Mental health and well-being trends among children and young people in the UK, 1995-2014: analysis of repeated cross-sectional national health surveys

Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT

BACKGROUND AND OBJECTIVES

Transdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience.

METHODS

This follow-up study captured data from 162 of 316 initial students (aged 8-13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator.

RESULTS

At 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found.

LIMITATIONS

Although self-report measures are common in universal, school-based research, this represents a study limitation.

CONCLUSIONS

Both interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research.

Mental health among school children and adolescents in China: A comparison of one-child and multiple-children families from a nationwide survey

The influence of China's "one-child" policy on the mental health of children and adolescents is still unclear. This study examined the associations between number of children and children's mental health using data from the national school children and adolescents survey of China. Mental health was measured using the Achenbach's Child Behavior Checklist (CBCL). Linear regression models were used to explore the relationship between number of children per family and children's mental health. A total of 64,017 students were enrolled, with 68.60 % from one-child families. Compared with children from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales (all P<0.001). Analyses suggested children from multiple-child families have a higher risk of mental health problems (total problems on the CBCL: adjusted B=2.217, 95 %CI=1.883-2.550, P<0.001). Regular mental health assessments should be implemented and effective interventions should be developed for those in need.

Children and young people's reported contact with professional services for mental health concerns: a secondary data analysis

Children and young people's mental health services have been under increasing pressure following COVID-19. Understanding, for which channels help is sought from, will highlight services needing support. This study aims to explore the professional services that parents of children, and young people get help from when they have a concern for the child's/their mental health. Secondary analysis of data is taken from Mental Health of Children and Young People in England Survey, 2017. 7608 reports of mental health-related contact with professional services from parents of 5-16 year-olds and self-reports from young people aged 17-19 were available. Service contact was reported by Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis, age, gender and ethnicity. Less than two-thirds of children and young people with a DSM-V diagnosis (63.5% (95% CI 58.6-68.1) aged 5-10, and 64.0% (95% CI 59.4-68.4) aged 11-16) reported contact with any professional services. The figure was lower for those aged 17-19; 50.1% (95% CI 42.8-58.2), p = 0.005. Children and young people aged 5-16 from Black (11.7%; 95% CI 2.4-41.4), Asian (55.1%; 95% CI 34.7-73.9) and Mixed (46.0%; 95% CI 32.4-60.3) ethnic groups reported less contact with professional services compared to those from the White group (66.9%; 95% CI 63.5-70.2). Patterns of service access during the three main educational stages aid with understanding service need during childhood. These lower levels of reported service access for young people aged 17-19 with a DSM-V diagnosis and those in ethnic minority groups demand further investigation.

Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master's program

Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master's program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students' knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys

AIM

Research has indicated a rise in the prevalence of depression and anxiety among adolescents over the past three decades. However, the factors underpinning increases in mental health difficulties remain poorly understood. This study examines psychological, social and environmental risk and protective factors that may explain changes in depression and anxiety among adolescents.

METHODS

Data were taken from two nationally representative My World Surveys of adolescents aged 12-19 years in 2012 (N = 5,490) and 2019 (N = 9,844). Survey data on depression and anxiety and a range of potential risk (e.g., alcohol use, psychotic symptoms) and protective factors (e.g., resilience, self-esteem) were assessed at both time points. Multiple group analyses assessed whether the predictive ability of risk/protective factors changed from wave 1 to wave 2.

RESULTS

Results showed that the prevalence of depression and anxiety increased significantly between 2012 and 2019, particularly among females. Predictors accounted for between 37% and 61% of the variance in outcomes across waves. While some risk/protective factors were consistent predictors of depression and anxiety at both waves (e.g., bullying, discrimination, optimism), reporting female gender and having higher formal help-seeking tendencies more strongly predicted anxiety at wave 2, while lower self-esteem and lower resilience (personal competence) strongly predicted both depression and anxiety at wave 2.

CONCLUSION

Findings highlight the need to prioritize adolescent mental health service provision, especially in females. Self-esteem and resilience are potentially important targets for supporting adolescent mental health. Further research is required to understand the causal factors associated with increases in anxiety and depression.

Trends in adolescent emotional problems in Wales between 2013 and 2019: the contribution of peer relationships

BACKGROUND

Epidemiological evidence shows a substantial increase in adolescent emotional problems in many countries, but reasons for this increase remain poorly understood. We tested change in emotional problems in a national sample of young people in Wales in 2013, 2017 and 2019 using identical symptom screens, and examined whether trends were accounted for by changes in youth friendship quality and bullying.

METHODS

The present study of 230,735 11-16-year olds draws on repeat cross-sectional data obtained on three occasions (2013, 2017 and 2019) in national school-based surveys in Wales (conducted by the School Health Research Network). Emotional problems were assessed with a brief validated symptom screen (the SCL-4).

RESULTS

There was a significant increase in emotional problem scores between 2013 and 2019 (b[95% CI] = 1.573 [1.380, 1.765]). This increase was observed for all ages and was more pronounced for girls than boys (interaction b [95% CI] = 0.229 [0.004, 0.462]) and for young people from less affluent families (interaction b [95% CI] = -0.564[-0.809, -0.319]). Of the total sample, 14.2% and 5.7% reported frequent face-to-face and cyberbullying respectively. There were modest decreases in friendship quality and increases in rates of bullying between 2013 and 2019, but accounting for these changes did not attenuate estimates of the population-level increase in emotional problems.

CONCLUSIONS

This study provides evidence of a substantial increase in emotional problems among young people in Wales, particularly for young people from less affluent backgrounds. Changes in bullying or friendship quality did not explain this increase.

Characteristics of drug overdose suicide attempts presenting to the psychiatric emergency department of Beijing Anding Hospital

BACKGROUND

Overdose-related suicide attempts represent a significant portion of self-harm presentations in the psychiatric emergency department (ED). Identifying specific patient characteristics associated with these attempts holds promise for pinpointing drug classes with elevated risk and paving the way for tailored suicide prevention interventions. This study aims to examine the demographic profiles of ED patients who had experienced overdose-related suicide attempts.

METHODS

This retrospective study was conducted at Beijing Anding Hospital, Capital Medical University, from January 2020 to December 2021. Patients with psychiatric drug overdose suicide attempts presenting to the psychiatric ED were included. Sociodemographic characteristics and the specific classes of drugs involved were collected, and analysed descriptively.

RESULTS

This study examined 252 overdose patients, excluding 51 patients treated with alcohol or nonpsychiatric drugs, and a total 201 cases were included. The mean age of the patients was 28 ± 16 years (median 23, range 12-78), and 82% (n = 165) of the sample were females. Notably, nearly half (45%) of the patients were aged ≤ 20 years. While the number of cases decreased with increasing age, a significant increase was observed in 2021 compared to 2020. Benzodiazepines (BZDs) were the most frequently implicated substance class (n = 126, 63%), followed by antidepressants (n = 96, 48%), antipsychotics (n = 44, 22%), Z-drugs (n = 43, 21%), and mood stabilizers (n = 36, 18%). For adolescents, antidepressants (n = 52, 71%) overtook BZDs (n = 38, 52%) as the most common drug. The monthly distribution of cases revealed peaks in April and November. Furthermore, 21% (n = 42) of patients ingested more than two psychotropic medications concurrently. Finally, approximately half (n = 92) of the patients required inpatient admission for further treatment. Comparisons between hospitalized and nonhospitalized patients did not reveal any significant differences.

CONCLUSIONS

The present study revealed a greater prevalence of suicide overdose attempts among young females receiving prescriptions for antidepressants and/or BZDs. This finding suggests a potential need for enhanced monitoring of suicidal behaviour in this specific population when prescribing psychotropic medications. These findings contribute to the growing body of knowledge regarding drug overdose suicide attempts in psychiatric emergency settings and underscore the importance of further research to develop targeted prevention interventions.

Youth not engaged in education, employment, or training: a discrete choice experiment of service preferences in Canada

BACKGROUND

Prior research has showed the importance of providing integrated support services to prevent and reduce youth not in education, employment, or training (NEET) related challenges. There is limited evidence on NEET youth's perspectives and preferences for employment, education, and training services. The objective of this study was to identify employment, education and training service preferences of NEET youth. We acknowledge the deficit-based lens associated with the term NEET and use 'upcoming youth' to refer to this population group.

METHODS

Canadian youth (14-29 years) who reported Upcoming status or at-risk of Upcoming status were recruited to the study. We used a discrete choice experiment (DCE) survey, which included ten attributes with three levels each indicating service characteristics. Sawtooth software was used to design and administer the DCE. Participants also provided demographic information and completed the Global Appraisal of Individual Needs-Short Screener. We analyzed the data using hierarchical Bayesian methods to determine service attribute importance and latent class analyses to identify groups of participants with similar service preferences.

RESULTS

A total of n=503 youth participated in the study. 51% of participants were 24-29 years of age; 18.7% identified as having Upcoming status; 41.1% were from rural areas; and 36.0% of youth stated that they met basic needs with a little left. Participants strongly preferred services that promoted life skills, mentorship, basic income, and securing a work or educational placement. Three latent classes were identified and included: (i) job and educational services (38.9%), or services that include career counseling and securing a work or educational placement; (ii) mental health and wellness services (34.9%), or services that offer support for mental health and wellness in the workplace and free mental health and substance use services; and (iii) holistic skills building services (26.1%), or services that endorsed skills for school and job success, and life skills.

CONCLUSIONS

This study identified employment, education, and training service preferences among Upcoming youth. The findings indicate a need to create a service model that supports holistic skills building, mental health and wellness, and long-term school and job opportunities.

Looking at the Mental Health of Children and Adolescents with Cleft Lip and/or Palate through Neuroticism and Emotional Regulation Strategies: A Case-Controlled Observational Study

Background: Children and adolescents with cleft lip and/or palate (CL/P) are at an increased risk of developing emotional disorders. This study aims to explore this question in greater depth by addressing three objectives: (1) the presence of neuroticism as an indicator of emotional symptomatology, (2) the use of adaptive and non-adaptive emotional regulation strategies, and (3) the relationship between these strategies and neuroticism. Methods: A case-control correlational methodology was employed, with 60 children and adolescents with CL/P (mean age = 12.80 years; 33 females) and 60 non-clinical equivalent children and adolescents. Results: The CL/P group has higher scores on neuroticism (t = -7.74; p ≤ 0.001, d Cohen = 1.43) and lower scores in almost all emotional regulation strategies. The presence of CL/P moderated the relationship between neuroticism and self-blame (Beta = -0.46, t = -2.81, p = 0.005), rumination (Beta = -0.49, t = -3.73, p < 0.001), catastrophizing (Beta = -0.61, t = -4.26, p < 0.001), and blaming others (Beta = -0.45, t = -2.84, p = 0.005). This model predicted a significant variance of neuroticism (all p < 0.005), which ranged from 39% to 41%. Conclusions: The CL/P group has worse mental health indicators. Particularly novel results about the CL/P group are the lower scores on regulation strategies (both adaptive and non-adaptive) and the fact that non-adaptive strategies contribute, contrary to their effect in the general population, to a decrease in neuroticism. It supports the need to incorporate mental health indicators in the diagnosis and treatment of children and adolescents with CL/P.

Global, regional and national burdens of depression in adolescents and young adults aged 10-24 years, from 1990 to 2019: findings from the 2019 Global Burden of Disease study

BACKGROUND

Depression is a significant mental health concern affecting the overall well-being of adolescents and young adults. Recently, the prevalence of depression has increased among young people. Nonetheless, there is little research delving into the longitudinal epidemiology of adolescent depression over time.

AIMS

To investigate the longitudinal epidemiology of depression among adolescents and young adults aged 10-24 years.

METHOD

Our research focused on young people (aged 10-24 years) with depression, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We explored the age-standardised prevalence, incidence and disability-adjusted life-years (DALYs) of depression in different groups, including various regions, ages, genders and sociodemographic indices, from 1990 to 2019.

RESULTS

The prevalence, incidence and DALYs of depression in young people increased globally between 1990 and 2019. Regionally, higher-income regions like High-Income North America and Australasia recorded rising age-standardised prevalence and incidence rates, whereas low- or middle-income regions mostly saw reductions. Nationally, countries such as Greenland, the USA and Palestine reported the highest age-standardised prevalence and incidence rates in 2019, whereas Qatar witnessed the largest growth over time. The burden disproportionately affected females across age groups and world regions. The most prominent age effect on incidence and prevalence rates was in those aged 20-24 years. The depression burden showed an unfavourable trend in younger cohorts born after 1980, with females reporting a higher cohort risk than males.

CONCLUSIONS

Between 1990 and 2019, the general pattern of depression among adolescents varied according to age, gender, time period and generational cohort, across regions and nations.

Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study

BACKGROUND

Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area.

OBJECTIVE

We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health.

METHODS

We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis.

RESULTS

A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable.

CONCLUSIONS

The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.

Vegetarianism and mental health: Evidence from the 1970 British Cohort Study

BACKGROUND

Reducing animal product consumption has benefits for population health and the environment. The relationship between vegetarianism and mental health, however, remains poorly understood. This study explores this relationship in a nationally representative cohort in Great Britain.

METHODS

We use data from the 1970 British Cohort Study, which collected information on vegetarianism at age 30 in 2000 (n = 11,204) and psychological distress (PD) at ages 26, 30, 34, 42, and 46-48 in 2016/18. We first developed a statistical adjustment strategy by regressing PD at age 30 on vegetarianism and 14 confounders measured at ages 10 and 26. We then ran multilevel growth curve models, testing whether within-person changes in PD between ages 30 and 46-48 differed by vegetarianism, before and after statistical adjustment.

RESULTS

At age 30, 4.5 % of participants reported being vegetarian. In the cross-sectional models at age 30, vegetarians reported more distress compared with non-vegetarians in bivariate analysis (b = 0.30, 95%CI 0.09, 0.52), but this difference disappeared in the fully-adjusted model (b = 0.02, 95%CI -0.17, 0.21). In the longitudinal models between ages 30 and 46/48, there were no differences in within-person changes in psychological distress between vegetarians and non-vegetarians (p = .723). Sensitivity analyses using red meat consumption yielded similar findings.

CONCLUSION

In this British cohort, vegetarianism at age 30 was not associated with changes in psychological distress during mid-adulthood. Since psychological distress in early adulthood predicted vegetarianism at age 30, more studies are needed to disentangle the progression of this relationship over the life-course.

Secular trends in mental health problems among young people in Norway: a review and meta-analysis

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks

BACKGROUND

For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents.

METHODS

This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation.

RESULTS

After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention.

CONCLUSION

Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.

Trends in comorbid physical and mental health conditions in children from 1999 to 2017 in England

INTRODUCTION

Children with long-term physical health conditions (pLTCs) are at increased risk of mental health conditions but less is known about time trends in the mental health of this group of children.

METHODS

We used data from three comparable, population-based surveys of children conducted in 1999, 2004, and 2017. We examined whether the proportion of children aged 5-15 years old with comorbid mental health conditions (measured using the multi-informant Development and Well-being Assessment tool) and pLTCs (measured using parental report) in England increased from 1999 to 2017 using linear regression analysis.

RESULTS

Our analysis used data from 8662 (1999), 6401 (2004) and 6219 (2017) children, respectively. The proportion of children with comorbid pLTCs and psychiatric disorders was 0.050 (95% CI = 0.045, 0.055) in 1999, 0.054 (95% CI = 0.049, 0.060) in 2004, and 0.059 (95% CI = 0.053, 0.065) in 2017. The linear regression model revealed a non-significant effect of time on the proportion of children with comorbid pLTCs and psychiatric disorders from 1999 to 2017 (B = 0.0004785; SE = 0.0001256; p = 0.163).

CONCLUSION

The estimated prevalence of school-aged children with comorbid pLTCs and mental health conditions in England remained stable since 1999, highlighting the need to prioritize mental health resources for children with physical health comorbidities.

Current evidence and opportunities in child and adolescent public mental health: a research review

BACKGROUND

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.

METHODS

This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.

RESULTS

In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements.

CONCLUSIONS

There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

Use of social media in recruiting young people to mental health research: a scoping review

OBJECTIVES

This review explored the literature on the use of social media in recruiting young people, aged 13-18 years, to mental health research. It aimed to identify barriers and facilitators to recruitment and strategies to improve participation in future research.

DESIGN

Scoping review.

DATA SOURCES

Articles published between January 2011 and February 2023 were searched for on PubMed, Scopus, Medline (via EBSCOhost) and Cochrane Library databases.

ELIGIBILITY CRITERIA

Studies that outlined social media as a recruitment method and recruited participants aged 13-18 years.

DATA EXTRACTION AND SYNTHESIS

Data was extracted by two reviewers independently and cross-checked by a third reviewer. Data on study design, aims, participants, recruitment methods and findings related specifically to social media as a recruitment tool were collected.

RESULTS

24 journal articles met the inclusion criteria. Studies were predominantly surveys (n=13) conducted in the USA (n=16) recruiting via Facebook (n=16) and/or Instagram (n=14). Only nine of the included articles provided a summary of success and reviewed the efficacy of social media recruitment for young people in mental health research. Type of advertisement, the language used, time of day and the use of keywords were all found to be factors that may influence the success of recruitment through social media; however, as these are based on findings from a small number of studies, such potential influences require further investigation.

CONCLUSION

Social media recruitment can be a successful method for recruiting young people to mental health research. Further research is needed into recruiting socioeconomically marginalised groups using this method, as well as the effectiveness of new social media platforms.

REGISTRATION

Open Science Framework Registry (https://osf.io/mak75/).

Quantifying the mental health and economic impacts of prospective Universal Basic Income schemes among young people in the UK: a microsimulation modelling study

OBJECTIVE

Universal Basic Income (UBI)-a largely unconditional, regular payment to all adults to support basic needs-has been proposed as a policy to increase the size and security of household incomes and promote mental health. We aimed to quantify its long-term impact on mental health among young people in England.

METHODS

We produced a discrete-time dynamic stochastic microsimulation that models a close-to-reality open cohort of synthetic individuals (2010-2030) based on data from Office for National Statistics and Understanding Society. Three UBI scheme scenarios were simulated: Scheme 1-Starter (per week): £41 per child; £63 per adult over 18 and under 65; £190 per adult aged 65+; Scheme 2-Intermediate (per week): £63 per child; £145 per adult under 65; £190 per adult aged 65+; Scheme 3-Minimum Income Standard level (per week): £95 per child; £230 per adult under 65; £230 per adult aged 65+. We reported cases of anxiety and depression prevented or postponed and cost savings. Estimates are rounded to the second significant digit.

RESULTS

Scheme 1 could prevent or postpone 200 000 (95% uncertainty interval: 180 000 to 210 000) cases of anxiety and depression from 2010 to 2030. This would increase to 420 000(400 000 to 440 000) for Scheme 2 and 550 000(520 000 to 570 000) for Scheme 3. Assuming that 50% of the cases are diagnosed and treated, Scheme 1 could save £330 million (£280 million to £390 million) to National Health Service (NHS) and personal social services (PSS), over the same period, with Scheme 2 (£710 million (£640 million to £790 million)) or Scheme 3 (£930 million (£850 million to £1000 million)) producing more considerable savings. Overall, total cost savings (including NHS, PSS and patients' related costs) would range from £1.5 billion (£1.2 billion to £1.8 billion) for Scheme 1 to £4.2 billion (£3.7 billion to £4.6 billion) for Scheme 3.

CONCLUSION

Our modelling suggests that UBI could substantially benefit young people's mental health, producing substantial health-related cost savings.

Adolescent help-seeking: an exploration of associations with perceived cause of emotional distress

Background

Help-seeking is intrinsic to efforts to manage the onset, maintenance, or escalation of mental health difficulties during adolescence. However, our understanding of adolescent help-seeking remains somewhat nebulous. A greater comprehension of help-seeking behavior from the perspective of adolescents is needed. It is also prudent to explore help-seeking behavior in the context of perceived cause for emotional distress, particularly as causal beliefs have been found to influence help-seeking behavior in adults.

Objectives

The present study sought to categorize adolescents' experiences of help-seeking, and to examine the extent to which these categories (or "types") of help-seeking behavior are associated with their perceptions of causal factors for emotional distress.

Methods

The data for this study were drawn from interviews conducted as part of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11-12 years. Ideal-type analysis, a qualitative form of person-centered analysis, was used to construct a typology of adolescent help-seeking. Participants' help-seeking "type" was then compared with their perceived cause for emotional distress "type."

Findings

We developed four distinct categories of help-seeking: (1) guided by others who have taken notice; (2) skeptical with unmet needs; (3) motivated and solution focused; and (4) preference for self-regulation. Simultaneously, we identified principal associations between perceived cause of emotional distress-(1) perceived lack of control; (2) unfair treatment; (3) others: their actions and judgements as the catalyst; (4) concern for self and others; and (5) self as cause-and help-seeking approaches. "Perceived lack of control" was most likely to be associated with "others who have taken notice"; "Unfair treatment" with "skeptical with unmet needs"; "others: their actions and judgements as the catalyst" with "motivated and solution focused"; "concern for self and others' with 'guided by others who have taken notice"; finally, "self as cause" was most likely to be associated with "preference for self-regulation."

Conclusions

This study demonstrates meaningful and distinct categories of adolescent help-seeking and offers empirical evidence to support the assertion that perceived cause for emotional distress may influence the help-seeking approaches of adolescents.

The impact of the COVID-19 pandemic on adolescent mental health across the world

The global impact of the COVID-19 pandemic on adolescents has been substantial. The current review aimed to summarize the existing literature on the impact of the pandemic on mental health during adolescence, with a specific focus on longitudinal studies. The findings from these studies indicated that many adolescents experienced increased mental health problems, especially those who were already vulnerable prior to the pandemic. Several preexisting factors, such as socioeconomic background and gender, and pandemic-related factors, such as perceived stress and restrictive measures, were identified that contribute to interindividual differences in how adolescents were affected by the pandemic. However, it is crucial to interpret these changes in the context of the ongoing trend of increasing mental health problems among youth over the past decades.

Electronic health records identify timely trends in childhood mental health conditions

BACKGROUND

Electronic health records (EHRs) data provide an opportunity to collect patient information rapidly, efficiently and at scale. National collaborative research networks, such as PEDSnet, aggregate EHRs data across institutions, enabling rapid identification of pediatric disease cohorts and generating new knowledge for medical conditions. To date, aggregation of EHR data has had limited applications in advancing our understanding of mental health (MH) conditions, in part due to the limited research in clinical informatics, necessary for the translation of EHR data to child mental health research.

METHODS

In this cohort study, a comprehensive EHR-based typology was developed by an interdisciplinary team, with expertise in informatics and child and adolescent psychiatry, to query aggregated, standardized EHR data for the full spectrum of MH conditions (disorders/symptoms and exposure to adverse childhood experiences (ACEs), across 13 years (2010-2023), from 9 PEDSnet centers. Patients with and without MH disorders/symptoms (without ACEs), were compared by age, gender, race/ethnicity, insurance, and chronic physical conditions. Patients with ACEs alone were compared with those that also had MH disorders/symptoms. Prevalence estimates for patients with 1+ disorder/symptoms and for specific disorders/symptoms and exposure to ACEs were calculated, as well as risk for developing MH disorder/symptoms.

RESULTS

The EHR study data set included 7,852,081 patients < 21 years of age, of which 52.1% were male. Of this group, 1,552,726 (19.8%), without exposure to ACEs, had a lifetime MH disorders/symptoms, 56.5% being male. Annual prevalence estimates of MH disorders/symptoms (without exposure to ACEs) rose from 10.6% to 2010 to 15.1% in 2023, a 44% relative increase, peaking to 15.4% in 2019, prior to the Covid-19 pandemic. MH categories with the largest increases between 2010 and 2023 were exposure to ACEs (1.7, 95% CI 1.6-1.8), anxiety disorders (2.8, 95% CI 2.8-2.9), eating/feeding disorders (2.1, 95% CI 2.1-2.2), gender dysphoria/sexual dysfunction (43.6, 95% CI 35.8-53.0), and intentional self-harm/suicidality (3.3, 95% CI 3.2-3.5). White youths had the highest rates in most categories, except for disruptive behavior disorders, elimination disorders, psychotic disorders, and standalone symptoms which Black youths had higher rates. Median age of detection was 8.1 years (IQR 3.5-13.5) with all standalone symptoms recorded earlier than the corresponding MH disorder categories.

CONCLUSIONS

These results support EHRs' capability in capturing the full spectrum of MH disorders/symptoms and exposure to ACEs, identifying the proportion of patients and groups at risk, and detecting trends throughout a 13-year period that included the Covid-19 pandemic. Standardized EHR data, which capture MH conditions is critical for health systems to examine past and current trends for future surveillance. Our publicly available EHR-mental health typology codes can be used in other studies to further advance research in this area.

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

BACKGROUND

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

AIMS

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

MATERIALS AND METHODS

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

RESULTS

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

DISCUSSION AND CONCLUSION

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

Does social capital aid in leveling the income gradient in child mental health? A structural analysis of the left-behind and not-left-behind Chinese children

BACKGROUND

Few prior studies have investigated the income gradient in child mental health from a socio-environmental perspective. In an age when child mental health problems in a rapidly changing social environment have become a worldwide issue, an understanding of the socio-environmental mechanisms of the income disparities in child mental health outcomes is imperative and cost-effective.

METHODS

By conducting structural equation analyses with Chinese nationally representative survey data, this study explored the family income gradient in child depression and its potential socio-environmental pathways at the neighborhood, family and school levels, differentiating left-behind and not-left-behind children.

RESULTS

We found a robust family income gradient in depressive symptoms. Neighborhood cohesion mitigated the income gradient in depressive symptoms by playing a suppression role. School social capital acted as a mediator. Neighborhood trust, neighborhood safety and family social capital played no significant impact. The mitigating and mediating roles of social capital components were significant among only the not-left-behind children.

CONCLUSIONS

To reduce income-related inequalities in child mental health in the long run, integrating policies that directly reduce poverty with policies that improve distal socio-environments is necessary.

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys

BACKGROUND

Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends.

METHODS

We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010.

RESULTS

Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall.

CONCLUSION

Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Analysis of Protective Factors in Schoolchildren in England Using the Dual-factor Model of Mental Health

The dual-factor approach to mental health was employed to explore levels and interrelations of protective factors associated with resilience in a dataset of 30,841 schoolchildren aged 11-14 in England. ANOVA was used to contrast levels of protective factors between groups (combinations of higher/lower psychopathology and higher/lower wellbeing) and network analysis to explore protective factor interrelations. Levels of protective factors tended to be highest for those who had higher wellbeing and lower psychopathology (termed 'complete mental health'). Those with lower levels of protective factors were split between two subpopulations: having lower wellbeing and higher psychopathology (termed 'troubled'), and having lower wellbeing and lower psychopathology (termed 'vulnerable'). Analysis of the protective factor networks revealed that the four subpopulations of the model were distinguished by both their overall structure and individual node connectivity (the 'complete mental health' subpopulation demonstrated the greatest connectivity), though two were similar: those with higher wellbeing and higher psychopathology (termed 'symptomatic but content') and lower wellbeing and higher psychopathology ('troubled'). The results indicate that while 'vulnerable' and 'symptomatic but content' may be hard to discriminate conceptually, the former may reflect a lower capacity to cope during periods of adversity (i.e., show resilience). Overall, the results encourage a holistic approach to mental health screening, particularly as children with lower wellbeing had lower levels of the protective factors, regardless of their level of psychopathology. Moreover, interventions to improve protective factors associated with positive development in stressed environments may therefore have a greater impact on improving wellbeing than decreasing symptoms of psychopathology.

Socioeconomic and sex inequalities in parent-reported adolescent mental ill-health: time trends in four British birth cohorts

BACKGROUND

Studies using symptom-based screeners have suggested that mental ill-health has increased in adolescents in recent decades, however, few studies have tested the equivalence of their instruments, which is critical for inferring changes in prevalence. In addition, little research has explored whether socioeconomic position (SEP) and sex inequalities in adolescent mental health have changed over time.

METHODS

Using structural equation modelling, we explored SEP and sex differences in harmonised parent reports of emotional and behavioural problems, using data from four UK birth cohorts: the 1958 National Child Development Study (NCDS'58; n = 10,868), the 1970 British Cohort Study (BCS'70; n = 8,242), the 1991-92 Avon Longitudinal Study of Parents and Children (ALSPAC'91; n = 5,389), and the 2000-01 Millennium Cohort Study (MCS'01; n = 9,338).

RESULTS

Compared with the two earliest cohorts, members of MCS'01 had higher latent mean scores on emotional problems (both sexes), and lower scores on behavioural problems (females only). The associations between four indicators of SEP and emotional problems were strongest in MCS'01, with housing tenure having the strongest association. All four SEP indicators were associated with behavioural problems in each cohort, with housing tenure again more strongly associated with problems in the MCS'01. Mediation analyses suggested that the increase in emotional problems occurred despite broadly improving socioeconomic conditions.

CONCLUSIONS

Our findings suggest that parent reports of adolescent emotional problems, but not behavioural problems, have risen in recent generations and this trend is not solely due to reporting styles. A failure to address widening social inequalities may result in further increases in mental ill-health amongst disadvantaged young people.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Mental health inequalities during the second COVID-19 wave among Millennials who grew up in England: Evidence from the Next Steps cohort study

BACKGROUND

There is relatively little evidence on socioeconomic inequalities in mental health among young adults after the end of the first COVID-19 wave in the UK, despite this group having faced the worse mental health and economic shocks across age groups at the start of the pandemic.

METHODS

We examined differences in mental health across two points - September 2020 and February 2021 - in a cohort of 4167 Millennials aged 30-31 using life dissatisfaction, psychological distress (GHQ-12), anxiety (GAD-2), and depressive symptoms (PHQ-2). We report adjusted prevalence ratios (aPR) from random-intercept models, testing differences by educational attainment and time-varying conditions (relationship status, living arrangements with adults and children, work status, and financial changes compared with before the outbreak), adjusting for baseline covariates at ages 13-14 and health covariates at ages 25-26.

RESULTS

Only dissatisfaction with life changed between time points (PR = 1.26, 95%CI 1.02-1.55). Educational attainment was not significantly associated with mental health. Being single (aPRs from 1.36 to 1.89) and being financially worse off since the start of the pandemic (aPRs from 1.58 to 1.76) were each associated with worse mental health. These associations did not further vary by educational attainment.

CONCLUSION

Among Millennials who grew up in England, educational attainment was not associated with mental health whereas negative social and financial conditions were associated with worse mental health during the second COVID-19 wave. Mental health inequalities in this generation are likely to have continued increasing after the end of the first COVID-19 wave.

Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: A time trend analysis

OBJECTIVE

We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan.

METHODS

Suicide data (1971-2019) for 10-24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e. the age of most 15-24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression.

RESULTS

Suicide rates in Taiwan's 10-24 year olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40-59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates.

CONCLUSION

Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.

Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19

BACKGROUND

Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend.

METHODS

Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression.

RESULTS

Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support.

LIMITATIONS

The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes.

CONCLUSIONS

Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.

Prevalence of mental health disorders in children and adolescents in the Republic of Ireland: a systematic review

Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services.

AIM

To establish prevalence of MH disorders among youth (under 18) in Ireland.

METHOD

A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Empirical studies conducted in Ireland, in youth and focusing on MH disorders were included.

RESULTS

From a total of 830 papers identified, 38 papers met inclusion criteria. Significant variation in rates of MH disorders was evident based on study methodology. Screening questionnaires for general psychopathology reported rates of 4.8-17.8% scoring above clinical cut-offs, with higher rates for ADHD (7.3%). Studies examining depression ranged from 4% to 20.8%, while rates for 'current' MH disorder, determined by semi-structured interview, were 15.5%, while 'lifetime' rates varied from 19.9% to 31.2%. Fewer than half (44%) of those identified as 'in need' of specialist MH services were accessing CAMHS.

CONCLUSION

Data on MH disorders among Irish youth is limited, and studies showed significant variance in rates, making service planning difficult. There is an urgent need for serial epidemiological surveys, with clear operational criteria for clinically impairing MH difficulties. Such studies are essential to understand potential demand and service planning. This is most urgent given the expected increased demand post Covid-19.

Gene-environment correlations and genetic confounding underlying the association between media use and mental health

The increase in online media use and mental health problems have prompted investigations into their association, although most literature is focussed on deleterious effects. We assessed the aetiology of media use and mental health associations (M age = 22.14, SD = 0.85) using twin (n = 4000 pairs) and polygenic score methods (n = 6000 unrelated individuals) in the Twins Early Development Study. Beyond the traditionally explored negative uses of online media (online victimisation and problematic internet use), we investigate general media uses such as posting online and watching videos and distinguish both positive (pro-social behaviour) and negative (anxiety, depression, peer and behaviour problems) mental health measures. Negative media use correlated with poor mental health (r = 0.11-0.32), but general media use correlated with prosocial behaviour (r = 0.20) and fewer behavioural problems (r =  - 0.24). Twin analyses showed that both general and negative media use were moderately heritable (ranging from 20 to 49%) and their associations with mental health were primarily due to genetic influences (44-88%). Genetic sensitivity analysis combining polygenic scores with heritability estimates also suggest genetic confounding. Results indicate research on the mental health impact of media use should adopt genetically informed designs to strengthen causal inference.

Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

Instagram Use and Mental Well-Being: The Mediating Role of Social Comparison

Instagram has grown in popularity among young adults and adolescents and is currently the second-favorite social network in the world. Research on its relationship to mental well-being is still relatively small and has yielded contradictory results. This study explores the relationship between time spent on Instagram and depressive symptoms, self-esteem, and disordered eating attitudes in a nonclinical sample of female Instagram users aged 18-35 years. In addition, it explores the mediating role of social comparison. A total of 1172 subjects completed a one-time-only online survey. Three different mediation analyses were performed to test the hypotheses that social comparison on Instagram mediates the association time spent on Instagram with depressive symptoms (model 1), self-esteem (model 2), and disordered eating attitudes (model 3). All three models showed that the relationship between intensity of Instagram use and the respective mental health indicator is completely mediated by the tendency for social comparison on Instagram.

Digital access constraints predict worse mental health among adolescents during COVID-19

The COVID-19 pandemic and ensuing social restrictions disrupted young people's social interactions and resulted in several periods during which school closures necessitated online learning. We hypothesised that digitally excluded young people would demonstrate greater deterioration in their mental health than their digitally connected peers during this time. We analysed representative mental health data from a sample of UK 10-15-year-olds (N = 1387) who completed a mental health inventory in 2017-2019 and thrice during the pandemic (July 2020, November 2020 and March 2021). We employed longitudinal modelling to describe trajectories of adolescent mental health for participants with and without access to a computer or a good internet connection for schoolwork. Adolescent mental health symptoms rose early in the COVID-19 pandemic, with the highest mean Total Difficulties score around December 2020. The worsening and subsequent recovery of mental health during the pandemic was greatly pronounced among those without access to a computer, although we did not find evidence for a similar effect among those without a good internet connection. We conclude that lack of access to a computer is a tractable risk factor that likely compounds other adversities facing children and young people during periods of social isolation or educational disruption.

A Meta-Analysis on the Impact of Prenatal and Early Childhood Antimicrobial Use on Autism Spectrum Disorders

OBJECTIVE

To investigate the impact of prenatal and early childhood antimicrobial use on autism spectrum disorders (ASD).

DATA SOURCES

We searched PubMed and Embase databases for relevant studies from inception to August 2022.

STUDY SELECTION AND DATA EXTRACTION

Peer-reviewed, observational studies were all acceptable. Raw data were extracted into a predefined worksheet and quality analysis was performed using the Newcastle-Ottawa Scale.

DATA SYNTHESIS

Nineteen studies were identified in the meta-analysis. Prenatal antimicrobial exposure was not associated with ASD (P = 0.06 > 0.05), whereas early childhood antimicrobial exposure was associated with an increased odds ratio of ASD (OR = 1.17, 95% CI = [1.08-1.27], P value < 0.001). The sibling-matched analysis, with a very limited sample size, suggested that neither prenatal (P = 0.47 > 0.05) nor early childhood (P = 0.13 > 0.05) antimicrobial exposure was associated with ASD. Medical professionals may need to take the possible association into consideration when prescribing an antimicrobial in children.

CONCLUSIONS

Early childhood antimicrobial exposure could increase the incidence of ASD. In future studies, it would be necessary to control for confounding factors, such as genetic factors, parenteral age at birth, or low birthweight, to further validate the association.

Mapping Geographic Trends in Early Childhood Social, Emotional, and Behavioural Difficulties in Glasgow: 2010-2017

Measuring variation in childhood mental health supports the development of local early intervention strategies. The methodological approach used to investigate mental health trends (often determined by the availability of individual level data) can affect decision making. We apply two approaches to identify geographic trends in childhood social, emotional, and behavioural difficulties using the Strengths and Difficulties Questionnaire (SDQ). SDQ forms were analysed for 35,171 children aged 4-6 years old across 180 preschools in Glasgow, UK, between 2010 and 2017 as part of routine monitoring. The number of children in each electoral ward and year with a high SDQ total difficulties score (≥15), indicating a high risk of psychopathology, was modelled using a disease mapping model. The total difficulties score for an individual child nested in their preschool and electoral ward was modelled using a multilevel model. For each approach, linear time trends and unstructured spatial random effects were estimated. The disease mapping model estimated a yearly rise in the relative rate (RR) of high scores of 1.5-5.0%. The multilevel model estimated an RR increase of 0.3-1.2% in average total scores across the years, with higher variation between preschools than between electoral wards. Rising temporal trends may indicate worsening social, emotional, and behavioural difficulties over time, with a faster rate for the proportion with high scores than for the average total scores. Preschool and ward variation, although minimal, highlight potential priority areas for local service provision. Both methodological approaches have utility in estimating and predicting children's difficulties and local areas requiring greater intervention.

Mental distress among young adults in Great Britain: long-term trends and early changes during the COVID-19 pandemic

PURPOSE

In Great Britain, few studies documented mental health trends in young adults in the years preceding 2020, the mental health dimensions affected, and how these compare with changes observed during the COVID-19 pandemic.

METHODS

Long-term trends in mental health among 16-34 year old men and women between 1991 and 2018, and changes between 2018-19 and July-September 2020 were examined using all waves from the British Household Panel Study (1991-2008), the UK Household Longitudinal Study (2009-20), and the first five UKHLS COVID-19 waves administered in April, May, June, July, and September 2020. Findings are based on the GHQ-12 continuous score (0-36), clinically significant cases (4 + /12) and severe cases (7 + /12) for mental distress, and item endorsements.

RESULTS

Between 1991 and 2018, the prevalence of cases (4 + /12) increased from 14-22% to 19-32% across groups. Increases were largest in women aged 16-24. In April 2020, the risk of caseness (4 + /12) increased across groups by 55% to 80% compared to the 2018-19 baseline. This increase, however, rapidly diminished over time: in July-September 2020, there was only a higher risk of caseness (4 + /12) in men aged 25-34 (prevalence ratio = 1.29, 95% CI 1.01-1.65) compared to the 2018-19 baseline.

CONCLUSION

Whereas distress surged in April 2020, its return to pre-pandemic levels by September 2020 highlights the nuanced impact that the pandemic may have over time. Given the magnitude of the decline in mental health over the past decade, attention must be given to young adults once the pandemic ends.

Estimating prevalence of child and youth mental disorder and mental health-related service contacts: a comparison of survey data and linked administrative health data

AIMS

Prevalence estimates of child and youth mental disorder and mental health-related service contacts are needed for policy formulation, research, advocacy and resource allocation. Our aim is to compare prevalence estimates of child and youth mental disorder and mental health-related service contacts derived from general population survey data v. linked administrative health data.

METHODS

Provincially representative 2014 Ontario Child Health Study data were linked to administrative health records for 5563 children and youth aged 4-17 in Ontario. Emotional disorders (mood and anxiety) and attention-deficit/hyperactivity disorder were assessed using a standardised diagnostic interview in the survey and using diagnostic codes in administrative health data. Physician-based mental health-related service contacts were assessed using parent self-reports from the survey and administrative data related to mental health-related diagnostic codes. Prevalence estimates were calculated and compared based on one-sample z-tests and ratios of survey data to administrative data-based prevalence. Sensitivity, specificity and agreement between classifications were compared using κ. Prevalence estimates were calculated by age, sex and geography sub-groups and consistent group differences across data source were counted.

RESULTS

Disorder prevalence and service contact estimates were significantly higher in survey data in all cases, except for mood disorder. Ratios of survey data to administrative data-based prevalence varied, ranging from 0.80 (mood) to 11.01 (attention-deficit/hyperactivity disorder). Specificity was high (0.98-1.00), sensitivity was low (0.07-0.41) and agreement ranged from slight (κ = 0.13) to moderate (κ = 0.46). Out of 18 sub-group difference comparisons, half were non-significant in either data source. In the remaining nine comparisons, the only significant differences between groups that were consistent across data source were for sex-based differences (attention-deficit/hyperactivity disorder and service contacts). There were no consistent age- or geography-based differences in prevalence across data sources.

CONCLUSIONS

Our findings suggest that conclusions drawn about prevalence, service contacts and sub-group differences in these estimates are dependent on data source. Further research is needed to understand who and what is being captured by each source. Researchers should conduct data linkage where possible to access and compare multiple sources of information.

Social Inequalities in Young People's Mental Distress During the COVID-19 Pandemic: Do Psychosocial Resource Factors Matter?

The COVID-19 pandemic disproportionately affected young people aged 16–25 years and has brought about a major increase in mental health problems. Although there is persisting evidence regarding SES differences in mental health status, there is still little knowledge of the processes linking SES to young people's mental health, in particular during the current pandemic. Guided by a stress process model this study examines the role of different psychosocial resource factors in mitigating the vulnerability to mental distress among disadvantaged young people and specifies a range of possible mediating pathways. The research draws on a nationally representative longitudinal sample of 16–25 year-olds who participated in the Youth Economic Activity and Health (YEAH) online survey conducted in the UK between February and October 2021. Mental health was measured using the Hopkins Symptom Checklist for anxiety and depression. Socio-economic disadvantage was indicated by parental education and receipt of free school meals. Experience of stress was indicated by financial strain. Psychosocial resource factors included indicators of optimism, self-efficacy, and social support. We controlled for age, gender, living arrangements, and economic activity of the young person (being in education, employment or NEET). The findings suggest sequential mediating processes where SES influences are partially mediated via financial strain and the psychosocial resource factors. In addition, the psychosocial resource factors showed independent effects supporting mental health in the face of socio-economic adversity. Moreover, social support played a significant role in boosting self-efficacy and optimism, which in turn reduce mental distress. The findings highlighting the importance of specifying the assumed mediating processes, and to consider multiple resource factors instead of single aspects to gain a more comprehensive understanding of the processes linking SES to young people's mental health.

Transition milestones and life satisfaction at ages 25/26 among cohorts born in 1970 and 1989-90

The transition to adulthood has become more prolonged, complex, and risk-laden over the past two decades. These changes may contribute to the decline in wellbeing observed among young adults. We test the role of reaching different transition milestones on life satisfaction by ages 25-26 among men and women born 20 years apart in 1970 and 1989-90, using data from the 1970 British Cohort (men n = 3764, women n = 4568) and Next Steps (men n = 3246, women n = 4281) studies. We regressed life satisfaction on education, housing tenure, cohabitation with parents, economic activity, relationship status, and parenthood, and tested the role of changes in the prevalence and association of milestones in explaining cohort differences in life satisfaction using decomposition analyses. Home ownership, full-time employment, cohabitation with a partner, and marriage were robust predictors of life satisfaction in both cohorts. Comparing cohorts, the association of milestones with life satisfaction was stable among men but differed among women: in the later-born cohort, women no longer benefitted from higher education and further suffered from not being in full-time employment. The findings shed new light on the relationships between young adult transitions and life satisfaction during the third decade of life. These support the argument that decreases in wellbeing may be driven by changes in the prevalence and meaning of these milestones over time, particularly among women.

Perceived impact of formulating, implementing and enacting national mental health policies recommendations in practice: An exploratory qualitative study within child and adolescent mental health services in Scotland

OBJECTIVE

To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland.

METHODS

Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland.

RESULTS

Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment.

CONCLUSION

The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations.

Mental health and life satisfaction among 10-11-year-olds in Wales, before and one year after onset of the COVID-19 pandemic

BACKGROUND

In many countries, including in the United Kingdom (UK), COVID-19 social distancing measures placed substantial restrictions on children's lives in 2020 and 2021, including closure of schools and limitations on play. Many children faced milestones such as transition to secondary school having missed several months of face-to-face schooling in the previous academic years.

METHODS

This paper examines change in mental health difficulties, life satisfaction, school connectedness, and feelings about transition to secondary school among 10-11-year-olds in Wales, UK, using data from repeat cross-sectional surveys before and after the onset of the COVID-19 pandemic. Participants were 4032 10-11-year-old schoolchildren. The first cohort completed a school-based survey in 2019 (prior to introduction of social distancing measures), and the second in 2021 (following full return to school after two rounds of school closure).

RESULTS

The percentage of children reporting elevated emotional difficulties rose from 17% in 2019 to 27% in 2021 (Odds Ratio = 1.65; 95%CI = 1.23 to 2.20). There was no evidence of increased behavioural difficulties (OR = 1.04; 95%CI = 0.73 to 1.46). There was a tendency toward declines in life satisfaction in all analyses, but this intersected the null (OR = 0.86; 95%CI = 0.70 to 1.07). Children reported a high degree of school connectedness before and after the pandemic, with no evidence of change in ratings of teacher relationships, pupil relationships or pupil involvement in school life. There was no evidence of impacts of the pandemic on children's feelings about the transition to secondary school, with feelings becoming more positive as transition neared. Most findings were robust to a range of sensitivity analyses.

CONCLUSIONS

Supporting children's emotional recovery from the COVID-19 pandemic is a public health priority requiring urgent and effective action at multiple levels of society. Maintaining connectedness to school through the pandemic may have played a role in preventing a steeper increase in child mental health difficulties.

Anxiety and Depression Symptoms in Children and Adolescents Who Stutter: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this study was to investigate whether there are elevated symptoms of anxiety or depression in children and adolescents (aged 2-18 years) who stutter, and to identify potential moderators of increased symptom severity.

METHOD

We conducted a preregistered systematic review of databases and gray literature; 13 articles met criteria for inclusion. A meta-analysis using robust variance estimation was conducted with 11 cohort studies comparing symptoms of anxiety in children and adolescents who do and do not stutter. Twenty-six effect sizes from 11 studies contributed to the summary effect size for anxiety symptoms (851 participants). Meta-analysis of depression outcomes was not possible due to the small number of studies.

RESULTS

The summary effect size indicates that children and adolescents who stutter present with increased anxiety symptoms (g = 0.42) compared with nonstuttering peers. There were insufficient studies to robustly analyze depression symptoms, and qualitative review is provided. No significant between-groups differences were reported in any of the depression studies.

CONCLUSIONS

Preliminary evidence indicates elevated symptoms of anxiety in some children and adolescents who stutter relative to peers. There was a tendency toward higher depression scores in this population, although reported between-groups differences did not reach statistical significance. These findings require replication in larger, preferably longitudinal studies that consider factors that may moderate risk. Nevertheless, our findings highlight a need for careful monitoring of mental health and well-being in young people who stutter. Supplemental Materials: http://osf.io/5m6zv.

The Contributing Role of Family, School, and Peer Supportive Relationships in Protecting the Mental Wellbeing of Children and Adolescents

Globally, mental disorders are the leading cause of disability in children and adolescents. Previous research has demonstrated that supportive relationships are a key protective factor against poor mental health in children, particularly amongst those who have experienced adversity. However, fewer studies have examined the relative impact of different types of supportive relationships. The current study examined the association between level of family adult support, school adult support, and school peer support and mental wellbeing in a sample of children (age 8-15 years, N = 2,074) from schools in the UK. All three sources of support were independently associated with mental wellbeing. Analyses demonstrated a graded relationship between the number of sources of support and the odds of low mental wellbeing (LMWB), reflecting a cumulative protective effect. While all three sources of support were best, it was not vital, and analyses demonstrated a protective effect of school sources of support on LMWB amongst children with low family support. Peer support was found to be particularly important, with prevalence of LMWB similar amongst children who had high peer support (but low family and school adult support), and those who had high family and school adult support, (but low peer support), indicating that high peer support has an equivalent impact of two other protective factors. Findings from the study highlight the crucial context schools provide in fostering positive peer relationships and supportive teacher-student relationships to promote mental health and resilience for all children, including both those with and without supportive home environments.

Cross-sectional associations of schoolchildren's fruit and vegetable consumption, and meal choices, with their mental well-being: a cross-sectional study

BACKGROUND

Poor mental well-being is a major issue for young people and is likely to have long-term negative consequences. The contribution of nutrition is underexplored. We, therefore, investigated the association between dietary choices and mental well-being among schoolchildren.

METHODS

Data from 7570 secondary school and 1253 primary school children in the Norfolk Children and Young People Health and Well-being Survey, open to all Norfolk schools during October 2017, were analysed. Multivariable linear regression was used to measure the association between nutritional factors and mental well-being assessed by the Warwick-Edinburgh Mental Well-being Scale for secondary school pupils, or the Stirling Children's Well-being Scale for primary school pupils. We adjusted all analyses for important covariates including demographic, health variables, living/home situation and adverse experience variables.

RESULTS

In secondary school analyses, a strong association between nutritional variables and well-being scores was apparent. Higher combined fruit and vegetable consumption was significantly associated with higher well-being: well-being scores were 3.73 (95% CI 2.94 to 4.53) units higher in those consuming five or more fruits and vegetables (p<0.001; n=1905) compared with none (n=739). The type of breakfast or lunch consumed was also associated with significant differences in well-being score. Compared with children consuming a conventional type of breakfast (n=5288), those not eating any breakfast had mean well-being scores 2.73 (95% CI 2.11 to 3.35) units lower (p<0.001; n=1129) and those consuming only an energy drink had well-being scores 3.14 (95% CI 1.20 to 5.09) units lower (p=0.002; n=91). Likewise, children not eating any lunch had well-being scores 2.95 (95% CI 2.22 to 3.68) units lower (p<0.001; 860) than those consuming a packed lunch (n=3744). In primary school analyses, the type of breakfast or lunch was associated with significant differences in well-being scores in a similar way to those seen in secondary school data, although no significant association with fruit and vegetable intake was evident.

CONCLUSION

These findings suggest that public health strategies to optimise the mental well-being of children should include promotion of good nutrition.

Time trends in adolescent mental wellbeing in the Czech Republic between 2002 and 2018: gender, age and socioeconomic differences

OBJECTIVES

Recent literature indicates a decline over time in adolescent mental wellbeing but results are inconsistent and rely mainly on data from Western societies. This study investigates time trends in adolescent mental wellbeing (psychological and somatic complaints, life satisfaction) among Czech adolescents and explores the moderating role of gender, age and socioeconomic status.

METHODS

Nationally representative data from 29,376 Czech adolescents (50.8% girls, mean age = 13.43; SD = 1.65) across five Health Behaviour in School-aged Children (HBSC) surveys (2002, 2006, 2010, 2014, 2018) were used. Hierarchical regression models estimated national trends in adolescent mental wellbeing and established the moderating role of gender, age and socioeconomic status.

RESULTS

From 2002 to 2018, an increase in the psychological complaints was observed. Life satisfaction decreased over time up to 2014 only, whereas somatic symptoms increased until 2010, followed by a decline in 2014 and 2018. Girls, older adolescents and those from low family affluence reported poorer mental wellbeing. Gender gap increased over time for psychological complaints and life satisfaction. Socioeconomic inequalities gap remained stable over the investigated timeframe.

CONCLUSIONS

Our findings do not provide evidence for substantial temporal changes in mental wellbeing among adolescents in the Czech Republic. Yet, the increase in psychological complaints has been consistent which is an indicator of a small decline over time in adolescent mental wellbeing. Furthermore, the gender gap in mental wellbeing increased over time, whereas the age and socioeconomic differences remained relatively stable. This calls for the attention of public health professionals and policy makers from the Czech Republic.