Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review

Using codesign to engage primary care practices in a participatory change process

Healthcare has experienced significant transformation in recent years with many changes being imposed on practices from outside sources. When tailoring outside interventions to specific settings, it is important to engage practice members in participatory processes. Yet, tailoring remains a difficult and poorly understood element of implementation. Codesign is one method to achieve context-sensitive, bottom-up change by engaging stakeholders in the design process. With a complex adaptive system (CAS) perspective, codesign reframes interventions as tools to empower practices to drive change based on local challenges and experiences rather than change being imposed upon them. Observing adaptations and facilitating innovations of practice members offers insight into dynamics of the CAS, implementation context, and its limitations. Here, the codesign process is illustrated through a pediatric primary care practice adopting integrated health. Contextual inquiry was performed using ethnographic observations to identify barriers and facilitators to integrated health. Observation findings informed codesign workshops with clinicians. Workshop transcripts and drawings were analyzed using an immersion/crystallization approach guided by the Practice Change Model (PCM), an established framework based on complexity science concepts. In these workshops, clinicians described tension between their motivations to care for complex patients and limitations imposed by the health system. Participants' knowledge of their real-world context allowed them to identify resources and opportunities for changes they could make within their current environment. The reconciliation of the ideal and the real is a core benefit of codesign methods. This innovative approach can be applied more generally to support the development, implementation, and evaluation of interventions that reflect real world interactions and complexities.

Cancer awareness among adolescents in Irish schools: A cross-sectional study

PURPOSE

The aim of this study was to assess adolescents' awareness of cancer signs and symptoms, cancer risk factors, cancer screening programmes, and perceived barriers to seeking medical advice.

METHODS

A cross-sectional survey was conducted using an adapted version of the adolescent cancer awareness tool which was originally modified from the Cancer Awareness Measure (CAM) (Version 2.1). The sample included 474 adolescents aged 15 to 18 years recruited from nine Irish schools between November 2021 and May 2022.

RESULTS

Awareness of cancer warning signs and symptoms was low when open-ended (recall) questions were used and relatively high for closed (recognition) questions. Unexplained lump or swelling was the most frequently identified cancer symptom. The least reported were difficulty swallowing and a sore that does not heal. Smoking was the most reported cancer risk factor. The least reported were not eating enough fruit and vegetables, a diet high in fat, and infection with viruses. Generally, females had greater awareness than males. The greatest barrier to seeking help was "worry about what the doctor might find" and the least reported barrier was "I don't feel respected by the doctor."

CONCLUSIONS

Overall recognition of symptoms or risk factors of cancer was higher than recall. Several modifiable barriers to medical help-seeking were identified. Findings from this study suggest further exploration using a qualitative approach to investigate the factors influencing adolescents' cancer awareness and barriers to help-seeking.

Psychosocial and mental health in cystic fibrosis in the modern era of care: time to evolve

Cystic fibrosis (CF) treatment has revolutionised care over the past three decades with major advances in survival. Despite these advances, CF continues to create psychological and social challenges for people with CF (PWCF) throughout their life and is associated with worse health outcomes and higher healthcare costs. Anxiety and depression screening and management protocols are widely implemented within CF care; however, a much broader scope of psychosocial challenges exist which lack a standardised screening and management approach. The advent of CF transmembrane conductance regulator modulator therapies is transforming the psychosocial landscape for PWCF with new challenges and evolving psychosocial needs. What it means to have CF, the expectations, hopes and stressors are rapidly changing, and psychosocial care must keep pace if health outcomes are to be fully optimised. A symposium of international CF and psychosocial experts was convened in November 2022 to explore current and emerging issues in psychosocial health and identify opportunities and approaches to optimise psychosocial care. This state-of-the-art review summarises key symposium proceedings and highlights priorities for clinical practice and research in psychosocial health across the lifespan among PWCF. It also summarises state-of-the-art initiatives for screening and intervention to optimise CF psychosocial healthcare and patient outcomes.

Reaching adolescents with health services: Systematic development of an adolescent health check-ups and wellbeing programme in Ghana (Y-Check, Ghana)

BACKGROUND

Routine health check-ups may improve adolescent health, but global guidelines are lacking. Phase 1 of the WHO-coordinated Y-Check Research Programme involved three African cities to co-produce a programme of adolescent health check-ups. We describe a systematic approach to developing a routine adolescent health check-ups and wellbeing programme (Y-Check) to contribute evidence on whether adolescent health check-ups should be part of routine health services in Ghana.

METHODS

Y-Check Phase 1 was conducted in four communities in Cape Coast Ghana, over two stages using a variety of methods: (a) needs assessment and landscape analysis on the health of adolescents (existing policies/programmes, school system, adolescent health conditions) was conducted through desk-review and interviews with key informants to identify the potential content, delivery strategy and settings for adolescent health check-ups in this context; (b) co-designing the Y-Check intervention framework through person-centred participatory workshops and a consensus-building workshop with multiple stakeholders, including adolescents (10-19 years) and their parents. The study was conducted between January 2020 and October 2020.

RESULTS

The Y-Check intervention consists of two check-ups with content that is tailored to the needs of younger adolescents and older adolescents; delivered at both school and community settings by a team of trained staff in multiple steps involving up to four stations. Y-Check includes a referral system for adolescents with any problems that cannot be investigated or treated on-the-spot.

CONCLUSIONS

Our systematic approach to co-producing Y-Check has resulted in an intervention whose content and structure is determined by the local context, and which was adjudged by multiple stakeholders to be likely to be both useful and acceptable, and which builds on best practice. As a logical next step, the Y-Check will be subjected to pilot testing and implementation research to rigorously evaluate the feasibility, acceptability, coverage, yield of previously undiagnosed conditions and cost of these health check-ups.

Screening for Emotional Problems in Pediatric Hospital Outpatient Clinics: Psychometric Traits of the Pediatric Symptom Checklist (Hebrew Version)

This study assessed feasibility and psychometric properties of the Hebrew parent version of the Pediatric Symptom Checklist (PSC-17), aiming to improve treatment access for children and adolescents with behavioral and mental needs through early screening. The PSC-17 and the Strengths and Difficulties Questionnaire (SDQ) were filled in the waiting room, at three ambulatory clinics in a tertiary pediatric center, by 274 parents using a tablet or their cellphone. Demographic and clinical data were retrieved from patients' files. PSC results were compared to SDQ results and assessed vis-a-vis a psychiatric diagnosis, determined previously and independently by trained pediatric psychiatrists for 78 pediatric patients who attended these clinics. Construct and discriminant validity of the PSC-17 Hebrew version were good. Sensitivity, specificity, and positive and negative predictive values are presented. The PSC-17 (Hebrew version) was found to be a feasible tool for mental health screening at pediatric ambulatory care clinics.

Low Level of Well-being in Young People With Physical-Mental Multimorbidity: A Population-Based Study

PURPOSE

We aimed to examine whether wellbeing, health behavior, and youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions.

METHODS

The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index and life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis.

RESULTS

A total of 52% of YP with physical-mental multimorbidity reported a low level of wellbeing, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical conditions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions.

DISCUSSION

YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings.

Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.

Youth, Social Media, and Telehealth: How COVID-19 Changed Our Interactions

Adolescents and young adults (AYA) use social media more than any other generation, including to learn about their health. The coronavirus disease 2019 pandemic further accelerated both health harming and health benefits of technology use. Also, during this time, medical professionals moved more quickly to virtual visits, changing AYA, family, and provider interactions and expectations. Remote health care, broader technology use, and improved youth engagement have the potential to address long-standing barriers to health equity. Telehealth disadvantages still exist, however, especially for those with decreased access. Recent rapid changes have not allowed for sufficient study to address optimizing the experience, effectiveness, and utilization of remote health care. Fortunately, because of their expansive engagement with social media and technology, AYA are paving the way toward a digital health future. Health professionals are encouraged to improve their virtual and social media interactions with AYA patients, while finding ways to improve health equity. [Pediatr Ann. 2022;51(4):e161-e166.].

Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments

Objective

Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group.

Method

A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps.

Results

We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.

Conclusion

The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.

Electronic Screening, Feedback, and Clinician Training in Adolescent Primary Care: A Stepped-Wedge Cluster Randomized Trial

PURPOSE

The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors.

METHODS

We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.

RESULTS

Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months.

CONCLUSIONS

The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.

Psychometric evaluation of the Russian version of the Gaming Disorder Scale for Adolescents

Problematic gaming has become an emerging global health issue. Formal recognition of gaming disorder in the ICD-11 is a new opportunity for the discipline to conduct further investigation concerning the psychological consequences of problematic gaming. The present study investigated the psychometric properties and construct structure of the recently developed Gaming Disorder for Scale for Adolescents (GADIS-A), a multi-dimensional instrument that screens for gaming disorder symptoms, among Russian adolescent gamers. The sample comprised 933 adolescent gamers (547 boys and 386 girls) recruited via a web-based platform, using a multistage sampling method. Analysis showed the GADIS-A had very good internal consistency (Cronbach's alpha coefficient = .891; Composite reliability = .89) and adequate test-retest reliability after two weeks (intraclass coefficient  =0.68 with 95% CI [0.61, 0.77]. Exploratory structural equation modeling (ESEM) showed the data fitted well. Measurement invariance testing indicated the GADIS-A was invariant by gender and gaming medium (online vs. offline). As for criterion-related validity, high scores on the GADIS-A positively correlated with scales assessing depression, anxiety, impulsivity, and difficulties in emotion regulation, and negatively correlated with social connectedness and life satisfaction. Using latent profile analysis, four groups of gamers were identified, and problematic gaming was associated with greater mental health problems. The findings indicated that psychological comorbidity (e.g., depression and anxiety) was more prevalent among gamers with higher risk of GD. The findings indicate that GADIS-A is a reliable and valid instrument to assess the symptoms and severity of gaming disorder among Russian adolescents.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02575-w.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

Measuring mental wellness among adolescents living with a physical chronic condition: a systematic review of the mental health and mental well-being instruments

Background

Globally, promoting mental health and well-being among adolescents has become a public health priority, especially for adolescents living with a physical chronic condition (CC), as research suggests they may be more at risk of developing mental health co-morbidities. Valid and reliable instruments are needed to measure and better understand mental health and mental well-being among adolescents living with a CC. To this end, we reviewed studies reporting on mental health and well-being instruments used in adolescent populations living with a chronic physical condition/disease globally.

Methods

We used a systematic review method guided by PRISMA to identify assess mental health and mental well-being instruments used in adolescents living with a CC. In this instance, mental health instruments were defined as those representing negative domains of mental health (i.e. depression and anxiety) while mental well-being instruments included positive aspects of mental health (i.e. self-concept and resilience).

Results

We identified 22 articles, which included 31 instruments that were used to measure either mental health (n = 8) or mental well-being (n = 15) or both (n = 8) in adolescents living with a CC. Of these, thirteen studies used a Health-Related Quality of Life (HRQoL) scale to measure mental health and/or mental well-being. The KIDSCREEN questionnaires and the Strengths and Difficulties Questionnaire were identified as being frequently used across the 22 studies. Additionally, 7 out of the 31 instruments were disease specific, with 3 focusing on adolescents with diabetes. All the instruments were developed in high income countries and adapted for use in lower- and middle-income countries (LMICs). Adolescents with Type 1 Diabetes (n = 7) and HIV (n = 4) were researched in 11 out of 22 studies. Only eight studies were conducted in LMIC, of which four were in Africa.

Conclusions

HRQoL instruments are useful in measuring mental health and well-being in adolescents living with a CC. However, relatively few valid measures of mental health and mental well-being for adolescents living with a CC exist, which accentuates the paucity of research on mental health and mental well-being of adolescents who are living with a CC. Specific measures need to be developed in and for LMICs where cultural contexts affect mental well-being in unique ways.

Systematic review registration: PROSPERO CRD42020186707.