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Harris JL, Swanson B, Petersen IT. A Developmentally Informed Systematic Review and Meta-Analysis of the Strength of General Psychopathology in Childhood and Adolescence. Clin Child Fam Psychol Rev 2024; 27:130-164. [PMID: 38112921 PMCID: PMC10938301 DOI: 10.1007/s10567-023-00464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
Considerable support exists for higher-order dimensional conceptualizations of psychopathology in adults. A growing body of work has focused on understanding the structure of general and specific psychopathology in children and adolescents. No prior meta-analysis has examined whether the strength of the general psychopathology factor (p factor)-measured by explained common variance (ECV)-changes from childhood to adolescence. The primary objective of this multilevel meta-analysis was to determine whether general psychopathology strength changes across development (i.e. across ages) in childhood and adolescence. Several databases were searched in November 2021; 65 studies, with 110 effect sizes (ECV), nested within shared data sources, were identified. Included empirical studies used a factor analytic modeling approach that estimated latent factors for child/adolescent internalizing, externalizing, and optionally thought-disordered psychopathology, and a general factor. Studies spanned ages 2-17 years. Across ages, general psychopathology explained over half (~ 56%) of the reliable variance in symptoms of psychopathology. Age-moderation analyses revealed that general factor strength remained stable across ages, suggesting that general psychopathology strength does not significantly change across childhood to adolescence. Even if the structure of psychopathology changes with development, the prominence of general psychopathology across development has important implications for future research and intervention.
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Affiliation(s)
- Jordan L Harris
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Avenue G60, Iowa City, IA, 52242, USA.
| | - Benjamin Swanson
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Isaac T Petersen
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Avenue G60, Iowa City, IA, 52242, USA
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2
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Lathe J, Silverwood RJ, Hughes AD, Patalay P. Examining how well economic evaluations capture the value of mental health. Lancet Psychiatry 2024; 11:221-230. [PMID: 38281493 DOI: 10.1016/s2215-0366(23)00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
Health economics evidence informs health-care decision making, but the field has historically paid insufficient attention to mental health. Economic evaluations in health should define an appropriate scope for benefits and costs and how to value them. This Health Policy provides an overview of these processes and considers to what extent they capture the value of mental health. We suggest that although current practices are both transparent and justifiable, they have distinct limitations from the perspective of mental health. Most social value judgements, such as the exclusion of interindividual outcomes and intersectoral costs, diminish the value of improving mental health, and this reduction in value might be disproportionate compared with other types of health. Economic analyses might have disadvantaged interventions that improve mental health compared with physical health, but research is required to test the size of such differential effects and any subsequent effect on decision-making systems such as health technology assessment systems. Collaboration between health economics and the mental health sciences is crucial for achieving mental-physical health parity in evaluative frameworks and, ultimately, improving population mental health.
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Affiliation(s)
- James Lathe
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK.
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
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3
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Golden TL, Ordway RW, Magsamen S, Mohanty A, Chen Y, Ng TWC. Supporting youth mental health with arts-based strategies: a global perspective. BMC Med 2024; 22:7. [PMID: 38166923 PMCID: PMC10763059 DOI: 10.1186/s12916-023-03226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
The devastating impact of youth mental health concerns is increasingly evident on a global scale. This crisis calls for innovative solutions that are sufficiently accessible, scalable, and cost-effective to support diverse communities around the world. One such solution involves engagement in the arts: incorporating and building upon existing local resources and cultural practices to bolster youth mental health. In this article, we describe the global youth mental health crisis and note major gaps in the knowledge and resources needed to address it. We then discuss the potential for arts- and culture-based strategies to help meet this challenge, review the mounting evidence regarding art's ability to support mental health, and call for action to undertake critical research and its translation into accessible community practices. Four steps are suggested: (1) elevate and prioritize youth voice, (2) develop core outcome measures, (3) identify and analyze successful models around the globe, and (4) generate clear funding pathways for research and translational efforts. Worldwide implementation of arts- and culture-based strategies to address youth mental health will provide critical resources to support the health, wellbeing and flourishing of countless youth across the globe.
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Affiliation(s)
- Tasha L Golden
- International Arts + Mind Lab, Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste #110, Baltimore, MD, 21209, USA.
| | - Richard W Ordway
- Department of Biology and Doctors, Kienle Center for Humanistic Medicine, Penn State University, University Park, PA, 16802, USA
| | - Susan Magsamen
- International Arts + Mind Lab, Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste #110, Baltimore, MD, 21209, USA
| | - Aanchal Mohanty
- International Arts + Mind Lab, Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste #110, Baltimore, MD, 21209, USA
| | - Yifan Chen
- International Arts + Mind Lab, Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste #110, Baltimore, MD, 21209, USA
| | - T W Cherry Ng
- International Arts + Mind Lab, Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste #110, Baltimore, MD, 21209, USA
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Kasai K, Kumagaya SI, Takahashi Y, Sawai Y, Uno A, Kumakura Y, Yamagishi M, Kanehara A, Morita K, Tada M, Satomura Y, Okada N, Koike S, Yagishita S. "World-Informed" Neuroscience for Diversity and Inclusion: An Organizational Change in Cognitive Sciences. Clin EEG Neurosci 2023; 54:560-566. [PMID: 35695218 DOI: 10.1177/15500594221105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By nature, humans are "tojisha (participating subjects/player-witnesses)" who encounter an unpredictable real world. An important characteristic of the relationship between the individual brain and the world is that it creates a loop of interaction and mutual formation. However, cognitive sciences have traditionally been based on a model that treats the world as a given constant. We propose incorporating the interaction loop into this model to create "world-informed neuroscience (WIN)". Based on co-productive research with people with minority characteristics that do not match the world, we hypothesize that the tojisha and the world interact in a two-dimensional way of rule-based and story-based. By defining the cognitive process of becoming tojisha in this way, it is possible to contribute to the various issues of the real world and diversity and inclusion through the integration of the humanities and sciences. The critical role of the brain dopamine system as a basis for brain-world interaction and the importance of research on urbanicity and adolescent development as examples of the application of WIN were discussed. The promotion of these studies will require bidirectional translation between human population science and animal cognitive neuroscience. We propose that the social model of disability should be incorporated into cognitive sciences, and that disability-informed innovation is needed to identify how social factors are involved in mismatches that are difficult to visualize. To promote WIN to ultimately contribute to a diverse and inclusive society, co-production of research from the initial stage of research design should be a baseline requirement.
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Affiliation(s)
- Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- St Luke's International Hospital, Tokyo, Japan
| | - Yutaka Sawai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akito Uno
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mika Yamagishi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Morita
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Tada
- Center for Research on Counseling and Support Services, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Satomura
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Sho Yagishita
- Department of Structural Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Dooley N, Kennelly B, Arseneault L, Zammit S, Whelan R, Mosley O, Cotter D, Clarke M, Cotter DR, Kelleher I, McGorry P, Healy C, Cannon M. Functional Outcomes Among Young People With Trajectories of Persistent Childhood Psychopathology. JAMA Netw Open 2023; 6:e2336520. [PMID: 37773492 PMCID: PMC10543080 DOI: 10.1001/jamanetworkopen.2023.36520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Understanding which children in the general population are at greatest risk of poor functional outcomes could improve early screening and intervention strategies. Objective To investigate the odds of poor outcomes in emerging adulthood (ages 17 to 20 years) for children with different mental health trajectories at ages 9 to 13 years. Design, Setting, and Participants Growing Up in Ireland is a longitudinal, nationally representative population-based cohort study. Data collection began in August 2007 and was repeated most recently in September 2018. All results were weighted to account for sampling bias and attrition and were adjusted for socioeconomic factors. Data analysis took place from October 2022 to April 2023. Exposure Four latent classes captured variation in mental health in children aged 9 and 13 years, based on the parent-completed Strengths and Difficulties Questionnaire. Classes included no psychopathology, internalizing, externalizing, and high (comorbid) psychopathology. Those who remained in the same class from ages 9 to 13 years were included. Main Outcomes and Measures Poor functional outcomes in emerging adulthood were measured at approximate ages 17 years (range, 16 to 18 years) and 20 years (range, 19 to 21 years). Outcomes included poor mental health, poor physical health, social isolation, heavy substance use, frequent health service use, poor subjective well-being, and adverse educational/economic outcomes. Results Of 5141 included participants, 2618 (50.9%) were male. A total of 3726 (72.5%) were classed as having no childhood psychopathology, 1025 (19.9%) as having persistent externalizing psychopathology, 243 (4.7%) as having persistent internalizing psychopathology, and 147 (2.9%) as having persistent high psychopathology. Having any childhood psychopathology was associated with poorer functional outcomes in emerging adulthood. The internalizing group had elevated odds of most outcomes except for heavy substance use (range of odds ratios [ORs]: 1.38 [95% CI, 1.05-1.81] for frequent health service use to 3.08 [95% CI, 2.33-4.08] for poor mental health). The externalizing group had significantly elevated odds of all outcomes, albeit with relatively small effect sizes (range of ORs: 1.38 [95% CI, 1.19-1.60] for frequent health service use to 1.98 [95% CI, 1.67-2.35] for adverse educational/economic outcomes). The high psychopathology group had elevated odds of all outcomes (nonsignificantly for frequent health service use), though with wide confidence intervals (range of ORs: 1.53 [95% CI, 1.06-2.21] for poor physical health to 2.91 [95% CI, 2.05-4.12] for poor mental health). Female participants with any psychopathology had significantly higher odds of poor physical health and frequent health service use compared with male participants with any psychopathology. Conclusions and Relevance In this longitudinal cohort study, childhood psychopathology was associated with a widespread pattern of functional impairment in emerging adulthood. Findings point to the need for a wider range of preventive interventions in child and adolescent mental health services.
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Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Social, Genetic and Developmental Psychology, King’s College London, London, United Kingdom
| | - Brendan Kennelly
- School of Business and Economics, University of Galway, Galway, Ireland
| | - Louise Arseneault
- Social, Genetic and Developmental Psychology, King’s College London, London, United Kingdom
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rob Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Olivia Mosley
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Delia Cotter
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David R. Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ian Kelleher
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- NHS Lothian Child and Adolescent Mental Health Service, Edinburgh, United Kingdom
- School of Medicine, University College Dublin, Dublin, Ireland
- University of Oulu, Faculty of Medicine, Oulu, Finland
| | - Pat McGorry
- Centre for Youth Mental Health, Orygen, Melbourne, Australia
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hoffmann MS, Moore TM, Axelrud LK, Tottenham N, Rohde LA, Milham MP, Satterthwaite TD, Salum GA. Harmonizing bifactor models of psychopathology between distinct assessment instruments: Reliability, measurement invariance, and authenticity. Int J Methods Psychiatr Res 2023; 32:e1959. [PMID: 36655616 PMCID: PMC10485343 DOI: 10.1002/mpr.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Model configuration is important for mental health data harmonization. We provide a method to investigate the performance of different bifactor model configurations to harmonize different instruments. METHODS We used data from six samples from the Reproducible Brain Charts initiative (N = 8,606, ages 5-22 years, 41.0% females). We harmonized items from two psychopathology instruments, Child Behavior Checklist (CBCL) and GOASSESS, based on semantic content. We estimated bifactor models using confirmatory factor analysis, and calculated their model fit, factor reliability, between-instrument invariance, and authenticity (i.e., the correlation and factor score difference between the harmonized and original models). RESULTS Five out of 12 model configurations presented acceptable fit and were instrument-invariant. Correlations between the harmonized factor scores and the original full-item models were high for the p-factor (>0.89) and small to moderate (0.12-0.81) for the specific factors. 6.3%-50.9% of participants presented factor score differences between harmonized and original models higher than 0.5 z-score. CONCLUSIONS The CBCL-GOASSESS harmonization indicates that few models provide reliable specific factors and are instrument-invariant. Moreover, authenticity was high for the p-factor and moderate for specific factors. Future studies can use this framework to examine the impact of harmonizing instruments in psychiatric research.
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Affiliation(s)
- Maurício Scopel Hoffmann
- Department of NeuropsychiatryUniversidade Federal de Santa MariaSanta MariaBrazil
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Tyler Maxwell Moore
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Luiza Kvitko Axelrud
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Nim Tottenham
- Department of PsychologyColumbia UniversityNew YorkNew YorkUSA
| | - Luis Augusto Rohde
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT‐CNPq)São PauloBrazil
- Department of Psychiatry and Legal MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Michael Peter Milham
- Nathan S. Kline Institute for Psychiatric ResearchOrangeburgNew YorkUSA
- Center for the Developing BrainChild Mind InstituteNew YorkNew YorkUSA
| | - Theodore Daniel Satterthwaite
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Informatics and Neuroimaging CenterPhiladelphiaPennsylvaniaUSA
| | - Giovanni Abrahão Salum
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT‐CNPq)São PauloBrazil
- Department of Psychiatry and Legal MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Center for the Developing BrainChild Mind InstituteNew YorkNew YorkUSA
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7
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Hoffmann MS, Evans-Lacko S, Collishaw S, Knapp M, Pickles A, Shearer C, Maughan B. Parent- and teacher-reported associations from adolescent bifactor models of psychopathology: an outcome-wide association study of 26 outcomes in mid-life. J Child Psychol Psychiatry 2023; 64:397-407. [PMID: 36151972 DOI: 10.1111/jcpp.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescent mental health problems have lasting impacts on health and social functioning later in life. Evidence to date mostly comes from studies of specific diagnostic categories/dimensions, but hierarchical models can elucidate associations with general as well as specific dimensions of psychopathology. We provide evidence on long-term outcomes of general and specific dimensions of adolescent psychopathology using both parent and teacher reports. METHODS Parents and teachers from the Isle of Wight study completed Rutter behaviour scales when participants were 14-15 years old (n = 2,275), assessing conduct, emotional and hyperactivity problems. Metric-invariant bifactor models for parents and teachers were used to test domain-specific and domain-general associations with 26 self-reported psychosocial outcomes at mid-life (age 44-45 years, n = 1,423). Analyses examined the individual and joint contributions of parent and teacher reports of adolescent psychopathology. All analyses were adjusted for covariates (gender, IQ and family social class) and weighted to adjust for the probability of nonresponse. RESULTS Parent- and teacher-reported general factors of psychopathology (GFP) were associated with 15 and 12 outcomes, respectively, across the socioeconomic, relationship, health and personality domains, along with an index of social exclusion. Nine outcomes were associated with both parent- and teacher-reported GFP, with no differences in the strength of the associations across reporters. Teacher-reported specific factors (conduct, emotional and hyperactivity) were associated with 21 outcomes, and parent-reported specific factors were associated with seven. Five outcomes were associated with the same specific factors from both reporters; only one showed reporter differences in the strength of the associations. CONCLUSIONS These findings confirm the relevance of the GFP and the utility of teacher as well as parent reports of adolescent mental health in predicting psychosocial outcomes later in the life course.
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Affiliation(s)
- Mauricio Scopel Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.,Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Brazil.,Graduation program in Psychiatry and Behavioural Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christina Shearer
- Child and Adolescent Mental Health Service, South West London and St George's Mental Health NHS Trust, London, UK
| | - Barbara Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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8
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Evans-Lacko S, Araya R, Bauer A, Garman E, Álvarez-Iglesias A, McDaid D, Hessel P, Matijasevich A, Paula CS, Park AL, Lund C. Potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people: A conceptual framework and lines of enquiry for research and policy. Glob Ment Health (Camb) 2023; 10:e13. [PMID: 37854414 PMCID: PMC10579689 DOI: 10.1017/gmh.2023.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/29/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023] Open
Abstract
Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.
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Affiliation(s)
- Sara Evans-Lacko
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ricardo Araya
- Centre for Global Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Annette Bauer
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Alejandra Álvarez-Iglesias
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - David McDaid
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, Colombia
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brasil
| | - Cristiane Silvestre Paula
- Centro Mackenzie de Pesquisa sobre Infância e Adolescência, Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - A-La Park
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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9
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Hazell M, Thornton E, Haghparast-Bidgoli H, Patalay P. Socio-economic inequalities in adolescent mental health in the UK: Multiple socio-economic indicators and reporter effects. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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10
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Copeland WE, Tong G, Shanahan L. Do "Real World" Childhood Mental Health Services Reduce Risk for Adult Psychiatric Disorders? J Am Acad Child Adolesc Psychiatry 2022; 61:1041-1049.e7. [PMID: 35063586 PMCID: PMC9294070 DOI: 10.1016/j.jaac.2021.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
| | | | - Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
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Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries. Lancet Reg Health Eur 2022; 17:100368. [PMID: 35373171 PMCID: PMC8969158 DOI: 10.1016/j.lanepe.2022.100368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The European Mental Health Action Plan (EMHAP) 2013–2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it. Methods Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011–2015) and two (2015–2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure. Findings Across 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20–2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54–13.46]) and Austria (AOR for trend=10.07[7.32–13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62–9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50–64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12–1.80]) and the largest in Israel (AOR=2.34[1.46–3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied. Interpretation Usage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research. Funding Medical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
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Mansfield R, Santos J, Deighton J, Hayes D, Velikonja T, Boehnke JR, Patalay P. The impact of the COVID-19 pandemic on adolescent mental health: a natural experiment. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211114. [PMID: 35601452 PMCID: PMC9043696 DOI: 10.1098/rsos.211114] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/06/2022] [Indexed: 05/19/2023]
Abstract
Despite widespread concern about the impact of COVID-19 on adolescent mental health, there remains limited empirical evidence that can causally attribute changes to the pandemic. The current study aimed to overcome existing methodological limitations by exploiting a serendipitously occurring natural experiment within two ongoing, multi-phase cluster randomized controlled trials. Depressive symptoms (primary outcome), externalizing difficulties and life satisfaction (secondary outcomes) were assessed at baseline (phase 1 [pre-COVID-19 group]: September - October 2018, phase 2 [COVID-19 group]: September - October 2019) and 1-year follow-up (pre-COVID-19 group: January - March 2020, COVID-19 group: February - April 2021). Participants in phase 1 (N = 6419) acted as controls. In phase 2, participants (N = 5031) were exposed to the COVID-19 pandemic between the baseline and follow-up assessments providing a natural experimental design. The primary analysis used a random intercept linear multivariable regression model with phase (exposure to the COVID-19 pandemic) included as the key predictor while controlling for baseline scores and individual and school-level covariates. Depressive symptoms were higher and life satisfaction scores lower in the group exposed to the COVID-19 pandemic. Had the COVID-19 pandemic not occurred, we estimate that there would be 6% fewer adolescents with high depressive symptoms. No effect of exposure to the pandemic on externalizing difficulties was found. Exploratory analyses to examine subgroup differences in impacts suggest that the negative impact of the COVID-19 pandemic on adolescent mental health may have been greater for females than males. Given the widespread concern over rising adolescent mental health difficulties prior to the pandemic, this paper quantifies the additional impacts of the pandemic. A properly resourced, multi-level, multi-sector public health approach for improving adolescent mental health is necessary. Following in-principle acceptance, the approved Stage 1 version of this manuscript was preregistered on the OSF at https://doi.org/10.17605/OSF.IO/B25DH. This preregistration was performed prior to data analysis.
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Affiliation(s)
- Rosie Mansfield
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Joao Santos
- Manchester Institute of Education, University of Manchester, Manchester, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
| | - Daniel Hayes
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tjasa Velikonja
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
| | - Jan R. Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, Population Science and Experimental Medicine, University College London, London, UK
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Abstract
AIMS Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions. METHODS Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6-14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising-related conditions (attention deficit and hyperactivity disorder, conduct and oppositional-defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females. RESULTS Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (β = -0.23; 95% CI = -0.34, -0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration. CONCLUSIONS The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities.
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