Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis

Racial Socialization and Black Adolescent Mental Health and Developmental Outcomes: A Critical Review and Future Directions

OBJECTIVE

Black American adolescents are beleaguered with the most frequent and severe experiences of racial discrimination (RD) among their peers. To protect Black adolescents' mental health and developmental outcomes from the pernicious impact of discrimination, parents and other proximal adults and peers often utilize racial socialization (RS), or communications and behaviors emphasizing the importance of race and the harms of racism. While several recent RS reviews have been conducted across ethnicity, a modern review investigating RS practices related to and predictive of Black adolescent psychosocial outcomes is needed.

METHOD

To ground our critical systematic review of 45 articles, we first highlighted the ways RD impacts the lives of Black adolescents. Then, drawing from integrative models for Black youth development, we synthesized recent psychological, academic, and sociocultural literatures to describe the role of RS in Black adolescents' wellness.

RESULTS

The impact of various tenets of RS was seen most clearly as a protective factor against RD with respect to adolescents' mental health (e.g. depression), academic achievement (e.g. GPA), and sociocultural identity (e.g. public and private racial regard) development. Cultural socialization, a strategy related to extolling pride for one's race, was the most consistent RS protective factor, with novel RS constructs (e.g. parental competency) emerging as a method to buffer youth internalizing and externalizing problems.

CONCLUSIONS

Recommendations are made for future research on understudied components of RS and multiple methods and reporters to capture a more holistic depiction of RS practices. We emphasize preventative and intervening approaches to reduce the impetus for RS and its impact, including burgeoning clinical and community-level programs and the importance for provider training to yield positive mental health outcomes for Black adolescents.

Developmental Trajectories of Mental Health in Chinese Early Adolescents: School Climate and Future Orientation as Predictors

There is growing support for the dual-continua model of mental health, which emphasizes psychopathology and well-being as related but distinct dimensions. Yet, little is known about how these dimensions co-develop from childhood to early adolescence and what factors predict their different trajectories. The current study aimed to identify distinct patterns of mental health in Chinese early adolescents, focusing on both psychopathological symptoms (i.e., depressive symptoms and self-harm behaviors) and subjective well-being (i.e., life satisfaction and affect balance). This study also examined the contributions of school climate and future orientation to these trajectories. A total of 1,057 students (Mage = 11.88, SDage = 1.67; 62.1% boys) completed four assessments over two years, with six-month intervals. Using parallel-process latent class growth modeling, we identified four groups: Flourishing (32.5%), Languishing (43.8%), Troubled with Stable Depressive Symptoms (16.1%), and Troubled with Increasing Self-Harm Risk (7.6%). Furthermore, school climate and future orientation contributed to adolescents' membership in these trajectories, either independently or jointly. Specifically, higher levels of future orientation combined with higher school climate were associated with a lower likelihood of belonging to the Troubled with Increasing Self-Harm Risk trajectory, compared to the Flourishing group. Our findings identified four distinct mental health trajectories consistent with the dual-continua model, and demonstrated that the development of psychopathology and well-being were not always inversely related (e.g., the Languishing group). Adolescents with unique developmental profiles may benefit from tailored intervention strategies that build on the personal and environmental assets of the adolescent.

Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review

Background

Disciplinary behaviour management strategies are implemented in schools to manage pupil behaviour. There is limited evidence of their intended impact on behaviour but there is growing concern around the potential negative impacts on pupil wellbeing.

Methods

We carried out a systematic review to examine the impact of these strategies on psychosocial outcomes in pupils (PROSPERO Registration: CRD42021285427). We searched multiple sources and double-screened titles, abstracts, and full texts. Data extraction and risk of bias assessment were done by one reviewer and checked by another. Results were narratively synthesised.

Results

We included 14 studies, from 5375 citations, assessing temporary suspension (n=10), verbal reprimand (n=2), and mixed strategies (n=2). Depression was the most common outcome (n=7), followed by academic grades (n=4) and behaviour in class (n=4). All except one study were at high risk of bias. We found a recurring pattern in the evidence of disciplinary strategies associated with poor mental wellbeing and behaviour in pupils. The effect on academic attainment was unclear.

Conclusions

Disciplinary behaviour management strategies may have negative impact on pupil mental wellbeing and class behaviour. These important consequences should be assessed in better designed studies before these strategies are implemented.

Dual-factor Models of Mental Health: A Systematic Review of Empirical Evidence

Objective: Dual-factor models of mental health propose that mental health includes two interrelated yet distinct dimensions - psychopathology and well-being. However, there is no systematization of the evidence following these models. This review aims to address the following research question: what evidence exists using dual-factor models? Method: The current systematic review was conducted using PRISMA guidelines on the following databases: Web-of-science, Scopus, Academic Search Complete, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, ERIC, and MEDLINE. The screening process resulted in 85 manuscripts that tested the assumptions of dual-factor models. Results: Evidence revealed psychometric substantiation on the two-dimensionality of the dual-factor model, and 85% of the manuscripts provided evidence related to classifying participants into different mental health groups. Most studies showed that the Complete Mental Health or Positive Mental Health group is the most prevalent status group, and longitudinal evidence suggests that most participants (around 50%-64%) remain in the same group across time. Regarding the factors associated with mental health status groups, studies reviewed in this manuscript focus mainly on school-related outcomes, followed by supportive relationships, sociodemographic characteristics, psychological assets, individual attributes, physical health, and stressful events. Conclusions: This review highlights the importance of considering the two dimensions of mental health when conceptualizing, operationalizing, and measuring mental health. Fostering mental health must go beyond reducing symptoms, and practitioners would be able to include well-being-related interventions in their regular practice to improve individuals' mental health outcomes.

Mental health profiles and academic achievement in Australian school students

This study explored mental health profiles in Australian school students using indicators of well-being (i.e., optimism, life satisfaction, and happiness) and psychological distress (i.e., sadness and worries). The sample included 75,757 students (ages 8-18 years) who completed the 2019 South Australian Wellbeing and Engagement Collection. Latent profile analysis identified five mental health profiles consisting of (a) complete mental health (23%), (b) good mental health (33%), (c) moderate mental health (27%), (d) symptomatic but content (9%), and (e) troubled (8%). Findings provide partial support for the dual-factor model of mental health. Distal outcomes analysis on a sub-set of students (n = 24,466) found students with a symptomatic but content, moderate mental health, or troubled profile had poorer academic achievement than students with complete mental health. Implications for schools and education systems are discussed, including the need to pair clinical supports for students with psychological distress with population-level preventative health approaches to build psychological well-being.

Intersection of Perceived COVID-19 Risk, Preparedness, and Preventive Health Behaviors: Latent Class Segmentation Analysis

Background

COVID-19 risk perception is a factor that influences the pandemic spread. Understanding the potential behavioral responses to COVID-19, including preparedness and adoption of preventive measures, can inform interventions to curtail its spread.

Objective

We assessed self-perceived and latent class analysis (LCA)-based risks of COVID-19 and their associations with preparedness, misconception, information gap, and preventive practices among residents of a densely populated city in Nigeria.

Methods

We used data from a cross-sectional survey conducted among residents (N=140) of Onitsha, Nigeria, in March 2020, before the government-mandated lockdown. Using an iterative expectation-maximization algorithm, we applied LCA to systematically segment participants into the most likely distinct risk clusters. Furthermore, we used bivariate and multivariable logistic regression models to determine the associations among knowledge, attitude, preventive practice, perceived preparedness, misconception, COVID-19 information gap, and self-perceived and LCA-based COVID-19 risks.

Results

Most participants (85/140, 60.7%) had good knowledge and did not perceive themselves as at risk of contracting COVID-19. Three-quarters of the participants (102/137, 74.6%; P<.001) experienced COVID-19-related information gaps, while 62.9% (88/140; P=.04) of the participants had some misconceptions about the disease. Conversely, most participants (93/140, 66.4%; P<.001) indicated that they were prepared for the COVID-19 pandemic. The majority of the participants (94/138, 68.1%; P<.001) self-perceived that they were not at risk of contracting COVID-19 compared to 31.9% (44/138) who professed to be at risk of contracting COVID-19. Using the LCA, we identified 3 distinct risk clusters (P<.001), namely, prudent or low-risk takers, skeptics or high-risk takers, and carefree or very high-risk takers with prevalence rates (probabilities of cluster membership that represent the prevalence rate [γc]) of 47.5% (95% CI 40%-55%), 16.2% (95% CI 11.4%-20.9%), and 36.4% (95% CI 28.8%-43.9%), respectively. We recorded a significantly negative agreement between self-perceived risk and LCA-based segmentation of COVID-19 risk (κ=-0.218, SD 0.067; P=.01). Knowledge, attitude, and perceived need for COVID-19 information were significant predictors of COVID-19 preventive practices among the Onitsha city residents.

Conclusions

The clustering patterns highlight the impact of modifiable risk behaviors on COVID-19 preventive practices, which can provide strong empirical support for health prevention policies. Consequently, clusters with individuals at high risk of contracting COVID-19 would benefit from multicomponent interventions delivered in diverse settings to improve the population-based response to the pandemic.

Human Capital Development Factors and Black Adolescent Tobacco and Cannabis Use

INTRODUCTION

This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth.

AIMS AND METHODS

Nationally representative annual cross-sectional data for black adolescents (12-17 years; N = 9017) in the National Survey on Drug Use and Health 2015-2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU.

RESULTS

In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001).

CONCLUSIONS

Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities.

IMPLICATIONS

This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities.

COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States

IMPORTANCE

The adverse effects of COVID-19 containment policies disrupting child mental health and sleep have been debated. However, few current estimates correct biases of these potential effects.

OBJECTIVES

To determine whether financial and school disruptions related to COVID-19 containment policies and unemployment rates were separately associated with perceived stress, sadness, positive affect, COVID-19-related worry, and sleep.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was based on the Adolescent Brain Cognitive Development Study COVID-19 Rapid Response Release and used data collected 5 times between May and December 2020. Indexes of state-level COVID-19 policies (restrictive, supportive) and county-level unemployment rates were used to plausibly address confounding biases through 2-stage limited information maximum likelihood instrumental variables analyses. Data from 6030 US children aged 10 to 13 years were included. Data analysis was conducted from May 2021 to January 2023.

EXPOSURES

Policy-induced financial disruptions (lost wages or work due to COVID-19 economic impact); policy-induced school disruptions (switches to online or partial in-person schooling).

MAIN OUTCOMES AND MEASURES

Perceived stress scale, National Institutes of Health (NIH)-Toolbox sadness, NIH-Toolbox positive affect, COVID-19-related worry, and sleep (latency, inertia, duration).

RESULTS

In this study, 6030 children were included in the mental health sample (weighted median [IQR] age, 13 [12-13] years; 2947 [48.9%] females, 273 [4.5%] Asian children, 461 [7.6%] Black children, 1167 [19.4%] Hispanic children, 3783 [62.7%] White children, 347 [5.7%] children of other or multiracial ethnicity). After imputing missing data, experiencing financial disruption was associated with a 205.2% [95% CI, 52.9%-509.0%] increase in stress, a 112.1% [95% CI, 22.2%-268.1%] increase in sadness, 32.9% [95% CI, 3.5%-53.4%] decrease in positive affect, and a 73.9 [95% CI, 13.2-134.7] percentage-point increase in moderate-to-extreme COVID-19-related worry. There was no association between school disruption and mental health. Neither school disruption nor financial disruption were associated with sleep.

CONCLUSIONS AND RELEVANCE

To our knowledge, this study presents the first bias-corrected estimates linking COVID-19 policy-related financial disruptions with child mental health outcomes. School disruptions did not affect indices of children's mental health. These findings suggest public policy should consider the economic impact on families due to pandemic containment measures, in part to protect child mental health until vaccines and antiviral drugs become available.

Longitudinal Patterns of Strengths Among Youth with Psychiatric Disorders: A Latent Profile Transition Analysis

A better understanding of variability in the strengths of youth with psychiatric disorders is critical as a strength-based approach can lead to recovery. This study aimed to identify subgroups of strengths among youth with mental disorders and determine whether subgroups changes were associated with mental health recovery. Youth with mental disorders (N = 2228) from a statewide database were identified in the state fiscal year of 2019. Using the latent profile analysis and latent transition analysis, we identified three strength profiles (i.e., essential, usable, and buildable). Over 90% of youth sustained or developed strengths over time. Positive transitions were associated with mental health recovery, symptom reduction, and personal recovery. Buildable strengths supported youth's personal recovery independent of improving mental health needs. The findings suggest that subgroups of strengths may be a promising source for planning and tracking youth's progress and guiding clinicians to more efficiently allocate community-based resources.

Becoming More Resilient during COVID-19: Insights from a Process Evaluation of Digital Resilience Training

Resilience training is gaining attention as a strategy to build students' resistance to adversity and promote their mental well-being. However, owing to inconsistencies and variations in the content and delivery of resilience training, more work is needed to examine students' experiences and preferences to address issues relating to intervention fidelity. This study adopted a qualitative approach in exploring students' experience of synchronous and asynchronous versions of a digital resilience training program. Seventeen students were interviewed using a semi-structured virtual face-to-face interview via Zoom. The thematic analyses unveiled four themes: embarking on a journey toward resilience, discovering strategies to develop resilience, finding a balance to benefit from resilience skill enhancement, and instilling resilience in the everyday. Future resilience training should consider students' workload and interactivity to enhance their engagement. As being resilient is associated with better mental well-being, the findings of this study may support the development of future wellness programs.

Substance use and individual assets in urban adolescents: Subgroups and correlates in emerging adulthood

INTRODUCTION

To investigate patterns of divergence in adolescent adjustment, this study examined the co-occurring patterns of adolescents' individual assets (e.g., school engagement, values) and substance use, and whether the co-occurring patterns were associated with later functioning in emerging adulthood.

METHODS

Participants were 358 (54% females), predominantly African American, urban adolescents, recruited at birth for a prospective study on the effects of prenatal substance exposure in the Midwest United States. Individual assets, using the Developmental Assets Profile, substance use (alcohol, tobacco, marijuana), via biologic assays and self-report, and substance use-related problems were assessed at age 15 years. High-school completion, substance use disorder, mental health symptoms, and legal problems were assessed at age 21 years.

RESULTS

Latent class analysis identified five classes as follows: high assets with low substance use (C1, 10.2%); moderate assets with low substance use (C2, 28.7%); low assets with low substance use (C3, 32%); moderate assets with high substance use (C4, 9.4%); and low assets with high substance use (C5, 19.2%). Despite similar levels of assets, adolescents in C5 reported more life adversities (suboptimal caregiving environment, daily hassles, non-birth parents' care) than those in C3. C4 and C5 reported more substance use disorder at age 21 years than the three low substance use classes; adolescents in C5 were less likely to complete high school than those in C2. More females in C5 reported greater mental health symptoms than those in C1 and C3, and criminal justice involvement than those in C1.

CONCLUSIONS

The current findings underscore the significance of substance use in adolescence in disrupting healthy transition to adulthood, especially among females in the context of low individual assets.

Association of Social Determinants of Health and Vaccinations With Child Mental Health During the COVID-19 Pandemic in the US

IMPORTANCE

The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic.

OBJECTIVE

To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates.

DESIGN, SETTING, AND PARTICIPANTS

This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021.

EXPOSURES

Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH.

MAIN OUTCOMES AND MEASURES

Perceived Stress Scale, the National Institutes of Health-Toolbox emotion measures, and COVID-19-related worry.

RESULTS

The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19-related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic-related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19-related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = -1.78; 95% CI, -3.39 to -0.18; P = .03) among children.

CONCLUSIONS AND RELEVANCE

Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.

Flattening the quality of life curve? A prospective person-centred study from Norway amid COVID-19

Purpose

We examined multidimensional, heterogeneous reactions to the COVID-19 pandemic and associated measures to provide further insights into the developmental processes of risk and adaptation.

Method

We used three-wave questionnaire data from 8156 individuals participating in the Norwegian County Public Health Survey assessed 1–5 months before and three (June 2020) and nine (December 2020) months after the outbreak. Latent profile and latent transition analyses were used to identify latent quality of life (QoL) classes and multiform changes, their probabilities, and predictors.

Results

We identified five distinct QoL classes of varying proportions, namely Flourishing (i.e. 24–40%), Content (31–46%), Content-Symptomatic (8–10%), Languishing (14–20%), and Troubled (2–5%). Despite higher levels of negative affect and lower levels of life satisfaction and positive emotions, most individuals remained in their pre-pandemic QoL profiles. Yet, changes occurred for a meaningful proportion, with transition to a less favourable class more common than to a favourable. Between time 1 and 3, the flourishing and troubled groups decreased by 40% and 60%, while the content and languishing groups increased by 48% and 43%, respectively. Favourable pre-pandemic relational (marital status, support, interpersonal trust, and belonging), health, and economy-related status predicted significantly lower odds of belonging to the high-risk groups both pre-pandemic and during the pandemic.

Conclusions

Overall, this study shows lower levels of QoL amid the COVID-19 pandemic, but substantial stability in the QoL distribution, and an overall levelling of the QoL distribution. Our findings also underscore the importance of financial, health-related, and social capital to QoL.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03113-2.

Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic

OBJECTIVE

The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China.

METHODS

A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors.

RESULTS

In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19.

CONCLUSIONS

Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.

Test anxiety, anxiety disorders, and school-related wellbeing: Manifestations of the same or different constructs?

Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Suicide is the second leading cause of death for people aged 10-34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (Mage = 14.99 [SD = 1.61]) from Waves I-IV National Longitudinal Study of Adolescent to Adult Health (1994-2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01-2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21-2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69-4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08-2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage.

Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis

BACKGROUND

Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors.

OBJECTIVE

This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic.

METHODS

A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes.

RESULTS

The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021.

CONCLUSIONS

Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups.

TRIAL REGISTRATION

PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/26948.

Does Test Anxiety Predispose Poor School-Related Wellbeing and Enhanced Risk of Emotional Disorders?

Background

Previous studies have shown that children and adolescents who report high levels of test anxiety also report symptoms of, and meet clinical criteria for, emotion disorders (anxiety and depression). However, the directionality of this relation cannot be established from existing studies: Is high test anxiety predisposing persons at elevated risk for developing emotion disorders or vice versa? In the present study, we addressed this question in a sample of adolescents. In addition to the risk of developing an emotion disorder, based on the Dual Factor Model of Mental Health, we also considered school-related wellbeing.

Method

Self-reported data were collected over two waves from 1198 participants, aged 16–19 years, in upper secondary education.

Results

Data were analysed using a structural equation model controlling for gender and age. We found reciprocal relations between test anxiety and elevated risk for developing emotion disorders, and between school-related wellbeing and elevated risk for developing emotion disorders. School-related wellbeing was negatively related to subsequent test anxiety but not vice versa.

Conclusions

Our findings imply that there would be downstream benefits to improved mental health from using interventions to address test anxiety but also, from addressing emotion disorders, to improve school-related wellbeing and test anxiety.

Latent Class Analysis of Mental Health in Middle Childhood: Evidence for the Dual-Factor Model

Mental health is complex, comprising both mental distress and well-being. This study used latent class analysis to identify common combinations of mental distress and well-being (‘mental health classes’) among schoolchildren aged 8–9 years (N = 3340). Thirteen items, measuring a range of conduct problems, emotional symptoms, and subjective well-being, were included in the analysis. Four mental health classes were identified: (1) complete mental health (n = 1895, 57%), (2) vulnerable (n = 434, 13%), (3) emotional symptoms but content (n = 606, 18%), and (4) conduct problems but content (n = 404, 12%). The classes were reliably identified across different datasets, and for males and females. Differential relations with covariates indicated that mental health classes were distinct and externally valid. The results supported the dual-factor model of mental health, suggesting that mental distress and subjective well-being are separate continua. Three of the four possible combinations of high and low distress and subjective well-being posited by the dual-factor model were found using this inductive statistical method. Importantly, our analysis also revealed two ‘symptomatic but content’ groups, differentiated by symptom domain (internalising/externalising). The covariate analyses between mental health classes and sociodemographic factors, prior academic attainment, school connectedness, and peer support, indicated that there are nuanced relations between those variables and particular constellations of mental distress and well-being. As one of the few dual-factor studies to focus on middle childhood, the current study adds important new evidence that contributes to our understanding of the complexities of mental health among schoolchildren.

The role of parental citizenship status on depression of U.S. citizen children

The purpose of this study was to determine how parental citizenship status played a role in the depression scores of Hispanic/Latinx children in the sample. Eight-hundred thirty-five participants from the Children of Immigrants Longitudinal Study (CILS) were included in this study. The Center of Epidemiology Studies Depression Scale (CES-D) was used to assess depression scores among this sample of Hispanic/Latinx children. Participants were separated into the following categories: Both parents U.S. citizens, one parent U.S. citizen, neither parent U.S. citizen. Analysis of variance showed that there is a significant relationship between depression and parental citizenship status. The depression scores of individuals who had one parent who is a U.S. citizen was significantly higher than those who had both parents who are U.S. citizens. Ordinary least of squares regression revealed that having one parent who is a U.S. citizen was a significant predictor of depression outcomes.

Profiles of individual assets and mental health symptoms in at-risk early adolescents

INTRODUCTION

Few studies investigated the combined patterns of individual assets (e.g., social competence, positive identity) and mental health symptoms (MHS) in adolescents. This study examined the patterns of early adolescents' individual assets and MHS and whether identified patterns were associated with later adolescents' outcomes.

METHODS

Participants were 352 (164 boys, 188 girls) adolescents who were primarily African-American and from low socioeconomic status families, participating in a prospective study of the effects of prenatal cocaine exposure from birth in the Midwest United States. Individual assets, using the Developmental Assets Profile, and MHS, using the Youth Self-Report, were assessed at age 12. Substance use, via self-report and biologic assays, early (before age 15) sexual behaviors, and behavioral adjustment were assessed at age 15.

RESULTS

Latent profile analysis indicated four distinctive profiles: low assets with elevated MHS (P1, n = 54, 15.3%); adequate assets with thought and social problems (P2, n = 84, 23.9%); low assets without MHS (P3, n = 101, 28.7%); and high assets without MHS (P4, n = 113, 32.1%). Children in the profile with high assets without MHS (P4) were more likely to have a higher IQ and to be in a more optimal environment (higher parental monitoring and less family conflict) than those in other profiles. Although profiles with MHS were associated with adolescent risk behaviors, this relationship was more pronounced for girls than for boys.

CONCLUSIONS

Girls in the low assets with elevated MHS (P1) should be a primary concern for preventive intervention. Our study demonstrates the heterogeneity of individual patterns of adaptation and maladaptation.

The Application of Latent Class Analysis for Investigating Population Child Mental Health: A Systematic Review

Background: Latent class analysis (LCA) can be used to identify subgroups of children with similar patterns of mental health symptoms and/or strengths. The method is becoming more commonly used in child mental health research, but there are reservations about the replicability, reliability, and validity of findings. Objective: A systematic literature review was conducted to investigate the extent to which LCA has been used to study population mental health in children, and whether replicable, reliable and valid findings have been demonstrated. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A search of literature, published between January 1998 and December 2017, was carried out using MEDLINE, EMBASE, PsycInfo, Scopus, ERIC, ASSIA, and Google Scholar. A total of 2,748 studies were initially identified, of which 23 were eligible for review. The review examined the methods which studies had used to choose the number of mental health classes, the classes that they found, and whether there was evidence for the validity and reliability of the classes. Results: Reviewed studies used LCA to investigate both disparate mental health symptoms, and those associated with specific disorders. The corpus of studies using similar indicators was small. Differences in the criteria used to select the final LCA model were found between studies. All studies found meaningful or useful subgroups, but there were differences in the extent to which the validity and reliability of classes were explicitly demonstrated. Conclusions : LCA is a useful tool for studying and classifying child mental health at the population level. Recommendations are made to improve the application and reporting of LCA and to increase confidence in findings in the future, including use of a range of indices and criteria when enumerating classes, clear reporting of methods for replicability, and making efforts to establish the validity and reliability of identified classes.