Systematic Review of Gender-Specific Child and Adolescent Mental Health Care

Mental health literacy interventions for female adolescents: a systematic review and meta-analysis

Suicide and self-harm are a leading cause of death globally, with females aged 15-24 years being a high-risk group requiring urgent intervention. Promoting mental health literacy is a well-established strategy for early intervention. No review has explored the available interventions promoting mental health literacy for female adolescents and their reach, effectiveness, adoption, implementation, and maintenance as a whole remains unknown. This study reviews existing interventions promoting mental health literacy in female adolescents. Searches included original peer-reviewed articles from inception to May 2024 across six databases, identifying twelve studies for review. Five independent meta-analyses were conducted, showing no significant effects immediately post-intervention for mental health literacy, knowledge, stigmatising attitudes, and help-provision. A significant reduction in stigmatising attitudes was found > 6 months post-intervention. Moderation analyses could not be performed due to insufficient data. None of the included studies reported on interventions specifically for female adolescents. This review also evaluated reporting of RE-AIM components, finding limited reporting on reach, adoption, and maintenance. These findings highlight a substantial gap in high-impact and tailored mental health prevention and promotion interventions for female adolescents. Therefore, there is a clear need to understand and target female adolescents' mental health literacy needs to develop and implement more effective interventions.

Children's emerging concepts of resilience: insights from using body mapping in an East London cohort sample of 7-10-year-old children

Background

Understanding resilience factors in children is essential for developing early mental health interventions. Middle childhood is an understudied developmental stage, with many quantitative measures lacking validation for this age group and not capturing diverse experiences. This study aimed to use body mapping, an arts-based method, as a novel approach to understand 7-10-year-old children's concepts of resilience (including definitions and factors that contribute to resilience) in East London. An advisory group of six children commented on the findings.

Methods

Body mapping was included in the Development of Emotional Resilience (DEER) Study. Participants drew a resilience symbol, wrote recent worries and colored on an A4-sized body map to signal where they embody stress. Demographic data were collected via self- and parent-report surveys and school records. Manifest content analysis identified four thematic categories related to worries, somatic stress and resilience.

Results

196 children (48.47% boys, 46.43% girls; 35.20% White, 30.10% Asian, 11.22% Black) across school years 3-5 completed body mapping. Concepts of resilience included perseverance and metaphorical representations of personal strength. We also identified socioecological factors that contributed to resilience, mainly at the individual and interpersonal levels. Boys more often depicted Sports whilst more girls depicted Engagement in the arts and Social networks. 11 worry categories emerged, including education, relationships and physical health. Of the body categories colored (n = 51), the most common were the head, hands and abdomen/stomach.

Conclusion

Children expressed dominant and abstract symbols of resilience and identified factors that contributed to resilience. Hobbies and strong relationships may be particularly important in middle childhood, corroborated by the advisory group's experiences. Body mapping revealed diverse worries (e.g., education, change and uncertainty and global and societal concerns) and somatic experiences of stress (e.g., the head, chest and torso). Through prioritising children's perspectives, body mapping holds promise in clinical and educational settings.

Risk and protective factors for mental health problems in children and adolescents during the COVID-19 pandemic: results of the longitudinal COPSY study

The COVID-19 pandemic has had profound effects on the mental health of children and adolescents worldwide, exacerbating existing challenges and introducing new stressors. This paper explores the impact of risk and protective factors on the mental well-being of young individuals during the pandemic. Using data from the German nationwide, population-based, longitudinal COPSY study (n = 2,471, girls: 50.0%, age 7-17 years) spanning nearly three years, this study investigates how factors such as gender, age, parental education, parental depressive symptoms, family cohesion, and social support influence mental health. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Latent growth analysis and structural equation modeling were employed to analyze cross-sectional and longitudinal data collected at five measurement points (initial response rate: 46.8%). Findings revealed that boys and younger children are at a higher risk for mental health problems. Additionally, low parental education, single parenthood, parental burden due to the pandemic and parental depressive symptoms were significantly linked with mental health problems in children. Conversely, personal resources, family cohesion, and social support were associated with less symptoms. Family cohesion additionally buffered against the negative impact of parental depressive symptoms. The study underscores the importance of multi-level interventions that consider individual, familial, and societal factors in promoting positive mental health outcomes among children and adolescents during challenging times. Continued research and collaborative efforts are needed to develop evidence-based strategies for supporting the resilience of young individuals in the face of future adversities.

Key mental health differences in conflict-related sexual violence and how sex, severity, and early intervention impact on improvement: a retrospective observational study

BACKGROUND

Conflict-related sexual violence (CRSV) is a significant health and human rights issue in humanitarian contexts, but there is a need of further research on differences between sexes in terms of severity of symptoms and improvement. Consequently, we explored the differences in severity and outcomes among male and female survivors of CRSV who received mental health and psychosocial support (MHPSS) in an armed conflict setting.

METHODS

We retrospectively analysed medical records from 3442 CRSV survivors in a MHPSS programme in Borno State, Nigeria, between 2018 and 2019. Patient characteristics, severity (measured with Clinical Global Impression of Severity Scale [CGI-S scale]), and improvement (measured with Clinical Global Impression of improvement [CGI-I] scale) were assessed by an attending counsellor. We assessed predictors for severity and improvement using a multivariable logistic regression analysis and time to improvement by sex using Kaplan Meier (K-M) curves and Cox regression.

RESULTS

We included 3442 patients who had at least one CRSV event in this study (2955 [85.9%] female, 486 [14.1%] male, one unknown). The most prevalent categories of symptoms were depression (49.9%; n = 1716), post-traumatic (25.6%; n = 879), and anxiety (20.3%; n = 697) symptoms. Most patients had mild (59.0%; n = 1869/3170) or moderate (36.4%; n = 1153/3170) symptoms at baseline, with 4.7% having severe symptoms (n = 148/3170). The logistic regression analysis (n = 1106), showed male patients had a 59% higher odds of severe symptoms at baseline than female patients (aOR 1.59; 95% CI 1.04-2.45). Among males, those older than 55 years had three times higher odds of presenting severe symptoms than younger patients (aOR 3.65; 95% CI 1.43-9.34). Women aged 36-55 years were more likely to present improvement than younger female patients (aOR 1.32; 95% CI 1.11-1.58). For both sexes, prompt attention after a CRSV event (≤ 3 days) positively predicted improvement (aOR 13.9; 95% CI 1.48-130 males, aOR 2.11; 95% CI 1.22-3.64 females) compared to late attention. Time to improvement did not differ between sexes, with an average of at least three consultations needed to achieve improvement.

CONCLUSIONS

Our study suggests that psychological attention of survivors within the first 72 h should be a priority. MHPSS programmes addressing CRSV should be inclusive to all patients, and gender-neutral approaches to ensure access, safety, confidentiality, and non-discrimination for all survivors should be developed.

Mental health and BMI in children and adolescents during one year in obesity treatment

BACKGROUND

Mental health plays a major role in children and adolescents with obesity. The aim of this study was (1) to compare mental health in children with obesity with the background population and (2) to investigate if mental health changed during one year in an obesity treatment program.

METHODS

Data on self-reported mental health was collected in 107 children and adolescents (mean age 13.2 years) with obesity at first visit in an obesity treatment program and at one year follow-up (n = 47). Mental health was assessed by eight questions from the Danish Health Behaviour in School-aged Children (HBSC) questionnaire: (1) self-rated health (2) life satisfaction (3) feeling low (4) body-image (5) loneliness (6) self-esteem (7) self-efficacy and (8) social competence. Data was compared to a reference population based on HBSC data. BMI-SDS was based on Danish reference values.

RESULTS

Children and adolescents with obesity had significantly higher odds of reporting negative body image and feeling low and lower odds of reporting high self-rated health and high self-esteem compared to a reference population. There was no difference between the groups regarding life-satisfaction, social competence, self-efficacy or feeling lonely. There were no significant changes in mental health from first visit to one-year follow-up.

CONCLUSION

Our findings highlight the mental health difficulties in children and adolescents with obesity, and the importance of addressing these issues in obesity treatment. The results also indicate that children with obesity have psychosocial resources that should be exploited in treatment protocols.

Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives

INTRODUCTION

Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs).

METHOD

Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach.

RESULT

The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery.

CONCLUSION

Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.