Global priorities for improving access to mental health services for adolescents in the post-pandemic world

Is mobile renewal enough? A qualitative study exploring stakeholders' perspectives on mobile phone-based add-ons for national health insurance uptake in Ghana

BACKGROUND

The Mobile Renewal System (MRS) has increased insurance renewal rates among Ghana's National Health Insurance Scheme (NHIS) subscribers. However, population coverage with active NHIS membership remains insufficient for Universal Health Coverage (UHC) ambitions, especially among informal workers. This qualitative study aimed to explore stakeholders'(technical experts and informal workers) perspectives on the implementation and use of mobile renewal system (MRS) add-on(s) to improve NHIS uptake in Ghana.

METHODS

Technical experts were interviewed in depth based on their experience and ability to provide information on developing and implementing mobile health technology, and 17 focus group discussions were held with informal workers in Accra and Kumasi between March and August 2022. Thematic analysis was used to identify recurring themes and categories.

RESULTS

Participants (13 technical experts and 96 informal workers) suggested several add-ons to improve the use of the MRS. These included reminders to renew, mobile registration of new members, an automatic renewal option, a savings wallet, and a facility locator. These add-ons could potentially encourage more people to use the MRS and further increase insurance uptake. For implementing and utilizing the MRS and these add-ons, reliable technological infrastructure, stakeholder involvement, adequate funding, training, and awareness campaigns were considered crucial. Barriers to using MRS and add-ons may arise from concerns regarding data protection, transparency, and potential taxes on digital transactions resulting in additional costs. In addition, individual factors such as experience with mobile phone transactions and knowledge about insurance influenced participants' willingness to use the MRS and the suggested add-ons.

CONCLUSION

Different mobile phone-based technologies can potentially increase NHIS coverage in Ghana. Implementation should address insurance literacy and build communities' trust in mobile technology.

Barriers to treatment seeking for depression among elderly service users at Butabika National Referral and Teaching hospital, Kampala- Uganda

OBJECTIVES

Depression among the elderly is a significant public health concern in Uganda, where cultural, social, and healthcare-related barriers hinder access to treatment and support. This study examines the barriers to mental health service access faced by elderly service-users in Uganda.

METHOD

Using an interpretive phenomenological approach, in-depth interviews were conducted to capture the lived experiences of elderly Baganda service users receiving treatment at Butabika National Referral and Teaching hospital.

RESULTS

The findings reveal an intricate interaction between cultural, social, economic, and healthcare system-related barriers. Key barriers include limited mental health awareness, financial constraints, fragmentation, drug shortage and geographical access. Social and cultural stigma further exacerbate these challenges contributing to delayed or avoided help-seeking behaviours among the elderly.

CONCLUSION

The study highlights the intersectionality of aging and mental health issues, underscoring the urgent need for a comprehensive, integrated approach to mental health care for the elderly. This research calls for targeted interventions to reduce stigma, increase mental health literacy, and improve the accessibility and affordability of care for vulnerable elderly populations in Uganda. Such services can improve mental health outcomes and quality of life for the elderly in Uganda.

The Sociology of Suicide After COVID-19: Assessment of the Spanish Case

The phenomenon of suicide has become a significant global concern, claiming over 800,000 lives annually and resulting in millions of suicide attempts worldwide. In the aftermath of the COVID-19 pandemic, these troubling statistics have worsened, with notable increases in suicidal behavior, especially among vulnerable populations such as the youth, the elderly, and those in socioeconomically disadvantaged groups. This paper aims to explore the impact of the COVID-19 pandemic on suicide rates in Spain, using a theoretical ex post facto analysis. Spain has witnessed an alarming rise in suicide rates, particularly among young people, and a disturbing trend of increased suicidal ideation and self-harm behaviors. While some studies report no significant change in suicide rates during the pandemic, others point to the exacerbating effects of social isolation, economic instability, and public health measures. This study provides an in-depth examination of the psychosocial consequences of the pandemic on mental health in Spain, emphasizing the urgency of the need to address pre-existing inequalities and implement effective suicide prevention measures. Furthermore, it highlights the importance of gender-sensitive strategies and the need for systemic reforms to ensure better mental healthcare access for all segments of society. To achieve this goal, this paper uses a narrative literature review combined with a theoretical ex post facto analysis to assess the influence of the COVID-19 pandemic on suicide patterns in Spain.

Promoting Youth Mental Wellbeing: A Photovoice Project with Adolescents and Young Adults in the Hospital Context

Given the importance of youth mental health for public policy, it is crucial to involve young people directly in participatory research to investigate their views and translate their demands into concrete actions. The aim of the study was to define the concept of mental wellbeing as perceived by a group of adolescent and young adult patients in two large hospitals in northwestern Italy and to find out, together with them, what institutions can do to promote youth wellbeing. Thirty-nine participants (13-25 years old, 90% female), divided into four groups, took part in a Photovoice workshop. Individual interviews were conducted with 21 participants and the transcripts were thematically analyzed. The photos were categorized into five themes: nature, traveling, passions and leisure, relationships, and animals. The definition of mental wellbeing can be traced back to eight themes: sharing experiences and emotions with others, calm and tranquility, personal fulfilment, sense of belonging, pleasant physical sensations, freedom and discovery, involvement and commitment, and happiness. The key recommendations for promoting mental wellbeing were providing information about mental health, tackling the stigma of mental illness, and providing psychological support in school and health services. The implications of these findings for policy makers involved in planning health services for young people are discussed.

Subjective Outcome Evaluation of a Positive Youth Development Program in Mainland China: Evidence in the Post-Pandemic Era

BACKGROUND

Optimizing the development of adolescents in the post-pandemic era is an urgent concern. As an active initiative, the "Tin Ka Ping P.A.T.H.S. Project", rooted in the "Positive Youth Development (PYD)" approach, represents a curriculum-based program aimed at fostering the psychosocial competence and well-being of adolescents. This study presents evaluation findings of the program's effectiveness during the 2022-2023 academic year.

METHODS

Using a validated "36-item Subjective Outcome Evaluation scale (SOES)", we evaluated perceptions of 2165 junior students (Mage = 13.43 years, SD = 0.70 years, 51.3% females) and 3287 senior students (Mage = 16.07 years, SD = 0.65 years, 52.8% females).

RESULTS

Replicating our previous findings before and during the pandemic, the 36-item SOES exhibited satisfactory validity and reliability in the current study. Students commonly provided favorable evaluations regarding program quality, implementer quality, and perceived benefits. Senior-grade students were more likely to perceive the program more positively.

CONCLUSIONS

These replications underscore the generalizability of the robustness of the 36-item SOES as a reliable evaluation measurement tool across different time periods and research backgrounds. The participants' positive responses indicated the positive impact of the "Tin Ka Ping P.A.T.H.S. Project" in enhancing the psychosocial competence and well-being of the students across background contexts and time periods.

Exploring Support Preferences for Young Women Who Self-Harm: A Qualitative Study

Rates of self-harm among young women have been increasing in recent years across multiple high-income nations. Given the negative outcomes associated with self-harm, it is essential that young women who engage in self-harm receive the support that best addresses their specific needs. The aim of the current study is to explore support preferences among Australian young women with a history of self-harm. Semi-structured interviews were conducted with 27 young women (M = 20.9, SD = 2.1) with a history of self-harm, recruited through social media posts. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a Reflexive Thematic Analysis approach. Thematic analysis of the data identified themes pertaining to the following: (1) the types of support young women want around self-harm, and (2) how young women would like to receive support for self-harm. Regarding the former, participants expressed wanting information about self-harm and self-harm interventions, education about self-harm for those around them, age-specific mental health education, and alternative coping strategies. Some participants expressed not wanting any support. Regarding the latter, participants wanted self-harm information to be provided by health professionals and in school settings, and preferred for information to be provided in written or digital forms. The findings highlight the need to improve access to formal mental health support among young women, the importance of young people being able to access support confidentially, and the need for young peoples' caregivers and health professionals to be educated about self-harm. Additionally, the findings support a role for schools in providing information about mental health and available support.

The Healthy Minds, Thriving Kids Project: Educator perspectives on relevance and potential impact of a mental health skill building program

BACKGROUND

Healthy Minds Thriving Kids (HMTK) is a free to user mental health skill building program developed by the Child Mind Institute with the aim to normalize conversations about emotional health and provide educators with wellness tools. The aim of this study was to explore the applicability of the HMTK program for universal school-based delivery from the perspective of educators, specifically to understand acceptability of program materials, perception of the quality of the program, and impressions of the program's usefulness and relevance across K-12 settings.

METHODS

The HMTK program was available to view by educator registrants between 01/26/2022 and 09/07/2022 in the State of California. Educator participants viewed an introductory video for the program and a minimum of two skills videos before participating in an online survey.

RESULTS

Of 68,861 registrants to the website, 64,376 provided survey data. Post-pandemic levels of stress and anxiety were increased, and 89.5% of respondents said young people required a greater degree of support than in the past. Almost all educators (90%) endorsed a need for additional mental health skill building tools for students, and following review of HMTK, > 80% of respondents said they would use the program in their classrooms. Most (86.6%) found the program engaging, and 85.1% found the program relevant to and representative of their student cohorts. More than three quarters (79.6%) said their students would find the program engaging and beneficial. Post-exposure to HMTK, 18.8% more educators believed that the State of California was committed to supporting students' emotional learning.

CONCLUSION

This survey demonstrates that from the perspective of educators the HMTK program is a valuable and complementary resource to school curricula to improve the mental health skills of young people. It provides an easy-to-implement framework that school districts and administrators can integrate within their curriculum planning.

Efficacy of solution-focused brief therapy versus case management for psychological distress in adolescents and young adults in a community-based youth mental health service in Singapore: protocol for a randomised controlled trial

INTRODUCTION

There are insufficient scalable, evidence-based treatments to meet increasing mental health needs of young people. Offering interim, brief interventions for young persons with psychological distress can improve access to care and mitigate adverse effects of long waiting times. This study tests the efficacy of solution-focused brief therapy (SFBT), a strength-based, goal-directed intervention, in adolescents and young adults at a community-based youth mental health service in Singapore.

METHODS AND ANALYSIS

This is a fully powered, randomised, single-centre, two-arm, parallel, superiority, controlled trial. From September 2023 to March 2025, the study will recruit 124 participants (aged 16-30) presenting at a national youth mental health service in Singapore (CHAT, Centre of Excellence for Youth Mental Health) with clinically assessed general psychological distress, subthreshold or prodromal symptoms, or a first episode of a mood disorder. Participants will be excluded if they have high risk of suicide, psychosis, cognitive impairments, or current psychological treatments. Participants will be randomised in a 1:1 ratio to receive six-session, case manager delivered SFBT or treatment as usual (TAU) case management, and be followed up for 3 months post-intervention. Participants receiving SFBT are hypothesised to have greater improvements in self-reported psychological distress, from baseline to 8 weeks, compared with the control group. Secondary outcomes are self-reported depression and anxiety symptoms, and functional impairment. The study will also explore whether SFBT is associated with increased self-efficacy and decreased hopelessness, decreased downstream referrals post-intervention, and sustained clinical gains 3 months post-intervention compared with TAU. Adverse events and clinical deterioration will be recorded and reported.

ETHICS AND DISSEMINATION

The Institute of Mental Health (IMH) Institutional Research Review Committee (reference 822-2022) and the Singapore National Health Group Domain Specific Review Board (DSRB) (reference 2023/00052) have approved the study protocol. Findings will be published in international, peer-reviewed scientific journals. Summaries will be disseminated to study funders, mental healthcare systems administrators, and clinicians.

TRIAL REGISTRATION NUMBER

ISRCTN13671612 https://doi.org/10.1186/ISRCTN13671612.

Networks of care for the modern adolescent

BACKGROUND

At a time of increased demand for specialist mental health services, a more nuanced understanding of how adolescents navigate systems of care and support is essential. We mapped 'networks of care' to explore patterns of mental health help-seeking alongside the perceived helpfulness of support accessed.

METHODS

We examined data from 23 927 adolescents aged 11-18 years who participated in the 2023 OxWell Student Survey, an English school-based, repeated cross-sectional survey of mental health and wellbeing. Students self-reported past-year access to 18 types of support across informal (e.g. friends and family), semi-formal (e.g. school and charities), and formal (e.g. health and social care) domains, alongside how helpful they found the support. We used a network approach to explore interconnections between sources of support accessed and perceived helpfulness.

RESULTS

One in four (27.0%, 6449/23927) adolescents reported past-year access to mental health support, of which 56.7% (3658/6449) reported accessing multiple types. Informal networks were the most commonly accessed (23.1%, 5523/23927), followed by semi-formal (9.7%, 2317/23927) and formal (6.8%, 1623/23927) supports. Informal sources had high acceptability, with around 80-90% reporting them as helpful, whereas child and adolescent mental health services (CAMHS), helplines, and online supports were perceived to be the least helpful. The networks also identified groups who might not be optimally served by current systems, including gender diverse adolescents and adolescents who found mental health support from their parents unhelpful.

CONCLUSIONS

Adolescents are accessing mental health support across informal, semi-formal, and formal sources of care. Services can no longer be developed, delivered, or evaluated in isolation from these networks.

Assessing service usage and protective factors in a pediatric psychiatry clinic during the COVID-19 pandemic

Youth with developmental and pre-existing mental health conditions have been particularly vulnerable to declines in psychological functioning during the COVID-19 pandemic. This study aimed to first, analyze service usage within an outpatient child and adolescent psychiatry clinic in the months preceding and during the COVID-19 pandemic, and second, to examine associations with potential protective factors against mental health concerns in a treatment-engaged sample. Service usage was examined using clinic billing data, and reports on protective factors were gathered via parent survey of 81 children ages 6-17 years who received mental health treatment in an outpatient psychiatry clinic during the pandemic. Protective factors were assessed at the individual, family, and community levels, and included children's use of coping strategies, parental resilience, and parents' perceived social supports. Study outcomes, including mental health concerns, mental health emergencies, pandemic-related distress, and social impact of the pandemic, were analyzed via Pearson correlations and simultaneous multiple linear regressions. Findings suggest increased service usage and child coping, parental resilience, and social connectedness as factors associated with fewer mental health concerns in youth with psychiatric concerns during the pandemic. This study lends support for expanding psychiatric services with continued use of telemedicine platforms. Further, findings suggest a mental health benefit to optimizing individual, parental, and community-based resources to enhance children's psychological functioning, particularly for youth with pre-existing mental health conditions.

The 5Cs of positive youth development: their impact on symptoms of depression, anxiety, stress, and emotional distress in Chilean adolescents

Effective approaches to addressing mental health challenges faced by adolescents require a deep understanding of the factors contributing to optimal development, well-being, and prosperity. From the perspective of Positive Youth Development (PYD), this study proposes to examine the relationship between the 5Cs of PYD (Competence, Confidence, Connection, Character, and Caring) and symptoms of depression, anxiety, stress, and emotional distress among Chilean adolescents. A quantitative, cross-sectional, non-experimental study was conducted with 425 adolescents (ages 12 to 19, M = 14.95, SD = 1.81) from three Chilean cities: Arica (23%), Alto Hospicio (32%), and Iquique (46%). Data analysis included the use of confirmatory factor analysis (CFA) and structural equation modeling (SEM). The results indicate that two of the 5Cs, Confidence and Connection, have a significant negative direct effect on the four evaluated criterion indicators. These findings contribute to the literature on positive youth development in Latin America and underscore the importance of fostering confidence and connection in interventions aimed at promoting the mental health of adolescents in Chile and in similar contexts.

The Effectivity of a School-Based Early Intervention Targeting Psychological Complaints and Non-Suicidal Self-Injury in Adolescents

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11-14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention.

AI Technology panic-is AI Dependence Bad for Mental Health? A Cross-Lagged Panel Model and the Mediating Roles of Motivations for AI Use Among Adolescents

Background

The emergence of new technologies, such as artificial intelligence (AI), may manifest as technology panic in some people, including adolescents who may be particularly vulnerable to new technologies (the use of AI can lead to AI dependence, which can threaten mental health). While the relationship between AI dependence and mental health is a growing topic, the few existing studies are mainly cross-sectional and use qualitative approaches, failing to find a longitudinal relationship between them. Based on the framework of technology dependence, this study aimed to determine the prevalence of experiencing AI dependence, to examine the cross-lagged effects between mental health problems (anxiety/depression) and AI dependence and to explore the mediating role of AI use motivations.

Methods

A two-wave cohort program with 3843 adolescents (Male = 1848, Mage = 13.21 ± 2.55) was used with a cross-lagged panel model and a half-longitudinal mediation model.

Results

17.14% of the adolescents experienced AI dependence at T1, and 24.19% experienced dependence at T2. Only mental health problems positively predicted subsequent AI dependence, not vice versa. For AI use motivation, escape motivation and social motivation mediated the relationship between mental health problems and AI dependence whereas entertainment motivation and instrumental motivation did not.

Discussion

Excessive panic about AI dependence is currently unnecessary, and AI has promising applications in alleviating emotional problems in adolescents. Innovation in AI is rapid, and more research is needed to confirm and evaluate the impact of AI use on adolescents' mental health and the implications and future directions are discussed.

Navigating social and academic isolation: a qualitative exploration of American university students' perspectives and experiences early in the COVID-19 pandemic

Objective: To qualitatively explore the multifaceted impacts of the early months of the COVID-19 pandemic on the lives of American university students.Method: Undergraduate students in general education courses at a mid-sized public Western U.S. university were recruited to complete a Qualtrics survey that evaluated their perceptions, beliefs, and behaviours towards COVID-19. Thematic analysis identified prevailing themes regarding the positive and negative changes to students' lives during the pandemic.Results: Participants included undergraduate students (N = 241) between the ages of 18 and 24 (74.7% women), with 49.4% identifying as White. Thematic analysis of the survey identified several codes encompassed by six key themes: (1) shifting social interactions; (2) wellness; (3) school; (4) financial changes; (5) loss of experiences; and (6) political turmoil.Conclusion: Some students identified positive consequences (e.g., more family time, more flexible schedule), while almost all students reported negative consequences (e.g., difficulty with time management and organisation, loss of job or income) of the COVID-19 pandemic. University communities should consider providing additional academic, financial, and mental health resources to students to further mitigate the lasting consequences of the pandemic.