The role of parents in the care for adolescents suffering from emotional and behavioral problems

Parental involvement in school-based mental health interventions for young people in low-resource settings: A qualitative study from Zimbabwe and Ghana

BACKGROUND

Young people in low-resource settings are disproportionately affected by mental health problems, yet access to formal mental healthcare remains limited. However, schools in these regions have increasingly become the primary settings for mental health interventions, offering an accessible and supportive environment for mental health services. Recognising the critical role schools play in providing mental health services for young people, there has been a growing emphasis on involving parents in school-based mental health (SBMH) interventions in low-resource settings. This study explored the mechanisms for effectively involving parents in SBMH interventions for young people in Zimbabwe and Ghana.

METHODS

Cross-sectional qualitative research was conducted in Harare, Zimbabwe and Navrongo, Ghana. This study is a sub-analysis of a larger formative qualitative study which aimed to identify evidence for adapting interventions for depression and anxiety for young people aged 15-24 in Zimbabwe, and 15-18 in Ghana, and test the feasibility of the adapted intervention. We utilised semi-structured in-depth interviews, key informant interviews and focus group discussions with various stakeholders until data saturation was achieved. All interviews were audiotaped and later transcribed verbatim and translated to English for analysis. Data for this study were inductively coded and analysed using thematic analysis.

RESULTS

Effective mechanisms for engaging parents in SBMH include routine parent-teacher meetings, interface meetings between parents and school-based mental healthcare providers, and direct parental participation in sessions. However, while parental involvement is key for SBMH interventions, it can be problematic. In some cases, parents may unintentionally breach their children's privacy and confidentiality or may be the source of their children's mental health problems.

CONCLUSION

The study's findings underscore the importance of parents as vital partners in SBMH interventions. Given the positive impact of parental involvement, it is essential to incorporate parents into the design and implementation of these interventions. By leveraging the insights from this study, interventionists can develop and implement more effective and low-cost SBMH interventions, which can significantly improve mental health outcomes for young people in low-resource settings.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study

AIM

This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations.

DESIGN

Strauss and Corbin's Grounded Theory.

METHODS

Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached.

RESULTS

A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment.

CONCLUSION

Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process.

IMPLICATIONS FOR THE PROFESSION

Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment.

IMPACT

This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations.

REPORTING METHOD

The COREQ guidelines were utilised.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Associations Between Family Factors and Mental Health Service Use Among Children with Physical Illness: the Mediating Role of Child Psychopathology Trajectories

This study investigated whether child psychopathology trajectories mediate the association between parent psychological distress/family functioning and mental health service use (MHSU) among children with a chronic physical illness (CPI). Data come from a longitudinal study of 263 children and youth aged 2-16 years diagnosed with a CPI and their parents assessed at baseline, six, 12, and 24 months. Parent psychological distress was measured by creating a composite score from the Centre for Epidemiological Studies Depression scale and Generalized Anxiety Disorder-7 scale, and family functioning was measured using the McMaster Family Assessment Device. Previous work identified three trajectories of psychopathology among children: low-stable, moderate-stable, and high-decreasing. Path analysis was used to estimate potential mediating effects. A significant indirect effect of parent psychological distress on healthcare professional contact through child psychopathology was found ([Formula: see text] 0.001(0.001), p = 0.021). The indirect effect of family functioning was not significant ([Formula: see text] - 0.001(0.001), p = 0.155). Addressing parent mental health may reduce child psychopathology and potentially decrease MHSU in children with CPI. Understanding these pathways is needed to develop family-centred interventions that support mental health in children with CPI and their parents.

Systematic Review: Intervention Strategies for Treating Relational Aggression in Female Juvenile Offenders and At-Risk Female Youth

Objective

Female juvenile offenders commonly display a distinct form of aggression, known as relational aggression, which demands its own dedicated focus and specialized intervention approaches, as exemplified by the limited yet steadily growing body of research on the issue. This review set out to explore current relational aggression interventions specifically designed for incarcerated female youth, which was subsequently broadened to include at-risk female adolescents.

Method

In stage 1, the effectiveness of intervention strategies targeting relationally aggressive behaviors in female juvenile offenders was systematically reviewed. As so few studies existed in the peer-reviewed literature, in stage 2, a review was conducted with a broader scope examining intervention strategies only with at-risk female adolescents.

Results

The electronic databases JBI EBP, PsycINFO, and PubMed/MEDLINE were searched for the systematic review. At stage 1, 16 full-text articles were reviewed for quality, and of these articles, 13 were excluded due to sample population, outcomes, and lack of measuring correlates of relevant behavior. At stage 2, 12 full-text articles were reviewed for quality, and of these articles, 6 were excluded for the above-mentioned reasons.

Conclusion

There are promising advancements in the development and implementation of interventions tailored to attenuate relationally aggressive behaviors in female youth deemed at risk or currently in the juvenile justice system.

Experiences of parents of children with mental illnesses: A systematic review and meta-ethnographic synthesis

In this paper, we present a qualitative meta-ethnographic synthesis of 26 articles reporting experiences of subjective burden in 389 parents of children with mental illnesses. The studies were identified through a systematic literature search of PubMed, CINAHL Ultimate, APA PsycInfo, and MedLine Ultimate. We conducted a quality appraisal and followed the seven stages of meta-ethnographic synthesis. We developed a line of argument synthesis in the form of a model that depicts the subjective, temporal, and psychological experiences of parents. The model proposes a cyclical process characterized by five stages, each depicting a transitional point in which parents re-evaluate their experiences: caring for an intimate stranger; turning point; unavoidable role; uncertain future; transcendence. This model highlights the complex psychological processes that parents endure when caring for a child with a mental illness. The review highlights several methodological issues in this field of research, including issues related to sampling, poor reporting of data analysis, limited critical appraisal, and a lack of reflexivity. Future research should address the gaps in the literature while also attending to the issues that have been highlighted by this review.

Care providers' view of the barriers in providing care for adolescents with emotional and behavioral problems

Objectives

Emotional and behavioral problems (EBP) during adolescence are a major public health issue due to its high prevalence and long-lasting consequences. The knowledge of the barriers in providing psychosocial care can be a starting point for subsequent efficiency improvement. Therefore, the aim of this study is to assess which barriers do care providers experience while providing psychosocial care for adolescents with EBP.

Methods

We performed a qualitative assessment that was embedded in the Slovak Care4Youth study mapping the system of care provided for adolescents with EBP. We conducted 25 semi-structured individual and group interviews with a total of 49 care providers from 17 institutions that provided preventive counselling, social, and mental healthcare for adolescents with EBP. We focused on the care provider's perception of barriers in providing care for these adolescents. The interviews were audiotaped and transcribed verbatim. We coded the data using the consensual qualitative research approach in combination with conventional content analysis.

Results

We found that care providers experienced several barriers in providing care for adolescents with EBP which relate to six themes-legislative framework and legislative changes; financing of the care system; coordination of care; workforce development, education, methodical guidance and supervision; personnel and institutional capacities; and administrative burden.

Conclusion

Addressing these barriers within the care system from the "front line" perspective provides clues to efficiently improve the psychosocial care for adolescents with EBP. According to the care providers, the organization and financing of the care system requires adaptation; the burden of the care providers should be reduced; and care providers require quality practical education, training, and methodological guidance.

Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study

BACKGROUND

Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam.

METHODS

As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10-17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs.

FINDINGS

Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9-13·5) in Kenya, 5·5% (4·3-6·9) in Indonesia, and 3·3% (2·7-4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3-10·6) in Kenya, 4·4% (3·4-5·6) in Indonesia, and 2·7% (2·2-3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0-2·0) and Viet Nam (1·0-1·9) to 4·6% (3·9-5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3-0·8) and Viet Nam (0·2-0·6) to 2·4% (1·9-2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1-0·4) and Viet Nam (0·1-0·3) to 1·0% (0·7-1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6-1·3) in Indonesia to 1·2% (0·9-1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1-15·9] in Indonesia to 14·7 [7·5-28·6] in Viet Nam).

INTERPRETATION

NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries.

FUNDING

The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.

The association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents

The purpose of this study is to investigate the association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents. This cross-sectional study was conducted by investigating the 2018 Bolivia global school-based student health survey (GSHS). The total number of students who participated in this survey was 7931, and the final sample was 7377. The mean age of the participants was 15.3 years (SD = 1.4). Psychological distress was assessed with a 2-item screener (loneliness and worry induced sleep disturbance). In all 22.3% of participants reported experiencing psychological distress, with 18.1% among adolescent males and 26.2% among adolescent females. In adjusted logistic regression analysis (AOR, 95% CI), there are two significant directions of association. One is the negative association, such as parental involvement as a protective factor. School adolescents who had more parental involvement were less likely to experience psychological distress. Parents understand problems or worries (0.64, 0.54-0.75, p < .001) and parents disregard privacy (0.69, 0.58-0.82, p < .001). On the other hand, many psycho-social factors are significantly positively associated with psychological distress. School adolescents who experience more psychosocial factors are more likely to experience psychological distress. Physical assault in the previous year (1.83, 1.59-2.11, p < .001), being bullied at school (1.27, 1.07-1.52, p < .01), being bullied outside of school (1.36, 1.15-1.61, p < .001), and being cyberbullied (1.60, 1.37-1.88, p < .001), were all significantly associated with psychological distress. Healthy relationships in a family, and interventions to reduce violence and bullying, should be encouraged and promoted.