Codesigned online cognitive bias modification of interpretations for anxiety and depression in children: study protocol of a randomised controlled trial

INTRODUCTION

Previous research has shown that cognitive bias modification of interpretations (CBM-I) may be a promising intervention for anxiety in youth; however, results are mixed. Given the high comorbidity between anxiety and depression in youth, it is surprising that no child studies have targeted biases associated with both. This study aims to evaluate the effectiveness and acceptability of an online CBM-I intervention (Mindmaster) for children with symptom scores of anxiety or depression above a borderline or clinical threshold. The intervention has been codesigned with children, parents and mental health professionals to promote user engagement.

METHODS AND ANALYSIS

The study is a randomised controlled trial, with two parallel arms. Participants are 143 children aged 8-10 years with scores of anxiety and/or depressive symptoms above a borderline or clinical threshold. They will be allocated to either the intervention group or the waitlist control group. The intervention consists of 2 weeks of online CBM-I training, with four sessions (10-15 min) per week. Outcome assessments will be conducted at baseline, 4 weeks after baseline (post-training/post-waitlist) and 8 weeks after baseline (follow-up) for the intervention group only. The primary outcome is interpretation bias. Secondary outcomes are anxiety and depressive symptoms and life interference. Analyses will be conducted within an intention-to-treat framework using mixed models for repeated measures.

ETHICS AND DISSEMINATION

The study was approved by the University of New South Wales Human Research Ethics Committee (HC220758). Findings will be reported to (1) participating families; (2) presented at scientific conferences and (3) disseminated to peer-review publications. Data will be available from the corresponding author on request.

TRIAL REGISTRATION NUMBER

ACTRN12622001493730.

Waiting-list interventions for children and young people using child and adolescent mental health services: a systematic review

QUESTION

Children and young people experience delays in assessment and/or treatment within mental health services. The objective of this systematic review, funded by the Emerging Minds Network, was to explore the current evidence base for mental health waiting list interventions to support children and young people.

STUDY SELECTION AND ANALYSIS

A literature search was conducted in MEDLINE, PsycINFO, Web of Science and the Cochrane databases from 2000 to 2023 (last searched October 2023). Included studies described interventions to support children and young people and/or their family while on a waiting list for child and adolescent mental health services. Titles and abstracts were screened independently by two reviewers, data were extracted by one reviewer, confirmed by a second and a narrative synthesis was provided.

FINDINGS

Eighteen studies including 1253 children and young people were identified. Studies described waiting list interventions for autism spectrum disorders, eating disorders, generic conditions, transgender health, anxiety/depression, self-harm and suicide and behavioural issues. Many interventions were multicomponent; 94% involved psychoeducation, other components included parental support, bibliotherapy and coaching. Duration of the interventions ranged from a single session to over a year; 66% involved face-to-face contact. All studies demonstrated benefits in terms of improved clinical outcomes and/or feasibility/acceptability. Evidence for service outcomes/efficiency was largely unexplored. Limitations of the underpinning research, such as sample size and low-quality papers, limit the findings.

CONCLUSIONS

There is limited research exploring waiting list interventions, however, the findings from small-scale studies are promising. Further research using robust study designs and real-world implementation studies are warranted.

Suicidality Treatment Occurring in Paediatrics (STOP) Medication Suicidality Side Effects Scale in young people in two cohorts across Europe

OBJECTIVES

As part of the 'Suicidality: Treatment Occurring in Paediatrics (STOP)' study, we developed and performed psychometric validation of an electronic-clinical-outcome-assessment (eCOA), which included a patient-reported-outcome (ePRO), an observer-rated-outcome (eObsRO) for parents/carers and a clinician-reported-outcome (eClinRO) that allows identification and monitoring of medication-related suicidality (MRS) in adolescents.

DESIGN

STOP: Prospective study: A two phase validation study to assess the impact of medication on suicidal ideations.

SETTING

Six participating countries: Netherlands, UK, Germany, France, Spain and Italy that were part of the Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 261411.

PARTICIPANTS

Cohort 1 consisted of 41 adolescent-completions, 50 parent-completions and 56 clinician-completions. Cohort 2 consisted of 244 adolescent-completions, 198 parent-completions and 240 clinician-completions from across the six countries. The scale was administered only to participants who have screened positive for the STOP-Suicidality Assessment Scale (STOP-SAS).

RESULTS

A total of 24 items for the development of the STOP-Medication Suicidality Side Effects Scale (STOP-MS3) were identified and three versions (for patients, parents and clinicians) of the STOP-MS3 were developed and validated in two separate study cohorts comprising of adolescents, their parents and clinicians. Cronbach's α coefficients were above 0.85 for all domains. The inter-rater reliability of the STOP-MS3 was good and significant for the adolescent (ePRO), clinician (eClinRO) (r=0.613), parent (eObsRO) versions of the scale (r=0.394) and parent and clinician (r=0.347). Exploratory factor analysis identified a 3-factor model across 24 items for the adolescent and parent version of the scale: (1) Emotional Dysregulation, (2) Somatic Dysregulation and (3) Behavioural Dysregulation. For the clinician version, a 4-factor model defined the scale structure: (1) Somatic Dysregulation, (2) Emotional Dysregulation, (3) Behavioural Dysregulation and (4) Mood Dysregulation.

CONCLUSION

These findings suggest that the STOP-MS3 scale, a web-based eCOA, allows identification and monitoring of MRS in the adolescent population and shows good reliability and validity.

Advancing Suicide Intervention Strategies for Teens (ASSIST): study protocol for a multisite randomised controlled trial

INTRODUCTION

Brief interventions that reduce suicide risk following youth's experience with acute care due to suicidality are needed.

METHODS AND ANALYSIS

The study will use a three-arm randomised controlled trial designed to test the effectiveness of the Safety Planning Intervention with structured follow-up (SPI+) and the Collaborative Assessment and Management of Suicidality (CAMS) compared with enhanced usual care. The primary outcomes measure will be suicidal events, defined as death by suicide, attempted suicide, preparatory acts toward imminent suicidal behaviour or suicidal ideation resulting in a change in emergency evaluation or inpatient admission. Secondary measures will be the number of suicide attempts and severity of suicidal ideation. The experimental interventions, SPI+ and CAMS, consist of up to eight sessions over approximately 8 weeks that are designed to manage (SPI+) or treat (CAMS) patient-identified 'drivers' of suicidal thoughts and behaviours. Mechanisms and moderators of change will be evaluated to understand treatment impacts.

ETHICS AND DISSEMINATION

This study has been approved by the Seattle Children's Institutional Review Board and is monitored by external agencies including the University of Washington Institute for Translational Health Sciences, and a National Institute of Mental Health (NIMH)-appointed Data Safety and Monitoring Board. Trial results will help establish evidence towards safe and effective treatment strategies for youth transitioning from acute to outpatient care due to a suicidal crisis. The data will be shared with the NIMH Data Archives and disseminated through publications and conferences.

TRIAL REGISTRATION NUMBER

NCT05078970.

Patterns, prevalence and risk factors of intimate partner violence and its association with mental health status during COVID-19: a cross-sectional study on early married female adolescents in Khulna district, Bangladesh

OBJECTIVES

This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with mental health problems.

DESIGN

Cross-sectional survey.

SETTINGS

Dumuria Upazila (subdistrict) under the Khulna district of Bangladesh.

PARTICIPANTS

A total of 304 participants were selected purposively based on some specifications: they must be female adolescents, residents of Dumuria Upazila and married during the COVID-19 pandemic when under 18 years of age.

OUTCOME MEASURES

By administering a semi-structured interview schedule, data were collected regarding IPV using 12 five-point Likert scale items; a higher score from the summation reflects frequent violence.

RESULTS

The findings suggest that the prevalence of physical, sexual and emotional IPV among the 304 participants, who had an average age of 17.1 years (SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. Stepwise regression models identified age at marriage (p=0.001), number of miscarriages (p=0.005), education of spouse (p=0.001), income of spouse (p=0.016), age gap between spouses (p=0.008), marital adjustment (p<0.001) and subjective happiness (p<0.001) as significant risk factors. Hierarchical regression, however, indicated that age at marriage (p<0.001), age gap between spouses (p<0.001), marital adjustment (p<0.001) and subjective happiness (p<0.001) had negative associations with IPV, while the number of miscarriages (p<0.001) had a positive relationship. Pearson's correlation showed that IPV was significantly associated with depression, anxiety and stress.

CONCLUSION

During the COVID-19 pandemic, an increase in IPV and mental health problems among early married adolescents was documented. To reduce physical and mental harm and to assure their well-being, preventive and rehabilitative measures should be devised.

Effectiveness of lifestyle interventions for improving the physical health of children and adolescents taking antipsychotic medications: protocol for a systematic review and meta-analysis

INTRODUCTION

Children and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of adverse events that compromise ongoing physical health. Of particular concern is the negative impact antipsychotic medications have on cardiometabolic health. Interventions that aim to modify lifestyle habits have the potential to alleviate the adverse effects of antipsychotic medication by enhancing weight management, increasing physical activity, promoting better nutritional practices, improving dietary habits and promoting healthier sleep patterns and sleep hygiene. However, a comprehensive review has not been performed to ascertain the effectiveness of lifestyle interventions for children and adolescents who are at increased risk of antipsychotic-induced compromises to their physical health.

METHODS AND ANALYSIS

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases will be searched without any year constraints to identify randomised controlled trials that are published in the English language and report a lifestyle intervention compared with usual care with any physical health outcome measure. Trial registers and results repositories will be scoured to identify additional studies. Two reviewers will independently conduct screening, data extraction and quality assessment and compare the results. Quantitative data will be synthesised, where appropriate, through a random-effects meta-analysis model. Otherwise, data will be reported in a qualitative (narrative) synthesis. Heterogeneity will be quantified using the I2 statistic. The Cochrane Risk of Bias 2 tool will be used for risk of bias assessment. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to evaluate the cumulative body of evidence.

ETHICS AND DISSEMINATION

Ethics approval is not required. The publication plan will target high-impact, peer-reviewed journals that fall under the scope of Psychiatry and Mental Health.

PROSPERO REGISTRATION NUMBER

CRD42022380277.

Childbirth self-efficacy and fear of childbirth and their predictors in adolescent and adult pregnant women referring to health centres of Urmia-Iran: a cross-sectional study

OBJECTIVE

Adolescent pregnancy as a growing phenomenon in the world has been investigated from different aspects. However, the examination of childbirth fear and self-efficacy has received less attention. Therefore, this study was conducted to compare the self-efficacy and fear of childbirth and to determine their predictors in adolescent and adult pregnant women.

DESIGN

In this comparative cross-sectional study, participants were selected through two-stage cluster sampling method. Data were collected using the Childbirth Self-Efficacy Inventory and Wijma Delivery Expectancy/Experience Questionnaire. The Pearson correlation test, independent t-test, and general linear model were used for data analysis.

SETTING

Urmia health centres, Iran in 2020.

PARTICIPANTS

Three hundred and sixty adults and adolescent pregnant women.

RESULTS

The mean (SD) of fear of childbirth was 114.7 (14.1) and 108.1 (23.1) in adolescent and adult pregnant women, respectively. The mean (SD) of childbirth self-efficacy in the active phase and the second stage of labour respectively were also obtained 208.8 (28.6) and 203.5 (32.1) for adolescent pregnant women and 213.8 (25.7) and 212.0 (26.5) for adult ones. There was a significant difference between adolescent and adult pregnant women in fear of childbirth (p=0.001), self-efficacy expectancy (p=0.003) and total childbirth self-efficacy (p=0.008) in the second stage of labour. After adjusting the sociodemographic characteristics, the mean score of fear of childbirth was significantly higher in adolescent pregnant women than in adult ones whereas the mean total self-efficacy score in the second stage of labour was significantly lower in adolescent pregnant women than in adult ones.

CONCLUSION

This study showed that adolescent pregnant women had more fear of childbirth and low self-efficacy than adult mothers, and there was also a relationship between fear of childbirth and self-efficacy. Paying more attention to fear and self-efficacy in childbirth and their predictors by health providers can improve pregnancy and childbirth outcomes.

Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data

BACKGROUND

There is an increasing demand for mental health services for young people, which may vary across the year.

OBJECTIVE

To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.

METHODS

This cohort study used anonymised electronic health records from general practices in England contributing to QResearch. It included 5 081 263 males and females aged 14-18 (adolescents), 19-23 and 24-28 years between 2006 and 2019. The incidence rates per 1000 person-years and the incidence rate ratios (IRRs) were calculated for the first records of a selective serotonin reuptake inhibitor (SSRI) prescription, depression, anxiety and self-harm. The IRRs were adjusted for year, region, deprivation, ethnic group and number of working days.

FINDINGS

There was an increase in SSRI prescribing, depression and anxiety incidence in male and female adolescents in the autumn months (September-November) that was not seen in older age groups. The IRRs for SSRI prescribing for adolescents peaked in November (females: 1.75, 95% CI 1.67 to 1.83, p<0.001; males: 1.72, 95% CI 1.61 to 1.84, p<0.001, vs in January) and for depression (females: 1.29, 95% CI 1.25 to 1.33, p<0.001; males: 1.29, 95% CI 1.23 to 1.35, p<0.001). Anxiety peaked in November for females aged 14-18 years (1.17, 95% CI 1.13 to 1.22, p<0.001) and in September for males (1.19, 95% CI 1.12 to 1.27, p<0.001).

CONCLUSIONS

There were higher rates of antidepressant prescribing and consultations for depression and anxiety at the start of the school year among adolescents.

CLINICAL IMPLICATIONS

Support around mental health issues from general practitioners and others should be focused during autumn.

School-based Evaluation Advancing Response for Child Health (SEARCH): a mixed longitudinal cohort study from multifaceted perspectives in Jiangsu, China

BACKGROUND

Schools play a crucial role in providing mental health services to children and adolescents. However, the vastness of the student population and mental health workforce shortage in China severely limit the capacity for adequate care access and delivery.

OBJECTIVE

We propose a large, mixed longitudinal cohort study, 'School-based Evaluation Advancing Response for Child Health (SEARCH)', aimed at addressing the increasing demand from individuals seeking access to mental healthcare services.

METHODS

SEARCH uses a digital platform and school-based protocol for comprehensive assessment of the mental well-being of Chinese students in grades 4-12 incorporating individual, caregiver and teacher input, including capture of facial and acoustic features and response times, as well as mental well-being assessments.

FINDINGS

We completed first wave data collection from nearly 20 000 participants (students, caregivers and teachers) at 11 schools, grades 4-12, in 3 cities in Jiangsu province in Southeast China from September 2022 to February 2023. We intend to conduct follow-up assessments for grades 4 through 12 at the 11 school sites every 6 months for 5 years.

CONCLUSIONS

SEARCH will provide important insight into the developmental trajectory of mental well-being in Chinese children and adolescents. The study protocol does not simply focus on student self-report and incorporates caregiver and teacher viewpoints as well. It also collects objective indicators that may facilitate development of screening tools.

CLINICAL IMPLICATIONS

We believe future study findings will guide the development and implementation of school-based mental healthcare initiatives to improve the well-being of children and adolescents.

Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

BACKGROUND

Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary.

OBJECTIVE

To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs.

METHODS

Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap.

FINDINGS

Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap.

CONCLUSIONS

Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need.

CLINICAL IMPLICATIONS

It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.

Individualisation, personalisation and person-centredness in mental healthcare: a scoping review of concepts and linguistic network visualisation

BACKGROUND

Targeted mental health interventions are increasingly described as individualised, personalised or person-centred approaches. However, the definitions for these terms vary significantly. Their interchangeable use prevents operationalisations and measures.

OBJECTIVE

This scoping review provides a synthesis of key concepts, definitions and the language used in the context of these terms in an effort to delineate their use for future research.

STUDY SELECTION AND ANALYSIS

Our search on PubMed, EBSCO and Cochrane provided 2835 relevant titles. A total of 176 titles were found eligible for extracting data. A thematic analysis was conducted to synthesise the underlying aspects of individualisation, personalisation and person-centredness. Network visualisations of co-occurring words in 2625 abstracts were performed using VOSViewer.

FINDINGS

Overall, 106 out of 176 (60.2%) articles provided concepts for individualisation, personalisation and person-centredness. Studies using person-centredness provided a conceptualisation more often than the others. A thematic analysis revealed medical, psychological, sociocultural, biological, behavioural, economic and environmental dimensions of the concepts. Practical frameworks were mostly found related to person-centredness, while theoretical frameworks emerged in studies on personalisation. Word co-occurrences showed common psychiatric words in all three network visualisations, but differences in further contexts.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The use of individualisation, personalisation and person-centredness in mental healthcare is multifaceted. While individualisation was the most generic term, personalisation was often used in biomedical or technological studies. Person-centredness emerged as the most well-defined concept, with many frameworks often related to dementia care. We recommend that the use of these terms follows a clear definition within the context of their respective disorders, treatments or medical settings.

SCOPING REVIEW REGISTRATION

Open Science Framework: osf.io/uatsc.

Can a nation-wide e-cohort of ADHD and ASD in childhood be established using Welsh routinely available datasets?

OBJECTIVES

We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research.

DESIGN

Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of directly assessed individuals with ADHD.

SETTING

This study used data from the Welsh Secure Anonymised Information Linkage Databank in Wales, UK. Routinely collected data from primary care, emergency department and hospital admissions were linked at person level.

PARTICIPANTS

All individuals in Wales, UK born between 1 January 1991 and 31 December 2000. Individuals with a recorded diagnosis of ADHD and/or ASD by age 18 years were identified using International Classification of Diseases, 10th Revision and National Health Service (NHS) READ codes and matched to 3 controls each and 154 individuals with ADHD recruited from an established research study.

OUTCOME MEASURES

Recorded service use for anxiety and depression, alcohol and drug use and self-harm including emergency department use in young adulthood (age 16-25 years).

RESULTS

7726 individuals had a recorded diagnosis of ADHD (80% male) and 5001 of ASD (79% male); 1.4% and 0.9% of the population, respectively. Cox's regression analyses showed ADHD was associated with increased risks of anxiety/depression (HR: 2.36, 95% CI: 2.20 to 2.53), self-harm (HR: 5.70, 95% CI: 5.07 to 6.40), alcohol (HR: 3.95, 95% CI: 3.42 to 4.56), drug use (HR: 5.88, 95% CI: 5.08 to 6.80) and emergency department service use (HR: 1.36, 95% CI: 1.31 to 1.41). Those with ASD were at increased risk of anxiety/depression (HR: 2.11, 95% CI: 1.91 to 2.34), self-harm (HR: 2.93, 95% CI: 2.45 to 3.50) and drug use (HR: 2.21, 95% CI: 1.66 to 2.95) but not alcohol use. The ADHD e-cohort were similar to the directly assessed cohort.

CONCLUSIONS

Our identification strategy demonstrated the feasibility of establishing a large e-cohort of those with ADHD/ASD with expected patterns of poorer early adult outcomes, demonstrating a valid method of identifying large samples for future longitudinal studies without selective attrition.

The impact of facilitators and rural immersion on medical student engagement during a child and adolescent mental health videoconference workshop

OBJECTIVE

Child and adolescent mental health (CAMH) disorders are a major public health problem in Australia, especially outside metropolitan areas. The issue is compounded by a shortage of child and adolescent psychiatrists (CAPs). CAMH receives minimal coverage in health professional training, training opportunities are scarce, and support for generalist health professionals, who treat most cases, is lacking. Novel approaches to early medical education and teaching are required to strengthen the available skilled workforce in rural and remote settings.

METHOD

This qualitative study explored the factors influencing medical student engagement in a CAMH videoconferencing workshop as part of the Rural Clinical School of WA.

RESULTS

Our results confirm the priority of personal characteristics of medical educators, over clinical and subject matter expertise, on student learning. This research affirms that general practitioners are well-placed to facilitate recognition of learning experiences, especially given that students may not readily recognise exposure to CAMH cases.

CONCLUSION

Our findings support the effectiveness, efficiencies, and benefits of utilising general medical educators in supporting child and adolescent psychiatry expertise in delivering subspecialty training within medical school curricula.

One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis

OBJECTIVES

To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022.

ELIGIBILITY CRITERIA

Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment.

DATA EXTRACTION AND SYNTHESIS

Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale.

RESULTS

Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63).

CONCLUSIONS

The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety.

PROSPERO REGISTRATION NUMBER

CRD42021251556.

Quality of life and relapse of Opioid Use Disorder: a scoping review protocol

INTRODUCTION

Quality of life (QoL) greatly influences the outcomes of patients with mental illnesses and there is evidence that there is an association between QoL and the relapse of Opioid Use Disorder (OUD). However, no reviews elucidate the relationship between QoL and the relapse of OUD. This document provides a scoping review protocol that aims to systematically chart and synthesise the published, unpublished and grey literature about the relationship between QoL and relapse of OUD.

METHODS AND ANALYSIS

The enhanced six-stage methodological framework for scoping reviews of Arksey and O'Malley will be used. The main research question guiding the review will be: What is the relationship between QoL and relapse of OUD? Peer-reviewed and non-peer-reviewed articles, reports, and policy documents will be eligible to be included in the review with no limits on publication date. PubMed, PsycINFO, Google Scholar, Scopus, OVID and Cochrane Library will be among the databases searched. We shall identify grey literature from Google Scholar, ProQuest database, Grey Source Index, Open Grey and OpenDOAR. The reporting of the review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Criteria for evidence inclusion and exclusion will be used during literature screening and mapping.

ETHICS AND DISSEMINATION

Patients and the public will not be involved in the interpretations of the findings, therefore, we shall not seek approval from an ethics committee. Results will be disseminated through publication in a peer-reviewed, scientific journal, conference presentations.

Prevalence of externalising disorder comorbidities in adolescents: a systematic review and meta-analysis protocol

INTRODUCTION

Externalising disorders are some of the most prevalent problems in childhood and particularly during adolescence that can change into more severe psychopathology in adulthood if left unattended. In the research literature, these disorders include attention deficit/hyperactivity disorder, oppositional/defiant disorder, conduct disorder and substance use disorders. The comorbidity prevalence of these disorders is significant and cannot be considered a random factor. The dimensional structure of psychopathology has always been studied by researchers to address disorder comorbidities and aetiology. There has always been controversy over the number of spectra and the lower levels. Currently, the new top-down, Hierarchical Taxonomy of Psychopathology model conceptualising psychopathology is being used, which is a dimensional classification system for the different spectra of psychopathology based on a combination of conceptual modelling and factor analysis of symptoms. This systematic review investigates the comorbidity prevalence of spectra of externalising disorders to provide valuable information and feedback on this model.

METHODS AND ANALYSIS

This systematic review will include all the studies conducted from 1/1/1990 to 1/12/2020 to examine the prevalence and comorbidity of each of the externalising disorders in the general population, schools and outpatients using any instrument (questionnaires or interviews). There will be no language restrictions in selecting the studies. The studies are age restricted and must be conducted on adolescents only, but there are no restrictions on the gender and nationality of the participants.

ETHICS AND DISSEMINATION

This systematic review is based on previously published articles and therefore will not require ethical approval. The results of the systematic review will be disseminated as publication in a peer-reviewed journal and conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42022327629.

Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study

OBJECTIVES

To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020-31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019-31 January 2020, referred to as 2019/2020), between CEV children and the general population.

DESIGN

Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list.

SETTING

Primary and secondary healthcare settings covering 80% of the population of Wales.

PARTICIPANTS

Children aged 2-17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009).

PRIMARY OUTCOME MEASURE

First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes.

RESULTS

A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p<0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population.

CONCLUSIONS

Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic.

Caregiver experiences of feeding children with developmental disabilities: a qualitative study using interpretative phenomenological analysis from India

OBJECTIVE

We aimed to explore caregiver experiences of feeding children with developmental disabilities, in the context of it being influenced by biological, personal and social factors.

DESIGN

This study applied a qualitative study design through focus group discussions (FGDs), using interpretative phenomenological analysis. Data were analysed using thematic content analysis.

SETTING

This study was conducted at the Child Psychiatry Unit of a tertiary care centre in South India, between March and November 2020.

PARTICIPANTS

Seventeen mothers of children with developmental disabilities, who provided written informed consent, participated in four FGDs.

RESULTS

Three over-arching themes were identified. Feeding experience: (a) a tedious, confusing task; (b) disproportionate onus on mothers; (c) influenced by sociocultural norms.

CONCLUSION

Feeding can be a stressful activity for both caregiver and child, influenced by family structure and sociocultural belief systems. Considering caregivers' emotional status, facilitatory and hindering environmental factors, and actively exploring strategies to promote the generalisation of strategies learnt into real-life outcomes are essential in tailoring deficit-specific feeding interventions.

Early biomarkers of neurodevelopmental disorders in preterm infants: protocol for a longitudinal cohort study

INTRODUCTION

Preterm (PT) infants are at high likelihood for poor neurodevelopmental outcomes, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and other neurodevelopmental disorders (NDDs), which could considerably impair the individuals' functions throughout their whole life. The current cohort study aims to investigate adverse outcomes, especially NDDs, in PT children, and the related early aberrant brain developmental biomarkers.

METHODS AND ANALYSIS

This is a prospective cohort study in Beijing, China. We plan to recruit 400 PT infants born at <37 weeks of gestational age (GA), and 200 full-term (FT) controls during the neonatal period (40 weeks corrected GA), then follow them up until they reach 6 years of age. This cohort is designed to assess neuropsychological functions, brain development, related environmental risk factors and the incidence of NDDs by using the following measures: (1) social, emotional, cognitive and sensorimotor functions; (2) MRI, electroencephalogram and functional near-infrared spectroscopy; (3) social economic status, maternal mental health and DNA methylation; and (4) symptoms and diagnosis of NDDs. Main data analyses will include comparing the neurodevelopment outcomes and brain developmental trajectories between PT and FT children using linear or logistic regressions and mixed-effects models. Regression analyses and machine learning will be used to identify early biological predictors and environmental risk or protective factors for later NDDs outcomes.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the research ethics committee of Peking University Third Hospital (M2021087). This study is under review in the Chinese Clinical Trial Register. The study results from the current cohort will be disseminated and popularised through social media to participating parents, as well as parents who are giving care to PT children.

Investigating online activity in UK adolescent mental health patients: a feasibility study using a natural language processing approach for electronic health records

OBJECTIVES

To assess the feasibility of using a natural language processing (NLP) application for extraction of free-text online activity mentions in adolescent mental health patient electronic health records (EHRs).

SETTING

The Clinical Records Interactive Search system allows detailed research based on deidentified EHRs from the South London and Maudsley NHS Foundation Trust, a large south London Mental Health Trust providing secondary and tertiary mental healthcare.

PARTICIPANTS AND METHODS

We developed a gazetteer of online activity terms and annotation guidelines, from 5480 clinical notes (200 adolescents, aged 11-17 years) receiving specialist mental healthcare. The preprocessing and manual curation steps of this real-world data set allowed development of a rule-based NLP application to automate identification of online activity (internet, social media, online gaming) mentions in EHRs. The context of each mention was also recorded manually as: supportive, detrimental or neutral in a subset of data for additional analysis.

RESULTS

The NLP application performed with good precision (0.97) and recall (0.94) for identification of online activity mentions. Preliminary analyses found 34% of online activity mentions were considered to have been documented within a supportive context for the young person, 38% detrimental and 28% neutral.

CONCLUSION

Our results provide an important example of a rule-based NLP methodology to accurately identify online activity recording in EHRs, enabling researchers to now investigate associations with a range of adolescent mental health outcomes.

Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial

INTRODUCTION

Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD.

METHODS AND ANALYSIS

A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach.

ETHICS AND DISSEMINATION

The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards.

TRIAL REGISTRATION NUMBER

NCT04723719.

Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study

INTRODUCTION

Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care.

METHODS AND ANALYSIS

Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.

Lifelong mental health service use among 15-22 years old offenders: a document-based, mixed-methods descriptive study

OBJECTIVES

Among young offenders, psychiatric morbidity and comorbidity are common, but our knowledge about their use of mental health services during childhood and adolescence is scarce. We aimed to describe the lifelong use of mental health services of young offenders who have committed serious crimes.

DESIGN AND STUDY SETTING

Using data on forensic psychiatric examinations of 42 Finnish offenders aged 15-22 years, we analysed the timing and typical patterns of their prior mental health service use with qualitative and quantitative content analysis and typification.

RESULTS

Young offenders appeared in this study as children with plenty of perinatal and developmental risks, and risks related to their family situation and peer relations. Most subjects were described as having had emotional or behavioural symptoms, or both, since childhood. Involvement in mental health services was rare before the age of 7 years but increased markedly after that, staying on the same level during adolescence. Five categories of mental health service users were identified: (1) continuing service use around a decade (14.3%), (2) one brief fixed treatment (11.9%), (3) involuntary use of services (31.0%), (4) evasive use of services (21.4%) and (5) no mental health service use (21.4%).

CONCLUSIONS

Young offenders had symptoms from early ages, but during childhood and adolescence, involvement in mental health services appeared for most as relatively short, repetitive or lacking. To help children at risk of criminal development, a multiprofessional approach, an early evidence-based intervention for behavioural symptoms and screening for learning problems, traumatic experiences and substance use are necessary. Results can help identify children and adolescents with a risk of criminal development, to develop mental health services and to plan further research.

Common mental health and emotional and behavioural disorders among adolescents and young adults in Harare and Mashonaland East, Zimbabwe: a population-based prevalence study

OBJECTIVES

To estimate the prevalence of common mental health disorders (CMDs) and emotional and behavioural disorders among young people and to explore the correlates of CMDs risk.

SETTING

Five urban and periurban communities in Harare and Mashonaland East, Zimbabwe DESIGN: Population-based cross-sectional study PARTICIPANTS: Young people aged 13-24 years living in households in the study areas.

OUTCOME MEASURES

The primary outcome was the proportion of participants screening positive for probable CMDs defined as a Shona Symptoms Questionnaire (SSQ) score ≥8. Secondary outcomes were emotional and behavioural disorders measured using the Strength and Difficulties Questionnaire (SDQ), and adjusted ORs for factors associated with CMD.

RESULTS

Out of 634 young people, 37.4% (95% CI 33.0% to 42.0%) screened positive for probable CMDs, 9.8% (95% CI 7.5% to 12.7%) reported perceptual symptoms and 11.2% (95% CI 9.0% to 13.8%) reported suicidal ideation. Using UK norms to define normal, borderline and abnormal scores for each of the SDQ domains, a high proportion (15.8%) of Zimbabwean young people had abnormal scores for emotional symptoms and a low proportion had abnormal scores for hyperactivity/inattention scores (2.8%) and prosocial scores (7.1%). We created local cut-offs for the emotional symptoms, hyperactivity/attention and prosocial SDQ domains. The odds of probable CMDs increased with each year of age (OR 1.09, p<0.001) and was higher among those who were out of school and not working compared with those in school or working (adj. OR 1.67 (1.07, 2.62), p=0.04). One in five participants (22.1%) were referred immediately for further clinical assessment but uptake of referral services was low.

CONCLUSIONS

We observed a high prevalence of symptoms of CMDs among general population urban and peri-urban young people especially among those with no employment. There is a need for more accessible and acceptable youth-friendly mental health services.

Effects of non-invasive brain stimulation (NIBS) for executive function on subjects with ADHD: a protocol for a systematic review and meta-analysis

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with a high risk of multiple mental health and social difficulties. Executive function domains are associated with distinct ADHD symptom burdens. Non-invasive brain stimulation (NIBS) mainly includes repetitive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), which is a promising technique, but its impact on the executive function of ADHD is uncertain. Therefore, the aim of this systematic review and meta-analysis is to derive solid and updated estimates on the effect of NIBS on executive function in children/adults with ADHD.

METHODS AND ANALYSIS

A systematic search will be performed through EMBASE, MEDLINE, PsycINFO and Web of Science databases from inception until 22 August 2022. Handsearching of grey literature and the reference lists of selected articles will also be conducted. Empirical studies assessing the effect of NIBS (TMS or tDCS) on executive function in children or adults with ADHD will be included. Two investigators will independently perform literature identification, data extraction and risk of bias assessment. Relevant data will be pooled by a fixed-effects or random-effects model according to I² statistic. Sensitivity analysis will be performed to test the robustness of the pooled estimates. Subgroup analyses will be conducted to investigate the potential heterogeneity. This protocol will generate a systematic review and meta-analysis that comprehensively synthesises the evidence on the NIBS treatment of executive function deficit of ADHD.Ethics approval is not required as this is a protocol for a systematic review of published literature. The results will be submitted to a peer-reviewed journal or a conference.

PROSPERO REGISTRATION NUMBER

CRD42022356476.

Examining the acceptability of actigraphic devices in children using qualitative and quantitative approaches: protocol for a systematic review and meta-analysis

INTRODUCTION

Actigraphy is commonly used to record free living physical activity in both typically and atypically developing children. While the accuracy and reliability of actigraphy have been explored extensively, research regarding young people's opinion towards these devices is scarce. This review aims to identify and synthesise evidence relating to the acceptability of actigraphic devices in 5-11 year olds.

METHODS AND ANALYSIS

Database searches will be applied to Embase, MEDLINE, PsychInfo and Social Policy and Practice through the OVID interface; and Education Resources Information Center (ERIC), British Education Index and CINAHL through the EBSCO interface from January 2018 until February 2023. Supplementary forward and backward citation and grey literature database searches, including Healthcare Management Information Consortium (HMIC) and PsycEXTRA will be conducted. Qualitative and quantitative studies, excluding review articles and meta-analyses, will be eligible, without date restrictions. Article screening and data extraction will be undertaken by two review authors and disagreements will be deferred to a third reviewer. The primary outcome, actigraphic acceptability, will derive from the narrative synthesis of the main themes identified from included qualitative literature and pooled descriptive statistics relating to acceptability identified from quantitative literature. Subgroup analyses will determine if acceptability changes as a function of the key participant and actigraphic device factors.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review as it uses data from previously published literature. The results will be presented in a manuscript and published in a peer review journal and will be considered alongside a separate stream of codesign research to inform the development of a novel child-worn actigraphic device.

PROSPERO REGISTRATION NUMBER

CRD42021232466.

Double-blind, randomised placebo-controlled clinical trial of metformin as an adjunct to a sleep-wake, activity and metabolically focused behavioural intervention to improve cardiometabolic outcomes and mood symptoms in youth with major mood syndromes: study protocol

INTRODUCTION

Metformin is a medication likely to improve measures of cardiometabolic disturbance in young people with mental illness. Evidence also suggests metformin may improve depressive symptoms. This 52-week double-blind randomised control trial (RCT) aims to investigate the efficacy of metformin pharmacotherapy as an adjunct to a healthy lifestyle behavioural intervention in improving cardiometabolic outcomes, and depressive, anxiety and psychotic symptoms in youth with clinically diagnosed major mood syndromes.

METHODS AND ANALYSIS

At least 266 young people aged 16-25 presenting for mental healthcare for major mood syndromes who are also at risk for poor cardiometabolic outcomes will be invited to participate in this study. All participants will engage in a 12-week sleep-wake, activity and metabolically focused behavioural intervention programme. As an adjunctive intervention, participants will receive either metformin (500-1000 mg) or placebo pharmacotherapy for 52 weeks.Participants will undergo a series of assessments including: (1) self-report and clinician-administered assessments; (2) blood tests; (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) actigraphy. Univariate and multivariate tests (generalised mixed-effects models) will be used to examine changes in primary and secondary outcomes (and associations with predetermined predictor variables).

ETHICS AND DISSEMINATION

This study has been approved by the Sydney Local Health District Research Ethics and Governance Office (X22-0017). The results of this double-blind RCT will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001559101p, 12 November 2019.

Intensive community and home-based treatments for eating disorders: a scoping review study protocol

INTRODUCTION

Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes.

METHODS

This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy.

ETHICS AND DISSEMINATION

Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.

Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study

INTRODUCTION

Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%-5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers' preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital 'toolkit' of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions.

METHODS AND ANALYSIS

A randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16-32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility.

ETHICS AND DISSEMINATION

Ethical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.

Critical appraisal and comparison of recommendations of clinical practice guidelines for the treatment of schizophrenia in children and adolescents: a methodological survey

INTRODUCTION

The production of clinical practice guidelines (CPGs) has grown in the past years. Notwithstanding, the quality of these documents and their recommendations for the treatment of schizophrenia in children and adolescents is still unknown.

OBJECTIVE

To assess the quality of the guidelines and recommendations for the treatment of schizophrenia in this population.

METHODS

CPGs from 2004 to December 2020 were identified through a systematic search on EMBASE, MEDLINE, PsycINFO, PubMed, Epistemonikos, VHL, Global Index Medicus and specific CPG databases. The CPGs' quality was independently assessed by three reviewers using AGREE II and they were considered of high quality if they scored ≥60% in domains 3 and 6. The evidence classification systems were described, the quality of recommendations was assessed in pairs using AGREE-REX and the recommendations were compared.

RESULTS

The database search retrieved 3182 results; 2030 were screened and 29 were selected for full-text reading. Four guidelines were selected for extraction. Two CPGs were considered of high quality in the AGREE II assessment. We described the commonly agreed recommendations for each treatment phase. The pharmacological recommendations were described in all treatment phases. Scores of AGREE-REX were lower for psychosocial recommendations.

CONCLUSION

There are still few clinical studies and CPGs regarding schizophrenia in children and adolescents. The quality of the documents was overall low, and the quality of the recommendations report has much to improve. There is also a lack of transparency about the quality of the evidence and the strength of the recommendations.

PROTOCOL REGISTRATION NUMBER

CRD42020164899.

Placebo response in trials with patients with anxiety, obsessive-compulsive and stress disorders across the lifespan: a three-level meta-analysis

QUESTION

Randomised controlled trials assessing treatments for anxiety, obsessive-compulsive and stress-related disorders often present high placebo response rates in placebo groups. Understanding the placebo response is essential in accurately estimating the benefits of pharmacological agents; nevertheless, no studies have evaluated the placebo response across these disorders using a lifespan approach.

STUDY SELECTION AND ANALYSIS

We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies and international registers from inception to 9 September 2022. The primary outcome was the aggregate measure of internalising symptoms of participants in the placebo arms of randomised controlled trials designed to assess the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in individuals diagnosed with anxiety, obsessive-compulsive or stress-related disorders. The secondary outcomes were placebo response and remission rates. Data were analysed through a three-level meta-analysis.

FINDINGS

We analysed 366 outcome measures from 135 studies (n=12 583). We found a large overall placebo response (standardised mean difference (SMD)=-1.11, 95% CI -1.22 to -1.00). The average response and remission rates in placebo groups were 37% and 24%, respectively. Larger placebo response was associated with a diagnosis of generalised anxiety disorder and post-traumatic stress disorder, when compared with panic, social anxiety and obsessive-compulsive disorder (SMD range, 0.40-0.49), and with absence of a placebo lead-in period (SMD=0.44, 95% CI 0.10 to 0.78). No significant differences were found in placebo response across age groups. We found substantial heterogeneity and moderate risk of bias.

CONCLUSIONS

Placebo response is substantial in SSRI and SNRI trials for anxiety, obsessive-compulsive and stress-related disorders. Clinicians and researchers should accurately interpret the benefits of pharmacological agents in contrast to placebo response.

PROSPERO REGISTRATION NUMBER

CRD42017069090.

Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial

OBJECTIVE

Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT).

DESIGN

A single-blinded randomised controlled feasibility trial.

SETTING

A specialist outpatient clinic in Sweden.

PARTICIPANTS

Thirty-two adolescents with mild-to-moderate major depression, aged 13-17 years.

INTERVENTIONS

Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care.

OUTCOMES

Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children's Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up.

RESULTS

154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen's d=2.43 and 2.23, respectively), but not TAU (Cohen's d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes.

CONCLUSIONS

Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04117789).

Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT

INTRODUCTION

Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience.

METHOD AND ANALYSIS

In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13-21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes.

ETHICS, FUNDING AND DISSEMINATION

The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences.

TRIAL REGISTRATION NUMBER

NCT05551468; NL8237.

Mental healthcare in primary and community-based settings: evidence beyond the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide

OBJECTIVES

The WHO's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH).

DESIGN

We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base.

RESULTS

Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training.

CONCLUSIONS

The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration.PROSPERO registration numberCRD42017068459.

Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data

QUESTION

Digital interventions based on cognitive-behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence.

STUDY SELECTION AND ANALYSIS

We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response.

FINDINGS

We included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=-0.247, 95% CI -0.322 to -0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data.

CONCLUSIONS

The current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.

Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case-control study

OBJECTIVE

To test whether variant connective tissue structure, as indicated by the presence of joint hypermobility, poses a developmental risk for mood disorders in adolescence.

DESIGN

Cohort-based case-control study.

SETTING

Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were interrogated.

PARTICIPANTS

6105 children of the ALSPAC cohort at age 14 years old, of whom 3803 also were assessed when aged 18 years.

MAIN OUTCOME MEASURES

In a risk analysis, we examined the relationship between generalised joint hypermobility (GJH) at age 14 years with psychiatric symptoms at age 18 years. In an association analysis, we examined the relationship between presence of symptomatic joint hypermobility syndrome (JHS) and International Classification of Diseases-10 indication of depression and anxiety (Clinical Interview Schedule Revised (CIS-R), Anxiety Sensitivity Index) at age 18 years.

RESULTS

GJH was more common in females (n=856, 28%) compared with males (n=319, 11%; OR: 3.20 (95% CI: 2.78 to 3.68); p<0.001). In males, GJH at age 14 years was associated with depression at 18 years (OR: 2.10 (95% CI: 1.17 to 3.76); p=0.013). An index of basal physiological arousal, elevated resting heart rate, mediated this effect. Across genders, the diagnosis of JHS at age 18 years was associated with the presence of depressive disorder (adjusted OR: 3.53 (95% CI: 1.67 to 7.40); p=0.001), anxiety disorder (adjusted OR: 3.14 (95% CI: 1.52 to 6.46); p=0.002), level of anxiety (B=8.08, t(3278)=3.95; p<0.001) and degree of psychiatric symptomatology (B=5.89, t(3442)=5.50; p<0.001).

CONCLUSIONS

Variant collagen, indexed by joint hypermobility, is linked to the emergence of depression and anxiety in adolescence, an effect mediated by autonomic factors in males. Recognition of this association may motivate further evaluation, screening and interventions to mitigate development of psychiatric disorders and improve health outcomes.

Risk and protective factors for self-harm and suicide in children and adolescents: a systematic review and meta-analysis protocol

INTRODUCTION

Self-harm and suicide are major public health concerns among children and adolescents. Many risk and protective factors for suicide and self-harm have been identified and reported in the literature. However, the capacity of these identified risk and protective factors to guide assessment and management is limited due to their great number. This protocol describes an ongoing systematic review and meta-analysis which aims to examine longitudinal studies of risk factors for self-harm and suicide in children and adolescents, to provide a comparison of the strengths of association of the various risk factors for self-harm and suicide and to shed light on those that require further investigation.

METHODS AND ANALYSIS

We perform a systematic search of the literature using the databases EMBASE, PsycINFO, Medline, CINAHL and HMIC from inception up to 28 October 2020, and the search will be updated before the systematic review publication. Additionally, we will contact experts in the field, including principal investigators whose peer-reviewed publications are included in our systematic review as well as investigators from our extensive research network, and we will search the reference lists of relevant reviews to retrieve any articles that were not identified in our search. We will extract relevant data and present a narrative synthesis and combine the results in meta-analyses where there are sufficient data. We will assess the risk of bias for each study using the Newcastle-Ottawa Scale and present a summary of the quantity and the quality of the evidence for each risk or protective factor.

ETHICS AND DISSEMINATION

Ethical approval will not be sought as this is a systematic review of the literature. Results will be published in mental health journals and presented at conferences focused on suicide prevention.

PROSPERO REGISTRATION NUMBER

CRD42021228212.

An investigation of cultural influences in survivors of paediatric cancer: a systematic review protocol

INTRODUCTION

Paediatric cancer affects children and families from diverse backgrounds. However, there is a limited understanding of how diversity/cultural factors play a role, especially in survivorship. This protocol outlines a systematic review on the cultural influences in survivors of childhood cancer.

METHODS AND ANALYSIS

This protocol is reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines checklist and is registered with PROSPERO. EMBASE, MEDLINE and PsycINFO are searched. Eligibility criteria include original research studies published in English, and an assessment of culture on survivors of childhood cancer. Search terms are developed with a medical librarian. Primary objective will be to describe culture (ethnic and population groups, migration status, acculturation, cultural characteristics) in survivors of paediatric cancer and study characteristics and methods. Secondary objective will be to identify the role of culture in outcomes of survivors of paediatric cancer. Data extraction will include participant characteristics such as the number of participants and/or controls, sex, age at diagnosis. Extraction will also include analytical approaches, type of cultural variables (predictor, moderator, mediator, outcome) and effect measures.

ETHICS AND DISSEMINATION

Ethical approval was not required for this systematic review. Results from this systematic review will be disseminated in line with PRISMA guidelines through peer-reviewed publications and conference presentations. Findings will also be shared with our target communities, including survivors of childhood cancer and their families, through the creation of lay summaries and/or educational workshops in the community. Knowledge gathered from this review may help to identify gaps in knowledge and directions for future research. They may also inform the development of clinical recommendations for healthcare providers of survivors of childhood cancer.

PROSPERO REGISTRATION NUMBER

CRD42021234101.

Impact of a reduced nicotine standard on young adult appeal for menthol and non-menthol cigarettes

INTRODUCTION

The Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA's regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs.

METHODS AND ANALYSIS

This study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment.

ETHICS AND DISSEMINATION

The protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.

TRIAL REGISTRATION NUMBER

NCT04340947.

Cross-sectional survey of the Mental health and Addictions effects, Service impacts and Care needs of children, youth and families during the COVID-19 pandemic: the COVID-19 MASC study protocol

INTRODUCTION

The COVID-19 pandemic has had a tremendous negative effect on the mental health and well-being of Canadians. These mental health challenges are especially acute among vulnerable Canadian populations. People living in Canada's most populous province, Ontario, have spent prolonged time in lockdown and under public health measures and there is a gap in our understanding of how this has impacted the mental health system. This protocol describes the Mental health and Addictions Service and Care Study that will use a repeated cross-sectional design to examine the effects, impacts, and needs of Ontario adults during the COVID-19 pandemic.

METHODS AND ANALYSIS

A cross-sectional survey of Ontario adults 18 years or older, representative of the provincial population based on age, gender and location was conducted using Delvinia's AskingCanadians panel from January to March 2022. Study sample was 2500 in phases 1 and 2, and 5000 in phase 3. The Alcohol, Smoking and Substance Involvement Screening Test and Diagnostic Statistical Manual-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult were used to assess for substance and mental health concerns. Participants were asked about mental health and addiction service-seeking and/or accessing prior to and during the pandemic. Analyses to be conducted include: predictors of service access (ie, sociodemographics, mental illness and/or addiction, and social supports) before and during the pandemic, and χ² tests and logistic regressions to analyse for significant associations between variables and within subgroups.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Sunnybrook Research Ethics Board. Dissemination plans include scientific publications and conferences, and online products for stakeholders and the general public.

Adolescents hospitalised for suicidality: biomarkers, social and affective predictors: a cohort study

OBJECTIVES

The present research examines genomics and in vivo dynamics of family context and experienced affect following discharge from psychiatric hospitalisation for suicidal thoughts and behaviours (STBs). The purpose of this paper is to provide an overview of a new model, description of model-guided integration of multiple methods, documentation of feasibility of recruitment and retention and a description of baseline sample characteristics.

DESIGN

The research involved a longitudinal, multimethod observational investigation.

SETTING

Participants were recruited from an inpatient child and adolescent psychiatric hospital. 194 participants ages 13-18 were recruited following hospitalisation for STB.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants underwent a battery of clinical interviews, self-report assessments and venipuncture. On discharge, participants were provided with a phone with (1) the electronically activated recorder (EAR), permitting acoustic capture later coded for social context, and (2) ecological momentary assessment, permitting assessment of in vivo experienced affect and STB. Participants agreed to follow-ups at 3 weeks and 6 months.

RESULTS

A total of 71.1% of approached patients consented to participation. Participants reported diversity in gender identity (11.6% reported transgender or other gender identity) and sexual orientation (47.6% reported heterosexual or straight sexual orientation). Clinical interviews supported a range of diagnoses with the largest proportion of participants meeting criteria for major depressive disorder (76.9%). History of trauma/maltreatment was prevalent. Enrolment rates and participant characteristics were similar to other observational studies.

CONCLUSIONS

The research protocol characterises in vivo, real-world experienced affect and observed family context as associated with STB in adolescents during the high-risk weeks post discharge, merging multiple fields of study.

Measuring negative emotional responses to climate change among young people in survey research: a systematic review protocol

INTRODUCTION

Many young people report experiencing negative emotional responses to their awareness of climate change and the threats it poses to their future. With that, an increasing number of survey instruments have been developed to examine young people's negative emotional responses to their awareness of climate change. This report describes a protocol for a systematic review that aims to identify, synthesise and critically appraise how negative emotional responses to climate change among young people have been measured in survey research. The research questions addressed in this review are: (1) How has negative emotional responses to climate change been defined and measured among young people? (2) How do survey instruments measuring young people's negative emotional responses to climate change vary in terms of reliability and validity? (3) What factors are associated with negative emotional responses to climate change among young people?

METHODS AND ANALYSIS

Seven academic databases (CINAHL, ERIC, MEDLINE, PsycINFO, Web of Science, Scopus, and Environment Complete) will be searched to retrieve studies published between 1 January 2006 and 31 March 2022 and published in English. Studies including survey instruments that measure negative emotional responses among young people (aged 10-24 years) will be eligible for inclusion. Targeted journals will be hand-searched. This review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic reviews. The methodological quality, in terms of reliability and validity, of the included studies will be assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist for risk of bias of patient-reported outcome measures. To rate the quality of the instruments, we will use a modified Grading of Recommendations, Assessment, Development and Evaluations technique defined by the COSMIN guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not applicable for this study. We will disseminate the findings through publication in peer-reviewed journals and presentations.

PROSPERO REGISTRATION NUMBER

CRD42022295733.

Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial

INTRODUCTION

Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents.

METHOD AND ANALYSIS

A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver-adolescent relationship and caregivers' well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings.

ETHICS

Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan.

DISSEMINATION

The findings of the study will be disseminated by WHO and through peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ISRCTN17755448.

Effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder in Korean school-aged children: a nationwide time-series study

OBJECTIVES

This study explored the effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder (ASD), a proxy for symptom aggravation, among Korean children aged 5-14 years.

DESIGN

Time-series study.

SETTING, PARTICIPANTS AND OUTCOME MEASURES

We used data from the National Health Insurance Service (2011-2015). Daily concentrations of fine particulate matter (PM_2.5), nitrogen dioxide (NO₂) and ozone (O₃) levels in each region were used as exposures. ASD cases were defined based on a principal admission diagnosis of the claims data. We applied distributed lag non-linear models and a generalised difference-in-differences method to the quasi-Poisson models to estimate the causal effects of air pollution for up to 6 days. We also performed weighted quantile sum regression analyses to assess the combined effects of air pollution mixtures.

RESULTS

PM_2.5 levels at lag day 1, NO₂ levels at lag day 5 and O₃ levels at lag day 4 increased the risks of hospital admissions for ASD (relative risk (RR)=1.17, 95% CI 1.10 to 1.25 for PM_2.5; RR=1.09, 95% CI 1.01 to 1.18 for NO₂ and RR=1.03, 95% CI 1.00 to 1.06 for O₃). The mean daily count of hospital admissions for ASD was 8.5, and it would be 7.3, 7.8 and 8.3 when the PM_2.5 levels would be decreased by 10.0 µg/m³, NO₂ by 10 ppb and O₃ by 10 ppb, respectively. The weighted quantile sum index, constructed from PM_2.5, NO₂ and O₃ levels, was associated with a higher risk of hospital admissions for ASD (RR 1.29, 95% CI 1.14 to 1.46), where NO₂ was found to contribute to the effects most (the weight of 0.80).

CONCLUSIONS

These results emphasise that reduction of air pollution exposure should be considered for ASD symptom management, with important implications for the quality of life and economic costs.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

OBJECTIVE

To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0-11) and young people (12-25).

DESIGN

A systematic review of literature was undertaken.

DATA SOURCE

PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.

ELIGIBILITY CRITERIA

English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians' views on ACE screening in children/young people attending health settings were also included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.

RESULTS

Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.

CONCLUSION

As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being.

PROSPERO REGISTRATION NUMBER

University of York Centre for Reviews and Dissemination (CRD42021260420).

Identifying resources used by young people to overcome mental distress in three Latin American cities: a qualitative study

OBJECTIVE

To explore which resources and activities help young people living in deprived urban environments in Latin America to recover from depression and/or anxiety.

DESIGN

A multimethod, qualitative study with 18 online focus groups and 12 online structured group conversations embedded into arts workshops.

SETTING

This study was conducted in Bogotá (Colombia), Buenos Aires (Argentina) and Lima (Peru).

PARTICIPANTS

Adolescents (15-16 years old) and young adults (20-24 years old) with capacity to provide assent/consent and professionals (older than 18 years of age) that had experience of professionally working with young people were willing to share personal experience within a group, and had capacity to provide consent.

RESULTS

A total of 185 participants took part in this study: 111 participants (36 adolescents, 35 young adults and 40 professionals) attended the 18 focus groups and 74 young people (29 adolescents and 45 young adults) took part in the 12 arts workshops. Eight categories captured the resources and activities that were reported by young people as helpful to overcome mental distress: (1) personal resources, (2) personal development, (3) spirituality and religion, (4) social resources, (5) social media, (6) community resources, (7) activities (subcategorised into artistic, leisure, sports and outdoor activities) and (8) mental health professionals. Personal and social resources as well as artistic activities and sports were the most common resources identified that help adolescents and young adults to overcome depression and anxiety.

CONCLUSION

Despite the different contexts of the three cities, young people appear to use similar resources to overcome mental distress. Policies to improve the mental health of young people in deprived urban settings should address the need of community spaces, where young people can play sports, meet and engage in groups, and support community organisations that can enable and facilitate a range of social activities.

Is in-utero exposure to cannabis associated with the risk of attention deficit with or without hyperactivity disorder? A cohort study within the Quebec Pregnancy Cohort

IMPORTANCE AND OBJECTIVE

Prenatal cannabis effect on attention deficit with or without hyperactivity disorder (ADHD) remains to be determined. Our aim is to quantify the impact of in-utero exposure to cannabis on the risk of ADHD.

DESIGN

Cohort study.

SETTING

Questionnaires were mailed to women sampled from the Quebec Pregnancy Cohort (QPC). Data from questionnaires were then linked with their QPC (built with administrative health databases, hospital patient charts and birth certificate databases).

PARTICIPANTS

Respondents who gave birth to a singleton live born between January 1998 and December 2003 and were continuously enrolled in the Régie de l'assurance maladie du Québec (RAMQ) medication insurance plan for at least 12 months before the first day of gestation and during pregnancy.

EXPOSURE

In-utero cannabis exposure was based on mothers' answers to the question on cannabis use during pregnancy (yes/no) and categorised as occasionally, regularly exposed and unexposed if they chose one of these categories.

OUTCOMES

ADHD was defined by a diagnosis of ADHD through the RAMQ medical services or MedEcho databases or a prescription filled for ADHD medication through RAMQ pharmaceutical services between birth and the end of the follow-up period. Follow-up started at the birth and ended at the index date (first diagnosis or prescription filled for ADHD), child death (censoring), end of public coverage for medications (censoring) or the end of study period, which was December 2015 (censoring), whichever event came first.

RESULTS

A total of 2408 children met the inclusion criteria. Of these children, 86 (3.6%) were exposed to cannabis in-utero and 241 (10.0%) had an ADHD diagnosis or medication filled. After adjustments for potential confounders, no significant association was found between in-utero cannabis exposure (occasional (1.22 (95% CI 0.63 to 2.19)) or regular (1.22 (95% CI 0.42 to 2.79))) and the risk of ADHD in children.

CONCLUSIONS

In-utero exposure to cannabis seemed to not be associated with the risk ADHD in children.

Scoping review to evaluate the effects of peer support on the mental health of young adults

OBJECTIVES

Young adults report disproportionality greater mental health problems compared with the rest of the population with numerous barriers preventing them from seeking help. Peer support, defined as a form of social-emotional support offered by an individual with a shared lived experience, has been reported as being effective in improving a variety of mental health outcomes in differing populations. The objective of this scoping review is to provide an overview of the literature investigating the impact of peer support on the mental health of young adults.

DESIGN

A scoping review methodology was used to identify relevant peer-reviewed articles in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across six databases and Google/Google Scholar. Overall, 17 eligible studies met the inclusion criteria and were included in the review.

RESULTS

Overall, studies suggest that peer support is associated with improvements in mental health including greater happiness, self-esteem and effective coping, and reductions in depression, loneliness and anxiety. This effect appears to be present among university students, non-student young adults and ethnic/sexual minorities. Both individual and group peer support appear to be beneficial for mental health with positive effects also being present for those providing the support.

CONCLUSIONS

Peer support appears to be a promising avenue towards improving the mental health of young adults, with lower barriers to accessing these services when compared with traditional mental health services. The importance of training peer supporters and the differential impact of peer support based on the method of delivery should be investigated in future research.

Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study

INTRODUCTION

Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16-25 diagnosed with an eating disorder. It will explore participants' perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons' Advisory Group, who will be key to study delivery and dissemination.

METHODS AND ANALYSIS

This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16-25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants' feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20-30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant's data from both phases compared alongside comparative analysis of the datasets as a whole.

ETHICS AND DISSEMINATION

The study gained ethical approval from the NHS HRA West Midlands-Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).

Strategies to mitigate the impact of the COVID-19 pandemic on child and youth well-being: a scoping review protocol

INTRODUCTION

Children and youth are often more vulnerable than adults to emotional impacts of trauma. Wide-ranging negative effects (eg, social isolation, lack of physical activity) of the COVID-19 pandemic on children and youth are well established. This scoping review will identify, describe and categorise strategies taken to mitigate potentially deleterious impacts of the COVID-19 pandemic on children, youth and their families.

METHODS AND ANALYSIS

We will conduct a scoping review following the Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. Well-being will be operationalised according to pre-established domains (health and nutrition, connectedness, safety and support, learning and competence, and agency and resilience). Articles in all languages for this review will be identified in CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, ERIC, Education Research Complete, MEDLINE and APA PsycINFO. The search strategy will be restricted to articles published on or after 1 December 2019. We will include primary empirical and non-empirical methodologies, excluding protocols, reports, opinions and editorials, to identify new data for a broad range of strategies to mitigate potentially deleterious impacts of the COVID-19 pandemic on child and youth well-being. Two reviewers will calibrate screening criteria and the data abstraction form and will independently screen records and abstract data. Data synthesis will be performed according to the convergent integrated approach described by the Joanna Briggs Institute.

ETHICS AND DISSEMINATION

Ethical approval is not applicable as this review will be conducted on published data. Findings of this study will be disseminated at national and international conferences and will inform our pan-Canadian multidisciplinary team of researchers, public, health professionals and knowledge users to codesign and pilot test a digital psychoeducational health tool-an interactive, web-based tool to help Canadian youth and their families address poor mental well-being resulting from and persisting beyond the COVID-19 pandemic.