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McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato Nogueira I, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Le LKD, Kieling C, Mac Dhonnagáin N, Malla A, Nieman DH, Rickwood D, Robinson J, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson J, Yung A, Iyer SN, Killackey E. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 2024; 11:731-774. [PMID: 39147461 DOI: 10.1016/s2215-0366(24)00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick D McGorry
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cristina Mei
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vivienne Browne
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Ella Gow
- Orygen, Melbourne, VIC, Australia; Melbourne, VIC, Australia
| | | | | | | | - Elina Pang
- Hong Kong Special Administrative Region, China
| | | | | | | | - Steven Adelsheim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Y H Chen
- Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; LKS School of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pattie P Gonsalves
- Youth Mental Health Group, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Matthew P Hamilton
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Dorien H Nieman
- Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia; headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Jo Robinson
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ian Soosay
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Jean Twenge
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lucia Valmaggia
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison Yung
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Eóin Killackey
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, Jansen W. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:2051-2065. [PMID: 36129544 PMCID: PMC9490713 DOI: 10.1007/s00787-022-02077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/19/2022]
Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.
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Affiliation(s)
- S Verhoog
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D G M Eijgermans
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Y Fang
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W Jansen
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands.
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Braund TA, Baker STE, Subotic-Kerry M, Tillman G, Evans NJ, Mackinnon A, Christensen H, O'Dea B. Potential mental health-related harms associated with the universal screening of anxiety and depressive symptoms in Australian secondary schools. Child Adolesc Psychiatry Ment Health 2024; 18:46. [PMID: 38566202 PMCID: PMC10985850 DOI: 10.1186/s13034-024-00734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. METHODS A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. RESULTS Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. CONCLUSIONS The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821 .
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Affiliation(s)
- Taylor A Braund
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | | | - Mirjana Subotic-Kerry
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Gabriel Tillman
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Nathan J Evans
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Porter A, d’Apice K, Albers P, Woodrow N, Fairbrother H, Breheny K, Mills C, Tebbett S, De Vocht F. The impact of the newly developed school-based 'Digital Health Contact'-Evaluating a health and wellbeing screening tool for adolescents in England. PLoS One 2024; 19:e0297016. [PMID: 38215072 PMCID: PMC10786370 DOI: 10.1371/journal.pone.0297016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Supporting adolescents with their health and wellbeing is an international public health priority. Schools are well placed to universally detect unmet health needs and support pupils. This study aimed to evaluate the effectiveness of a digital health and wellbeing screening tool, called the 'Digital Health Contact' (DHC) implemented in schools in the East Midlands of England. The DHC, delivered by Public Health Nurses (School Nurses) (PHN(SN)), aims to identify pupils with unmet health needs (via a 'red flag' system) and provide appropriate support. MATERIALS AND METHODS Using data from 22 schools which took part in the DHC and 14 schools which did not take part, across three academic years (2018-2020), we conducted a controlled interrupted timeseries analysis with negative binomial regression to explore the effect of the DHC on the number of annual referrals to PHN(SN). Using DHC data from 164 pupils, we further conducted a Difference-in-Difference analysis to explore the impact of 'red flag' and referral via the DHC in Year 9 (age 13-14) on the number of red flags in Year 11 (age 15-16). RESULTS Across all schools, the mean annual number of referrals increased over the three year follow-up period. In the adjusted model, the number of referrals was comparable between schools taking part in the DHC and non-participating schools (0.15 referrals [95% CI -0.21, 0.50]). Red flag score was not significantly different among Year 11 pupils, after being referred via the DHC in Year 9 (-0.36 red flags [95% CI -0.97, 0.24]). DISCUSSION The DHC, and similar screening tools, have the potential to raise awareness of the health and wellbeing support in schools and provide an additional pathway of referral to this support for pupils with unmet health needs, without replacing the traditional pathway where pupils refer themselves or are referred by teachers.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katrina d’Apice
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Patricia Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nicholas Woodrow
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Hannah Fairbrother
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Clare Mills
- Public Health, Leicester City Council, Leicester, United Kingdom
| | - Sarah Tebbett
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Frank De Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (NIHR ARC West), Bristol, United Kingdom
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Chen JK, Yang B, Wang LC, Chang CW, Lin CY. Is Psychological Distress a Risk Factor or an Outcome of School Violence and Cyberbullying Perpetrated by Adolescents? A Short-Term Longitudinal Panel Study. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231163249. [PMID: 37032613 DOI: 10.1177/08862605231163249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Although the associations between adolescent psychological distress (i.e., depression, anxiety, and somatization), school violence, and cyberbullying have been examined using cross-sectional data, little evidence from longitudinal panel data exists to determine the temporal association. A two-wave longitudinal panel data with a 10-month interval were obtained from a random sample of 487 Chinese junior high school students (grades 7-9) in Tianjin in Mainland China. The cross-lagged panel analysis showed that adolescent psychological distress in the first wave of the survey was significantly associated with subsequent school violence against peers and teachers in the second wave but not in the opposite direction. Student psychological distress in the first wave of the survey was not significantly associated with cyberbullying perpetration in the second wave and vice versa. The findings suggested that adolescent psychological distress was a risk factor rather than the consequence of violence against peers and teachers in school. However, the temporal associations between adolescent psychological distress and cyberbullying perpetration were non-significant. These findings were relevant to both sex groups. The findings may imply that potential interventions and policies to prevent students from committing school violence should consider reducing students' psychological distress as one of the core elements.
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Affiliation(s)
- Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, Hong Kong
| | - Boyuan Yang
- Department of Social Work, Chinese University of Hong Kong, Hong Kong
| | - Li-Chih Wang
- Department of Special Education, National Tsing Hua University, Hsinchu, Taiwan
| | - Ching-Wen Chang
- Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sekhar DL, Schaefer EW, Hoke AM, Rosen P, Chuzie RA, Milakovic DM. A Collaborative Analysis of Trends in Referrals to the Pennsylvania Student Assistance Program from 2013 to 2018. THE JOURNAL OF SCHOOL HEALTH 2023; 93:331-339. [PMID: 36404435 DOI: 10.1111/josh.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/11/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Student Assistance Program (SAP) is mandated kindergarten to 12th grade in Pennsylvania schools to address barriers to student academic success. Following student referral, SAP teams use a systematic process to inform recommendations for school or community-based services. To evaluate program outcomes, a review of student SAP referral trends over a 5-year period was undertaken. METHODS The Pennsylvania Network for Student Assistance Services (PNSAS), the state leadership providing oversight of SAP, partnered with Penn State College of Medicine in a retrospective analysis of student referral data from 2013 to 2018. Public school enrollment demographics were used for comparison. Frequencies and percentages were calculated. RESULTS Referrals (total n = 352,640) increased by 24% over the 5 years; demographics 55% male, 69% non-Hispanic white, 16% non-Hispanic black, and 10% Hispanic. Referrals were most commonly for behavioral concerns (31%). Discontinued referrals (39%) were primarily for parent refusal/no permission. Trends included rising minority and elementary referrals over the study period. CONCLUSIONS SAP referral demographics were consistent with state public school enrollment race/ethnicity breakdown suggesting lack of systematic bias. The proportion of behavioral referrals was consistent with rising youth behavioral health needs. PNSAS must consider strategies to support rising referral numbers and trends.
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Affiliation(s)
- Deepa L Sekhar
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alicia M Hoke
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Perri Rosen
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, Harrisburg, PA, USA
| | - Roberta A Chuzie
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, Harrisburg, PA, USA
| | - Dana M Milakovic
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, Harrisburg, PA, USA
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The effect of childhood adversities on the persistence of suicidal ideation and plans among college students: A longitudinal study. J Affect Disord 2023; 323:354-360. [PMID: 36470554 DOI: 10.1016/j.jad.2022.11.078] [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: 05/03/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Exposure to childhood adversities (CAs) is known to be associated with the onset of suicidal ideation and plans. However, little is known regarding the contribution of CAs to their persistence. AIMS The study aims to examine the type, number and frequency of CA exposure on the persistence of suicidal ideation and plans at one-year. METHOD Data were drawn from the French portion of the World Mental Health International College Student survey. At baseline (n = 2661, response rate = 7,58 %), exposure to 12 types of CAs prior to age 18, lifetime mental disorders, lifetime and 12-month suicidal ideation and plans were assessed. At one-year follow-up (n = 1221), 12-month mental disorders, suicidal ideation and plans were assessed. Among those with a prior history of suicidal ideation, logistic regressions were performed to examine the role of CAs on the persistence of ideation and plans at one-year. RESULTS At baseline, frequency and number of CAs were associated with 12-month suicidal ideation and plans. Among lifetime ideators, 49.6 % reported 12-month suicidal ideation at follow-up. Physical abuse was associated with an increased risk of suicidal ideation and plan persistence at one year in univariate analyses. However, CAs were not associated with the persistence of suicidal ideation and plans at one-year in multivariate analyses. LIMITATIONS Retrospective report of CA exposure, and low baseline response rate. CONCLUSIONS Using a fine-grained operationalization of CA exposure, CAs were not involved in the persistence of suicidal ideation or plans, their deleterious effect more likely to occur early in the course of psychopathology.
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Long MW, Ward ZJ, Wright DR, Rodriguez P, Tefft NW, Austin SB. Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders. Am J Prev Med 2022; 63:935-943. [PMID: 36109308 DOI: 10.1016/j.amepre.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults. METHODS Using data from 2001 to 2017, the authors developed a microsimulation model of a closed cohort starting at the age of 10 years and ending at 40 years. In 2021, an analysis was conducted of 5 primary and secondary prevention strategies for eating disorders: school-based screening, primary care‒based screening, school-based universal prevention, excise tax on over-the-counter diet pills, and restriction on youth purchase of over-the-counter diet pills. The authors estimated the reduction in years lived with eating disorders and the increase in quality-adjusted life-years. Intervention costs and net monetary benefit were estimated using a threshold of $100,000/quality-adjusted life year. RESULTS All the 5 interventions were estimated to be cost-saving compared with the current practice. Discounted per person cost savings (over the 30-year analytic time horizon) ranged from $63 (clinic screening) to $1,102 (school-based universal prevention). Excluding caregiver costs for binge eating disorder and otherwise specified feeding and eating disorders substantially reduced cost savings (e.g., from $1,102 to $149 for the school-based intervention). CONCLUSIONS A range of public health strategies to reduce the societal burden of eating disorders are likely cost saving. Universal prevention interventions that promote healthy nutrition, physical activity, and media use behaviors without introducing weight stigma may prevent additional negative health outcomes, such as excess weight gain.
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Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Patricia Rodriguez
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington
| | | | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Sekhar DL, Hivner E, Molinari A, Allen K, Stuckey H. A qualitative analysis of participant experiences with universal school-based depression screening. Prev Med Rep 2022; 31:102073. [DOI: 10.1016/j.pmedr.2022.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
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Weist MD, Splett JW, Halliday CA, Gage NA, Seaman MA, Perkins KA, Perales K, Miller E, Collins D, DiStefano C. A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline. J Sch Psychol 2022; 94:49-65. [DOI: 10.1016/j.jsp.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023]
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Huang YH, Liu HC, Sun FJ, Liu SI. Predictors of repeated adolescent self-harm: The display of multiple variables and mediators in a 2-year study. J Formos Med Assoc 2022; 121:2584-2592. [PMID: 36100494 DOI: 10.1016/j.jfma.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data on self-harm (SH) repetition in non-Western adolescents are limited; this study is to survey the predictors. METHODS A total of 5879 adolescents (mean age 16.02 years) in Northern Taiwan were recruited. The participants filled in online questionnaires about their sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use at baseline (T1) and at the 1 year follow-up (T2). We used logistic regression analysis to examine the predictors of SH continuation. Generalized structural equation modeling (GSEM) was then estimated to analyze the treatable variables for both years and to investigate their relationships and mediating effects. RESULTS A total of 125 students were identified as being in the SH continuation group; while 470 students were identified as being in the SH stop group. The SH continuation rate was 21%; no significant gender difference was found. Logistic regression analysis showed that the predictors of SH continuation were low school ranking, poor quality of listening from relatives, use of the cutting method for SH, and a suicide plan in the past year at T1, and more depressed mood, use of the cutting method for SH, more suicide ideation and plans at T2. Similar predictors were found by GSEM; self-esteem at T1 and depressed mood at T2 were found to be mediators in the pathways. CONCLUSION The continuation rate of SH was similar to that reported in Western countries. These predictors should be included in the treatment plan to prevent SH continuation.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan; Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan; Suicide Prevention Center, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan; Suicide Prevention Center, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan
| | - Fang-Ju Sun
- MacKay Junior College of Medicine, Nursing, and Management, No. 92, Shengjing Road, Beitou District, Taipei 11272, Taiwan; Department of Medical Research, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City 25160, Taiwan
| | - Shen-Ing Liu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan; Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan; Suicide Prevention Center, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd., Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, No. 92, Shengjing Road, Beitou District, Taipei 11272, Taiwan; Department of Medical Research, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City 25160, Taiwan.
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Sekhar DL, Schaefer EW, Waxmonsky JG, Walker-Harding LR, Pattison KL, Molinari A, Rosen P, Kraschnewski JL. Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2131836. [PMID: 34739064 PMCID: PMC8571659 DOI: 10.1001/jamanetworkopen.2021.31836] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Adolescent major depressive disorder (MDD) prevalence has nearly doubled in the past decade. The US Preventive Services Task Force endorses universal adolescent MDD screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment. OBJECTIVE To evaluate the effectiveness of universal adolescent MDD screening in the school setting in an effort to reduce disparities and improve MDD identification and treatment initiation. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial, conducted from November 6, 2018, to November 20, 2020, compared the usual school practice of targeted or selected screening based on observable behaviors of concern with universal MDD screening. Students within an identified school were randomized by grade to 1 of the 2 study groups. Study groups were compared using mixed-effects logistic regression. Participants included students in grades 9 through 12 enrolled at 1 of the 14 participating Pennsylvania public high schools. INTERVENTIONS In targeted screening, students with behaviors prompting concern for MDD were referred to the Student Assistance Program (SAP), mandated in all Pennsylvania schools. The SAP determined follow-up recommendations. In universal screening, all students completed the Patient Health Questionnaire-9 (PHQ-9); students with positive scores proceeded to SAP. The universal screening group could also have targeted referral to SAP for concerning behavior independent of the PHQ-9. MAIN OUTCOMES AND MEASURES The primary outcome was initiation of MDD treatment or services based on data collected by school SAP teams during the academic year. RESULTS A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03716869.
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Affiliation(s)
- Deepa L. Sekhar
- Department of Pediatrics, Pennsylvania State College of Medicine, Hershey
| | - Eric W. Schaefer
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey
| | - James G. Waxmonsky
- Department of Psychiatry, Pennsylvania State College of Medicine, Hershey
| | | | - Krista L. Pattison
- Department of Pediatrics, Pennsylvania State College of Medicine, Hershey
| | - Alissa Molinari
- Department of Pediatrics, Pennsylvania State College of Medicine, Hershey
| | - Perri Rosen
- Statewide Project Advisor, Garrett Lee Smith Youth Suicide Prevention Grant, Harrisburg, Pennsylvania
| | - Jennifer L. Kraschnewski
- Department of Pediatrics, Pennsylvania State College of Medicine, Hershey
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey
- Department of Medicine, Pennsylvania State College of Medicine, Hershey
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Conroy K, Salem H, Georgiadis C, Hong N, Herrera A, Furr JM, Greif Green J, Comer JS. Gauging Perceptions and Attitudes About Student Anxiety and Supports Among School-Based Providers. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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O'Dea B, Subotic-Kerry M, King C, Mackinnon AJ, Achilles MR, Anderson M, Parker B, Werner-Seidler A, Torok M, Cockayne N, Baker ST, Christensen H. A cluster randomised controlled trial of a web-based youth mental health service in Australian schools. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 12:100178. [PMID: 34527971 PMCID: PMC8356132 DOI: 10.1016/j.lanwpc.2021.100178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Secondary schools have attempted to address gaps in help-seeking for mental health problems with little success. This trial evaluated the effectiveness of a universal web-based service (Smooth Sailing) for improving help-seeking intentions for mental health problems and other related outcomes among students. METHODS A cluster randomised controlled trial was conducted to evaluate the 12-week outcomes of the Smooth Sailing service among 1841 students from 22 secondary schools in New South Wales, Australia. Assignment was conducted at the school level. The control condition received school-as-usual. The primary outcome was help-seeking intentions for general mental health problems at 12-weeks post-baseline. Secondary outcomes included help-seeking behaviour, anxiety and depressive symptoms, psychological distress, psychological barriers to help-seeking, and mental health literacy. Data were analysed using mixed linear models. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224). FINDINGS At 12-weeks post-baseline, there was a marginal statistical difference in the relative means of help-seeking intentions (effect size=0•10, 95%CI: -0•02-0•21) that favoured the intervention condition. Help-seeking from adults declined in both conditions. There was a greater reduction in the number of students who "needed support for their mental health but were not seeking help" in the intervention condition (OR: 2•08, 95%CI: 1•72-2.27, P<•0001). No other universal effects were found. Participants found the service easy to use and understand; However, low motivation, time, forgetfulness, and lack of perceived need were barriers to use. INTERPRETATION Smooth Sailing led to small improvements in help-seeking intentions. Refinements are needed to improve its effectiveness on other mental health outcomes and to increase student uptake and engagement. FUNDING HSBC and Graf Foundation.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | | | - Catherine King
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | | | | | - Melissa Anderson
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Belinda Parker
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Aliza Werner-Seidler
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Michelle Torok
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Nicole Cockayne
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Simon T.E. Baker
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Helen Christensen
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
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Burns JR, Rapee RM. Barriers to Universal Mental Health Screening in Schools: The Perspective of School Psychologists. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2021. [DOI: 10.1080/15377903.2021.1941470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- John R. Burns
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
- Shore, North Sydney, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Fragala MS, Hunter JL, Satish A, Jelovic NA, Carr S, Bailey AM, Stokes M, Hayward JI, Kim PM, Peters ME. Workplace Mental Health: Application of a Population Health Approach of Proactive Screening to Identify Risk and Engage in Care. J Occup Environ Med 2021; 63:244-250. [PMID: 33399307 DOI: 10.1097/jom.0000000000002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate a proactive, voluntary screening program designed to identify employees with emerging mental health risk and engage them in care. METHODS Risk was proactively identified through online screening of 344 participants. At-risk participants were offered a mental health care concierge to provide support, develop a care plan, and connect to care. RESULTS Risk for common mental health conditions was identified in 244 (71%) participants, of whom 66 (27%) connected with a care concierge. Compared with participants who did not connect to a care concierge, those who did were more likely to report a financial crisis (68.2% vs 50.8%) and less likely to report verbal abuse (9.1% vs 19.6%) and difficulty meeting daily needs (12.1% vs 25.1%). CONCLUSION Implementation of this screening program identified employees at risk for mental health conditions and facilitated connection to care.
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Affiliation(s)
- Maren S Fragala
- Quest Diagnostics, Secaucus, New Jersey (Dr Fragala, Ms Satish); Emvitals, Cleveland, Ohio (Ms Hunter, Ms Jelovic); Johns Hopkins Healthcare (Ms Carr); The Johns Hopkins University School of Medicine (Dr Bailey, Dr Kim, Dr Peters); Guide+Thrive Powered by BHS (Ms Stokes, Dr Hayward), Baltimore, Maryland
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Arango A, Gipson PY, Votta JG, King CA. Saving Lives: Recognizing and Intervening with Youth at Risk for Suicide. Annu Rev Clin Psychol 2021; 17:259-284. [PMID: 33544628 DOI: 10.1146/annurev-clinpsy-081219-103740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Suicide is the second leading cause of death for youth in the United States. Fortunately, substantial advances have been achieved in identifying and intervening with youth at risk. In this review, we first focus on advances in proactive suicide risk screening and psychoeducation aimed at improving the recognition of suicide risk. These strategies have the potential to improve our ability to recognize and triage youth at risk who may otherwise be missed. We then review recent research on interventions for youth at risk. We consider a broad range of psychotherapeutic interventions, including crisis interventions in emergency care settings. Though empirical support remains limited for interventions targeting suicide risk in youth, effective and promising approaches continue to be identified. We highlight evidence-based screening and intervention approaches as well as challenges in these areas and recommendations for further investigation.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Polly Y Gipson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Jennifer G Votta
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
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18
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Contributing Factors in Adolescents’ Mental Well-Being—The Role of Socioeconomic Status, Social Support, and Health Behavior. SUSTAINABILITY 2020. [DOI: 10.3390/su12229597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mental disorders are common in adolescents, and for effective interventions we should be aware of their determinants. However, there are only a small number of studies investigating the combined effect of multiple factors. Therefore, our aim is to assess the impact of socioeconomic status, social support, and health behavior on adolescents’ mental well-being. A cross-sectional health survey of 1641 children was carried out in accordance with the study protocol of the Hungarian Health Behavior in School-aged Children survey. Multivariate multiple regression was used to analyze the main determinants of mental well-being. The boys’ mental well-being was favorable compared to girls; lower subjective family wealth was associated with lower life satisfaction and depressive mood. Life satisfaction was positively related to healthy eating, social support, and physical activity. Unhealthy eating, sedentary lifestyle, and lower social support were associated with higher depression scores. Higher social support reduces psychosomatic symptoms, while unhealthy eating and spending a lot of time in front of the computer increase them. Both social support and healthy lifestyle seem to be protective against mental health problems among adolescents, and thus interventions should focus on these factors regardless of the socioeconomic status of the participants, with special attention given to girls.
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19
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Bryant A, Guy J, Holmes J. The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners. Front Psychol 2020; 11:587821. [PMID: 33329246 PMCID: PMC7717974 DOI: 10.3389/fpsyg.2020.587821] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.
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Affiliation(s)
- Annie Bryant
- Department of Clinical Psychology, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jacalyn Guy
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Joni Holmes
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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20
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Kim J, Hong SH, Hong HJ. The Impact of Referral to Mental Health Services on Suicide Death Risk in Adolescent Suicide Survivors. Soa Chongsonyon Chongsin Uihak 2020; 31:177-184. [PMID: 33110354 PMCID: PMC7584284 DOI: 10.5765/jkacap.200028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aims to examine the effect of adolescent suicide survivors' experience on suicide death risk, and the effect of referral to mental health services (hereafter referral) in this regard. Methods This study used the data of 878 suicide-deceased and suicide-attempted adolescents aged 8-19 years, managed by the Suicide and School Mental Health Institute from 2016 to 2018. Results Regression analysis for main effects showed that although suicide experience had no direct effect on suicide death, non-referral status was associated with a greater risk of death by suicide. While the "non-suicide survivor with non-referral" and "suicide survivor with non-referral" groups showed 1.87 [adjusted odds ratio=1.87, 95% confidence interval (CI)=1.21-2.89] and 4.59 (adjusted odds ratio= 4.59, 95% CI=2.02-10.42) times higher odds of suicide death, respectively, the "suicide survivor with referral" group showed no difference compared to the "non-suicide survivor with referral" group. Conclusion From these findings, there is a need to strengthen referral to mental health services and apply complicated grief treatment to improve the mental health of adolescent suicide survivors.
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Affiliation(s)
- Joonbeom Kim
- Suicide and School Mental Health Institute, Anyang, Korea.,Yonsei University, Interdisciplinary Graduate Program in Social Welfare Policy, Seoul, Korea
| | - Sung Hee Hong
- Suicide and School Mental Health Institute, Anyang, Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Anyang, Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
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21
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De Luca SM, Lim J, Yueqi Y. Young Adolescents' Help Seeking Behaviors and Attitudes: An Examination of an Underserved Community. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2019; 36:599-607. [PMID: 38284001 PMCID: PMC10817752 DOI: 10.1007/s10560-019-00604-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Young adolescents' endorsement of help-seeking and reported levels of connectedness are vital for culturally-tailored prevention initiatives. There is a dearth of information on how younger adolescents attending middle schools (ages 11-15) obtain help from trusted adults, especially among Hispanics. This is problematic as Hispanics, especially female high school students, have consistently reported higher rates of depression and suicidal behaviors for over 30 years. This pilot study included 72 young adolescents (86% Hispanic) in Central Texas. Surprisingly, although there were significant gender and age differences, no group strongly endorsed seeking help during times of distress. Yet, females were more likely to report that they would talk to a counselor or other adult at school when distressed compared to males. While no gender differences were found endorsing trusted adults as helpful, younger female adolescents held higher beliefs these individuals could help during times of distress. What is most pivotal is that this study suggests that changes in help seeking attitudes can occur from one grade to another. Therefore, early adolescence, instead of the more common period of high school, might be a critical time to offer upstream mental health prevention approaches.
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Affiliation(s)
- Susan M. De Luca
- School of Social Work, The Population Research Center Core Faculty, Center for Women and Gender Studies, University of Texas at Austin, 1925, 1925 San Jacinto Blvd, Austin 78712, Texas, USA
| | - Jessica Lim
- School of Social Work, University of Texas at Austin, 1925, San Jacinto Blvd, Austin 78712, Texas, USA
| | - Yan Yueqi
- Children and Family Futures, Lake Forest, California, USA
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Park S, Lee D, Jung S, Hong HJ. Four-year trajectory of Korean youth mental health and impacts of school environment and school counselling: a observational study using national schools database. BMJ Open 2019; 9:e027578. [PMID: 31767576 PMCID: PMC6887064 DOI: 10.1136/bmjopen-2018-027578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate changes in the mental health status of South Korean adolescents at a school level and identify school-related factors affecting these changes. DESIGN A retrospective data analysis, population study. SETTING South Korean high schools from 2013 to 2016. PARTICIPANTS Randomly sampled 827 schools (316 834 boys and 299 304 girls) PRIMARY OUTCOME MEASURES: Mean scores of the Adolescent Mental Health and Problem Behavior Questionnaire-II (AMPQ-II), a school-based mental health screening test, were used to explore changes in youth mental health. Data regarding the school environment and school counselling were gathered from the 'School info' website. A multilevel growth model was used to determine relationships between students' mental health and school-related factors. RESULTS Students' mental health statuses in South Korea gradually improved over time (coefficient=-1.46 to -1.70, p<0.001). School mobility rates (coefficient=0.93 to 1.00, p<0.05), school dropout rates (coefficient=0.38 to 0.40, p<0.001), school budgets per student (coefficient=-0.05 to -0.06, p<0.01) and number of school counselling sessions (coefficient=0.14, p<0.01) were significantly associated with baseline AMPQ-II scores. The rate of change in AMPQ-II score increased when the number of school counselling sessions was higher (coefficient=-0.03, p<0.05) or the school budget was lower (coefficient=0.02, p<0.001). School environment explained 21.6% of the AMPQ-II baseline score variance and 9.3% of the rate of change variance. School counselling further explained 2.0% of the variance in baseline AMPQ-II scores and 2.3% of the rate of change variance. CONCLUSIONS This study suggests that school environment stability and active provision of school-based mental health services have a positive impact on youth mental health.
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Affiliation(s)
- Seongjun Park
- Suicide and School Mental Health Institute, Hallym University, Anyang, The Republic of Korea
| | - Dayoung Lee
- Suicide and School Mental Health Institute, Hallym University, Anyang, The Republic of Korea
| | - Song Jung
- Suicide and School Mental Health Institute, Hallym University, Anyang, The Republic of Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Hallym University, Anyang, The Republic of Korea
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, The Republic of Korea
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Abstract
AIMS Mental disorders in children are a significant and growing cause of morbidity worldwide. Although interventions to help overcome barriers along the pathway to accessing health care for children with mental disorders exist, there is no overview of randomised controlled trials (RCTs) on these interventions as yet. This study aimed to systematically identify RCTs of interventions to improve access to mental health care for children and synthesise them using a conceptual framework of access to health care. METHODS This systematic review was performed following a predefined protocol registered with PROSPERO (ID: CRD42018081714). We searched the databases MEDLINE, EMBASE, PsycINFO and CENTRAL for RCTs up to 15 May 2019 using terms related to the concepts 'young people,' 'mental disorders' and 'help-seeking interventions' and scanned reference lists from relevant studies. Two reviewers independently screened all identified articles in a two-stage process, extracted results on outcomes of interest (knowledge, attitudes, intentions, help-seeking, accessing care, mental health outcomes and satisfaction), assessed the risk of bias and conducted meta-analyses where deemed appropriate. RESULTS After screening 5641 identified articles, 34 RCTs were eligible for inclusion. Eighty per cent of universal school-based interventions measuring knowledge (n = 5) and 67% measuring attitudes (n = 6) reported significantly better results compared with controls on those outcomes, whereas 20% measuring access to care (n = 5) and none measuring mental health outcomes (n = 7) did. In contrast, 71% of interventions targeting at-risk individuals (n = 21) reported better access to care compared with controls, while just 33% (n = 6) did for mental health outcomes. For satisfaction with care, this proportion was 80% (n = 5). Meta-analyses of interventions measuring initial appointment attendance yielded combined odds ratios of 3.11 (2.07-4.67) for appointment reminder interventions and 3.51 (2.02-6.11) for treatment engagement interventions. The outcomes for universal school-based interventions were heterogeneous and could not be summarised quantitatively through meta-analysis. CONCLUSIONS To have a population-level effect on improving children's access to mental health care, two-stage interventions that identify those in need and then engage them in the health-care system may be necessary. We need more evidence on interventions to target contextual factors such as affordability and infrastructural barriers.
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O’Dea B, King C, Subotic-Kerry M, Achilles MR, Cockayne N, Christensen H. Smooth Sailing: A Pilot Study of an Online, School-Based, Mental Health Service for Depression and Anxiety. Front Psychiatry 2019; 10:574. [PMID: 31481904 PMCID: PMC6710361 DOI: 10.3389/fpsyt.2019.00574] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Schools play an important role in supporting young people's mental health, but face challenges identifying and responding to students in need of care. To assist secondary schools, the Black Dog Institute has developed an online, school-based, mental health service (Smooth Sailing). Delivered in the classroom, Smooth Sailing uses a website to screen, assess, allocate, and deliver care for depression and anxiety. The service is based on the principles of stepped care, offering treatments with varied intensity and follow-up by a school counselor when necessary. The current study aimed to evaluate the feasibility, acceptability, and safety of this new type of service among secondary school students. Methods: Between February and June 2017, a single-arm, pre-post, pilot study was conducted among students from four NSW secondary schools. Schools were given access to the service for 6 weeks. Feasibility measures (consent rates and step allocations), acceptability measures (service use and satisfaction) and safety measures (deterioration in help-seeking intention scores and mental health symptoms) were assessed at baseline and completion of the 6-week trial period. Results: A total of 59 students took part in the service pilot (mean age, 14.57 years; SD, 0.89 years; range, 13-16 years). At baseline, 18.64% of students were found to require follow-up from the school counselor, and 80% of these were new cases. Although completion of the online modules was low, service satisfaction was high. At 6 weeks, the mean scores for help-seeking, depression, and anxiety remained relatively stable or improved. Conclusions: The current study presents important findings for the development and implementation of an online mental health service that screens students' mental health and allocates care accordingly, all within the school setting. Although the findings provide some support for the feasibility, acceptability, and safety, service improvements are needed. The modifications outlined are likely to improve the quality of the service and its effectiveness. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000977370.
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Affiliation(s)
- Bridianne O’Dea
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Catherine King
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Nicole Cockayne
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Totura CMW, Labouliere CD, Gryglewicz K, Karver MS. Adolescent Decision-Making: The Value of Perceived Behavioral Control in Predicting Engagement in Suicide Prevention Behaviors. J Youth Adolesc 2019; 48:1784-1795. [PMID: 31289976 DOI: 10.1007/s10964-019-01066-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022]
Abstract
Adolescent perceived behavioral control (self-efficacy) plays a key role in influencing decision-making processes within the context of suicide prevention programming. Guided by Theory of Planned Behavior, models tested attitudinal and social factors predicting adolescent intentions and actual engagement in suicide prevention behaviors. Participants included 233 racially and ethnically diverse high school students (54% female) in a southwestern U.S. school district. Measures included attitudes, norms, perceived behavioral control, intentions, and behavior over follow-up. Structural equation modeling indicated that perceived behavioral control, rather than intentions, was the direct predictor of behaviors. For adolescents, beliefs about effectively utilizing learned suicide prevention behavior may be more important than intentions. The design of suicide prevention efforts should account for this important influence on adolescent decision-making.
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Affiliation(s)
| | - Christa D Labouliere
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, FL, USA
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O'Dea B, King C, Subotic-Kerry M, Anderson M, Achilles MR, Parker B, Mackinnon A, Anderson J, Cockayne N, Christensen H. Evaluating a Web-Based Mental Health Service for Secondary School Students in Australia: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12892. [PMID: 31102370 PMCID: PMC6543801 DOI: 10.2196/12892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health problems are prevalent among Australian secondary school youth; however, help-seeking is low. Schools offer an ideal setting to address these concerns. The Black Dog Institute has developed a Web-based mental health service for secondary schools that is modeled on the principles of stepped care. The Smooth Sailing service aims to improve help-seeking and reduce anxiety and depressive symptoms in secondary school students. The acceptability of this service has been demonstrated in a pilot study. A full trial is now warranted. OBJECTIVE This study protocol for a cluster randomized controlled trial (RCT) aims to evaluate the effectiveness of the Smooth Sailing Web-based service for improving help-seeking intentions and behavior, and reducing depressive and anxiety symptoms, alongside other mental health outcomes, when compared with a school-as-usual control condition in secondary school youth. METHODS This RCT aims to recruit 1600 students from 16 secondary schools in regional and urban locations throughout New South Wales, Australia. Schools are randomly assigned to the intervention or school-as-usual control condition at the school level. Approximately 100 students from 1 or multiple grades are recruited from each participating school. Participants complete measures at 3 timepoints: baseline, 6 weeks post, and 12 weeks post, with the primary outcome assessed at 12 weeks posttest. Participants assigned to the intervention condition register to the Web-based service at baseline and receive care in accordance with the service model. Participants in the control condition receive school-as-usual. RESULTS The first baseline assessment occurred on February 22, 2018, with the 12-week endpoint assessments completed on Friday, June 29, 2018. Control schools are currently receiving the service, due for completion by June 30, 2019. The trial results are expected to demonstrate improved help-seeking intentions and behavior among students assigned to the intervention condition, alongside improvements in symptoms of depression, anxiety, distress, and other mental health outcomes when compared with students assigned to the control condition. CONCLUSIONS To our knowledge, this is the first time that a Web-based mental health service based on the principles of stepped care will have been integrated into, and evaluated in, the Australian school context. The findings of this trial will have implications for the suitability of this type of service model in Australian schools and for the delivery of school-based mental health services more broadly. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001539224 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821&isReview=true (Archived by WebCite at http://www.webcitation.org/77N3MDGS6). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12892.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Catherine King
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Andrew Mackinnon
- Black Dog Institute, Sydney, Australia.,Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Josey Anderson
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nicole Cockayne
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents? Compr Psychiatry 2019; 88:39-48. [PMID: 30471550 DOI: 10.1016/j.comppsych.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/11/2018] [Accepted: 11/03/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Given the high rates of suicide in the adolescent population and the reluctance of this population to seek help, developing proactive and effective strategies to timely detect individuals at high risk for suicide in non-clinical contexts is a worldwide recognized need. A series of brief self-report questionnaires have been developed for this purpose, however there are few studies providing evidence on their capability to accurately classify suicidal risk levels in specific populations. One of the instruments frequently used to evaluate suicide risk is the Columbia-Suicide Severity Rating Scales (C-SSRS). The goal of this study is to provide psychometric evidence about the accuracy of the Suicidal Ideation subscale (SI) of the C-SSRS to classify suicidal risk levels in a sample of Chilean adolescents using Item Response Theory (IRT). METHODS AND MATERIALS Through the two parameter logistic model (2-PLM), we analyzed the capability of a self-report questionnaire addressing suicidal ideation (SI) to differentiate and classify participants according to their SI severity levels. We tested two main parameters: difficulty (localization) and discriminating power of 6 items extracted and adapted from the Columbia-Suicide Severity Rating Scales (C-SSRS). We administered this questionnaire to a general sample of 1645 adolescents aged 13 to 18. RESULTS Our results show that the items differentiate symptoms addressing suicidal thoughts according to their severity, providing an accurate classification of the SI risk level. CONCLUSIONS These findings support the usage of the C-SSRS in Chilean adolescents. Further research is needed to test its predictive value in different populations.
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Anderson JK, Ford T, Soneson E, Coon JT, Humphrey A, Rogers M, Moore D, Jones PB, Clarke E, Howarth E. A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties. Psychol Med 2019; 49:9-19. [PMID: 30208985 DOI: 10.1017/s0033291718002490] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake. METHOD Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3-18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD. RESULTS We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes. CONCLUSIONS Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
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Affiliation(s)
- Joanna K Anderson
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health,Douglas House,18 Trumpington Road,Cambridge CB2 8AH,UK
| | - Tamsin Ford
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Emma Soneson
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Jo Thompson Coon
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Ayla Humphrey
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Morwenna Rogers
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Darren Moore
- Graduate School of Education,St Luke's Campus,Exeter EX1 2LU,UK
| | - Peter B Jones
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Emmet Clarke
- Norfolk and Suffolk NHS Foundation Trust,80 St Stephens Rd,Norwich NR1 3RE,UK
| | - Emma Howarth
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health,Douglas House,18 Trumpington Road,Cambridge CB2 8AH,UK
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Intervention Models for Increasing Access to Behavioral Health Services Among Youth: A Systematic Review. J Dev Behav Pediatr 2018; 39:754-762. [PMID: 30334855 DOI: 10.1097/dbp.0000000000000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this systematic literature review is to examine interventions designed to improve access to behavioral health services among youth in the United States and to identify how the concept of access to health care has been measured and conceptualized in these studies. METHOD The review used a systematic search strategy to identify articles published in medical, nursing, and psychological literature. The search yielded 579 initial articles, of which 69 appeared to be candidates for inclusion in the review. In the end, 19 studies qualified for synthesis in the review. Studies were required to use an experimental or quasi-experimental design and include a comparison group. RESULTS Results indicated that access to behavioral health services can be improved by providing services in schools, using telehealth models, or delivering multicomponent interventions in clinical settings. Models that incorporated parental support, peer support from other parents, or other ways of engaging parents in the utilization process, as well as multicomponent and policy interventions, helped improve access to care. In the studies reviewed, access was operationalized primarily in terms of child behavioral health service utilization. CONCLUSION Interventions delivered in schools, engaging parents, or utilizing telehealth technology show promise for increasing access for youth affected by behavioral health disorders.
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Cha CB, Franz PJ, Guzmán EM, Glenn CR, Kleiman EM, Nock MK. Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry 2018; 59:460-482. [PMID: 29090457 PMCID: PMC5867204 DOI: 10.1111/jcpp.12831] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts. RESULTS We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions. CONCLUSIONS There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.
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Affiliation(s)
- Christine B. Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia
University
| | | | - Eleonora M. Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia
University
| | - Catherine R. Glenn
- Department of Clinical and Social Sciences in Psychology, University of
Rochester
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Guo S, Kim JJ, Bear L, Lau AS. Does Depression Screening in Schools Reduce Adolescent Racial/Ethnic Disparities in Accessing Treatment? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 46:523-536. [DOI: 10.1080/15374416.2016.1270826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sisi Guo
- Department of Psychology, University of California, Los Angeles
| | - Joanna J. Kim
- Department of Psychology, University of California, Los Angeles
| | - Laurel Bear
- Gateway to Success, Alhambra Unified School District
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles
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Labouliere CD, Tarquini SJ, Totura CMW, Kutash K, Karver MS. Revisiting the concept of knowledge: how much is learned by students participating in suicide prevention gatekeeper training? CRISIS 2016; 36:274-80. [PMID: 26440624 DOI: 10.1027/0227-5910/a000323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. AIMS To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. METHOD Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. RESULTS Unlike in studies using forced-choice assessment, students' baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. CONCLUSION Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students' actual levels of knowledge after participation in gatekeeper training.
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Affiliation(s)
- Christa D Labouliere
- 1 Division of Child and Adolescent Psychiatry, The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | | | - Krista Kutash
- 4 Louis De La Parte Florida Mental Health Institute at the University of South Florida, Tampa, FL, USA
| | - Marc S Karver
- 5 Department of Psychology at the University of South Florida, Tampa, FL, USA
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Lambert MC, January SAA, Pierce CD. Latent Structure of Scores From the Emotional and Behavioral Screener. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2016. [DOI: 10.1177/0734282916676130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Emotional and Behavioral Screener (EBS) is a recently developed teacher-reported brief screening instrument for identifying students who are at-risk of an emotional or behavioral disorder (EBD). Although prior research supports the technical adequacy of scores from the EBS, there is a gap in the literature regarding strong evidence of the factor structure underlying EBS scores. This study investigated the latent structure of scores from the EBS in a sample of 646 elementary students who were rated by their teachers in a 2-week screening period. Single-factor confirmatory factor analysis (CFA) and bifactor models were used to test the hypothesis that EBS scores are a measure of both overall emotional and behavioral risk and students’ externalizing and internalizing behaviors. Results supported a bifactor structure, in that scores from the EBS can be considered to represent a general factor (i.e., risk of EBD) and two group factors (i.e., externalizing and internalizing domains). Findings have implications for interpreting scores when using the EBS as a universal screener for the risk of EBD.
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Maalouf FT, Ghandour LA, Halabi F, Zeinoun P, Shehab AAS, Tavitian L. Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1105-16. [PMID: 27246607 DOI: 10.1007/s00127-016-1241-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders. METHODS Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders. RESULTS The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders. CONCLUSIONS A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.
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Affiliation(s)
- Fadi T Maalouf
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon.
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi Halabi
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon
| | - Pia Zeinoun
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon
| | - Al Amira Safa Shehab
- Department of Psychology, Queens College, City University of New York, New York, USA
| | - Lucy Tavitian
- Department of Cross-Cultural Studies, Tilburg University, Tilburg, The Netherlands
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Torcasso G, Hilt LM. Suicide Prevention Among High School Students: Evaluation of a Nonrandomized Trial of a Multi-stage Suicide Screening Program. CHILD & YOUTH CARE FORUM 2016. [DOI: 10.1007/s10566-016-9366-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gonzalez A, Monzon N, Solis D, Jaycox L, Langley AK. Trauma exposure in elementary school children: Description of screening procedures, level of exposure, and posttraumatic stress symptoms. SCHOOL MENTAL HEALTH 2015; 8:77-88. [PMID: 27721907 DOI: 10.1007/s12310-015-9167-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic childhood events can have a significant impact on overall child functioning. Early identification and intervention could offer significant benefits for children's mental health and educational trajectories, but how to effectively identify young children is a challenge. In this paper, we describe screening for exposure to traumatic events and associated symptoms of posttraumatic stress, and examine differences by child gender and grade level. A total of 402 elementary school children in grades 1-5 participated across four elementary schools. We describe modified administration procedures of screening instruments for these young children. Children who endorsed exposure to one or more traumatic events were individually assessed for posttraumatic stress symptom severity. Thirty-four percent (n=138) of children screened experienced one or more traumatic events, and 75.4% of those exposed to at least one traumatic event endorsed moderate levels or higher of posttraumatic stress symptoms. Internal consistency of the symptom self-report instrument was adequate for children of all grade levels. Posttraumatic stress symptom severity increased for children exposed to more types of events. No gender/grade differences were found in symptom severity. Findings suggest that young children are impacted by traumatic events in relatively high numbers, that they can reliably report their posttraumatic stress symptoms, and that a large portion of those exposed to trauma experience significant distress. These results highlight the importance of early screening and identification of these children to curtail potential risk for future academic, social, and psychological maladjustment.
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Affiliation(s)
- Araceli Gonzalez
- California State University, Long Beach, Department of Psychology 1250 Bellflower Blvd., Long Beach, CA 90840-0901
| | - Nicholas Monzon
- California State University, Long Beach, Department of Psychology 1250 Bellflower Blvd. Long Beach, CA 90840-0901
| | - Diana Solis
- UCLA Semel Institute for Neuroscience and Human Behavior 1000 Veteran Avenue, Box 957142 Los Angeles, CA 90095
| | - Lisa Jaycox
- RAND Corporation 1200 South Hayes Street Arlington, VA 22202
| | - Audra K Langley
- UCLA Departments of of Psychiatry and Pediatrics 1000 Veteran Avenue, Box 957142 Los Angeles, CA 90095
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De Luca S, Schmeelk-Cone K, Wyman P. Latino and Latina Adolescents' Help-seeking Behaviors and Attitudes Regarding Suicide Compared to Peers with Recent Suicidal Ideation. Suicide Life Threat Behav 2015; 45:577-587. [PMID: 25581773 DOI: 10.1111/sltb.12152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Abstract
Although Latinas have consistently reported higher rates of suicidal behavior for the past 20 years (CDC, 1996), there is a dearth of information regarding their help-seeking attitudes and behaviors when dealing with distress and suicide. Associations between adolescents' ideation and help-seeking from adults were different for non-Hispanic Whites and Latinos from 14 high schools (N = 4,983). Among females, ideators and Latinas reported lower levels of help-seeking attitudes than nonideators and non-Hispanic Whites. Males showed interaction effects of ideation by race/ethnicity on help-seeking. Within sex by race/ethnicity, differences showed that while non-Hispanic White students reported consistent differences between suicidal ideation and no reported suicidal ideation, Latinos were more similar between these groups, particularly with having support from friends and family to seek help from adults. Research should clarify how culture contributes to decreased help-seeking norms among those with suicidal ideation.
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Affiliation(s)
- Susan De Luca
- University of Texas at Austin, School of Social Work, Austin, Texas, USA
| | - Karen Schmeelk-Cone
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
| | - Peter Wyman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
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Langley AK, Gonzalez A, Sugar CA, Solis D, Jaycox L. Bounce back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. J Consult Clin Psychol 2015; 83:853-65. [PMID: 26302251 PMCID: PMC4573344 DOI: 10.1037/ccp0000051] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety. METHOD Participants were 74 schoolchildren (Grades 1-5) and their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist) intervention. Parent- and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3 months, and 6 months. RESULTS Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent- and child-reported posttraumatic stress and child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent- and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). CONCLUSIONS Findings support the feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic stress. Implications are discussed.
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Affiliation(s)
- Audra K Langley
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Araceli Gonzalez
- Department of Psychology, California State University, Long Beach
| | - Catherine A Sugar
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Diana Solis
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
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Kahn JP, Tubiana A, Cohen RF, Carli V, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12277-90. [PMID: 26437422 PMCID: PMC4626968 DOI: 10.3390/ijerph121012277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/28/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022]
Abstract
Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE's two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician's motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.
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Affiliation(s)
- Jean-Pierre Kahn
- Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre les Nancy 54511, France.
- Université de Lorraine, Faculté de Médecine, Vandoeuvre les Nancy 54505, France.
- Centre Psychothérapique de Nancy, Laxou 54520, France.
| | | | | | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden.
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
- Department of Health Sciences, University of Molise, Campobasso 86100, Italy.
| | - Christina Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso 86100, Italy.
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden.
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Dowdy E, Furlong M, Raines TC, Bovery B, Kauffman B, Kamphaus RW, Dever BV, Price M, Murdock J. Enhancing School-Based Mental Health Services With a Preventive and Promotive Approach to Universal Screening for Complete Mental Health. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2014. [DOI: 10.1080/10474412.2014.929951] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Katz C, Bolton SL, Katz LY, Isaak C, Tilston-Jones T, Sareen J. A systematic review of school-based suicide prevention programs. Depress Anxiety 2013; 30:1030-45. [PMID: 23650186 DOI: 10.1002/da.22114] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 01/17/2013] [Accepted: 03/09/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Suicide is one of the leading causes of death among youth today. Schools are a cost-effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy. We conducted a systematic review of the empirical literature on school-based suicide prevention programs. METHOD Studies were identified through MEDLINE and Scopus searches, using keywords such as "suicide, education, prevention and program evaluation." Additional studies were identified with a manual search of relevant reference lists. Individual studies were rated for level of evidence, and the programs were given a grade of recommendation. Five reviewers rated all studies independently and disagreements were resolved through discussion. RESULTS Sixteen programs were identified. Few programs have been evaluated for their effectiveness in reducing suicide attempts. Most studies evaluated the programs' abilities to improve students' and school staffs' knowledge and attitudes toward suicide. Signs of Suicide and the Good Behavior Game were the only programs found to reduce suicide attempts. Several other programs were found to reduce suicidal ideation, improve general life skills, and change gatekeeper behaviors. CONCLUSIONS There are few evidence-based, school-based suicide prevention programs, a combination of which may be effective. It would be useful to evaluate the effectiveness of general mental health promotion programs on the outcome of suicide. The grades assigned in this review are reflective of the available literature, demonstrating a lack of randomized controlled trials. Further evaluation of programs examining suicidal behavior outcomes in randomized controlled trials is warranted.
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Affiliation(s)
- Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Ougrin D, Boege I. Brief report: The self harm questionnaire: A new tool designed to improve identification of self harm in adolescents. J Adolesc 2013; 36:221-5. [DOI: 10.1016/j.adolescence.2012.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 09/07/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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Association between school engagement and disclosure of suicidal ideation to adults among Latino adolescents. J Prim Prev 2013; 33:99-110. [PMID: 22538874 DOI: 10.1007/s10935-012-0269-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined associations between Latino adolescents' school engagement and their likelihood of disclosing suicidal ideation (SI) to adults and of asking for help for SI. A first set of analyses was conducted on a total sample of 14 high schools, and a second set of analyses was conducted on 8 "Latino-representative" high schools. The criterion for Latino representation was that ≥10% of the school's total student population was Latino. Across all 14 high schools, 17% (110/663) of Latino students reported SI in the past year, compared to 13% (359/2,740) of non-Hispanic White students and 11% (78/719) of African American students. Of Latino students with SI, 24% (26/110) told an adult and 35% (38/110) sought help. In the 8 Latino-representative schools, higher levels of reported school engagement were associated with a greater likelihood of seeking help (OR = 6.17) and disclosure of SI to an adult (OR = 7.64) for Latino males. For Latinas, however, school engagement was not associated with either disclosure of SI to an adult or seeking help. Additional research is needed to clarify the processes, including social connectedness, that contribute to the disclosure of and help-seeking for SI among Latino adolescents.
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Lindsey MA, Chambers K, Pohle C, Beall P, Lucksted A. Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives. JOURNAL OF CHILD AND FAMILY STUDIES 2013; 22:107-121. [PMID: 23355768 PMCID: PMC3551580 DOI: 10.1007/s10826-012-9668-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.
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Affiliation(s)
- Michael A. Lindsey
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, USA
| | - Kerri Chambers
- School of Medicine, Department of Psychiatry, University of Maryland, Baltimore, MD 21201, USA
| | - Cara Pohle
- School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA
| | - Peggy Beall
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, USA
| | - Alicia Lucksted
- School of Medicine, Department of Psychiatry, University of Maryland, Baltimore, MD 21201, USA
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A randomized controlled trial to engage in care of adolescent emergency department patients with mental health problems that increase suicide risk. Pediatr Emerg Care 2012. [PMID: 23187979 DOI: 10.1097/pec.0b013e3182767ac8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In pediatric emergency departments (EDs), adolescents at risk for suicide often escape detection and successful referral for outpatient mental health care. OBJECTIVE This study aimed to assess the effectiveness of a brief, ED-based mental health service engagement intervention to increase linkage to outpatient mental health services. DESIGN/METHODS Adolescents presenting to a pediatric ED who were not currently receiving mental health services were screened for suicide-related risk factors (Columbia Suicide Scale). If positive, youths were then screened for impairment, alcohol use, and depression. Those screening positive on the Columbia Suicide Scale and the alcohol, impairment, or depression screen were randomly assigned to the intervention (short motivational interview, barrier reduction, outpatient appointment established, reminders before scheduled appointment) or standard referral (telephone number for a mental health provider). Study groups were compared with respect to screen acceptability and outpatient mental health care linkage and change in depression symptoms at 60 days after the index ED visit. RESULTS A total of 204 families were enrolled. Overall, 24 adolescents (12%) screened positive for suicide risk factors and were randomized to the intervention (n = 11) or standard referral (n = 13) groups. The groups did not significantly differ on several measures of screen acceptability. As compared with the standard referral group (15.4%), the intervention group (63.6%) was significantly more likely to attend a mental health appointment during the follow-up period (Fisher exact test, P = 0.03). There was also a nonsignificant trend toward greater improvement of depressive symptoms in the intervention than standard referral group (t = 1.79, df = 18, P = 0.09). CONCLUSIONS When adolescents are identified in the ED with previously unrecognized mental health problems that increase suicide risk, a brief motivational and barrier-reducing intervention improves linkage to outpatient mental health services.
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Thombs BD, Roseman M, Kloda LA. Depression screening and mental health outcomes in children and adolescents: a systematic review protocol. Syst Rev 2012; 1:58. [PMID: 23176742 PMCID: PMC3563607 DOI: 10.1186/2046-4053-1-58] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED BACKGROUND Depression is an important cause of disability among children and adolescents. Depression screening is one possible method for managing depression, and screening programs have been initiated in some school and medical settings. However, in 2005, the Canadian Task Force on Preventive Health Care and the United Kingdom National Institute of Clinical Excellence did not recommend depression screening among children and adolescents. By contrast, in 2009, the United States Preventive Services Task Force recommended that all adolescents, but not younger children, be screened for depression in medical settings with integrated depression management services, although no trials of screening were identified. The objectives of this systematic review are to evaluate in children and adolescents the accuracy of depression screening tools; depression treatment efficacy; whether depression screening improves depression outcomes; and potential harms related to depression interventions and screening. METHODS/DESIGN Data sources will include the bibliographic databases MEDLINE, Cochrane CENTRAL, PsycINFO, EMBASE, LILACS and Web of Science, supplemented by reference harvesting of eligible articles, relevant systematic reviews, relevant guidelines and recommendations, and selected journals, and by searches for unpublished studies. Eligible studies will report data for children and adolescents aged 6 to 18 years. Eligible diagnostic accuracy studies must compare a depression screening tool to a validated diagnostic interview for major depressive disorder and report diagnostic accuracy data. Eligible treatment studies must be randomized controlled trials of pharmacological, psychotherapeutic, or other depression treatments commonly available for children and adolescents in pediatric, primary-care, and family medicine settings. Eligible screening studies must be randomized controlled trials that compare depression outcomes between children or adolescents who underwent depression screening versus those who did not. Studies of harms will include randomized controlled trials and observational studies that evaluate harms from depression screening or treatment. Two investigators will independently review titles and abstracts, followed by full article review. Disagreements will be resolved by consensus. Two investigators will independently extract the data, with discrepancies resolved via consensus. DISCUSSION The proposed systematic review will determine whether there is sufficient evidence of benefits in excess of harms and costs to support screening for depression in childhood and adolescence.
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Affiliation(s)
- Brett D Thombs
- Jewish General Hospital, Institute for Community and Family Psychiatry, 4333 Cote Ste Catherine Road, Montréal, QC, H3T 1E4, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Medicine, McGill University, Montréal, QC, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
- School of Nursing, McGill University, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Michelle Roseman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
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Husky MM, Sheridan M, McGuire L, Olfson M. Mental health screening and follow-up care in public high schools. J Am Acad Child Adolesc Psychiatry 2011; 50:881-91. [PMID: 21871370 DOI: 10.1016/j.jaac.2011.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services. METHOD Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days. RESULTS Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%). CONCLUSIONS Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.
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Affiliation(s)
- Mathilde M Husky
- New York State Psychiatric Institute, Columbia University, New York, NY 10019, USA.
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