Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

BACKGROUND

Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.

METHODS

The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.

RESULTS

The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including "left-behind" children/adolescents, "single-parent" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all pcorrected < 0.001). The effects in "left-behind" children/adolescents, CEDC, and "single-parent" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all pcorrected < 0.05).

CONCLUSIONS

The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.

Protocol for the economic evaluation of the Care for Adolescents who Received Information 'Bout Outcomes, 2nd iteration (CARIBOU-2) non-randomised, cluster-controlled trial of an integrated care pathway for depression in adolescents

INTRODUCTION

Depressive disorders in adolescents are highly prevalent and debilitating and are a risk factor for self-harm and death by suicide. In the context of recovery from the COVID-19 pandemic, strained healthcare resources are compounded by an increased demand for treatment services for adolescents with depression. The objective of this study protocol is to delineate the proposed economic evaluation of an integrated care pathway for depression in adolescents within the Care for Adolescents who Received Information 'Bout Outcomes, 2nd iteration (CARIBOU-2) non-randomised, cluster-controlled trial.

METHODS AND ANALYSIS

Two economic evaluations of the CARIBOU-2 trial (n=300) will be conducted-a cost-effectiveness analysis and a cost-utility analysis. In the cost-effectiveness analysis, we will examine the primary clinical outcome of the trial, change in the Mood and Feelings Questionnaire total score. In the cost-utility analysis, the clinical outcome will be quality-adjusted life-years, a generic measure of health burden. Data on the resources and respective costs required to deliver the intervention will be collected by the research team. Data on resource use post-intervention will be obtained from a mix of administrative data holdings and self-report; relevant unit costs will be obtained from existing data sources. The outcome of both economic evaluations will be the incremental cost-effectiveness ratio. Relevant sensitivity analyses will be undertaken, and cost-effectiveness acceptability curves will be produced to characterise any sources of uncertainty in the analysis. Equity considerations will also be examined, where relevant.

ETHICS AND DISSEMINATION

Ethical approval for the larger CARIBOU-2 trial, including the economic evaluation, has been obtained by the Centre for Addiction and Mental Health as well as site-level ethics boards (019/2021; Centre for Addiction and Mental Health). All participants will provide informed consent for their data to be analysed and reported. The results of the main trial and the economic evaluation will be submitted for publication in a peer-reviewed journal and shared with relevant policy makers across Canada.

TRIAL REGISTRATION NUMBER

NCT05142683.

Common mental disorders in young adults: temporal trends in primary care episodes and self-reported symptoms

BACKGROUND

Rates of common mental disorders (CMDs) including anxiety, depression and stress, treated in primary care have increased among young adults, but it is unclear if this reflects more help-seeking and/or an increase in symptoms, and if there are differences across sociodemographic groups.

OBJECTIVE

This study examined trends in primary care-recorded CMD and self-reported psychological distress symptoms in young adults over time.

METHODS

We used data from participants born between 1980 and 2003 in two datasets: UK primary care records and longitudinal cohort data. Participants were followed from age 16 to age 39 (maximum) or the end of the follow-up (2019-2020). Annual incidence rates of recorded CMD overall and by sociodemographic group were calculated for 2009-2019, using incidence rate ratios to explore changes. We calculated annual self-reported psychological distress symptoms from cohort data, calculating ratios to explore changes over time.

FINDINGS

Between 2009 and 2019, recorded CMD increased by 9.90%, while average psychological distress symptoms rose by 19.33%. The sharpest increases for both recorded CMD and average psychological distress symptoms were observed in older adolescents (ages 16-19) and those born after 1995. Recorded CMD increased more in males (20.61%) than in females (7.65%), despite similar symptom increases. Recorded CMD increased the most in the least deprived areas (16.34%) compared with the most deprived areas (3.55%), despite comparable rises in psychological distress symptoms.

CONCLUSIONS

Both recorded CMD and psychological distress symptoms in young adults increased between 2009 and 2019, which may indicate that the rising primary care-recorded CMD reflects increased symptom burden.

IMPLICATIONS

Differences between recorded CMD and psychological distress symptoms across sociodemographic groups highlight potential misalignment in mental healthcare with underlying population need, indicating that the most affected groups may not be those receiving the most care.

School-Based Mental Health Education: Program Effectiveness and Trends in Help-Seeking

One of the strategies to address the persistent youth mental health crisis is school-based educational programming. This paper reports on two distinct studies regarding Coming Up for AIR, a school-based mental health education program: (1) program effectiveness, measured as gains in student mental health literacy; and (2) trends in help-seeking behavior before, during, and after the pandemic. A survey on program content was administered to assess program effectiveness. Data collected between 2020 and 2023 from four schools yielded 473 responses. A comparison of pre- and post-scores demonstrated statistically significant gains in program content. Mental health literacy improved across gender and grade level (8th, 9th, and 10th), as well as for students with prior exposure to a mental health curriculum. In the second study, help-seeking behavior was evaluated before, during, and after the pandemic. While other programs measure intention, Coming Up for AIR measures actual behavior as students can ask for help for themselves or a friend. Data did not reflect individual student responses, but rather were aggregated and provided the number of students per presentation who requested help. Archived declaration card data from January 2019 through February 2024 was accessed, representing 28 different schools and 16,289 middle and high school student responses. School-level data were analyzed by grade level (middle school or high school) and date (pre-, intra-, or post-COVID-19). Significant differences in self-referral were found for both grade level and presentation date. Self-referrals were significantly higher post-COVID-19 compared to pre-COVID-19 with middle schoolers increasing 90% and high school students increasing 36%. Analysis of friend referrals showed a significant difference for grade level, but not presentation date. Again, middle school students were more likely to make a referral than high schoolers. The data suggest that the mental health crisis in middle school students persists at an alarming rate. Schools are at the forefront of addressing mental health issues for youth. External educational programming can bring awareness to mental health concerns and promote help-seeking in youth.

Energetic activity for depression in young people aged 13-17 years: the READY feasibility RCT

Background

Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.

Objective

To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.

Design

Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.

Setting

Local community venues in Hertfordshire, Bedfordshire and Norfolk.

Participants

Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.

Interventions

Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.

Main outcome measures

Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.

Results

Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.

Limitations

Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.

Conclusions

A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.

Future work

Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10.

Economic inequalities in adolescents' internalising symptoms: longitudinal evidence from eight countries

BACKGROUND

Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances.

METHODS

In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences.

FINDINGS

The overall pooled sample of eight studies featured 18 910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures.

INTERPRETATION

Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities.

FUNDING

Wellcome Trust.

Discriminative validity and interpretability of the mood and feelings questionnaire

BACKGROUND

Using the Mood and Feelings Questionnaire (MFQ) to differentiate between depression severity levels remains unexplored. We explored the discriminative validity of the MFQ to identify an optimal cut-off MFQ score to distinguish between subthreshold-to-mild and moderate-to-severe depression severity levels.

METHODS

An observational cross-sectional design was used in a sample (N = 67) of help-seeking youth (ages 13 to 18, inclusive) experiencing depressive symptoms. The MFQ was administered verbatim to youth by a research analyst over the phone. Youth were then grouped into subthreshold-to-mild or moderate-to-severe depression severity categories based on scores received on the Kiddie Schedule for Affective Disorders and Schizophrenia-Depression Rating Scale. Receiver Operating Characteristic curve analyses were conducted, with area under the curve (AUC) and Youden Index (J) as primary indices. We hypothesized that the lower limit of the 95 % confidence interval for the area under the curve would be ≥0.70.

RESULTS

The primary analysis yielded an AUC of 0.85 (95 % CI: 0.763-0.947) and an optimal cut-off of ≥43 (J = 0.60, positive predictive value = 91.4 %, negative predictive value = 62.5 %, sensitivity = 72.7 %, specificity = 87.0 %).

LIMITATIONS

Our study collected a small sample, and as such cannot identify how subgroup classification (e.g., based on race or gender) may moderate outcomes. Further, unknown measurement error of the predictor and reference variable measures can bias the estimates.

CONCLUSIONS

Our preliminary findings highlight the potential for the MFQ to support clinical decision-making relevant to adolescents experiencing varying severities of depressive symptoms in secondary care settings.

Effectiveness of a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark: an observational study and a propensity score-matched comparison

Objective

This study investigated the effectiveness of a 7-weeks peer-to-peer program for young people aged 15 to 25 years with depression or anxiety symptoms in Denmark.

Methods

A total of 483 participants (72% women) participated in the program and the evaluation. The participants completed questionnaires at baseline, postintervention, and at 5-month follow-up to assess changes in depression symptoms (using Beck's Depression Inventory-II), anxiety symptoms (using Spielbergers State-Trait Anxiety Inventory for Adults) and self-efficacy in controlling or managing the illness (using the personal control subscale from the Illness Perception Questionnaire-Revised). Analyses were done using repeated measures mixed linear regression models. Moreover, a register-based matched comparison group was derived as a comparison to assess changes in being in education and employment at 8-month follow-up.

Results

Within the intervention group, both depression and anxiety scores declined across the 5-month follow-up compared to baseline (b = -9.6, 95% CI: -11.2, -8.1 for depression symptoms). The self-efficacy score increased from baseline to post-intervention (b = 1.4, 95% CI: 1.0, 1.8) and this level was maintained at follow-up. More than half of the participants were in education at baseline while 24% received social transfer payments. Compared with matched comparison group, a lower proportion of the intervention group remaining in education (71% vs. 80%). Among participants who were employed at baseline, a higher proportion of the intervention group were enrolled in education (27% vs. 19%) and were unemployed (14% vs. 4%) compared to the matched comparison group.

Conclusion

This study supports the effectiveness of a peer-to-peer intervention for depression and anxiety symptoms, and self-efficacy in symptom control. However, mixed effects on education and employment were observed, indicating a negative impact on education among those initially enrolled and a higher proportion of employed participants starting education.

Qualitative study investigating the health needs of school-aged children and adolescents in Dubai

BACKGROUND

Children's health has been linked with morbidities such as cardiovascular events, type 2 diabetes and obesity in adulthood. Further efforts are needed to understand the current and emerging challenges due to the potential changes in the social context among school-aged children and adolescents at schools.

OBJECTIVE

The study aims to investigate the health needs of school-aged children and adolescents in Dubai, United Arab Emirates (UAE).

DESIGN

9 semistructured focus groups and 1 in-depth interview among 10 entities and 5 schools were used to investigate current health needs for schools. The participants were selected using purposive sampling. Data were analysed using a content analysis approach.

SETTING

The focus groups and the in-depth interviews were conducted face to face in Dubai, UAE, from February to May 2023.

PARTICIPANTS

52 participants representing different specialties and roles in school health, such as senior employees, managers, teachers, healthcare professionals, principals, social workers/counsellors and parents, participated in this study. Most participants were females, 41 (78.8%) compared with 11 males (21.2%).

RESULTS

The study identified six health themes that address the health needs in schools. The themes highlighted the importance of creating new school health services, programmes, health education sessions, policies, data quality measures and innovative technologies. The participants deemed developing and improving health services, programmes, health education sessions, policies in nutrition, social and mental health, physical activity, and health promotion necessary in schools. Training school staff to manage and handle data was also essential to improve data quality. Using innovative technologies such as applications and electronic student files linked to electronic medical systems may further support school health professionals in schools.

CONCLUSION

The health needs assessment identified the gaps and challenges that must be addressed to improve students' health. Policy-makers could use the key results from the six themes to develop effective school health strategies.

"I'm always going to be tired": a qualitative exploration of adolescents' experiences of fatigue in depression

Adolescent depression is a prevalent and disabling condition, but current psychological treatments are only moderately effective. One way to enhance outcomes is to further our understanding of adolescent depression and improve our capacity to target the most frequently reported and problematic symptoms. A common but often neglected symptom of depression is fatigue, which is associated with considerable impairment and has the potential to interfere with adolescents' engagement in psychological therapies. Despite this, the experience of fatigue in adolescent depression and how we target it in treatment is currently poorly understood. Therefore, we aimed to explore adolescents' experiences and understandings of fatigue in depression, recruiting from clinical and community settings. Semi-structured interviews were conducted with 19 UK-based adolescents aged 14-18 years old with elevated symptoms of depression. Using reflexive thematic analysis, three themes were generated. Fatigue is a complex concept explored adolescents' understanding of fatigue as a dynamic, multifaceted symptom which had mental and physical components. Trapped in a cycle of fatigue considered the complex and reciprocal relationship between fatigue and other depressive symptoms, and the subsequent impact of limited energy on engagement with everyday activities. Finally, stigma as a barrier to help-seeking highlighted how adolescents were reluctant to seek help due to experienced stigma and the perception that fatigue was not a serious enough symptom. Findings from this study suggest that fatigue should be viewed as a psychological as well as somatic symptom of depression, with implications regarding the identification and treatment of fatigue in depression in routine clinical practice.

The patient journeys of children and adolescents with depression: a study of electronic health records

In England, children and adolescents with depression can seek treatment from specialist mental health services. We know little about how they journey through these services, or whether healthcare providers collect sufficient data to accurately appraise this. We aimed to summarise the child and adolescent depression pathway for two healthcare providers. This cohort study used de-identified electronic health records extracted from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and South London and Maudsley NHS Foundation Trust (SLaM). We identified referrals between 2015 and 2019 during which the referred patient received their first depression diagnosis aged < 18 years. We described patient demographic and clinical characteristics, and features of the referral. In total, n = 296 (CPFT) and n = 2502 (SLaM) patients had a referral which met eligibility criteria. In both sites, patients were more frequently female (CPFT 79.3%; SLaM 69.3%) and White ethnicity (CPFT 88.9%; SLaM 57.9%) as compared to respective population estimates for the Trusts' catchment areas. Patients typically received their first depression diagnosis during adolescence (median ages 16 in CPFT and 15 in SLaM). The most common comorbidity was anxiety disorder. Referrals were usually routine, to community teams specialising in the child age group. Commonly mentioned interventions included antidepressant medication, cognitive behavioural therapy, and dialectical behaviour therapy. However, pathways varied within and between sites, and the quality and consistency of some data was poor. These findings provide an overview of service pathways experienced by children and adolescents with depression, but also highlight that pathways can vary according to individual need and healthcare provider. More systematic collection of some data, and standardisation in record systems used by different providers, would be beneficial.

An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial

INTRODUCTION

Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings.

METHODS AND ANALYSIS

We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13-18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale-Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness.

ETHICS AND DISSEMINATION

Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.

Effectiveness of psychodynamic treatment: Comparing trajectories of internalizing and externalizing psychopathology of adolescents in treatment, healthy and physically ill adolescents

Effectiveness of psychodynamic therapy for adolescents in reducing internalizing and externalizing psychopathology was determined by comparing treated adolescents (86 sessions) with the normative developmental progression in two groups without treatment: healthy and diabetic adolescents. In a three-wave longitudinal study, n = 531 adolescents (n = 303 patients, n = 119 healthy, n = 109 diabetics) and their mothers filled out psychopathology questionnaires (Youth Self-Report and Child Behavior Checklist). Latent growth curve modeling and multilevel modeling were used to analyze and compare within-person symptoms changes across groups. Analyses showed a significant reduction over the course of treatment for internalizing (Cohen's d = .90-.92) and externalizing (d = .58-.72) symptoms, also when the developmental progression of both control groups was accounted for (d = .48-.76). Mothers reported lower levels than their children in internalizing symptoms (p ≤ .01) while this discrepancy increased over time for treated adolescents (p = .02). Results established the effectiveness of psychodynamic treatment for adolescents both with externalizing and internalizing symptoms in comparison with growth and change in nonclinical samples. Cross-informant differences and age-specific trajectories require attention in psychotherapy treatment and research.

Cross-Sectional and Descriptive Study on the Challenges and Awareness of Hispanic Parents Regarding Their Adolescents' Mental Health during the COVID-19 Pandemic

Research has shown that during the COVID-19 pandemic, approximately 20% of children and adolescents in the United States experienced mental health issues that became a significant social concern. However, recent studies have demonstrated that the majority of adolescents maintain positive emotions despite the crisis. This cross-sectional and descriptive study delves into the emotional states of adolescents during the pandemic, considering the viewpoints of both adolescents and their parents, with a specific focus on Hispanic adolescents. Survey results revealed that most adolescents reported positive and happy moods. However, a percentage of adolescents experienced worry, significant changes in feelings, and loneliness as a result of the physical and social isolation associated with virtual learning. Unfortunately, most surveyed Hispanic parents did not adequately recognize their adolescents' mood changes well. This lack of awareness, caused by factors such as an insufficient understanding about the importance of adolescent mental health, cultural reasons, language barriers, low education, unstable jobs, and more, could lead to missed opportunities for timely mental health interventions. This study seeks to provide a comprehensive discussion on the mental health of adolescents, while also advocating for the emotional wellbeing of Hispanic adolescents.

Parent-carer experiences using a peer support network: a qualitative study

INTRODUCTION

Parent-carers of children and young people (CYP) with mental health problems are at greater risk of poor outcomes, such as poor physical and mental health. Peer interventions for parent-carers of CYP with disabilities may improve parent-carer outcomes. This qualitative study investigates parent-carer experiences of using Parental Minds (PM), a multi-component peer support service for parent-carers of CYP with disabilities.

METHODS

Twelve current service-users and four staff/volunteers at PM participated in one-to-one semi-structured interviews. All participants were white females, except for one service-user who was male. All interviews were recorded and transcribed verbatim. Thematic analysis of results was used to explore perceived benefits and disadvantages of PM and possible behaviour change mechanisms.

RESULTS

Three themes and eight subthemes were identified. Participants identified that internal and external factors influence their self-concept. The identification of themselves as a priority, and empowerment by reassurance and affirmation lead to improved parent-carer self-efficacy and agency to better care for their CYP. Participants described the difficulty of speaking honestly with friends and family about what they experience because it is perceived as different to what "normal" parents experience. From participant accounts, PM enables the construction of a support network and links external services to help manage family circumstances rather than offer curative treatment/intervention. Proactive and immediate advice which is constantly and consistently available was valued by participants. Participants expressed the need for a flexible range of service components which provide holistic support that encompasses both health and social care.

CONCLUSIONS

PM was perceived to be beneficial as a multi-component peer support service which increases parenting self-efficacy and empowerment, reduces isolation, improves access to services, and is tailored to individual needs. Parent-carers reported benefits in parenting and wellbeing practices. The development of a refined logic model will inform a future study of the effectiveness of PM on parent-carer outcomes.

Depression stigma, depression literacy, and psychological help seeking attitudes among school and university students

Very little research has specifically investigated depression stigma and its correlation with depression literacy and help-seeking attitudes among students. This study aimed to assess the levels and correlations of stigma, literacy, and psychological help-seeking attitudes related to depression among a sample of high school and university students in Jordan. A descriptive, correlational, cross-sectional design was employed using an anonymous, online, self-report survey. This study included a total of 650 students aged 16 to 24 years. The participants were found to have high levels of depression stigma, low levels of depression literacy, and negative attitudes towards seeking psychological help. The most frequently reported sources of psychological help were family members, relatives, and friends. A significant negative correlation was found between depression stigma and depression literacy. The predictive factors of depression stigma were depression literacy, age, gender, education, father's educational level, family size, and having history of mental health problems among family members, relatives, or friends. This study provides valuable information on the common mental health needs and concerns among students in Jordan. The findings also highlight the importance of developing and implementing depression awareness and prevention education campaigns for students in schools and universities. Such campaigns may increase students' knowledge about depression, enhance their use of mental healthcare services, and prevent or decrease their risk of developing depression.

Associations between dimensions of mental health literacy and adolescent help-seeking intentions

BACKGROUND

The majority of long-term mental health problems begin during adolescence. Low mental health literacy (MHL) may impede help-seeking for these problems. Although MHL is a multidimensional construct and adolescent help-seeking can be through formal and informal means, little is known about how dimensions of MHL influence these help-seeking intentions. This study examines associations between dimensions of MHL and formal and informal help-seeking intentions among adolescents. It also investigates whether informal help-seeking mediates the association between dimensions of MHL and formal help-seeking, and whether these associations are moderated by gender.

METHODS

A cross-sectional survey including measures of MHL, and help-seeking intentions was distributed to participants in 10 schools (12-17 years) across Scotland (n = 734). Data were analysed using Confirmatory Factor Analyses (CFA) and Structural Equation Modelling (SEM).

RESULTS

Confirmatory Factor Analyses identified two distinct dimensions of MHL: ability to identify a mental health problem, and knowledge of treatment efficacy. Only knowledge of treatment efficacy was associated with increased intention to seek formal and informal help. Ability to identify a mental health problem was negatively associated with both forms of help-seeking intentions. Informal help-seeking mediated the association between both forms of MHL and formal help-seeking. Gender did not moderate the associations between MHL and help-seeking.

CONCLUSIONS

Care should be taken when providing MHL interventions to ensure that adaptive forms of MHL are promoted. Future research should investigate possible mechanisms by which discrete forms of MHL influence adolescent help-seeking as well as investigating other potential moderators of MHL and help-seeking, such as stigma.

The effects of an adapted mental health literacy curriculum for secondary school students in Germany on mental health knowledge and help-seeking efficacy: results of a quasi-experimental pre-post evaluation study

Background

Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention's effects on mental health knowledge and help-seeking efficacy among 10th grade students in Germany.

Methods

10th grade students (aged 14-17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention's effects.

Results

Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574, p < 0.001, partial η2 = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311, p < 0.001, partial η2 = 0.09).

Conclusion

The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.

Digital technologies to support adolescents with depression and anxiety: review

Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents' access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.

Evaluating a prototype digital mental health literacy intervention for children and young people aged 11-15 in Java, Indonesia: a mixed methods, multi-site case study evaluation

BACKGROUND

The Improving Mental Health Literacy Among Children and Young People in Indonesia (IMPeTUs) intervention is a co-produced, evidence-based digital intervention designed to improve anxiety and depression focused mental health literacy and self-management among people aged 11-15 in Java, Indonesia. This study aimed to evaluate the usability, feasibility and preliminary impact of our intervention.

METHODS

Mixed methods, multi-site case studies based on a theory of change. Pre-and post-assessments of a range of outcomes and qualitative interviews/focus groups with children and young people (CYP), parents and facilitators. The intervention was implemented in 8 health, school and community sites across Java, Indonesia (Megelang, Jakarta and Bogor). Quantitative data designed to understand the impact of and feasibility of evaluating the intervention collected from 78 CYP who used the intervention were analysed descriptively. Qualitative data from interviews and focus groups collected from 56 CYP, 49 parents/caregivers and 18 facilitators were analysed using framework analysis.

RESULTS

Qualitative data analysis indicated high levels of usability and acceptability for the interface aesthetic, personalisation, message presentation and navigation. Participants reported minimal burden and no negative outcomes associated with the intervention. CYP, parents and facilitators identified a range of direct and spill over effects of interventions engagement, some of which were not anticipated at study outset. Quantitative data highlighted the feasibility of intervention evaluation, with high levels of recruitment and retention across study time points. Minimal changes were identified in outcomes pre-to-post intervention, which may in part be due to a lack of scale relevance and/or sensitivity to the intervention mechanisms indicated in the qualitative data.

CONCLUSIONS

Digital mental health literacy applications are potentially an acceptable and feasible way to prevent burdens of common mental health problems amongst CYP in Indonesia. Our intervention and evaluative processes will be further refined prior to definitive evaluation.

Further development and feasibility randomised controlled trial of a digital programme for adolescent depression, MoodHwb: study protocol

INTRODUCTION

A digital programme, MoodHwb, was codesigned with young people experiencing or at high risk of depression, parents/carers and professionals, to provide support for young people with their mood and well-being. A preliminary evaluation study provided support for the programme theory and found that MoodHwb was acceptable to use. This study aims to refine the programme based on user feedback, and to assess the acceptability and feasibility of the updated version and study methods.

METHODS AND ANALYSIS

Initially, this study will refine MoodHwb with the involvement of young people, including in a pretrial acceptability phase. This will be followed by a multicentre feasibility randomised controlled trial comparing MoodHwb plus usual care with a digital information pack plus usual care. Up to 120 young people aged 13-19 years with symptoms of depression and their parents/carers will be recruited through schools, mental health services, youth services, charities and voluntary self-referral in Wales and Scotland. The primary outcomes are the feasibility and acceptability of the MoodHwb programme (including usage, design and content) and of trial methods (including recruitment and retention rates), assessed 2 months postrandomisation. Secondary outcomes include potential impact on domains including depression knowledge and stigma, help-seeking, well-being and depression and anxiety symptoms measured at 2 months postrandomisation.

ETHICS AND DISSEMINATION

The pretrial acceptability phase was approved by the Cardiff University School of Medicine Research Ethics Committee (REC) and the University of Glasgow College of Medicine, Veterinary and Life Sciences REC. The trial was approved by Wales NHS REC 3 (21/WA/0205), the Health Research Authority(HRA), Health and Care Research Wales (HCRW), university health board Research and Development (R&D) departments in Wales, and schools in Wales and Scotland. Findings will be disseminated in peer-reviewed open-access journals, at conferences and meetings, and online to academic, clinical, and educational audiences and the wider public.

TRIAL REGISTRATION NUMBER

ISRCTN12437531.

Changes in Depression and Anxiety Among Children and Adolescents From Before to During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

Importance

There is a growing body of high-quality cohort-based research that has examined changes in child and adolescent mental health during the COVID-19 pandemic vs before the pandemic. Some studies have found that child and adolescent depression and anxiety symptoms have increased, while others have found these symptoms to have remained stable or decreased.

Objective

To synthesize the available longitudinal cohort-based research evidence to estimate the direction and magnitude of changes in depression and anxiety symptoms in children and adolescents assessed before and during the pandemic.

Data Sources

Medline, Embase, and PsycInfo were searched for studies published between January 1, 2020, and May 17, 2022.

Study Selection

Included studies reported on depression and/or anxiety symptoms, had cohort data comparing prepandemic to pandemic estimates, included a sample of children and/or adolescents younger than 19 years, and were published in English in a peer-reviewed journal.

Data Extraction and Synthesis

In total, 53 longitudinal cohort studies from 12 countries with 87 study estimates representing 40 807 children and adolescents were included.

Main Outcomes and Measures

Standardized mean changes (SMC) in depression and anxiety symptoms from before to during the pandemic.

Results

The analysis included 40 807 children and adolescents represented in pre-COVID-19 studies and 33 682 represented in during-COVID-19 studies. There was good evidence of an increase in depression symptoms (SMC, 0.26; 95% CI, 0.19 to 0.33). Changes in depression symptoms were most conclusive for study estimates among female individuals (SMC, 0.32; 95% CI, 0.21 to 0.42), study estimates with mid to high income (SMC, 0.35; 95% CI, 0.07 to 0.63), and study estimates sourced from North America (SMC, 0.25; 95% CI, 0.15 to 0.36) and Europe (SMC, 0.35; 95% CI, 0.17 to 0.53). There was strong evidence that anxiety symptoms increased slightly during the pandemic (SMC, 0.10; 95% CI, 0.04 to 0.16), and there was some evidence of an increase in study estimates with mid to high income.

Conclusions

This systematic review and meta-analysis of longitudinal studies including children and adolescents found an increase in depression symptoms during the COVID-19 pandemic, particularly among female individuals and those from relatively higher-income backgrounds.

Adult criminal outcomes of juvenile justice involvement

BACKGROUND

The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes.

METHODS

Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9-16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement.

RESULTS

Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders.

CONCLUSIONS

Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study

INTRODUCTION

This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan.

METHODS

Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis.

RESULTS

A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support.

CONCLUSIONS

The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

Autonomy versus support: self-reliance and help-seeking for mental health problems in young people

PURPOSE

Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems.

METHODS

An online survey was completed by a representative Australian community sample of 5,203 young people aged 12-25 years (half female), in May-June 2020.

RESULTS

Path analysis showed the hypothesised conceptual model did not fit the data well, but a modified model was a good fit. Higher self-reliance was associated with lower intentions to seek informal and professional help, as expected, but not with greater intentions for self-help. The relationship between self-reliance and informal help-seeking intentions was fully mediated by perceived social support, whereas the relationship between self-reliance and professional help-seeking was also direct. Perceived social support fully mediated the relationship between self-reliance and resilience. Intentions to use self-help were not influenced by variables in the study, but higher self-help intentions were associated with higher professional help-seeking intentions. Associations were consistent across age and gender groups.

CONCLUSION

The results show the critical role of social support for combating some of the unhelpful aspects of self-reliance for mental health help-seeking in young people. Future research should explore how self-reliance can hinder or be harnessed to facilitate accessing appropriate mental health.

Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial

OBJECTIVE

Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT).

DESIGN

A single-blinded randomised controlled feasibility trial.

SETTING

A specialist outpatient clinic in Sweden.

PARTICIPANTS

Thirty-two adolescents with mild-to-moderate major depression, aged 13-17 years.

INTERVENTIONS

Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care.

OUTCOMES

Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children's Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up.

RESULTS

154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen's d=2.43 and 2.23, respectively), but not TAU (Cohen's d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes.

CONCLUSIONS

Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04117789).

Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study

BACKGROUND

Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy.

OBJECTIVE

The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions.

METHODS

This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016).

RESULTS

Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness.

CONCLUSIONS

The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account.

Do "Real World" Childhood Mental Health Services Reduce Risk for Adult Psychiatric Disorders?

OBJECTIVE

This study tested the "intervention as prevention" hypothesis: that treatment of childhood psychopathology in the community might reduce risk for adult psychopathology.

METHOD

Analyses were based on a prospective, population-based study of 1,420 children followed up to 8 times during childhood (ages 9-16 years; 6,674 observations) about psychiatric status and specialty mental health services use. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants) to assess adult psychopathology.

RESULTS

Participants with a childhood psychiatric disorder who used childhood specialty mental health services were at similar risk for adult emotional (odds ratio [OR] = 0.7; 95% CI = 0.3-1.4, p = .29) disorders and at higher risk for adult substance disorders (OR = 2.1; 95% CI = 1.1-4.2, p = .03) as compared those with a childhood disorder who did not use services. The risk for substance disorders was driven by children with behavioral disorders (OR = 3.6; 95% CI = 1.6-8.1, p = .002). Sensitivity analyses suggest that an unmeasured confounder would have to have an E value of 3.26 or risk ratio of 1.92 to alter this finding. Higher "dose" of services use (defined at 6+ visits) was not associated with improved outcomes.

CONCLUSION

Community services use may reduce psychopathology within childhood, but they do not necessarily prevent adult psychiatric problems. These findings are consistent with the notion of mental health problems as chronic conditions that often begin in childhood but that may recur in different forms across the lifespan even when treated.

Loneliness and depressive symptoms among Australian female boarding school students

Loneliness in adolescence is a risk factor for the development and maintenance of a myriad of mental health conditions, especially among females. Adolescent females in boarding schools spend prolonged periods away from family and may therefore be more prone to experiencing loneliness and depression. Research into this significant issue is limited, however. The present study compared the levels of loneliness and depressive symptoms of 403, 13–17 year old adolescent females from a range of boarding and non-boarding secondary schools. Confirmatory Factor Analyses established the fit of the loneliness and depressive symptom measures. Multivariate Analysis of Variance revealed boarding school students scored significantly higher than non- boarding school students on levels of depressive symptoms and having a positive attitude to being alone. These differences remained significant when age was covaried. There were no differences in quality of friendships, feelings of isolation, and having a negative attitude to being alone. The implications of these findings for boarding schools are discussed.

High School Educator Training by Simulation to Address Emotional and Behavioral Concerns in School Settings: A Randomized Study

The purpose of this study is to examine the impact of an online virtual human role-play simulation in teaching high school educators and staff to identify, talk to, and if necessary, refer students in psychological distress to support services. High school educators (N = 31,144) from 43 US states and 5 American territories completed a baseline survey and then randomly assigned to a wait-list control or treatment group. Participants in the treatment group completed the training simulation which included active learning strategies to teach evidenced-based communication strategies such as motivational interviewing to build skills and shift attitudes. Immediately after the training, treatment group participants completed a post-survey and then a 3-month follow-up survey. Baseline and post-surveys included the validated gatekeeper behavior scale measures which assess attitudinal constructs that predict helping behaviors. Self-reported helping behaviors were collected at baseline from both groups and at the 3-month follow-up for the treatment group. The treatment group participants' post and follow-up data were compared to the control group's baseline measures. The treatment group post-training scores were significantly higher (p < .001) than the control group's baseline scores for all gatekeeper behavior scale attitudinal constructs of preparedness, likelihood, and self-efficacy to engage in helping behaviors. A teacher subsample reported significant increases (p < .001) in the number of students referred to mental health support services when compared to baseline measures of the control group. Role-play simulations hold promise in teaching educators to become the "eyes and ears" of student mental health by empowering them to identify students in psychological distress, engage them in effective conversations about their concerns, and if necessary, make a referral to behavioral health support services. Future studies need to implement measures that document students entering counseling as a result of self-reported referrals and examine the impact of the training on the overall mental health culture within schools. Such studies could lead to simulations being widely adopted to support public health initiatives that address student mental health and wellness.

Explaining ethnic variations in adolescent mental health: a secondary analysis of the Millennium Cohort Study

PURPOSE

The relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study.

METHODS

Parental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixed n = 492, Indian n = 275, Pakistani n = 496, Bangladeshi n = 221, Black Caribbean n = 102, Black African n = 187, Other Ethnic Group n = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use). Results were stratified by sex as evidence of a sex/ethnicity interaction was found (P = 0.0002).

RESULTS

There were lower unadjusted odds for mental health problems in boys from Black African (OR 0.15, 95% CI 0.04-0.61) and Indian backgrounds (OR 0.42, 95% CI 0.21-0.86) compared to White peers. After adjustment for income, odds were lower in boys from Black African (OR 0.10, 95% CI 0.02-0.38), Indian (OR 0.40, 95% CI 0.21-0.77), and Pakistani (OR 0.49, 95% CI 0.27-0.89) backgrounds, and girls from Bangladeshi (OR 0.18, 95% CI 0.05-0.65) and Pakistani (OR 0.63, 95% CI 0.41-0.99) backgrounds. After further adjustment for social support, participation, and adversity factors, only boys from a Black African background had lower odds (OR 0.16, 95% CI 0.03-0.71) of mental health problems.

CONCLUSIONS

Household income confounded lower prevalence of mental health problems in some young people from Pakistani and Bangladeshi backgrounds; findings suggest ethnic differences are partly but not fully accounted for by income, social support, participation, and adversity. Addressing income inequalities and socially focused interventions may protect against mental health problems irrespective of ethnicity.

Explaining ethnic variations in adolescent mental health: a secondary analysis of the Millennium Cohort Study

PURPOSE

The relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study.

METHODS

Parental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixed n = 492, Indian n = 275, Pakistani n = 496, Bangladeshi n = 221, Black Caribbean n = 102, Black African n = 187, Other Ethnic Group n = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use). Results were stratified by sex as evidence of a sex/ethnicity interaction was found (P = 0.0002).

RESULTS

There were lower unadjusted odds for mental health problems in boys from Black African (OR 0.15, 95% CI 0.04-0.61) and Indian backgrounds (OR 0.42, 95% CI 0.21-0.86) compared to White peers. After adjustment for income, odds were lower in boys from Black African (OR 0.10, 95% CI 0.02-0.38), Indian (OR 0.40, 95% CI 0.21-0.77), and Pakistani (OR 0.49, 95% CI 0.27-0.89) backgrounds, and girls from Bangladeshi (OR 0.18, 95% CI 0.05-0.65) and Pakistani (OR 0.63, 95% CI 0.41-0.99) backgrounds. After further adjustment for social support, participation, and adversity factors, only boys from a Black African background had lower odds (OR 0.16, 95% CI 0.03-0.71) of mental health problems.

CONCLUSIONS

Household income confounded lower prevalence of mental health problems in some young people from Pakistani and Bangladeshi backgrounds; findings suggest ethnic differences are partly but not fully accounted for by income, social support, participation, and adversity. Addressing income inequalities and socially focused interventions may protect against mental health problems irrespective of ethnicity.

Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa

BACKGROUND

 Living with or managing an adolescent suffering from depression predisposes the adolescent and parents to various experiences, considering the multifactorial nature of depression and associated symptoms.

OBJECTIVE

 This study explored and described the experiences of adolescents and their parents on the mental health management of depression in the North West province (NWP), South Africa.

METHOD

 A qualitative, exploratory, descriptive, contextual research design was adopted. Data was collect from two mental health care institutions and two mental health care units attached to two general hospitals in the NWP, SA. Thirty-two participants (18 adolescents and 14 parents) were purposefully selected for the study. Data were collected through individual interviews and analysed using Tesch's open-coding method to generate themes and categories which were presented with the concurrent support of participants direct quotations.

RESULTS

 The study revealed that the experiences of adolescents with depression and their parents taking care of them at homes include the following: emotional distress, poor coping mechanisms, financial burden, repeated suicidal attempts, negative attitudes from support systems and withdrawal behaviours. Appropriate therapeutic environments, ongoing monitoring by mental healthcare practitioners and adequate support systems were suggested by participants as management approaches that could enhance the recovery of adolescents from depression.

CONCLUSION

 The findings revealed the devastating experiences of adolescents with depression and their parents taking care of them in their various homes which confirms the dire need for attention on the plights of these groups in order to facilitate adolescents' recovery and strengthen the adolescents' and parents' coping mechanisms for a healthier family.

Collecting genetic samples and linked mental health data from adolescents in schools: protocol coproduction and a mixed-methods pilot of feasibility and acceptability

OBJECTIVES

To coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research.

DESIGN

Protocol coproduction and mixed-methods feasibility pilot.

SETTING

Secondary schools in Wales, UK.

PARTICIPANTS

Students aged 11-13 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Coproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility.

RESULTS

Five secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents.

CONCLUSIONS

There are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.

Capturing adolescents in need of psychiatric care with psychopathological symptoms: A population-based cohort study

BACKGROUND

The current study aims to overcome past methodological limitations and capture adolescents in need of psychiatric care with psychopathological symptoms in a cohort with unrestricted access to mental health professionals.

METHODS

The study source population consisted of a random sample of adolescents aged 16-17 years (N=1,369) assessed by the Israeli Draft Board. An adapted version of the Brief Symptom Inventory was used to identify clinically relevant psychopathological symptoms with scores categorized as severe if they were in the top 10th percentile of symptoms, otherwise not severe. An independent interview with a subsequent referral to a mental health professional was used to categorize adolescents in need of psychiatric care. To examine the association between severe psychopathological symptoms and the need for psychiatric care, logistic regression models were fitted unadjusted and adjusted for age, sex, and intellectual assessment scores. Adjusted classification measures were estimated to examine the utility of severe psychopathological symptoms for clinical prediction of need for psychiatric care.

RESULTS

Information on 1,283 adolescents was available in the final analytic sample. Logistic regression modeling showed a statistically significant (p<0.001) association between self-reported severe psychopathological symptoms and the need for psychiatric care (OR adjusted: 4.38; 95% CI: 3.55-5.40). Severe psychopathological symptoms had a classification accuracy of 83% (CI: 81%-85%).

CONCLUSIONS

Severe psychopathological symptoms, although accounting for a fair proportion of treatment seeking, would perhaps be better useful for classification purposes alongside other variables rather than in isolation.

Estimating the impact of child and early adolescent depression on subsequent educational attainment: secondary analysis of an existing data linkage

AIMS

Depression is thought to be associated with lower subsequent educational attainment during school. But, without longitudinal studies which take account of prior attainment and other potential confounders, estimates of the impact of clinically recognised depression in childhood and early adolescence are unknown. We investigated whether a clinical diagnosis of depression is associated with lower subsequent educational attainment, and whether the association is modified by gender, ethnicity and socioeconomic status.

METHODS

We conducted a secondary analysis of an existing administrative data linkage between national educational data and a large mental healthcare provider in London, UK (2007-2013). Depression diagnosis before age 15 (exposure) was measured from electronic health records, and subsequent educational attainment at age 15-16 (outcome) was measured from educational records. We fitted logistic regression models and adjusted for gender, ethnicity, socioeconomic status, relative age in school year, neurodevelopmental disorder diagnosis and prior attainment. We investigated effect modifiers using interaction terms.

RESULTS

In total, n = 63 623 were included in analysis, of whom n = 242 had record of a depression diagnosis before age 15. Depression was associated with lower odds of subsequently achieving expected attainment levels in national exams, after adjustment for all covariates (odds ratio = 0.60, 95% confidence interval = 0.43 to 0.84, p = 0.003). There was no evidence that gender, ethnicity or socioeconomic status modified this association.

CONCLUSIONS

These findings support a relationship between depression and lower subsequent educational attainment. This highlights the need for tailored educational interventions to support children and adolescents with depression, particularly in the lead up to key educational milestones.

Out of time: adolescents and those who wait for them

This paper draws on the scholarship of an inter-disciplinary project about time and waiting in healthcare to explore questions of urgency and risk in clinical work with depressed and suicidal young people, and how the feeling of being compelled to act can be meaningfully explored from a psychoanalytic perspective. The paper examines adolescence as both a time of inherent crisis and one in which self-harm and suicidal ideation represent particular challenges. It then considers Child and Adolescent Mental Health Service practice in relation to acute mental health crisis, and in the context of the chronic crisis affecting the UK National Health Service. Considering both formal psychoanalytic psychotherapy and the contribution of psychoanalytic thinking to multidisciplinary discussions and emergency work in CAMHS, the author then considers the anticipatory anxieties that affect such work, and the particular role of psychoanalytic thinking for young people burdened by suicidal ideation and the professionals caring for them.

Experience of stigmatization in children receiving inpatient and outpatient mental health treatment: a longitudinal study

Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children's perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8-12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.

Distinct trajectories of depression symptoms in early and middle adolescence: Preliminary evidence from longitudinal network analysis

Adolescent depression is a clinically relevant concern that has major implications for mental and physical health. The trajectory of depressive symptoms among adolescents suggests that there is likely variability throughout this developmental period. The aim of the study was to assess the longitudinal relationship between individual symptoms of depression among early and middle adolescents to provide guidance for future research investigating targeted intervention efforts. Data were extracted from electronic medical records (2015-2017) from a pediatric primary care clinic in an urban setting. Cross-Lagged Panel Network analysis was used to evaluate symptoms of depression measured with the Patient Health Questionnaire (PHQ-9) measured twice over a 1-year period among early adolescents (ages 11-13 years; n = 309) and middle adolescents (ages 14-16 years; n = 255). The sample was predominantly Hispanic (90%) and 56% female. The analyses highlighted key differences and similarities between early and middle adolescence, largely focused on the role of suicidal ideation and tightly linked with feelings of failure and appetitive disturbance. In early adolescence suicidal ideation was highly likely to lead to other symptoms. In middle adolescence, however, suicidal ideation no longer had connections to other symptoms and instead the strongest connections were toward suicidal ideation. Interestingly, across both early and middle adolescence feelings of failure and appetitive disturbance were highly likely to lead to suicidal ideation. These exploratory findings highlight several longitudinal associations between early and middle adolescence that provide insight into differences and similarities regarding how symptoms might progress within those developmental periods. Taken together these results can provide direction for future research to evaluate brief, targeted interventions for adolescents.

Joint trajectories of life style indicators and their links to psychopathological outcomes in the adolescence

BACKGROUND

Rapid socio-economic development makes China a unique laboratory for examining how lifestyle changes affect adolescent mental health. This study aims to identify joint trajectories of modifiable lifestyle indicators during pubertal transition and its associations with psychopathological outcomes.

METHODS

A cohort of 1974 children aged 7-9 years were recruited in Anhui Province, China during March 2013. The assessment of lifestyle behaviors (screen time, physical activity, sleep duration and beverage intake) and depressive symptoms were conducted from Wave 1 to Wave 4 (2018). Suicide ideation, non-suicidal self-harm (NSSI) and alcohol use were self-reported at Wave 4. Longitudinal trajectories of lifestyle patterns were defined using group-based multi-trajectory models in 2019.

RESULTS

Four lifestyle trajectories were identified: persistent healthy (39.9%), suboptimal healthy (25.3%), unhealthy mitigation (17.2%), and persistent unhealthy (17.7%). Compared with persistent healthy group, the risk of subsequent suicide ideation [odds ratio (OR): 2.86, 95%CI: 2.15-3.81], depressive symptoms (OR: 2.16, 95%CI: 1.39-3.35), alcohol use (OR: 2.53, 95%CI: 1.78-3.61) and non-suicidal self-harm (OR: 1.35, 95%CI: 1.09-1.67) was significantly higher in persistent unhealthy group.

CONCLUSIONS

This study provided convincing evidence that unhealthy lifestyle trajectory during adolescence is associated with more than two-fold elevated odds for multiple domains of psychopathological outcomes over 5 years.

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England

BACKGROUND

Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations.

METHODS

A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised.

OUTCOMES

Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20).

INTERPRETATION

Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.

Delivering and implementing child and adolescent mental health training for mental health and allied professionals: a systematic review and qualitative meta-aggregation

BACKGROUND

The increasing prevalence of mental health difficulties among children and young people (CYP) suggests that early intervention is vital. A comprehensive system of care and support requires the involvement of mental health professionals, including psychologists and psychiatrists, and allied professionals, including teachers, police, and youth workers. A critical starting point is the provision of effective training, in order that these professionals can better support the mental health needs of the CYP that they encounter.

OBJECTIVES

Given the primacy of training in the CYP mental health support system, understanding the factors that maximise potential gains and facilitate uptake is pertinent. The current review therefore located and explored qualitative research evidence, to identify the barriers and facilitators underpinning successful delivery and implementation of training focussed on the mental health of CYP, for both mental health and allied professionals.

METHODS

A systematic review and qualitative meta-aggregation were conducted. Systematic searches were carried out using ASSIA, EMBASE, MEDLINE, NICE Evidence, PsycINFO, and Scopus databases, for papers published between 2000 and 2020. Twelve thousand four hundred forty-eight records were identified, of which 39 were eligible for review. The records were appraised for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and synthesised using the qualitative meta-aggregation method.

RESULTS

One hundred eighty-two raw findings were extracted from the 39 papers, which were condensed into 47 sub-categories, 19 categories, and finally 5 synthesis statements. These synthesis statements reflected the barriers and facilitators influencing the training delivery process ("support"; "content, design, and planning"), and the implementation of training into the workplace ("context"; "perceived value"; "organisational factors").

CONCLUSIONS

The synthesis statements and underlying categories provide practical recommendations for those designing, delivering, or implementing CYP mental health training. Recommendations ranged from facilitating peer support during training, to the idea that training will be better implemented when perceived need is high. The review provides a robust evidence-based foundation to "common-sense" principles, drawing them into a coherent and organised framework using a synthesis method grounded in pragmatism.

PROTOCOL REGISTRATION NUMBER

PROSPERO reference ID: CRD42020162876.

Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics

BACKGROUND

Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent's quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship.

OBJECTIVE

To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD.

METHOD

Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles.

RESULTS

At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher's exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X²[2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment.

CONCLUSION

ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study's small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013.

A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol

BACKGROUND

Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery.

METHODS

The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness.

DISCUSSION

UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression.

TRIAL REGISTRATION

ISRCTN, ISRCTN66452702 . Registered 9 April 2020.

Adolescent depression, early psychiatric comorbidities, and adulthood welfare burden: a 25-year longitudinal cohort study

PURPOSE

Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopathology on these associations.

METHODS

This is a longitudinal cohort study of 539 participants assessed at age 16-17 using structured diagnostic interviews. An ongoing 25-year follow-up linked the cohort (n = 321 depressed; n = 218 nondepressed) to nationwide population-based registries. Outcomes included consecutive annual data on social transfer payments due to unemployment, work disability, and public assistance, spanning from age 18 to 40. Parameter estimations used the generalized estimating equations approach.

RESULTS

Adolescent depression was associated with all forms of social transfer payments. The estimated overall payment per person and year was 938 USD (95% CI 551-1326) over and above the amount received by nondepressed controls. Persistent depressive disorder was associated with higher recipiency across all outcomes, whereas the pattern of findings was less clear for subthreshold and episodic major depression. Moreover, depressed adolescents presenting with comorbid anxiety and disruptive behavior disorders evidenced particularly high recipiency, exceeding the nondepressed controls with an estimated 1753 USD (95% CI 887-2620).

CONCLUSION

Adolescent depression is associated with considerable public expenditures across early-to-middle adulthood, especially for those exposed to chronic/persistent depression and psychiatric comorbidities. This finding suggests that the clinical heterogeneity of early-life depression needs to be considered from a longer-term societal perspective.

Psychosocial interventions for violence exposed youth - A systematic review

BACKGROUND

Violence exposure (direct, indirect, individual, structural) affects youth mental health.

OBJECTIVE

We aimed to evaluate the effectiveness of psychosocial interventions in addressing the sequelae of violence exposure on youth (15-24 years old) and evaluate whether moderating factors impact intervention effectiveness.

METHODS

We systematically searched eight databases and reference lists to retrieve any studies of psychosocial interventions addressing mental health among youth aged 15-25 exposed to violence. We assessed study risk of bias using an adapted version of the Downs and Black's Risk of Bias Scale.

RESULTS

We identified n = 3077 studies. Sixteen articles representing 14 studies met were included. The studies assessed direct and indirect individual violence exposure at least once. We pooled the data from the 14 studies and evaluated the effects. We estimated an average effect of r+ = 0.57 (RCTs: 95 % CI 0.02-1.13; observational studies: 95 % CI 0.27-86) with some heterogeneity (RCTs: I² = 78.03, longitudinal studies: I² = 82.93). The most effective interventions are Cognitive Behavioral Therapy, and Exposure Therapy with an exposure focus. However, due to the small number of studies we are uncertain about benefits of interventions.

CONCLUSIONS

No study assessed structural violence. Therefore, studies are needed to evaluate the effects of psychosocial interventions for youth exposed to direct, indirect, individual and structural violence.

Discrepancies in adolescent-mother dyads' reports of core depression symptoms: Association with adolescents' help-seeking in school and their somatic complaints

OBJECTIVE

Parents of adolescents with mental problems do not always recognize the symptoms in their children, particularly regarding depression, and therefore do not seek professional help. Adolescents themselves tend to seek help from school personnel for their emotional or social difficulties. In contrast, adolescents do report somatic complaints and parents are likely to seek help for these problems. The current study explored whether the divergence between maternal and child reports of depression symptoms is associated with child's help-seeking in school and patterns of somatic complaints.

METHOD

A sample of 9th grade students (N = 693; 56% girls; mean age = 15.1) and their mothers representing the Muslim and Druze populations in northern Israel were interviewed simultaneously and independently. Maternal reports were classified either as underestimating, matching, or overestimating their own child self-report of three core symptoms of depression (depressed mood, anhedonia, and irritability). Adolescents reported whether they had consulted school staff and were classified into clusters based on self-reported somatic complaints.

RESULTS

Maternal misidentification of their child's depression symptoms was associated with increased help-seeking in school, particularly by boys if depressed mood or irritability were misidentified and particularly by girls if anhedonia was misidentified. Hierarchical cluster analysis indicated that the number and severity of somatic complaints was higher among adolescents whose depression symptoms were not identified, regardless of gender.

CONCLUSION

Mental health professionals, educators and parents should be aware that adolescents may attempt to communicate their emotional difficulties through somatic complaints and by seeking help in school.