Youth engagement in mental health research: A systematic review

Collaborating With Young People: Identifying the Barriers and Facilitators in Co-Designed Research

BACKGROUND

Undertaking collaborative research with young people could result in more relevant research and policy. However, there remains a limited understanding of the barriers and facilitators to meaningfully working with young people. This scoping review aimed to identify the barriers and facilitators of engaging young people in codesign research processes.

METHODS

This scoping review drew on methodological guidance from JBI. Searches were conducted in Proquest, Scopus, Informit, and Science Direct for relevant peer-reviewed publications for the period of January 2003-August 2023. Publications were included if they used the term codesign and/or related participatory research methods with young people aged 15-24 years. Two independent reviewers undertook all stages of screening and data extraction, with consensus reached at each stage of the study. Qualitative content analysis was used to group results into key themes.

RESULTS

The search yielded 1334 publications, with 41 meeting inclusion criteria. Publications varied with respect to the age range of included young people, and focused on a variety of populations, including young people with mental ill-health, with disabilities, First Nations youth, and young people involved with specific services or programs. In analyzing the barriers and facilitators to engaging young people in co-designed research we found overall that facilitators included consistent funding, dedicated staff, flexible methods, and youth involvement as co-creators, supported by community networks and extended timelines. Key barriers were limited resources, staff capacity, and logistical challenges like recruitment, transportation, and external responsibilities, which hinder participation.

CONCLUSIONS

In conclusion, there is no universal approach to codesign; instead, every project depends on the interplay of various factors. Elements such as resources, communication, process, agency, investment, and relationships can either facilitate or hinder progress, depending on how they are handled. A project that effectively incorporates these interconnected and interdependent factors is much more likely to foster meaningful and lasting collaboration.

PATIENT OR PUBLIC CONTRIBUTION

This study was a scoping review and did not involve patients, service users, caregivers, individuals with lived experience, young people, or members of the public in its design, conduct, analysis, interpretation, or preparation. While the nature of the research-focused on synthesising the existing literature-did not necessitate direct involvement, the absence of young people's participation is acknowledged as a limitation. Nevertheless, the findings are intended to inform future participatory research practices that centre and engage young people and other stakeholders in meaningful, collaborative ways.

Children and Young People's Priorities for Mental Health Research in Northern Ireland

INTRODUCTION

There are a number of factors contributing to the poor mental health of children and young people (CYP) specific to life in Northern Ireland (NI). Prevention and early intervention are of critical importance to the mental health and well-being of CYP. Policy decisions and service provision in the health and education sectors must be informed by research so that we can understand the factors affecting the mental health of young people and develop effective policy responses. This study examines the perceptions of young people in NI regarding mental health research priorities.

METHODS

CYP who live in NI and are aged between 11 and 25 were invited to contribute to this priority setting exercise. A short anonymous online survey asked: 'What do you think is the most important question that researchers should be trying to answer about the mental health and wellbeing of young people in NI? You may submit more than one question.' Two-hundred and seventy-nine questions were submitted from 147 respondents. The priorities were then further discussed and expanded through focus groups with young people.

RESULTS

The study identified 12 research priorities. Using thematic analysis, these were grouped into four themes: (i) Ensuring that the voices of young people in NI are heard, (ii) Understanding and addressing the root causes, extent and impact of mental health challenges in young people, (iii) Creating accessible and effective youth mental health services in NI and (iv) Fostering a whole-school approach to mental health and resilience.

CONCLUSIONS

The research priorities of young people are discussed in relation to current governmental strategic policies and statistics. Suggestions are put forward regarding how these research priorities may be addressed.

Participation their way: a mixed methods study on engaging Australian adolescents in non-communicable disease prevention

BACKGROUND

Non-communicable diseases (NCDs) are a major global health burden, particularly affecting adolescents due to preventable risk factors. However, adolescents are frequently overlooked in NCD prevention efforts that directly impact them. This study aimed to evaluate adolescents' perspectives, experiences, perceptions, and preferences regarding their participation in NCD prevention activities.

METHODS

To enable both breadth and depth, a mixed-methods study design was selected comprising cross-sectional online survey and focus groups, underpinned by community-based participatory research approach. Participants were 13-18 years and residing in Australia. Methodological integration through merging quantitative and qualitative data was employed. A weaving approach through narrative was used to report the findings. Adolescent researchers were actively engaged throughout all phases.

RESULTS

Five hundred one survey participants (mean 16.0 years, SD 1.2) and 19 focus group participants (mean 17.0 years, SD 0.9) contributed to this study. Mental health disorders were identified as the most significant health concern. Those with prior volunteer experience showed greater engagement in health-promoting activities. Participants recognised their pivotal role in NCD prevention, highlighting 'influence' as crucial for health improvements. They emphasised the importance of visibility, flexibility, and authenticity in engagement methods. Despite a strong willingness to participate in future NCD prevention activities, participants cited barriers such as limited opportunities.

CONCLUSION

This study highlights the importance of adolescent involvement in NCD prevention and suggests strategies to overcome participation barriers. Recommendations include promoting meaningful engagement, improving accessibility, and fostering collaboration with decision makers. These insights are crucial for guiding future efforts to tackle NCD challenges among adolescents.

A new treatment approach to conduct disorder and callous-unemotional traits: an assessment of the acceptability, appropriateness, and feasibility of Impact VR

Introduction

Conduct disorder (CD) is highly prevalent among youth, yet existing and conventional treatment approaches are limited and costly. Further, most interventions for CD focus on behavior management rather than targeting the underlying mechanisms of CD. To meet the needs of youth with CD (ages 10-17), we developed Impact VR, a virtual reality intervention that promotes competency in emotion recognition and regulation, as well as modeling prosocial behaviors. Impact VR provides immersive storylines and gamification of psychoeducation training. The present study aimed to understand the perceptions of Impact VR for acceptability, feasibility, and usability across key stakeholder groups, including youth with CD, caregivers of youth with CD, mental health practitioners, and educators.

Methods

A total of 60 adults, including mental health professionals (n=20), teachers (n=20), caregivers (n=20), and 20 youth with CD completed a trial of Impact VR and completed surveys.

Results

Results demonstrated a high overall acceptability of Impact VR (95% - 100%) across all groups, and a high approval rating for intervention appropriateness (98.75% - 100%) and feasibility of the intervention (97.50% - 100%) across stakeholder groups. The majority of youth (90%-100%) reported that the skills learned would improve their mental health and relationships with friends, parents, and teachers.

Discussion

Findings revealed that youth with CD and key stakeholder groups rate Impact VR favorably and positively. Future research is needed on the effectiveness of Impact VR in improving emotion recognition and reducing CD symptoms.

Mental Health and Suicide Research with Migrants in Australia: Necessary Knowledge, Skills and Engagement Strategies

(1) Research is fundamentally important in developing evidence-informed and effective policies and appropriate programs and services to reduce the burden of mental health problems, and prevent suicide, among migrants. However, this population continues to be underrepresented in mental health and suicide research, resulting in large evidence gaps that limit policy making, service design and delivery, as well as evaluation of outcomes. (2) Experts in mental health and suicide prevention research with migrants provided free-text responses to a survey that asked about the knowledge and skills required to effectively conduct mental health and suicide prevention research with migrants, and effective strategies for engaging migrant and refugee communities in such research. An adapted thematic analysis method was used to analyze the free-text responses to the six questions. (3) The study identified specific areas of knowledge and skills required for effective mental health and suicide research with migrants; the methodological and ethical challenges that may arise in such research; and strategies that are likely to be effective in engaging people with lived experience and migrant and refugee communities in such research. (4) The findings from this project can be used to inform researchers on how to ethically and effectively undertake mental health and suicide research with migrant and refugee populations.

Codesign is the zeitgeist of our time, but what do we mean by this? A scoping review of the concept of codesign in collaborative research with young people

BACKGROUND

Codesign is increasingly valued in health research as a way to actively include stakeholders in the research process, particularly for groups that have been historically excluded, such as young people. Despite its popularity, codesign is often inconsistently defined in literature. This creates challenges for applying it consistently across research projects and for evaluating its effectiveness. To address this definitional ambiguity, we conducted a scoping review to examine and clarify the concept of codesign in research with young people in the health and social sciences.

METHODS

This scoping review drew on methodological guidance from JBI. Searches were conducted in Proquest, Scopus, Informit and Science Direct for relevant peer-reviewed publications for the period of January 2003-August 2023. Publications were included if they used the term codesign and/or related participatory research methods with young people aged 15-24 years. Screening, full-text review and data extraction were completed by two independent reviewers. Qualitative synthesis was used to identify definitions.

RESULTS

The search yielded 1334 publications, with 49 meeting the inclusion criteria. Publications varied with respect to the age range of included young people and focused on a variety of populations, including young people with mental ill-health or with disabilities, First Nations youth and young people involved with specific services or programs. In analysing the way codesign was described, we found considerable variation, with most studies using multiple terms to refer to their methods. Common terms included coproduction (n = 21), coresearch (n = 15), participatory research (n = 10), codesign (n = 9) and participatory action research (n = 7).

CONCLUSIONS

Many different terms were used to describe codesign research with young people. Codesign was used and operationalized in a myriad of ways and overlapped with methods taken in other participatory approaches. This overlap may reflect the so-called blending of approaches in practice, highlighting the need to tailor different collaborative approaches to specific research projects, processes and participants. Ultimately, the ambiguity and overlap of terms describing collaborative methods such as codesign may matter less than the need for researchers to be transparent about their methods, their understanding of the terms and approaches they are using in research and their justification for undertaking collaborative research.

Involving adolescents in evidence syntheses: an umbrella review

BACKGROUND

Stakeholder involvement in evidence syntheses has the potential to enhance the quality and relevance of reviews. However, adolescents rarely participate in evidence synthesis, mainly because their role and influence in shaping the synthesis process relating to health outcomes are poorly understood. To fully unlock the potential of evidence syntheses for adolescent health, it is crucial to understand how adolescents can contribute at various stages of the review process and how their involvement can influence outcomes.

METHODS

To achieve this, we conducted an umbrella review examining adolescent involvement in reviews related to adolescent health research, complemented by a case study that highlights how adolescents were engaged at various stages of this review. We ran a search across 11 databases, screened reference lists and 12 journals, and consulted experts in youth involvement.

RESULTS

We found only 10 reviews which involved adolescents. In those reviews, adolescents were engaged at almost every stage of the review process, with most involvement centred around interpreting findings or co-authoring the final reports. While adolescent participation was often consultative, there were examples of more collaborative involvement using a wide range of methods, even at technical stages like study selection and data analysis. However, reviews did not report on the impacts or benefits of adolescent involvement in evidence syntheses.

CONCLUSION

To maximise the impact of adolescent involvement, we call for engagement of adolescents throughout the review process and the adoption of frameworks to ensure transparency and consistency in reporting.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021287467.

"We don't know how to talk": Adolescent meaning making and experiences of participating in research on violence in Romania, South Africa, and the Philippines

BACKGROUND

Current evidence on adolescent participation in violence research has primarily measured distress, harm or upset using quantitative methods. There are relatively few studies which have employed qualitative methods to understand adolescent emotional experiences, and to articulate the experiences of participation from their own perspective.

OBJECTIVE

This study aimed to assess adolescents' experiences of participating in research on violence in different contexts, namely Romania, South Africa, and the Philippines.

METHODS

A purposive sample of adolescents (N = 53, 51 % female) were recruited from rural, urban, and peri-urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth interviews and drawings sought adolescent perspectives on their experiences of participation, including the emotions they felt, and their perceptions of research on violence.

RESULTS

Drawing on analysis of interviews and drawings, adolescents reported a layered emotional experience, ranging from sadness, anger, apprehension, and upset, to joy, relief, and laughter. Their emotional experiences were driven by participation as a relational encounter, both with the researchers involved, as well as with other children and young people they encountered. Adolescents emphasized participation as enabling disclosure of difficult experiences, and the creation of awareness of violence.

CONCLUSIONS

Adolescent perspectives of participation in research on violence are nuanced and encompass their lived experience as well as the fundamentally relational nature of participation. Adolescents experienced increased awareness of topics in violence and perceived research participation as enabling disclosure and possible help-seeking. Measures of participation impact developed along with adolescents, which reflect this complexity, are needed.

Examining adolescents' experiences of distress when participating in research on well-being and early life adversity

RATIONALE

Most child well-being and childhood adversity research is informed by proxy informants such as parents or teachers rather than children and youth. This may be due to concerns about perceived sensitivity, challenges accessing and engaging with children in research, ethical considerations, and apprehensions about causing undue harm and distress. This study aimed to understand adolescents' identification of, and reactions to, questions in the context of participating in a survey of well-being and adversity.

OBJECTIVES

The aim of this study was to enhance our understanding of how adolescents identify and respond to potentially upsetting questions about well-being and life experiences, including childhood adversity.

METHOD

Data were from 1002 adolescent respondents aged 14 to 17 years. The Well-being and Experiences (WE) survey assessed several domains of life, including general health and well-being and early life adversity. Data were analyzed using descriptive statistics, logistic regression models, and thematic analysis approaches.

RESULTS

Few adolescent respondents reported feeling upset when completing the survey (11.2 %). Among those who reported feeling upset, 92.0 % indicated that it was still important to ask those upsetting questions, and only two respondents (1.8 %) thought upsetting questions should be removed. Ten themes emerged from the adolescents' reflections on self-reported upsetting questions, including identity and life satisfaction, motivation, mental health, and school; childhood adversity was not primarily identified.

CONCLUSIONS

Findings indicate that conducting research on well-being and childhood adversity directly with adolescents is feasible and minimally distressing. Future research should consider how to engage youth directly in research to understand better the scope and outcomes associated with childhood adversity.

Co-Authoring and Reporting on Lived Experience Engagement in Mental Health and/or Substance Research: A Qualitative Study and Guidance Document

INTRODUCTION

There is a move towards engaging people with lived experience and families (PWLE/F)-also referred to as PWLE/F engagement-in mental health and/or substance use research. However, PWLE/F engagement is inadequately reported on in mental health and/or substance use research papers.

OBJECTIVE

To understand what PWLE/F and researchers perceive are important components to report on related to engagement in mental health and/or substance use research.

METHODS

This study included a qualitative description study underpinned by pragmatism. Data were collected through virtual interviews with 13 PWLE/F and 12 researchers across Canada and analysed using template analysis. The results were used to develop a reporting guidance document for engagement in mental health and/or substance use research.

RESULTS

The results from the template analysis were structured through the following themes: (1) establishing the need for a guidance document; (2) aspects of engagement to report and reflect on; (3) guidance around co-authorship with PWLE/F; (4) practical tips for reporting on engagement and (5) considerations for journals. Participants identified a need for tailored guidance that is flexible and reflective, yet can promote transparency, accountability and learning in the field. A reporting guidance document was developed for engagement in mental health and/or substance use research that balances flexibility and standardisation while incorporating reflection into reporting. Guidance around co-authorship with PWLE/F partners was also included.

CONCLUSION

The guidance document is intended to be used as a roadmap to help guide authors to meaningfully write about engagement without the rigid boundaries of a reporting guideline. We encourage research teams that engage PWLE/F in mental health and/or substance use research to consider using the guidance document as they write up their work.

PATIENT AND PUBLIC INVOLVEMENT

PWLE/F members were engaged throughout the study from conception to manuscript production. This included a PWLE partner on the doctoral committee and a Lived Experience Advisory Group consisting of two PWLE and one family partner.

Frameworks Used to Engage Postsecondary Students in Campus Mental Health Research: A Scoping Review

BACKGROUND

There is an increasing prevalence of mental health concerns reported among postsecondary students (PSS) and growing demands for care on campuses around the world, as such there is an urgent need for research and innovations in PSS mental health that engages PSS. However, best practices and guidelines for facilitating PSS engagement in research is lacking. To address this gap, we undertook this review to explore frameworks used for engaging with PSS in research focused on PSS mental health.

METHODS

A scoping review of the academic literature was conducted. Frameworks used to engage PSS in mental health research were identified and categorized using the taxonomy of patient and public engagement by Greenhalgh et al. A list of barriers and facilitators to engaging with PSS was also identified and reported.

RESULTS

Of the articles assessed for full-text screening (n = 167), 26 journal articles were included. Frameworks used for engaging PSS in mental health research were classified into one of the three categories from Greenhalgh et al.'s taxonomy: study-focused (n = 14), partnership-focused (n = 9) and power-focused (n = 3). No relevant frameworks were found for two categories: priority- and report-focused. Seven documents reported relational or process-related barriers and/or facilitators to engaging with PSS. Based on these findings, recommendations were drafted with PSS advisors on how to implement an engagement framework in PSS mental health research.

CONCLUSIONS

We identified existing practices outlined within frameworks used to engage PSS and barriers and facilitators to engage with PSS in mental health research. Based on the review findings and PSS advisors recommendations, a need for developing a comprehensive engagement framework specific to the PSS context was identified.

PATIENT OR PUBLIC CONTRIBUTION

The research team led consultations with a PSS advisory group for this review. Student advisors were actively engaged in data analysis, which included categorizing and drafting of recommendations, and the preparation of this manuscript.

Youth patient and public involvement in health research in the Netherlands: experiences from a multi-stakeholder interview study

BACKGROUND

While patient and public involvement in health research is becoming gradually more common, there is still only limited involvement from children and adolescents. Especially in funded (health) research, youth has been found to be a hard to reach and vulnerable group. Previous literature argues that a responsive approach is needed. To obtain more insights into how such an approach can be perpetuated in funded health research projects, this study evaluated the experiences with youth involvement in health research from a multi-stakeholder perspective.

METHODS

Youth involvement was evaluated in eight projects of six subsidy programs for health research. The RE-AIM model was used as an evaluation framework. This framework is useful to evaluate interventions on multiple levels (both on an individual and setting level), which makes it very applicable to a multi-stakeholder evaluation. For the evaluation, 24 in-depth interviews with seven program managers, six committee members, ten researchers, and six youth participants were performed.

RESULTS

In the programs, approaches were used that are responsive to the context of the young participants such as a diverse, indirect and personal engagement approaches. Yet, difficulties in adapting to the needs of youth remain to exist due to the inflexible structure of the funded research process and limited time to explore diverse participation activities at multiple moments. As a result, the engagement of youth with a migration background or disability, were impeded.

CONCLUSION

To successfully implement youth patient and public involvement within funded health research, subsidy providers should allocate the necessary resources to create space for being responsive to the needs of young people.

Associations among victimization, communication, and social competence in mother-child dyads exposed to intimate partner violence

BACKGROUND

Mothers' experiences of child abuse (CA) and adulthood intimate partner violence (IPV) are linked with poorer social emotional functioning in their children.

OBJECTIVE

The current study examined direct relations between mothers' CA, mothers' adulthood IPV, and children's direct victimization on children's social competence using a cross-sectional dyadic design. The indirect effects of types of violence through open communication on children's social competence were also assessed.

PARTICIPANTS AND SETTING

Mother-child dyads (N = 162) were recruited from community organizations in the MidSouth region of the United States; all mothers (Mage = 35.24, SD = 6.70; 80.7 % Black) reported IPV exposure in the past 6 months. On average, children were 12 years old (Mage = 12.38, SD = 2.84; 59 % female) and predominantly Black (85.5 %).

METHODS

A mediated path model assessed the direct effects of mothers' CA, mothers' adulthood IPV, and children's direct victimization on children's social competence, and the indirect effects of these violence variables through open mother-child communication on social competence.

RESULTS

The path model yielded a strong fit [χ2(10) = 10.52, p = .38; RMSEA = 0.02 [CI, 0.00-0.09]; CFI = 0.99; SRMR = 0.04]. An indirect-only mediation effect was found between children's direct victimization through open mother-child communication on their social competence (β = -0.07, p = .025; 95 % CI [-0.18, -0.01]; children exposed to more direct victimization reported less open communication, which was linked to lower social competence.

CONCLUSIONS

Results demonstrate the relation between direct victimization and children's view of themselves and their relationship with their caregivers. Increasing access to family-based interventions that reduce conflict and strengthen mother-child communication could promote children's social competence following direct victimization.

Debate: Where to next for universal school-based mental health interventions? Can research led by young people shape universal solutions for mental health and suicide prevention in school settings?

We have engaged in work that aligns with the call from Birrell et al. (Child and Adolescent Mental Health, 2024), particularly in terms of thinking about co-design with young people to develop new outcomes and targets of universal school-based interventions. We engaged young people in a Cochrane systematic review and co-designed the outcomes for this review. What emerged was the need for research led by young people to develop and evaluate innovative universal school-based interventions that focus on creating environments that build and support young people's ability to cope by expressing and managing emotions. Whole-of-school approaches that ensure compassionate and caring responses can support the development of coping skills to manage distress, mental illness, self-harm and suicidal ideation.

Perspectives of Sexual and Gender Minority Youth on Anti-Vaping Messages in Social Media

INTRODUCTION

Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on anti-vaping social media messages and tailoring approaches.

AIMS AND METHODS

In-depth, qualitative videoconference interviews were conducted from February to July 2022 with 34 SGM youth recruited in the United States via social media ads. The interview guide addressed participants' beliefs about vaping, the context of vaping, perspectives on tailoring messages, and responses to examples of social media anti-vaping messages. Coding and thematic analysis followed a team-based approach.

RESULTS

SGM youth perspectives fell into four categories-representation and diversity, facts and evidence, empowering messages, and source credibility. Participants stressed the importance of accurate, genuine representation of SGM youth in messages, but also noted that more overt representation may be seen as tokenizing. Participants recommended partnering with known LGBTQ + influencers who can promote or share anti-vaping messages on social media platforms. They also recommended using culturally tailored language, including statistics specific to SGM youth, and invoking themes of empowerment to improve the relevance, reach, and effectiveness of anti-vaping campaigns.

CONCLUSIONS

Findings can inform future efforts to develop anti-vaping messages for SGM youth with effective reach through social media. Nuanced perspectives on SGM representation in messages suggest a careful approach to tailoring. Concerns around inauthenticity may be minimized by ensuring SGM youth are included in message development and dissemination.

IMPLICATIONS

This study describes the importance of being attentive to the tailoring preferences among the current generation of SGM youth. Findings will inform social media-based messaging strategies that discourage nicotine vaping tailored for SGM youth in health campaign material design and evaluation, ensuring that tailored messages are designed in ways that avoid unintended consequences. The study also describes methods for effectively engaging SGM youth in research to improve the relevance of health education materials for this population and increase reach, which in turn can lead to a reduction in vaping practices among SGM youth.

Practitioner Review: Treatments for young people who self-harm - challenges and recommendations for research and clinical practice

BACKGROUND

Self-harm is very common in young people and is associated with suicide. Rates of both self-harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self-harm.

METHOD

We significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self-harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world.

RESULTS

Currently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT-A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self-harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry-based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals.

CONCLUSIONS

Recommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT-A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural-based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self-harm in a person-centred and compassionate manner.

Giving children a voice: Concept development and foundation of the first Children's council "mental health" in Germany

Background

As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected.

Methods

Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council 'Mental Health' was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self-help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.).

Results

The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research.

Conclusions

To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6-12 years. This is associated with a child-friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.

Anything goes for participant, patient and public involvement in youth mental health research

Background

Participant and Public Involvement in youth mental health research aims at making research more responsive to the needs of youth struggling with mental health issues, their parents, and mental health professionals and other stakeholders. Do characteristics of Patient and Public Involvement (PPI) in youth mental health research align with transparency and replication prerequisites as necessary conditions for translation? Relatedly, the question is addressed whether co-authorship should be assigned to youth involved in the study.

Methods

Here we address these questions re-visiting 50 PPI studies included in two recent systematic reviews of PPI on characteristics that are pertinent to questions about transparency, replicability, translatability, and co-authorship in PPI research.

Results

Almost two-third of the studies on youth mental health incorporating PPI translate their results to policy or practice, mostly as recommendations but sometimes also by dissemination of (online) interventions. At the same time the authors of a substantial majority of the studies (70%) also suggest the need for further work on their results, for example, in randomized controlled trials to validate the outcome of their exploratory inquiry. Only a quarter of the studies using PPI met the conditions for replicability, thus a majority of the PPI studies suggest premature translation of results. Authorship to involved participants was assigned in 24% of the studies.

Conclusions

"Anything goes" for PPI in an exploratory stage to generate fruitful hypotheses. Translation of the findings of PPI studies however require a firm evidence base of replicated results. Radical merging of research and action in participatory action research seems incompatible with replicable and therefore translatable inquiry. Assigning co-authorship to PPI representatives is often at odds with current guidelines for authorship. More evidence from randomized trials on the translational impact of PPI is needed before grant foundations should require PPI in grant proposals.

A rapid realist review of literature examining Co-production in mental health services for youth

Background

An overview of internationally published literature on what works for co-production in youth mental health services is missing, despite a practice and policy context strongly recommending this approach. This rapid realist review develops a theory about how and why co-production methods in youth mental health services work, for whom and in which circumstances.

Methods

Relevant evidence was synthesised to develop Context-Mechanism-Outcome configurations (CMOs) that can inform policy and practice. Stakeholders were iteratively involved by engaging an expert panel including young people and a separate youth advisory group. Searches across eight databases and expert panel suggestions identified 5716 documents which were screened at abstract level, 532 at full-text and 57 documents were included in the review.

Results

Data extracted from 57 papers contributed to five CMO configurations to describe the generative mechanisms by which co-production in youth mental health services are linked to outcomes and influenced by context. The final programme theory is: Youth experts by experience (YEBE), particularly those from minoritised communities, provided with a supportive organisational culture can experience authentic engagement where their knowledge is perceived as credible by wider stakeholders. This leads to personal development for participating YEBE as well as service improvements from their input.

Conclusions

Rich data from a heterogenous sample of papers along with stakeholder consultation enabled this review to refine a clear programme theory for co-production in mental health services for young people. Nevertheless, further information is needed to identify what constitutes a supportive organisational culture and to explore rival theories or under-evidenced areas.

Enhancing Research Involvement of Young People With Lived Expertise: Reflecting on Experiences in Digital Mental Health Research

Given the rapid development of digital mental health technologies and a focus on connecting with youth, there is an urgent need to enhance the engagement of young people with lived expertise in research. Even so, youth with lived experience of accessing mental health services are particularly affected by power imbalances and may receive limited compensation in academic settings. Therefore, an emphasis on how research engagement not only improves the work but can benefit young people themselves is required. Here, 5 young people with lived expertise report on their experience of being employed as researchers at the University of Sydney's Brain and Mind Centre. As such, this team is uniquely placed to offer reflections from their work across multiple stages of research. This led to four key insights, including (1) creating accepting work cultures, (2) providing diverse opportunities for involvement, (3) giving young people agency and flexibility around sharing lived experiences, and (4) creating accommodating work environments for all researchers. We suggest that these insights can support more diverse ways of engaging young people and maximizing the value of participation for both researchers and young people themselves.

Youth Engagement Synergy in Mental Health Legislation and Programming

Youth engagement in implementing mental health legislation and programming is an intuitive best practice. However, well-intentioned efforts to work inclusively with youth are often perfunctory. Drawing from select community partnership models and insights from providers, public health advisors, and youth, we examine the typology, processes, and outcomes of youth engagement. We critically apply the theory of partnership synergy to understand how the convergence of youth and adult experiences and knowledge can advance mental health programming beyond what could be achieved by a single group.

Young people's perspectives on policies to create healthier food environments in England

Food environments are important determinants of healthy diets among young people. This study explored young people's perspectives on their food environment, their recommendations to policymakers and views on youth engagement in policy processes. There is limited research on young people's perspectives on their involvement in developing food environment policies. Youth engagement in policymaking processes can lead to greater policy integrity and inclusivity. Four focus group discussions were conducted with 39 young people (12-21 years) from a town in North West England and a metropolitan area in the English Midlands. Participants were recruited through youth organizations. Data were analysed using inductive thematic analysis. Young people reported concerns about the density of fast food outlets in their local area, the unaffordability of healthier food, and fast food advertisement. These issues were not believed to be prioritized in local and national policymaking. Accordingly, policy recommendations were mainly for structural food environment policies, including restrictions on fast food outlet density and incentives for menu reformulation. Young people did not feel involved in local decisions about the food environment. They expressed a need for more meaningful engagement beyond consultation. Young people have repeatedly shown to have a deep understanding of the social, commercial and political factors that influence diet and health. It is essential that policymakers aiming to improve young people's diets take their unique views and concerns into account to create effective policies that resonate with young people.

An Application of Evidence-Based Approaches to Engage Young People in the Design of a Global Mental Health Databank

INTRODUCTION

Engaging youth in mental health research and intervention design has the potential to improve their relevance and effectiveness. Frameworks like Roger Hart's ladder of participation, Shier's pathways to participation and Lundy's voice and influence model aim to balance power between youth and adults. Hart's Ladder, specifically, is underutilized in global mental health research, presenting new opportunities to examine power dynamics across various contexts. Drawing on Hart's ladder, our study examined youth engagement in mental health research across high- and middle-income countries using Internet-based technologies, evaluating youth involvement in decision-making and presenting research stages that illustrate these engagements.

METHODS

We conducted a directed content analysis of youth engagement in the study using primary data from project documents, weekly AirTable updates and discussions and interviews with youth and the research consortium. Using Hart's Ladder as a framework, we describe youth engagement along rungs throughout different research stages: cross-cutting research process, onboarding, formative research and quantitative and qualitative study designs.

RESULTS

Youth engagement in the MindKind study fluctuated between Rung 4 ('Assign, but informed') and Rung 7 ('Youth initiated and directed') on Hart's Ladder. Engagement was minimal in the early project stages as project structures and goals were defined, with some youth feeling that their experiences were underutilized and many decisions being adult-led. Communication challenges and structural constraints, like tight timelines and limited budget, hindered youth engagement in highest ladder rungs. Despite these obstacles, youth engagement increased, particularly in developing recruitment strategies and in shaping data governance models and the qualitative study design. Youth helped refine research tools and protocols, resulting in moderate to substantial engagement in the later research stages.

CONCLUSION

Our findings emphasize the value of youth-adult partnerships, which offer promise in amplifying voices and nurturing skills, leadership and inclusiveness of young people. Youth engagement in project decision-making progressed from lower to higher rungs on Hart's Ladder over time; however, this was not linear. Effective youth engagement requires dynamic strategies, transparent communication and mutual respect, shaping outcomes that authentically reflect diverse perspectives and mental health experiences.

PATIENT OR PUBLIC CONTRIBUTION

There was substantial patient and public involvement in this study. This paper reports findings on youth engagement conducted with 35 young people from India, South Africa and the United Kingdom, all of whom had lived experience of mental health challenges. Youth engagement in the MindKind study was coordinated and led by three professional youth advisors (PYAs) in these contexts, who were also young people with lived experience of mental health challenges. Each of the three study sites embedded a full-time, community-based PYA within their study team to inform all aspects of the research project, including the development of informational materials and the facilitation of Young People's Advisory Group (YPAG) sessions referenced in this paper. Each PYA also consulted with a site-specific YPAG that met bi-monthly throughout the project, shaping the formation of study materials and serving as a test group in both the quantitative and qualitative studies. Youth participants in this study also contributed extensively, engaging in data collection and manuscript writing. The following youth advisory panels members (J.B., L.B., D.O.J., M.V.) and all PYAs (E.B., S.R., R.S.) in the MindKind study contributed to the writing of this manuscript and are acknowledged as co-authors.

Benefits, barriers and recommendations for youth engagement in health research: combining evidence-based and youth perspectives

BACKGROUND

Youth engagement refers to the collaboration between researchers and youth to produce research. Youth engagement in health research has been shown to inform effective interventions aimed at improving health outcomes. However, limited evidence has identified promising practices to meaningfully engage youth. This synthesis aims to describe youth engagement approaches, frameworks, and barriers, as well as provide both evidence-based and youth-generated recommendations for meaningful engagement.

MAIN BODY

This review occurred in two stages: 1) a narrative review of existing literature on youth engagement and 2) a Youth Advisory Council (YAC) to review and supplement findings with their perspectives, experiences, and recommendations. The terms 'youth engagement' and 'health research' were searched in Google Scholar, PubMed, Web of Science, Scopus, and PsycINFO. Articles and non-peer reviewed research works related to youth engagement in health research were included, reviewed, and summarized. The YAC met with research team members and in separate youth-only forums to complement the narrative review with their perspectives. Types of youth engagement include participation as research participants, advisors, partners, and co-investigators. Barriers to youth engagement were organized into youth- (e.g., time commitments), researcher- (e.g., attitudes towards youth engagement), organizational- (e.g., inadequate infrastructure to support youth engagement), and system-level (e.g., systemic discrimination and exclusion from research). To enhance youth engagement, recommendations focus on preparing and supporting youth by offering flexible communication approaches, mentorship opportunities, diverse and inclusive recruitment, and ensuring youth understand the commitment and benefits involved.

CONCLUSIONS

To harness the potential of youth engagement, researchers need to establish an inclusive and enabling environment that fosters collaboration, trust, and valuable contributions from youth. Future research endeavors should prioritize investigating the dynamics of power-sharing between researchers and youth, assessing the impact of youth engagement on young participants, and youth-specific evaluation frameworks.

Key Challenges and Potential Strategies for Engaging Youth with Lived Experience in Clinical Science

Centering the perspectives of youth with lived experience (YWLE) in psychopathology is critical to engaging in impactful clinical research to improve youth mental health outcomes. Over the past decade there has been a greater push in clinical science to include community members, and especially community members with lived experience, in all aspects of the research process. The goal of this editorial is to highlight the need for and importance of integrating YWLE into every stage of clinical science research, from idea generation to interpretation and dissemination of research findings. We identify five key problems associated with pursuing research on adolescent mental health without involvement of YWLE and propose strategies to overcome barriers to youth engagement in clinical science research. We conclude with a call to action, providing guidance to clinical scientists, institutions, and funding agencies in conducting research on youth psychopathology with YWLE.

What Should Personalised Mental Health Support Involve? Views of Young People with Lived Experience and Professionals from Eight Countries

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Involving Young People With Lived and Living Experience of Suicide in Suicide Research

Background: Research into youth suicide prevention rarely involves young people with lived and living experiences as collaborators. Key barriers include a lack of guidelines or frameworks to inform collaboration, appropriate ethical approval processes, perceived risk, and recruitment. Aim: To develop guidelines for involving young people with lived and living experiences in suicide research as collaborators. Method: A Delphi expert consensus study was conducted with two expert panels: a youth lived and living experiences panel and a traditionally qualified researcher panel. Items rated as essential or important using a five-point Likert scale by more than 80% of both panels were included in the guidelines. Results: Forty-nine experts completed two consensus rounds. The guidelines are organized as follows: (1) preparation, (2) supporting safety and well-being, (3) evaluating involvement, and (4) tips for young people. Limitations: Participants were from English-speaking, Western countries only. Conclusion: These world-first guidelines address the unique challenges and opportunities for involving young people with lived and living experiences in suicide research.

New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey

In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.

Involvement of children and young people in the conduct of health research: A rapid umbrella review

BACKGROUND

Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research.

AIMS

This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement.

METHODS

We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis.

RESULTS

The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts-based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership.

CONCLUSION

Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated.

PATIENT/PUBLIC CONTRIBUTION

This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

Lived experience and family engagement in psychiatry research: A scoping review of reviews

BACKGROUND

A growing body of research is addressing the process and science of engaging people with lived experience (PWLE) of mental health challenges and other psychiatric conditions, and family members, in research activities.

OBJECTIVE

This scoping review of reviews synthesizes literature reviews on the engagement of PWLE and family members in research across the field of psychiatry.

METHOD

Systematic searches were conducted in seven bibliographic databases. Records were independently screened first at the title and abstract level, then at the full-text level. Included were any literature synthesis studies published in English, French, or Spanish in any given year, focusing on the engagement of PWLE and/or family members in research within psychiatry. Twenty records were included. Data were extracted in a spreadsheet and codebook thematic analysis was used across the body of articles to synthesize the findings.

RESULTS

Aspects of PWLE engagement have been synthesized in 20 review articles reviewing 376 articles across psychiatry as a whole and several subpopulations, including youth mental health, dementia, neurodevelopmental disorders, people who use drugs, and forensic mental health. Information specific to family engagement is lacking. Barriers, facilitators, and positive impacts of PWLE engagement have been widely reported across domains of research, with a considerable degree of consensus across subpopulations. Some negative impacts and reporting challenges have also been identified.

DISCUSSION

This scoping review of reviews provides an overarching understanding of the current state of the science of PWLE and family engagement across psychiatry research. The findings can inform future research practices enriched with a genuine and effective engagement with PWLE and families.

PATIENT OR PUBLIC CONTRIBUTION

The authorship team includes members with intersecting lived experience and academic identities. Additional lived experience engagement was not conducted as part of this review.

Understanding and Defining Young People's Involvement and Under-Representation in Mental Health Research: A Delphi Study

INTRODUCTION

The mental health of young people (aged 16-25 years) is a growing public health concern in the United Kingdom due to the increasing numbers of young people experiencing mental health difficulties, with many not in contact with mental health services. To design services that meet the needs of all young people, a diversity of young people must be involved in mental health research, beyond being participants. This Delphi study aimed to identify different types of 'involvement' and to define and describe 'under-representation' in young people's involvement in mental health research.

METHODS

Twenty-seven experts in young people's mental health research completed a series of online questionnaires. The experts were academic researchers, patient and public involvement (PPI) professionals and young 'experts by experience'. Round 1 generated panellists' views on 'involvement' and 'under-representation'. Round 2 summarised panellists' responses from Round 1 and sought consensus (minimum 70% agreement) in nine question areas. Round 3 validated the findings of the previous rounds.

RESULTS

Consensus was achieved in eight out of nine areas, resulting in a matrix (with definitions) of the different types of young people's involvement in mental health research, from being advisors to involvement ambassadors. The findings generated an agreed-upon definition of under-representation, an identification of when in the research process there is under-representation and the characteristics of the young people who are under-represented. Experts further agreed on demographic data that should be collected to improve reporting on involvement.

CONCLUSIONS

This study adds to our understanding of involvement and under-representation in the context of young people's mental health research through expert consensus. It provides a practical resource for researchers considering involving young people in the research process and suggests the data that should be collected to improve reporting on the diversity of the young people involved.

PATIENT AND PUBLIC CONTRIBUTION

A research oversight group of five young people advised on this study. They contributed throughout the project-from endorsing the research question to commenting on the findings and dissemination. Two of the group reviewed all participant materials and piloted the initial questionnaire.

Mental Health Among Elite Youth Athletes: A Narrative Overview to Advance Research and Practice

CONTEXT

Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs).

EVIDENCE ACQUISITION

A narrative overview of the literature combined with the clinical and research expertise of the authors.

STUDY DESIGN

Narrative overview.

LEVEL OF EVIDENCE

Level 5.

RESULTS

EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility.

CONCLUSION

A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes "youth" and "elite" in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport.

SORT

Level C.

Through the looking glass: empowering youth community advisory boards in Tanzania as a sustainable youth engagement model to inform policy and practice

More young people are living in the world than ever before, 90% of whom reside in low and middle income countries (LMICs). To address their needs, it is critical to have sustainable youth engagement when determining policy and to advance effective implementation of youth-focused interventions. Youth Community Advisory Boards (CABs) are a sustainable mechanism to achieve this goal. This paper describes engagement with youth CAB members across four locations in Tanzania. To set youth CAB meeting agendas and priorities, we asked youth CAB members to write (using free text) the top five challenges faced by young people in their communities (highest to lower priority). The Google Forms survey link was presented at the May 2023 youth CAB meeting and disseminated through WhatsApp. The survey was completed by smartphone, tablet, or paper provided to the youth liaison for data entry. Results were translated from Swahili to English and coded using excel. Findings were then presented back to the youth CABs at the September 2023 meeting. At that meeting, youth CAB members were then asked to write (free text) potential solutions to the most commonly described challenges. The surveys had response rates of 90% (84/93) for challenges and 78% (71/93) for solutions. The number one reported challenge was unemployment and financial instability (45%). Gender based violence (13%), sexual reproductive health issues (8%), and alcohol and drug use (8%) were in the top four both by priority and frequency of report. Other important challenges included physical and mental health, malnutrition, relationships, education, and societal and environmental norms, among others. Solutions included job creation, improved education, expanded legal systems, youth-friendly health care services, and increased social support through peer networks and community support. The National Accelerated Action and Investment Agenda for Adolescent Health and Wellbeing (NAIA-AHW) 2021/22-2024/25 includes most, but not all, of these top challenges and solutions. Ensuring young people have a seat at the policy table is critical to effective youth-empowerment in health and other related programs. Including a youth CAB member to represent this collective in youth-related government activities is a sustainable model to achieve this goal.

Discussing the gaps in the science and practice of lived experience engagement in mental health and substance use research: results of knowledge mobilization activities

BACKGROUND

Engaging people with lived experience of mental health or substance use challenges and family members (PWLE) improves the quality and relevance of the associated research, but it can be challenging to include them meaningfully and authentically in the work.

KNOWLEDGE MOBILIZATION EVENTS

After reviewing the literature on the science of lived experience engagement, we held two knowledge mobilization events to translate the findings to relevant partners and collect their feedback to guide our future research. A total of 55 people attended, bringing the perspective of people with lived experience, family members, research staff, research trainees, and scientists, as well as attendees holding multiple roles. We presented the scoping review findings, then held discussions to solicit feedback and encourage the sharing of perspectives.

ATTENDEE PERSPECTIVES

Through small and large group discussion activities, we found that our scoping review findings resonated with the attendees' personal experiences with engagement in mental health and substance use research. Among the gaps highlighted in the discussions, the two that were most emphasized were the critical importance of improving diversity in engagement work in mental health and substance use, and the importance of addressing gaps around communication, relationships, rapport, and power dynamics in engagement spaces.

CONCLUSIONS

Diversity, communication, relationships, and power dynamics emerge as key areas of work needed in the near future to advance the science of PWLE engagement in mental health and substance use research. We commit to pursuing the work that is considered of greatest need by a range of partners this research engagement sphere. We call on researchers in this area to continue this line of work, with a focus on the areas of research identified by attendees.

An umbrella review of reviews on challenges to meaningful adolescent involvement in health research

BACKGROUND

Less than 1% of studies on child and adolescent health report the involvement of adolescents in health research. This is attributed to barriers experienced by researchers and adolescents in the engagement process. To address this under-involvement of adolescents, we first need a better understanding of the factors that hinder adolescent involvement in health research.

OBJECTIVE

We conducted an umbrella review of reviews to consolidate the review-level evidence on the barriers to meaningful involvement of adolescents in health research.

METHODS

We preregistered this umbrella review of reviews with PROSPERO (CRD42021287467). We searched 11 databases; Google Scholar; and PROSPERO; supplemented by a hand search of the reference lists of eligible reviews, relevant journals, websites of 472 organisations, and input from experts. This resulted in the inclusion of 99 review articles exploring adolescent involvement in studies on adolescent physical or mental health, which were narratively synthesised. Adolescent coresearchers were engaged at all stages of the review.

RESULTS

We found that adolescent involvement in health research is impeded by several challenges experienced by researchers and adolescents. Some challenges experienced by researchers were organisational issues which included limited resources, gatekeeping and paying adolescents. Some barriers were related to a lack of preparedness among researchers and included a lack of awareness of adolescent involvement, the need for training and guidance, and negative attitudes towards participatory research. There were also barriers around how adolescents can be involved, such as researchers finding it challenging to adapt to new methods, issues with recruitment and retention of adolescents, inclusiveness and accessibility. There were also challenges specific to adolescents, such as adolescents' skills and expertise, training, motivations and study goals. Finally, barriers related to the ethical involvement of adolescents included issues with power dynamics, confidentiality, safety and protection of adolescents. Some of the barriers reported by adolescents included tokenistic involvement, inaccessibility of adolescent involvement, and their competing demands.

CONCLUSION

Researchers may find this review useful in understanding and planning for potential challenges of involving adolescents in research. Despite many identified barriers to adolescent engagement, few mitigation strategies were identified to address these barriers. There is a clear need to establish best practices for meaningful adolescent involvement in health research.

PUBLIC AND PATIENT INVOLVEMENT IN THE REVIEW

Adolescents were involved at multiple stages of this umbrella review of reviews. They reviewed the protocol, screened 25% of the articles at title and abstract screening stage, screened 10% of full-text articles, and worked on data analysis. They also helped plan and conduct a participatory workshop with an adolescent advisory group to discuss the challenges experienced by adolescents in health research.

Ameliorating epistemic injustice in practice: Communication strategies in a research project with refugee youth coresearchers

INTRODUCTION

Many researchers want to include seldom involved groups, such as refugees and youth, in patient and public involvement (PPI), but experience a number of barriers. The PPI research community calls for critical evaluations that are prospective, data-based and conducted by researchers and public contributors together. In this study, we conducted a longitudinal evaluation of a core activity in all collaborations: communication strategies. The aim was to evaluate the communication strategies adopted throughout a research project with refugee youth coresearchers.

METHODS

This article is based on the evaluation of a project where refugee youth were involved in the online adaptation of a group-based programme for youth with posttraumatic stress. Behavioural observations and field notes collected during the project were analysed with qualitative content analysis and a readability index, and discussed through the lens of epistemic injustice. The article was cowritten by researchers and refugee youth.

FINDINGS

Four manifest categories were identified: Facilitating engagement through coplanning and circumstantial flexibility; Different needs require different channels; It's not just about the channel-facilitation skills matter; Finding a common language opens a communicative flow. In addition, a latent underlying theme reflecting the role of trust was identified: Interactive moments facilitate trust-trust facilitates richer involvement.

CONCLUSION

At the core of the identified communication strategies were strengthening relationship-building and actively facilitating involvement. Establishing trusting relationships enabled refugee youth to share input. The communication strategies increased hermeneutical justice by contributing to a common understanding; thus, taking a step towards ameliorating epistemic injustice.

PATIENT OR PUBLIC CONTRIBUTION

This article is a participatory analysis of a PPI process; it was written in collaboration between researchers and refugee youth coauthors, who were all previously involved in the evaluated project.

A systematic review of theories, models and frameworks used for youth engagement in health research

BACKGROUND

Youth engagement in research, wherein youth are involved in the research beyond mere participation as human subjects, is growing and becoming more popular as an approach to research. However, systematic and deliberate theory-building has been limited. We conducted a systematic review to identify and synthesize theories, models and frameworks that have been applied in the engagement of youth in health research, including mental health.

METHODS

Six academic databases (MEDLINE, PsycINFO, Embase, PubMed, Scopus, CINAHL) and the grey literature were searched for relevant studies. Citation tracking was conducted through ancestry and descendancy searches. The final search was completed on 7 February 2023. Findings were summarized in a narrative synthesis informed by principles of hermeneutic analysis and interpretation. Reporting of results is in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 Statement.

RESULTS

Of the 1156 records identified, 16 papers were included, from which we extracted named theories (n = 6), implicit theories (n = 5) and models and frameworks (n = 20) used for youth engagement in health research. We identified theories that were explicitly stated and surfaced theories that were more implicitly suggested. Models and frameworks were organized into four categories based on their principal features: power-focused (n = 8), process-focused (n = 7), impact-focused (n = 3) and equity-focused (n = 2). Few frameworks (n = 5) were empirically tested in health-related research.

CONCLUSIONS

The state of theoretical development in youth engagement in research is still evolving. In this systematic review, we identified theories, models and frameworks used for youth engagement in health research. Findings from this systematic review offer a range of resources to those who seek to develop and strengthen youth engagement in their own research.

PATIENT OR PUBLIC CONTRIBUTION

Youth engaged as patients in the research were not involved in planning or conducting the systematic review. However, youth researchers in their early to mid-20s led the planning, implementation and interpretation of the review. As part of subsequent work, we formed a youth advisory board to develop a youth-led knowledge mobilization intended for an audience of youth with lived experience of being engaged as patients in research.

Protocol Development for a Qualitative Methodological Study Within a Trial (Qual-SWAT): The KARMA-Dep-2 Trial

Background

Despite methodological improvements in clinical trial design and conduct more generally, methodological limitations persist in trials concerning mental health care. A qualitative Study Within A Trial (Qual-SWAT), embedded in the KARMA-Dep-2 host trial, will be undertaken to explore and gain an understanding of two methodological questions in randomised trials specific to mental health care: (1) what are the key barriers and enablers of participation in randomised trials in mental health; and (2) how can randomised trials become part of routine mental health care. These issues will be examined from patient-participant and clinician- / researcher-participant perspectives, in alignment with PRioRiTy research themes.

Methods

A descriptive qualitative study design will be used. Data will be collected via one-to-one semi-structured interviews, conducted via Microsoft Teams. The interview data will be analysed using Braun and Clarke's Thematic Analysis approach. One-to-one interviews will be conducted with three participant groups ( N = 30): 1) host trial patient-participants ( n = 10); 2) potentially eligible host trial patient-participants who refused enrolment in the host trial ( n = 10); and 3) clinician- / researcher-participants who are associated with work on the host trial ( n = 10).

Ethics and dissemination

Ethical approval has been granted by St. Patrick's Mental Health Services Research Ethics Committee, Ireland (Ref: Protocol 09/20). When the study is completed, a report will be prepared and submitted to the Health Research Board (HRB). Findings will be shared with the host trial team and study participants, and submitted for publication.

Host trial registration

ClinicalTrials.gov ( NCT04939649); EudraCT ( 2019-003109-92). Official title: Ketamine as an Adjunctive Therapy for Major Depression - A Randomised Controlled Trial: [KARMA-Dep (2)].

Protocol Development for a Qualitative Methodological Study Within a Trial (Qual-SWAT): The KARMA-Dep-2 Trial

Background

Despite methodological improvements in clinical trial design and conduct more generally, methodological limitations persist in trials concerning mental health care. A qualitative Study Within A Trial (Qual-SWAT), embedded in the KARMA-Dep-2 host trial, will be undertaken to explore and gain an understanding of two methodological questions in randomised trials specific to mental health care: (1) what are the key barriers and enablers of participation in randomised trials in mental health; and (2) how can randomised trials become part of routine mental health care. These issues will be examined from patient-participant and clinician- / researcher-participant perspectives, in alignment with PRioRiTy research themes.

Methods

A descriptive qualitative study design will be used. Data will be collected via one-to-one semi-structured interviews, conducted via Microsoft Teams. The interview data will be analysed using Braun and Clarke's Thematic Analysis approach. One-to-one interviews will be conducted with three participant groups ( N = 30): 1) host trial patient-participants ( n = 10); 2) potentially eligible host trial patient-participants who refused enrolment in the host trial ( n = 10); and 3) clinician- / researcher-participants who are associated with work on the host trial ( n = 10).

Ethics and dissemination

Ethical approval has been granted by St. Patrick's Mental Health Services Research Ethics Committee, Ireland (Ref: Protocol 09/20). When the study is completed, a report will be prepared and submitted to the Health Research Board (HRB). Findings will be shared with the host trial team and study participants, and submitted for publication.

Host trial registration

ClinicalTrials.gov ( NCT04939649); EudraCT ( 2019-003109-92). Official title: Ketamine as an Adjunctive Therapy for Major Depression - A Randomised Controlled Trial: [KARMA-Dep (2)].

Kailo: a systemic approach to addressing the social determinants of young people's mental health and wellbeing at the local level

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

Lived experience adaptation of a psychosocial intervention for young adults with bipolar spectrum disorders: Process description and adaptation outcomes

AIM

Lived experience adaptation of mental health interventions can help ensure that the intervention is appropriate for the target population. This paper describes a youth-led adaptation of a self-stigma reduction intervention for young adults with bipolar spectrum disorders, that is, Narrative Enhancement and Cognitive Therapy.

METHODS

Standard guidelines for youth engagement were followed. A youth lived experience adaptation lead and a five-member youth lived experience advisory panel reviewed the intervention and made a number of adaptations to increase its relevance for young people with bipolar disorders. A brief evaluation of the engagement process was conducted.

RESULTS

The primary adaptations made to the intervention fell into five areas: (1) wording revisions for recovery-oriented language accessible to youth with a wide variety of language and literacy levels; (2) updating and tailoring to the diagnostic category, with the addition of new quotes describing the lived experience of stigma; (3) integration of a new, engaging graphic design; (4) development of a goal-setting module, as recommended by the research team; and (5) identification of the role of a peer co-facilitator. An evaluation of the engagement process showed that the engagement was extremely meaningful for the youth engaged.

CONCLUSIONS

Using a youth lived experience adaptation process, young people can make relevant, important changes to a psychosocial intervention. The resulting early intervention materials are research-ready and are hypothesized to meet the needs of young people with BD in a youth-friendly manner. Research on the acceptability, efficacy, and effectiveness of the newly adapted intervention will be required.

Mental health and wellbeing outcomes of youth participation: A scoping review protocol

There is growing recognition that young people should be given opportunities to participate in the decisions that affect their lives, such as advisory groups, representative councils, advocacy or activism. Positive youth development theory and sociopolitical development theory propose pathways through which youth participation can influence mental health and wellbeing outcomes. However, there is limited empirical research synthesising the impact of participation on youth mental health and/or wellbeing, or the characteristics of activities that are associated with better or worse mental health and/or wellbeing outcomes. This scoping review seeks to address this gap by investigating the scope and nature of evidence detailing how youth participation initiatives can influence mental health and/or wellbeing outcomes for participants. To be eligible, literature must describe youth (aged 15-24) in participation activities and the impact of this engagement on participant mental health and/or wellbeing outcomes. A systematic scoping review of peer-reviewed and grey literature will be conducted using Scopus, PsycINFO, Embase, Medline and grey literature databases. The scoping review will apply established methodology by Arksey and O'Malley, Levac and colleagues and the Joanna Briggs Institute. Title, abstract, and full text screening will be completed by two reviewers, data will be extracted by one reviewer. Findings will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), including a qualitative summary of the characteristics of youth participation and their influence on youth mental health outcomes. Youth advisory group members will be invited to deliver governance on the project from the outset; participate in, and contribute to, all stages of the review process; reflect on their own experiences of participation; and co-author the resulting publication. This scoping review will provide essential knowledge on how participation activities can be better designed to maximise beneficial psychosocial outcomes for involved youth.

'Just because we're younger doesn't mean our opinions should be any less valued': A qualitative study of youth perspectives on a Youth Advisory Council in a mental healthcare context

INTRODUCTION

Recognition of the importance of youth engagement in youth mental health and/or addiction (MHA) service design and delivery is increasing. Youth Advisory Councils embedded in MHA organizations represent one strategy that allows youth to be involved in MHA at the individual, organization and systemic levels. This level of involvement can facilitate positive outcomes for both the youth and the organization. As these councils become more common, it is important that organizations are prepared to partner with the participating youth. This study uses a descriptive qualitative approach to understand the motivations and expectations of youth with lived experience with MHA concerns who were beginning to work on a Youth Advisory Council in an MHA setting in the Greater Toronto Area.

METHODS

Semistructured interviews were conducted with each youth, ages 16-26, on the advisory council (N = 8) to understand their motivations, expectations and goals coming into the work. Interviews were transcribed verbatim and analysed using a reflexive thematic analysis.

RESULTS

Analysis resulted in five overarching themes: providing opportunities for youth learning and growth, platforming youth, empowering youth, embracing youth leadership and promoting youth-driven change. The findings illustrate that these youth came into the Youth Advisory Council motivated to create positive change in the mental health system, take on leadership roles and had high expectations for organizational support. Our analyses provide insight for organizations planning and implementing Youth Advisory Councils in the MHA sector with the goal of best supporting youth in driving positive change across the system.

CONCLUSION

Youth want to be provided authentic opportunities for their engagement to make a difference. MHA organizations must embrace youth leadership and move towards listening to youth experience and acting on youth recommendations to enhance service design and implementation to improve access and to better meet the needs of youth utilizing these services.

PATIENT OR PUBLIC CONTRIBUTIONS

This study incorporated service users, including youth ages 16-26 with lived experience of MHA concerns who served on the Youth Advisory Council at the Family Navigation Project, Sunnybrook. Youth Advisory Council members contributed to two relevant research activities: (1) youth reviewed the draft interview guide before data collection, and their feedback was prioritized in the final version and (2) youth contributed to knowledge translation through contributing to academic conference presentations.

Whole Person Modeling: a transdisciplinary approach to mental health research

The growing global burden of mental illness has prompted calls for innovative research strategies. Theoretical models of mental health include complex contributions of biological, psychosocial, experiential, and other environmental influences. Accordingly, neuropsychiatric research has self-organized into largely isolated disciplines working to decode each individual contribution. However, research directly modeling objective biological measurements in combination with cognitive, psychological, demographic, or other environmental measurements is only now beginning to proliferate. This review aims to (1) to describe the landscape of modern mental health research and current movement towards integrative study, (2) to provide a concrete framework for quantitative integrative research, which we call Whole Person Modeling, (3) to explore existing and emerging techniques and methods used in Whole Person Modeling, and (4) to discuss our observations about the scarcity, potential value, and untested aspects of highly transdisciplinary research in general. Whole Person Modeling studies have the potential to provide a better understanding of multilevel phenomena, deliver more accurate diagnostic and prognostic tests to aid in clinical decision making, and test long standing theoretical models of mental illness. Some current barriers to progress include challenges with interdisciplinary communication and collaboration, systemic cultural barriers to transdisciplinary career paths, technical challenges in model specification, bias, and data harmonization, and gaps in transdisciplinary educational programs. We hope to ease anxiety in the field surrounding the often mysterious and intimidating world of transdisciplinary, data-driven mental health research and provide a useful orientation for students or highly specialized researchers who are new to this area.

"I literally had no support": barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

BACKGROUND

There has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people's (10-25 years) and carers' experiences of mental health services, focusing on barriers and facilitators to services supporting young people's psychosocial functioning.

METHODS

This study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10-25 years with experience of mental illness, and 29 carers (n = 12 parent-child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level.

RESULTS

Young people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people's psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments.

CONCLUSIONS

This study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.

International youth mental health case study of peer researchers' experiences

BACKGROUND

The involvement of young people as peer researchers, especially with lived experience, is increasingly considered important in youth mental health research. Yet, there is variation in the understanding of the role, and limited evidence on its implementation across different research systems. This case study focusses on the barriers and enablers of implementing peer researcher roles within and across majority world countries contexts.

METHODS

Based on an international youth mental health project involving different levels of peer researchers and participants from eight countries, peer researchers and a co-ordinating career researcher reflect on lessons regarding enabling and challenging factors. These reflections are captured and integrated by a systematic insight analysis process.

RESULTS

Building on existing international networks, it was feasible to actively involve peer researchers with lived experience in a multi-country mental health study, who in turn recruited and engaged young participants. Identified challenges include the terminology and definition of the role, cultural differences in mental health concepts, and consistency across countries and sites.

DISCUSSION

Peer researchers' role could be strengthened and mainstreamed in the future through ongoing international networks, training, sufficient planning, and active influence throughout the research process.

TRIAL REGISTRATION

Not applicable.

Research evidence and implementation gaps in the engagement of people with lived experience in mental health and substance use research: a scoping review

BACKGROUND

There is growing recognition that engaging people with lived experience (PWLE) in mental health and substance use research improves the quality of the research in terms of relevance to the population and the feasibility of the work. Engagement also provides positive opportunities for research teams and the PWLE engaged. However, there are many gaps in the research on PWLE engagement. This scoping review synthesizes the gaps in the implementation of PWLE engagement and in the research on engagement as presented by research teams engaging PWLE in their work.

METHOD

A systematic electronic database search was conducted in 2022 for published articles on PWLE engagement in mental health and substance use research. Potential articles were screened for relevance. The search led to 49 final articles included in the review. The 49 articles were then coded using codebook thematic analysis to answer two research questions: (1) What are the research evidence gaps regarding the engagement of PWLE in mental health and substance use research?; and (2) What are the gaps in implementing PWLE engagement in mental health and substance use research? PWLE were engaged in the conduct of this review.

RESULTS

Results showed that research evidence gaps include further work on conceptualizing engagement; developing resources, tools, and practice recommendations to support research teams; increasing diversity in evaluations of engagement; and evaluating engagement, including its impact on the research, on PWLE, and on researchers. Implementation gaps included several broader institutional gaps and gaps in the day-to-day practice of engagement.

CONCLUSIONS

Despite progress in PWLE engagement in mental health and substance use research in recent years, research evidence and implementation gaps remain. Research teams are encouraged to consider these gaps and conduct research and implementation activities to address them in a rigorous manner.

Youth engagement in research and policy: The CO-CREATE framework to optimize power balance and mitigate risks of conflicts of interest

Including youth in the co-creation of policies that affect them has proven to be particularly impactful in public health. Using youth participatory action research methods, the CO-CREATE project engages European youth 16-18 years old in the co-creation of obesity prevention policies. To discuss the feasibility and implications of the policy, youth are invited to engage in an intergenerational dialogue. Given the youth-adult dynamic and policy discussion, conflicts of interests (COIs) can arise and impact the quality of the dialogue. COI frameworks are a tool that can help identify, mitigate, and address COIs. This paper presents a novel framework to mitigate COIs in intergenerational policy dialogues, with a focus on power imbalance. Following a series of youth consultations, interviews, and examination of existing frameworks, our findings suggest that safe, participatory, and empowering dialogues can take place if appropriate measures are integrated into all phases of a dialogue. The selection of stakeholders, use of accessible language, and youth moderation are all factors that can impact COI risks. Measures that promote mutual empowerment, such as equal representation of youth and adults, were deemed important. This framework provides a roadmap to ensure that youth participation in the formulation of policies is safe and empowering.