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Vallani TI, Naqqash Z, Lin B, Lu C, Austin JC, Stewart SE. The journey from concealment to disclosure of an obsessive-compulsive disorder diagnosis in the high school setting: A qualitative study exploring youth perspectives. Psychiatry Res 2023; 326:115275. [PMID: 37290366 DOI: 10.1016/j.psychres.2023.115275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
Disclosure of an OCD diagnosis in the high school setting could allow for timely provision of individualized school-based supports. As few studies have examined adolescent perspectives on the disclosure process in schools, we adopted a qualitative approach to explore this, and to gather recommendations for making disclosure of OCD at school safer and more helpful. Twelve participants, ranging from 13 to 17 years old, were recruited using maximum variance-based heterogeneous purposive sampling. Semi-structured interviews were conducted and analyzed inductively through Interpretive Description. From participants' stories, we generated a theoretical model describing the journey from concealment of an OCD diagnosis to disclosure. Four phases of youth disclosure were identified: managing enacted and perceived stigma related to the diagnosis, internal bargaining to determine their individualized disclosure boundaries, trust building with school members, and empowerment by being treated as a person first. Participants' recommendations for the school setting included meaningful education, safe spaces, deep reciprocal connections, and confidential personalized support. The model we developed can help inform school disclosure strategies and optimize support to promote best outcomes for youth with OCD.
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Affiliation(s)
- Tanisha I Vallani
- MD Undergraduate Program, University of British Columbia, Canada; Provincial OCD Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Zainab Naqqash
- Provincial OCD Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Boyee Lin
- Provincial OCD Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Cynthia Lu
- Provincial OCD Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Jehannine C Austin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Canada; Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada; British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada.
| | - S Evelyn Stewart
- Provincial OCD Program, BC Children's Hospital, Vancouver, BC, Canada; Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada; British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada
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Green JG, Oblath R, Kessel Schneider S, Miller M. Assessing Adolescent Mental Health Service Use: Developing the Adolescent Mental Health Support Scale (AMHSS). SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09460-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Duong MT, Bruns EJ, Lee K, Cox S, Coifman J, Mayworm A, Lyon AR. Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A Systematic Review and Meta-Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:420-439. [PMID: 32940884 DOI: 10.1007/s10488-020-01080-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.
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Affiliation(s)
- Mylien T Duong
- Education, Research, and Impact, Committee for Children, Seattle, USA.
| | - Eric J Bruns
- University of Washington School of Medicine, Seattle, USA
| | - Kristine Lee
- University of Washington School of Medicine, Seattle, USA
| | - Shanon Cox
- University of Washington School of Medicine, Seattle, USA
| | | | | | - Aaron R Lyon
- University of Washington School of Medicine, Seattle, USA
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Feigelman W, Joiner T, Rosen Z, Silva C, Mueller AS. Contrasts Between Young Males Dying by Suicide, Those Dying From Other Causes and Those Still Living: Observations From the National Longitudinal Survey of Adolescent to Adult Health. Arch Suicide Res 2016; 20:389-401. [PMID: 26752537 PMCID: PMC7064059 DOI: 10.1080/13811118.2015.1104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Utilizing Add Health longitudinal data, we compared 21 male suicide casualties to 10,101 living respondents identifying suicide correlates. METHOD 21 suicide decedents completed surveys in 1994/1995 (Wave 1) and 11 completed at Wave 3; responses were compared with Chi-square and oneway ANOVA tests. RESULTS Suicide decedents were prone to higher delinquency and fighting at Wave 1, but not at Wave 3. At Wave 1 suicide decedents remained undistinguished from living respondents in depression, self-esteem, and drug uses. Yet, after Wave 3, the 11 respondents dying by suicide showed significantly higher depression, drug use and lower self-esteem. CONCLUSION Delinquency trends can readily understood, but more complex causes are needed to account for unexpected changes in self-esteem, depression and drug uses.
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Feigelman W, Joiner T, Rosen Z, Silva C. Investigating Correlates of Suicide Among Male Youth: Questioning the Close Affinity Between Suicide Attempts and Deaths. Suicide Life Threat Behav 2016; 46:191-205. [PMID: 26247908 PMCID: PMC7871898 DOI: 10.1111/sltb.12183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/14/2015] [Indexed: 11/30/2022]
Abstract
This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z.
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Affiliation(s)
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Zohn Rosen
- Department of Psychology, New York Medical College, New York, NY, USA
| | - Caroline Silva
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Abstract
Asian American adults endorse more symptoms of social anxiety (SA) on self-report measures than European Americans, but demonstrate lower prevalence rates of SA disorder in epidemiological studies. These divergent results create ambiguity concerning the mental health needs of Asian Americans. The present study is the first to investigate this issue in adolescents through assessment of self-reported SA in Asian American high school students. Parent and self-ratings of impairment related to SA and self-reported mental health service use for SA were also measured. Asian American students endorsed a greater number of SA symptoms and scored in the clinical range more frequently than other ethnic groups. Also, Asian American and Latino students endorsed more school impairment related to SA than other ethnic groups. No differences in parent-reported impairment or service utilization were identified. Implications for future research and treatment for SA among Asian American adolescents are discussed.
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Sweeney C, Warner CM, Brice C, Stewart C, Ryan J, Loeb KL, McGrath RE. Identification of Social Anxiety in Schools: The Utility of a Two-Step Screening Process. ACTA ACUST UNITED AC 2015; 19:268-275. [PMID: 26609497 DOI: 10.1007/s40688-015-0055-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder (SAD) is highly prevalent yet largely undetected and untreated in adolescents despite the availability of effective treatments. Implementing interventions in schools enhances recognition and access to treatment for SAD. However, without reliable means to accurately identify youth in need of services, school-based interventions are not feasible. The purpose of this study is to evaluate the utility of a two-step, school-based screening approach to identify youth with SAD. Students at three public high schools were screened with self-report questionnaires or nominated by school personnel. Subsequently, a brief telephone assessment of student symptoms was completed with students' parents. Results showed that using both questionnaires and telephone assessments yielded acceptable detection rates, while school staff nominations were not beneficial. This study provides support for the use of a two-step screening procedure consisting of student self-reports followed by brief parent telephone interviews to identify youth with clinically impairing social anxiety. Implications for enhancing school-based detection of and intervention for socially anxious adolescents are discussed.
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Affiliation(s)
| | - Carrie Masia Warner
- William Paterson University, New York University Langone Medical Center, and Nathan S. Kline Institute for Psychiatric Research
| | - Chad Brice
- New York University Langone Medical Center
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Iancu I, Bodner E, Joubran S, Ben Zion I, Ram E. Why not the best? Social anxiety symptoms and perfectionism among Israeli Jews and Arabs: a comparative Study. Compr Psychiatry 2015; 59:33-44. [PMID: 25691264 DOI: 10.1016/j.comppsych.2014.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social Anxiety Disorder (SAD) has been repeatedly shown to be very prevalent in the Western society and is characterized by low self-esteem, pessimism, procrastination and also perfectionism. Very few studies on SAD have been done in the Middle East or in Arab countries, and no study tackled the relationship between social anxiety symptoms and perfectionism in non-Western samples. METHODS We examined social anxiety symptoms and perfectionism in a group of 132 Israeli Jewish (IJ) and Israeli Arab (IA) students. Subjects completed the Liebowitz Social Anxiety Scale (LSAS), the Multidimensional Perfectionism Scale (MPS), the Negative Automatic Thoughts Questionnaire (ATQ-N), the Positive Automatic Thoughts Questionnaire (ATQ-P) and a socio-demographic questionnaire. RESULTS The rate of SAD in our sample according to a LSAS score of 60 or more was 17.2% (IJ=13.8%, IA=19%, ns). The correlation between perfectionism and the LSAS was high in both groups, and in particular in the IJ group. The IA group had higher scores of social avoidance, of ATQ-P and of two of the MPS subscales: parental expectations and parental criticism. Concern over mistakes and negative automatic thoughts positively predicted social fear in the IJ group, whereas in the IA group being female, religious and less educated positively predicted social fear. Negative automatic thoughts and age positively predicted social avoidance in the IJ group. In general, the IJ and IA subjects showed higher social anxiety, higher ATQ-N scores and lower parental expectations as compared with non-clinical US samples. CONCLUSIONS Social anxiety symptoms and perfectionism are prevalent in Arab and Jewish students in Israel and seem to be closely related. Further studies among non-western minority groups may detect cultural influences on social anxiety and might add to the growing body of knowledge on this intriguing condition.
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Affiliation(s)
- I Iancu
- Yavne Mental Health Clinic, Sackler School of Medicine, Tel Aviv University Israel.
| | - E Bodner
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - S Joubran
- Department of Psychology and the Center for Psychobiological Research, The Yzreel Valley College, Emek Yzreel, Israel
| | | | - E Ram
- Rabin Medical Center-Campus Golda, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Masia Warner C, Brice C, Esseling PG, Stewart CE, Mufson L, Herzig K. Consultants' perceptions of school counselors' ability to implement an empirically-based intervention for adolescent social anxiety disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:541-54. [PMID: 23716144 DOI: 10.1007/s10488-013-0498-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.
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Flett GL, Hewitt PL. Disguised Distress in Children and Adolescents “Flying Under The Radar”. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2013. [DOI: 10.1177/0829573512468845] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is now recognized that there is a very high prevalence of psychological disorders among children and adolescents and relatively few receive psychological treatment. In the current article, we present the argument that levels of distress and dysfunction among young people are substantially underestimated and the prevalence of psychological problems is higher than realized because of a variety of factors. In particular, it is suggested that psychological problems are underestimated due, in part, to the presence of subthreshold conditions that do not meet diagnostic criteria yet involve substantial distress and impairment. In addition, we focus on a subset of children and adolescents who experience profound distress yet keep it hidden or disguised because of a personality style characterized by self-concealment and a tendency to engage in perfectionistic self-presentation. The characteristics of these students who are “flying under the radar” are described with a discussion of associated familial, cultural, and school factors that reduce the likelihood of these students ever seeking help. Given our premise that psychological problems are substantially underestimated, it is apparent that schools have a vitally important role in mental health promotion in terms of the need for proactive system-wide preventive interventions led by school mental health counsellors. Broad programs are needed to bolster levels of resilience and the willingness to seek help among all children and adolescents but especially among those students who would otherwise not be on anyone’s radar screen.
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Affiliation(s)
| | - Paul L. Hewitt
- University of British Columbia, Vancouver, British Columbia, Canada
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Gren-Landell M, Aho N, Carlsson E, Jones A, Svedin CG. Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization. Eur Child Adolesc Psychiatry 2013; 22:177-84. [PMID: 23099817 PMCID: PMC3586047 DOI: 10.1007/s00787-012-0336-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 09/29/2012] [Indexed: 11/28/2022]
Abstract
Recent findings from studies on adults show similarities between social anxiety disorder (SAD) and posttraumatic stress in the form of recurrent memories and intrusive and distressing images of earlier aversive events. Further, treatment models for SAD in adults have been successfully developed by using transdiagnostic knowledge on posttraumatic stress symptoms (PTSS). Studies on adolescents are though missing. The present study aimed at exploring the association between PTSS and SAD in Swedish adolescents. A second aim was to study mental health services utilization in relation to these conditions. A total of 5,960 high-school students participated and reported on SAD, life time victimization, PTSS and mental health service utilization. Socially anxious adolescents reported significantly higher levels of PTSS than adolescents not reporting SAD and this difference was seen in victimized as well as non-victimized subjects. Contact with a school counselor was the most common mental health service utilization in subjects with SAD and those with elevated PTSS. In the prediction of contact with a CAP-clinic, significant odds ratios were found for a condition of SAD and elevated PTSS (OR = 4.88, 95% CI = 3.53-6.73) but not for SAD only. Screening of PTSS in adolescents with SAD is recommended. The service of school counselors is important in detecting and helping young people with SAD and elevated PTSS. Clinical studies on SAD and PTSS in adolescents could aid in modifying treatment models for SAD.
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Affiliation(s)
- Malin Gren-Landell
- The Child and Adolescent Psychiatric Clinic, The University Hospital of Linköping, S-581 85, Linköping, Sweden.
| | - Nikolas Aho
- The Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth Carlsson
- Department of Behavioural Sciences and Learning, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Annica Jones
- Department of Behavioural Sciences and Learning, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Carl Göran Svedin
- The Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Advances and Challenges in School-Based Intervention for Anxious and Depressed Youth: Identifying and Addressing Issues of Sustainability. SCHOOL MENTAL HEALTH 2012; 4:193-196. [PMID: 23227130 DOI: 10.1007/s12310-012-9087-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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