latent growth curve models were used to assess the overall effects of the intervention and change over time. Results indicated that the intervention was effective in enhancing students’ overall self-efficacy; and that highly sensitive students, who scored significantly lower in well-being than their counterparts at baseline, responded more positively to the intervention, and had a greater reduction in depression and promotion of self-esteem. These findings provided unique evidence in line with the differential susceptibility perspective and useful implications to develop personalized treatment interventions for adolescents in different cultural contexts.

Predicting Psychological Distress Amid the COVID-19 Pandemic by Machine Learning: Discrimination and Coping Mechanisms of Korean Immigrants in the U.S

The current study examined the predictive ability of discrimination-related variables, coping mechanisms, and sociodemographic factors on the psychological distress level of Korean immigrants in the U.S. amid the COVID-19 pandemic. Korean immigrants (both foreign-born and U.S.-born) in the U.S. above the age of 18 were invited to participate in an online survey through purposive sampling. In order to verify the variables predicting the level of psychological distress on the final sample from 42 states (n = 790), the Artificial Neural Network (ANN) analysis, which is able to examine complex non-linear interactions among variables, was conducted. The most critical predicting variables in the neural network were a person's resilience, experiences of everyday discrimination, and perception that racial discrimination toward Asians has increased in the U.S. since the beginning of the COVID-19 pandemic.

Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators

BACKGROUND

This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care.

METHODS

A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included.

RESULTS

Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints.

CONCLUSIONS

The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making.

SYSTEMATIC REVIEW REGISTRATION

Not applicable.

Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial

BACKGROUND

There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico).

METHODS

The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed.

DISCUSSION

The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.

Common Elements of Childhood Universal Mental Health Programming

Despite the availability of multiple mental health prevention and promotion programs for children, challenges related to their dissemination limit their reach and impact. This review identifies the most common practice elements of effective childhood universal mental health programming for children ages 3-11, based on a structured interpretation and coding of program manuals and descriptions in peer-reviewed articles. Across a range of program goals and targeted outcomes, psychoeducation and problem solving emerged as the most common practice elements, followed by social skills training, insight building, and communication skills. These skills were largely taught via role-plays and modeling. Synthesizing what we know from the universal mental health programming literature has potential to facilitate dissemination of information to inform the development, adaptation or adoption of programs for children.

Randomized trial of a resilience intervention on resilience, behavioral strengths and difficulties of mainstreamed adolescent students with hearing loss

OBJECTIVES

Adolescents with hearing loss have shown emotional and behavioral difficulties. This study evaluated the effectiveness of a resilience-focused intervention on resilience, behavioral strengths, and difficulties of mainstreamed adolescent students with hearing loss.

METHODS

In this experimental study with a pre-test, post-test, follow up, and control group design, a total number of 122 students with hearing loss, were randomly assigned to two equal groups. The intervention group received training in small groups of 3-5 self-contained classes for six weeks (two times per week for 75 min). The "Connor-Davidson Resilience Scale" and the "self-report version of Strengths and Difficulties Questionnaire (SDQ)" were used to measure the resilience and the positive and negative behavioral attributes of participants prior to intervention, then repeat of 6 and 14 weeks later. The scores were compared between intervention and control groups using the Mann-Whitney Test.

RESULTS

After the intervention, the resilience scores in the intervention group was significantly higher than the control group (U = 831, p < .001). Also, the SDQ score in the intervention group was significantly higher than the control group (U = 634, (p < .001). Negative behavioral attributes (total SDQ scores, and sub-scales scores of hyperactivity, emotional, conduct, and peer problems) were decreased, and prosocial behavior was increased significantly in the intervention group (p < .001). All of the differences remained through follow-up measurement except for the subscale of conduct problems.

CONCLUSION

The twelve sessions of resilience-focused intervention led to a marked increase in resilience. It also is effective in decreasing the behavioral difficulties of adolescents with hearing loss and is suggested to apply for students with hearing impairment integrated into middle schools.

Resilience and self-harm among left-behind children in Yunnan, China: a community-based survey

BACKGROUND

Self-harm (SH) behaviors are established risk factors of suicide, however, in Chinese left-behind children (LBC), SH remains severely under-discussed. In this study, we aimed to investigate SH and explore its association between resilience in a large group of LBC.

METHODS

A community-based cross-sectional study of 2898 LBC was conducted in Yunnan province, China. Information was collected by self-reporting questionnaires. Descriptive analysis was used to depict and compare characteristics of the subjects. Univariate and multivariate logistic regression models were applied to estimate the associations between resilience and SH prevalence, SH severity, SH repetition.

RESULTS

The prevalence of SH in LBC was 48.8% (95%CI: 47.0-49.7%). Compared to LBC with lower level of resilience, a higher level of resilience was related to 0.40 folds of SH odds (95%CI: 0.34-0.48). Besides, among all dimensions of resilience, every 1 average score increase of emotion regulation and family support were associated with 0.13 (95%CI: 0.04-0.37) and 0.14 (95%CI: 0.04-0.47) folds of odds in severer SH, respectively; one unit increase in the average score of emotion regulation was related to an OR of 0.23 (95%CI: 0.07-0.71) for repeated SH.

CONCLUSIONS

Psychological resilience presented protective effect on SH in LBC, especially the dimensions of emotion regulation and family support. Intervention measures focusing on enhancing emotion regulation ability and building parent-child connection could be considered in order to reduce SH and suicidal risk in LBC.

UPRIGHT, a resilience-based intervention to promote mental well-being in schools: study rationale and methodology for a European randomized controlled trial

BACKGROUND

Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention.

METHODS

UPRIGHT project is a research and innovation project funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods.

DISCUSSION

We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03951376 . Registered 15 May 2019.

Social determinants of health and vulnerabilities to sexually transmitted infections in adolescents

OBJECTIVE

To verify the association between social determinants of health and the vulnerability of adolescents to Sexually Transmitted Infections (STIs).

METHOD

Cross-sectional study, performed with 287 students aged 11 to 17 years, in the outskirts of Fortaleza, Ceará, Brazil, from August do September 2016. Two instruments were used, one destined to social determinants of health and another to investigating the vulnerability to STIs. The magnitude of associations was expressed through odds ratio and interval of confidence, considering a 5% significance level. This research was approved by the Research Ethics Committee of the Federal University of Ceará.

RESULTS

212 (73.9%) adolescents were considered more vulnerable, with a score ≥ 4. The intermediate social determinant "housing (home ownership)" obtained significant association with with the vulnerability to STIs (p of 0.022; CI 1.1 to 3.3; OR 1.9).

CONCLUSION

The intermediate social determinant "type of housing" influences the vulnerability to STAs.

Mental Health Care Interventions in Child Welfare: Integrative Review of Evidence-Based Literature

Many of the youths living in vulnerable environments in child welfare settings are in need of psychiatric treatment as well as child protection services. There is an urgent demand for closer collaboration between these two sectors in order to ensure more effective work in child welfare regarding to mental health care interventions is provided. The aim of this integrative review was to describe the evidence-based literature related to mental health care interventions provided in child welfare. Seven databases (PubMed, EBSCOhost, Ovid MEDLINE, Eric, CINAHL, Elsevier Science Direct, Cochrane database) were searched, while search parameters included English-only manuscripts published prior to 20 May 2016. Out of 152 records, only eight studies met the inclusion criteria. Mental health care interventions described varied and were listed as follows: crisis assessment, respite child care, counselling, therapeutic interviews, cognitive and educational screening, different therapies, psychoeducational support, psychological testing, behavioural assessment, individual work and brief interval care. Despite using comprehensive searches in seven databases, we found only eight studies related to acute psychiatric services targeted at child welfare. There is not enough evidence to arrive at a definite conclusion on the effects of mental health care interventions in child welfare.

Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial

OBJECTIVES

Interventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use.

DESIGN

Secondary analysis of data from a cluster-randomised controlled trial.

SETTING

32 Australian secondary schools.

PARTICIPANTS

Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15-16 years; 2014; n=2105).

INTERVENTION

Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012-2014).

MEASUREMENTS

Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, 'risk' and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate individual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender; socioeconomic disadvantage (low/high); geographic location (major city/inner regional/outer regional-remote); and previous substance use (non-user/user)) at follow-up (36 models).

RESULTS

Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) -12.89, 95% CI -26.00 to 0.23) or high (MD 16.36, 95% CI -1.03 to 33.76) socioeconomic subgroups.

CONCLUSIONS

No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use.

TRIAL REGISTRATION NUMBER

ACTRN12611000606987.

Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: cluster-randomised controlled trial

OBJECTIVES

Initiation of tobacco, alcohol and illicit substance use typically occurs during adolescence, with the school setting recommended to reduce adolescent substance use. Strengthening individual (eg, problem solving) and environmental (eg, caring relationships at school) resilience protective factors of adolescents has been suggested as a strategy for reducing substance use by adolescents; however, few studies have examined this potential. A study was conducted to investigate the effectiveness of a pragmatic school-based universal 'resilience' intervention in reducing the prevalence of tobacco, alcohol and illicit substance use, and increasing the individual and environmental protective factors of students.

DESIGN

A cluster-randomised controlled trial.

SETTING

Thirty-two Australian secondary schools (20 intervention; 12 control).

PARTICIPANTS

Cohort of grade 7 students followed-up in grade 10 (2014; aged 15-16 years).

INTERVENTION

A pragmatic intervention involving school staff selection and implementation of available programmes and resources targeting individual and environmental 'resilience' protective factors for all grade 7-10 students was implemented in schools (2012-2014). School staff were provided implementation support.

MEASUREMENTS

An online survey collected baseline and follow-up data for primary outcomes: tobacco (ever, recent) and alcohol (ever, recent, 'risk') use, and secondary outcomes: marijuana and other illicit substance use, and individual (six-factor subscales, aggregate) and environmental (three-factor subscales, aggregate) protective factor scores. Generalised and linear mixed models examined follow-up differences between groups.

RESULTS

Follow-up data from 2105 students (intervention=1261; control=844; 69% of baseline cohort) were analysed. No significant differences were found between intervention and control students for any primary (ever tobacco: OR 1.25, 95% CI 0.92 to 1.68, p=0.14; recent tobacco: OR 1.39, 95% CI 0.84 to 2.31, p=0.19; recent ever alcohol: OR 1.11, 95% CI 0.83 to 1.48, p=0.46; alcohol: OR 1.13, 95% CI 0.78 to 1.62, p=0.51; 'risk' alcohol: OR 0.98, 95% CI 0.70 to 1.36, p=0.89) or secondary outcomes (marijuana: OR 1.12, 95% CI 0.74 to 1.68, p=0.57; other illicit substance: OR 1.19, 95% CI 0.67 to 2.10, p=0.54; individual protective factors: MD=0, 95% CI -0.07 to 0.06, p=0.89; environmental protective factors: MD: -0.02, 95% CI -0.09 to 0.06, p=0.65).

CONCLUSIONS

The universally implemented pragmatic school-based intervention was not effective in reducing the prevalence of tobacco, alcohol or illicit substance use, or in increasing the protective factors of students.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register reference: ACTRN12611000606987.