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Mori Y, Sourander A, Mishina K, Ståhlberg T, Klomek AB, Kolaitis G, Kaneko H, Li L, Huong MN, Praharaj SK, Kyrrestad H, Lempinen L, Heinonen E. Unmet need for mental health care among adolescents in Asia and Europe. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02472-0. [PMID: 38819661 DOI: 10.1007/s00787-024-02472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13-15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1-2% of those in middle-income countries and 6-25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries.
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Affiliation(s)
- Yuko Mori
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland.
- INVEST Research Flagship Center, University of Turku, Turku, Finland.
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland.
| | - Kaisa Mishina
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Tiia Ståhlberg
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Hitoshi Kaneko
- Psychological Support and Research Center for Human Development, Nagoya University, Nagoya, Japan
| | - Liping Li
- School of Public Health, Shantou University Medical College, Shantou, China
| | - Mai Nguyen Huong
- Department of Psychiatry, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, India
- Manipal Academy of Higher Education, Manipal, India
| | - Henriette Kyrrestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lotta Lempinen
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Emmi Heinonen
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, Turku, 20014, Finland
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Wei Y, Sha L, McWeeny R, Johal R, Easton C, Baxter A, Cao B, Greenshaw A, Carr W. Evaluating the effectiveness of a school-based mental health literacy intervention from a comprehensive demographic and social-cognitive perspective. Sci Rep 2024; 14:5901. [PMID: 38467742 PMCID: PMC10928151 DOI: 10.1038/s41598-024-56682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/09/2024] [Indexed: 03/13/2024] Open
Abstract
Childhood and adolescence are a critical period for the onset of mental and neurodevelopmental disorders and a time when many can be first identified. Research demonstrates that mental health literacy applied in school settings may be an effective approach to address these challenges. In contrast to many existing studies conducted in multicultural and multilingual settings that treated subjects' language as a demographic feature, the present study recognizes English proficiency as a social-cognitive factor and views the school-based mental health literacy (MHL) intervention as a learning process. The present study aimed to assess the effectiveness of school-based mental health literacy intervention and explore how ethnicity and English proficiency as a social-cognitive factor, as a modified, rather than a fixed variable, impacted the intervention outcomes. Grade 9 students (n = 240) from schools in West Canada with diverse social/cultural background received the intervention in the classroom delivered by trained teachers and completed the pre-test and post-test over a 6-month period. The intervention was effective in improving knowledge and help-seeking attitudes among all students. Non-Chinese and native English-speaking students performed the best on all outcomes. Gender demonstrated an association with changes in stigma, stress and wellbeing. English proficiency was linked to knowledge acquisition, while ethnicity was connected to changes of attitude-related outcomes. These findings deepened our understanding of how demographic and social-cognitive factors underlie changes in mental health literacy outcomes, which will facilitate the development of mental health literacy interventions for diverse student populations.
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Affiliation(s)
- Yifeng Wei
- Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
| | - Li Sha
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Robert McWeeny
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Rav Johal
- Richmond School District No. 38, Richmond, BC, Canada
| | | | | | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Wendy Carr
- Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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Yeo G, Reich SM, Liaw NA, Chia EYM. The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e51268. [PMID: 38421687 PMCID: PMC10941000 DOI: 10.2196/51268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/25/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. OBJECTIVE This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. METHODS We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. RESULTS Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. CONCLUSIONS For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.
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Affiliation(s)
- GeckHong Yeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Stephanie M Reich
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Nicole A Liaw
- SHINE Children and Youth Services, Singapore, Singapore, Singapore
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Qian L, McWeeny R, Shinkaruk C, Baxter A, Cao B, Greenshaw A, Silverstone P, Pazderka H, Wei Y. Child and youth mental health and wellbeing before and after returning to in-person learning in secondary schools in the context of COVID-19. Front Public Health 2023; 11:1212297. [PMID: 37727609 PMCID: PMC10506407 DOI: 10.3389/fpubh.2023.1212297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
Background As children reintegrate with in-person classroom learning after COVID-19, health and education institutions should remain mindful of students' mental health. There is a paucity of data on changes in students' mental health before, during and after their return to in-person classroom learning. Methods We collected and analyzed data on self-reported wellbeing, general mental health, perceived stress, and help-seeking attitudes from grade 7-12 students in a Catholic school division in Canada (n = 258 at baseline; n = 132 at follow-up). Outcomes were compared according to demographic differences such as gender, grade level, experience accessing mental health services, and presence of support staff between baseline and follow-up. Effects of time points and each demographic variable on each outcome and on the prediction of students' mental health were also analyzed. Results No significant differences were apparent for outcomes between baseline and follow-up. However, specific subgroups: junior high students, male students, students who had not accessed mental health services, and students who had access to support-staff had better outcomes than their counterparts. From baseline to follow-up, male students reported mental health decline [Mean = 11.79, SD = 6.14; Mean = 16.29, SD = 7.47, F(1, 333) = 8.36, p < 0.01]; students who had not accessed mental health services demonstrated greater stress [Mean = 20.89, SD = 4.09; Mean = 22.28, SD = 2.24, F(1, 352) = 6.20, p < 0.05]; students who did not specify a binary gender reported improved general mental health [Mean = 19.87, SD = 5.89; Mean = 13.00, SD = 7.40, F(1, 333) = 8.70, p < 0.01], and students who did not have access to support-staff improved help-seeking attitudes [Mean = 22.32, SD = 4.62; Mean = 24.76, SD = 4.81; F(1, 346) = 5.80, p < 0.05]. At each time point, students indicated parents, guardians, and close friends as their most-preferred help-seeking sources. High stress predicted lower wellbeing at baseline, but higher wellbeing at follow-up. Conclusion Students presented stable mental health. Subgroups with decreased mental health may benefit from extra mental health support through building capacity among teachers and health care professionals to support students following public health emergencies.
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Affiliation(s)
- Lei Qian
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Robert McWeeny
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Andrew Baxter
- Alberta Health Services Calgary Zone, Calgary, AB, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Andy Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Peter Silverstone
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Hannah Pazderka
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Williams H, Steinberg S, Vingum R, Leon K, Céspedes E, Berzin R, Hagg H. Parsley Health: Feasibility and acceptability of a large-scale holistic telehealth program for chronic disease care. Front Digit Health 2023; 5:1008574. [PMID: 37006822 PMCID: PMC10057965 DOI: 10.3389/fdgth.2023.1008574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/04/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundA holistic, personalized approach to medicine can be used to prevent and manage a variety of chronic diseases. However, effectively managing chronic diseases can be difficult due to barriers related to insufficient provider time, staffing, and lack of patient engagement. To address these challenges telehealth strategies are being increasingly adopted, yet few studies have explored how to evaluate the feasibility and implementation success of large-scale holistic telehealth models for chronic disease care. The aim of this study is to assess the feasibility and acceptability of a large-scale holistic telehealth program for the management of chronic diseases. Our study findings can inform the future development and assessment of chronic disease programs delivered through telehealth strategies.MethodsData was collected from participants enrolled in a Parsley Health membership from June 1, 2021 to June 1, 2022, a subscription-based holistic medicine practice designed to help people prevent or manage chronic diseases. Implementation outcome frameworks were used to understand engagement with services, participant satisfaction, and preliminary effectiveness of the program via a patient-reported symptom severity tool.ResultsData from 10,205 participants with a range of chronic diseases were included in our analysis. Participants averaged 4.8 visits with their clinical team and reported high levels of satisfaction with their care (average NPS score of 81.35%). Preliminary evidence also showed substantial reduction in patient reported symptom severity.ConclusionOur findings suggest the Parsley Health program is a feasible and acceptable large-scale holistic telehealth program for chronic disease care. Successful implementation was due, in part, to services that promoted participant engagement along with tools and interfaces that were helpful and easy to use. These findings can be used to develop future holistic-focused telehealth programs for the management and prevention of chronic diseases.
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Affiliation(s)
- Hants Williams
- School of Health Professions, Stony Brook University, Stony Brook, NY, United States
- Parsley Health, New York, NY, United States
- Correspondence: Hants Williams
| | | | - Ryan Vingum
- Untold Content, Cincinnati, OH, United States
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Tariku Seboka B, Hailegebreal S, Negash M, Mamo TT, Ali Ewune H, Gilano G, Yehualashet DE, Gizachew G, Demeke AD, Worku A, Endashaw H, Kassawe C, Amede ES, Kassa R, Tesfa GA. Predictors of Mental Health Literacy and Information Seeking Behavior Toward Mental Health Among University Students in Resource-Limited Settings. Int J Gen Med 2022; 15:8159-8172. [PMID: 36389023 PMCID: PMC9664927 DOI: 10.2147/ijgm.s377791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/03/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This paper investigated mental health literacy level and information seeking behavior, and mental health-related information sources in limited-resource settings, in the case of Ethiopian university students. METHODS A cross-sectional, self-administered web-based survey was conducted among Dilla University students, from 1 January to 29 February 2022, with a total of 780 respondents. We presented descriptive statistics using mean, standard deviations, and proportions. Bivariate and multivariate logistic regression were employed to identify factors associated with mental health literacy and information seeking behavior of students. Further, path analysis was also employed. RESULTS The result showed 71 (9.1%) respondents had a diagnosed history of mental illness. Overall, 397 (50.9%) respondents were identified as having adequate mental health literacy and 420 (53.8%) sought mental health information. In multivariate analysis, mental health literacy was significantly associated with: being female (AOR = 2.8; 95% CI (1.5-5.4)), higher digital health literacy (AOR=2.8; 95% CI (1.5-5.4), seeking mental health-related information (AOR=1.6; 95% CI: (1.1-2.5)), having family with mental illness, and students in health-related programs (AOR = 2.1; 95% CI (1.0-4.2)). Furthermore, health-related programs, level of mental health literacy, exposure to mental health problems in the family, and were associated with information seeking behavior regarding mental health. Further, path analysis revealed significant positive associations of information seeking behavior and digital health literacy with mental health literacy. CONCLUSION The result indicated the status of university students' mental health literacy level and information seeking behavior were low and inadequate. This study suggests the need to improve students' digital health competencies by designing mental health literacy programs by collaboration of different stakeholders, and mental health literacy programs need to optimize access to internet and online resources in the university settings.
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Affiliation(s)
| | | | - Misrak Negash
- Department of Psychiatry, Dilla University, Dilla, Ethiopia
| | | | | | - Girma Gilano
- Department of Health Informatics, Arbaminch University, Arbaminch, Ethiopia
| | | | | | | | - Aynadis Worku
- Department of Health Informatics, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | - Reta Kassa
- School of Public Health, Dilla University, Dilla, Ethiopia
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Kurki M, Gilbert S, Mishina K, Lempinen L, Luntamo T, Hinkka-Yli-Salomäki S, Sinokki A, Upadhyaya S, Wei Y, Sourander A. Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study. BMC MEDICAL EDUCATION 2021; 21:563. [PMID: 34742258 PMCID: PMC8571980 DOI: 10.1186/s12909-021-02990-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities. METHODOLOGY This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation. RESULTS The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (P<.001), but these changes were not maintained at the two-month follow up. The stigma of mental illness did not change during the study (P=.13). CONCLUSIONS The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic. TRIAL REGISTRATION The trial was registered at the ISRCTN registry (26 May 2021), registration number 10.1186/ ISRCTN10565335 ).
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Affiliation(s)
- Marjo Kurki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland.
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland.
- ITLA Children's Foundation, Porkkalankatu 24, 00180, Helsinki, Finland.
| | - Sonja Gilbert
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, FI-20014, Turku, Finland
| | - Lotta Lempinen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Terhi Luntamo
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Subina Upadhyaya
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Yifeng Wei
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
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