The stigma of mental illness in children and adolescents: A systematic review

Exploring mental health stigma among Indonesian healthcare students towards individuals with mental illnesses: a qualitative study

BACKGROUND

The social disapproval or stigma surrounding mental illness contributes to the postponement of individuals seeking assistance and frequently undermines therapeutic alliances between mental illness sufferers and health care professionals.

AIMS

This study explored perceptions and attitudes towards individuals with mental illness among college healthcare students in Indonesia.

METHODS

This study used a qualitative method. Twenty five students enrolled in six healthcare programs were interviewed using a semi structured format. The data analysis adopted a thematic analysis.

RESULTS

Our thematic analysis generated four main themes: (1) general perceptions of mental health and mental illness; (2) knowledge about mental illness; (3) mental health stigma; and (4) mental health stigma campaigns.

CONCLUSIONS

The participants exhibited positive perceptions of mentally ill people. Students understood mental health, and they exhibited positive attitudes toward mentally ill people. Some students have stigma and lack of confidence to assist those who have mental illness. Further efforts are required to acquaint students with mental health issues and facilitate their interaction with mentally ill individuals. Anti-stigma campaigns are required to combat the pervasive stigmatization of individuals with mental illness. It is recommended to conduct a more extensive study about the stigma that students encounter in relation to mentally ill individuals.

Self-Stigma of Canadian Youth With ADHD and Their Parents

OBJECTIVE

ADHD is subject to stigma from the general population. Exposure to stigma poses the risk of developing self-stigma of youth and parents, but few studies have focused on self-stigma of ADHD. Furthermore, parental factors have been implicated in self-stigma of youth, but no previous research has assessed the association between self-stigma of parents and youth. Therefore, the objective of this study was to better understand the experience of self-stigma of youth and their parents in the context of ADHD.

METHOD

Fifty-five youth with ADHD (aged 8-17) and one parent reporter per youth completed surveys to report their experiences.

RESULTS

The results of this study found that both youth and parents reported significantly lower self-stigma scores compared to most previously published research. Parents of boys reported higher self-stigma scores compared to parents of girls. Youth who reported higher self-stigma also reported lower self-esteem. Self-stigma scores in youth were predicted by inattentive symptoms but not hyperactive/impulsive symptoms or parental self-stigma.

CONCLUSION

Results emphasize the importance of understanding self-stigma of ADHD, symptom severity, and the need for interventions for families with ADHD.

"It's like an epidemic, we don't know what to do": The perceived need for and benefits of a suicide prevention programme in UK schools

BACKGROUND

Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known.

AIMS

We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation.

SAMPLE AND METHODS

A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis.

RESULTS

Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes.

CONCLUSIONS

Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

Understanding autism and its treatment: The child's perspective

INTRODUCTION

While parents' and professionals' perceptions regarding children with autism spectrum disorder (ASD) have been studied extensively, limited data regarding the perspectives of children with ASD on their needs and the challenges they face are available. The study aimed to examine how children with ASD understand their condition and the aims of the interventions they undergo.

METHODS

Nineteen children and adolescents (ages 5.7-14.2 years) formally diagnosed with ASD, with borderline to high intelligence (range 70-140), and able to converse verbally were interviewed in person at a child development clinic. A qualitative approach was used to capture children's perceptions of their strengths and challenges and their understanding of a novel ASD treatment. The interview included direct and projective open-ended questions on each topic. Interpretive content analysis was used to evaluate the children's answers. Medical data were extracted from medical records. The children's parents completed questionnaires on their children's disability levels, awareness of ASD diagnosis, and sociodemographic details.

FINDINGS

Children spoke of their embodied sensations and feelings and discussed "normality" vs. "disability." They varied in their awareness of their diagnosis/symptoms, and only one boy named his diagnosis and described its consequences in detail. Most children lacked an understanding of the educational and therapeutic aspects of the goals set for them.

DISCUSSION AND CONCLUSIONS

Children with ASD are aware of their unique emotional and behavioral challenges. Nevertheless, they are frequently excluded from the process of patient information provision and lack an understanding of the goals of interventions. Findings suggest the need to explore developmentally and emotionally adaptive ways to involve children with ASD in discussions of their condition and possible interventions.

Unveiling the Shadows: Childhood Traumas and the Dynamics of Seeking Psychological Help and Self-Stigmatization Among Prisoners

BACKGROUND

Compared with the general population, prison inmates show a higher prevalence of mental disorders, particularly among those with childhood traumas. Despite childhood traumas being robust indicators of poor mental health, there is limited research on their relationship with prisoners' attitudes toward seeking psychological help. This study investigates the impact of childhood traumas on prisoners' attitudes toward help-seeking and self-stigmatization.

METHODS

This cross-sectional, explanatory study was conducted with 250 persons in prison. Data were collected using a sociodemographic information form, the Childhood Trauma Questionnaire, the Attitudes Toward Seeking Psychological Help Scale, and the Self-Stigma of Seeking Help Scale. Statistical analysis was performed using Spearman correlation test and multiple linear regression analysis with SPSS Version 28.

RESULTS

A significant link was found between childhood traumas and self-stigmatization in seeking psychological help. Positive attitudes toward help-seeking were significantly associated with increased self-stigmatization. Childhood traumas were significantly related to single-parent families, conflicted intrafamilial relationships, entering prison at the age of 19 years or older, mental health issues, and behavioral disorders. Moreover, a meaningful association was observed between self-stigmatization in help-seeking and being from a single-parent family with a low socioeconomic status.

CONCLUSION

In conclusion, imprisoned persons with childhood traumas exhibit higher levels of self-stigmatization in seeking psychological help, contributing to negative attitudes. Recommendations for adequate access to mental health services in prisons include fostering a culture of psychological help, enhancing mental health literacy, providing trauma-informed care, and developing comprehensive strategies. In addition, the suggestion is made for the development of societal reintegration programs.

An investigation into symptoms of depression and anxiety and emotion regulation among older adolescents from low-income settings in South Africa

INTRODUCTION

Mental health conditions (MHC) among adolescents in low- and middle-income countries, including South Africa, are estimated to be high. Adaptive emotion regulation (ER) skills can protect against MHC among adolescents. In South Africa, there is limited adolescent mental health prevalence data as well as little understanding of the associations between MHC and ER among adolescents. This study aimed to address these gaps by describing the psychosocial characteristics of older South African adolescents from low-income settings as well as investigating associations between depression and anxiety symptoms and ER.

METHODS

We selected 12 schools in collaboration with two NGOs. Learners aged 15-18-years were recruited to complete a tablet-based survey. ER, depression, anxiety, and other psychosocial measures were included. Two multiple linear regression models were used to determine associations between depression symptoms, anxiety symptoms, other psychosocial factors, and ER.

RESULTS

Of the 733 participants from 12 Western Cape schools, 417 (56.90%) screened at risk for clinically significant anxiety symptoms, 423 (57.70%) participants for depression symptoms, 229 (31.40%) participants for PTSD symptoms and 263 (35.90%) for risky alcohol use. Depression and anxiety scores were found to be significantly positively correlated with ER difficulties and adolescents struggled most with identifying and utilizing adaptive ER strategies. The adjusted linear regression model reported that female gender, clinically significant depressive, anxiety, post-traumatic stress symptoms and risky-alcohol use were all significantly associated with poorer ER scores, while self-esteem was significantly associated with better ER scores.

CONCLUSION

These findings contribute to the South African adolescent mental health literature and to the research gap on the links between depression and anxiety and ER. Future research should consider further exploration of the relationships between psychosocial factors and ER to inform the urgent development and testing of appropriate adolescent interventions in this setting.

An exploratory cross-sectional study on Mental health literacy of Spanish adolescents

BACKGROUND

Mental health literacy (MHL) is especially important for young people, but comprehensive studies on MHL in adolescents are limited, with no nationwide studies in Spain. This research aims to study MHL among Spanish adolescents and its relationship with sociodemographic factors.

METHODS

An exploratory study is carried out using stratified random sampling in Spanish adolescents (N = 1000), aged 12-16 years and balanced in terms of gender, age and territorial distribution. Data collection took place in October and November 2023 through online surveys using the CAWI methodology. Sociodemographic variables, contact with mental health and the Spanish version of the Mental Health Literacy Questionnaire (MHLq-E), a self-administered instrument of 32 Likert-type items (1-5) that assesses the dimensions of help-seeking skills, knowledge about causes and symptoms, and stigma, were evaluated. Descriptive and multivariate analyses of variance (MANOVA) were conducted.

RESULTS

In general, adequate levels of literacy were observed, although some aspects related to help-seeking towards teachers, stigmatising attitudes towards people of low economic status and knowledge of severe mental health problems could be improved. The results show contact with previous mental health problems as a key variable for stigma and knowledge about symptomatology together with age. Likewise, gender and family educational level were found to be related to the ability to seek professional help.

CONCLUSION

This study provides information on levels of MHL among Spanish adolescents and highlights significant socio-demographic variables. These findings pave the way for interventions aimed at improving adolescents' understanding, attitudes and skills to manage mental health problems, making possible to adapt content and focus on specific groups, thus increasing its effectiveness.

The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial

BACKGROUND

Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers.

OBJECTIVE

This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people.

METHODS

This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability.

RESULTS

No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems.

CONCLUSIONS

Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

School Health Services' Use of Information and Communication Technologies in Interorganizational Collaboration Regarding Students With Mental Illness: A Scoping Review

School health services (SHSs) and school nurses play a crucial role in identifying and supporting students with mental illness. The integration of information and communication technology (ICT) can facilitate interorganizational collaboration in this context. Due to the limited research in this area, a scoping review was conducted to explore SHSs' use of ICT in interorganization collaboration regarding students with mental illness. Six articles were reviewed, revealing three key themes: "types of ICT employed by SHSs in interorganizational collaboration," "constellation of SHSs in interorganizational collaboration," and "opportunities and challenges for SHSs using ICT in interorganizational collaboration." Notably, two of the six articles highlighted the absence of school nurses in interorganizational collaboration. Even though ICT plays a crucial role in interorganizational collaboration, no comprehensive solution was found. This scoping review confirms that there are challenges with operability and regulations that govern the exchange of private information between organizations.

Cognitive Behavioral Digital Interventions are Effective in Reducing Anxiety in Children and Adolescents: A Systematic Review and Meta-analysis

Anxiety disorders are the most prevalent mental health issues in childhood, yet most children do not receive treatment. With recent advances in technology, a growing number of digital anxiety interventions are becoming accessible. This study is the first meta-analysis to evaluate the effectiveness and usefulness of digital cognitive-behavioral anxiety interventions for individuals under the age of 18. Five electronic databases (PsycNET, Web of Science, Science Direct, Pub Med, SAGE Journals.) were systematically searched in 2021. Inclusion criteria were: randomized control trials with a wait list no treatment control, standalone to blended care with minimal therapist involvement, diagnosed anxiety disorder or elevated levels of anxiety, outcome anxiety levels had to be assessed by a clinician, or the patients themselves by a validated anxiety measure. We assessed and controlled for publication bias, and considered the risk of bias using the Cochrane risk-of-bias tool. Eighteen studies were found eligible, which examined 1290 participants in total. Pooled effect sizes using a random-effects model yielded low overall effect for self-ratings (g = 0.28, k = 18, p < 0.001, 95% CI [0.14; 0.41]), and medium effect for ratings of clinicians (g = 0.66, k = 13, p < 0.001, 95% CI [0.50; 0.80]) as well as for parental report (g = 0.49, k = 16, p < 0.001, 95% CI [0.29; 0.69]). We found that the effects were homogenous across studies. Further examining potential moderating factors of treatment efficacy is needed in future research, as well as conducting studies that compare traditional methods of care to their digital counterparts. Digital interventions could contribute to the well-being of children regardless of age, minimizing therapist involvement. We conclude that digital cognitive-behavioral interventions may provide an accessible, cost-effective, and scalable anxiety treatment option for children and adolescents.

Adolescent and caregiver perceptions of addressing mental health in inflammatory bowel disease

Adolescents with inflammatory bowel disease (IBD) are at an increased risk of anxiety and depression compared to peers, but availability of mental health services in IBD clinics does not meet patients' needs, and use of primary care services for mental health screening and care is low. This study provides qualitative data regarding adolescent and caregiver perspectives on addressing mental health in IBD. Interviews were conducted with adolescents with IBD and caregivers of adolescents with IBD. Interview transcripts were coded and analyzed for prominent themes. Thirteen adolescents and fourteen caregivers were interviewed. Three primary themes emerged: mental health stigma makes discussing it more difficult, physician-adolescent trust makes conversations about mental health easier, and asking about mental health directly can help adolescents feel comfortable. Adolescents and caregivers highlighted the importance of considering each patient and their family individually when choosing how to discuss mental health. Fostering trust with adolescents with IBD is vital to addressing mental health. While encouraging standardized screening is important, the most patient-centered approach to mental health involves considering families individually to identify and address mental health challenges. Given the increased risk of anxiety and depression in pediatric patients with IBD, all providers encountering these patients should be equipped to discuss mental health non-judgmentally.

Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures

BACKGROUND

Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies.

OBJECTIVE

The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults.

METHODS

This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services.

RESULTS

This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes.

CONCLUSIONS

This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51667.

Representations of hallucinations and dissociation in young adult literature: using literature to challenge stigma about psychosis

This paper explores the role that sensitively portrayed literary representations of hallucinations and dissociation may have in counteracting stigma associated with these experiences. In it, we focus on narratives of young people experiencing hallucinatory and dissociative phenomena in two award-winning, young adult novels: How It Feels to Float by Helena Fox and A Monster Calls by Patrick Ness. We identify and discuss three literary devices in these two novels that promote empathy for the characters and their experiences. The narrative accounts in both novels challenge conceptions of hallucinations and dissociation as unknowable and unrelatable experiences with their empathic portrayals of relatable characters that create comprehensible accounts of adolescents grappling with their sense of reality. Importantly, they highlight the potential role that literature can play in stigma reduction by positively shaping young peoples' understandings of unfamiliar mental health experiences.

Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self-Compassion for Teens (MSC-T) for adolescents with subsyndromal depression

INTRODUCTION

Adolescents are experiencing high rates of depressive symptoms, with negative consequences to their long-term health. Group-based, mindful self-compassion programs show promise in mitigating the development of more significant depression in at-risk adolescents. However, the lack of well-designed, active control conditions has limited the ability to examine the efficacy of such interventions.

METHODS

Fifty-nine adolescents (Mage  = 15.81, 70% female) with subsyndromal depressive symptoms from the Southeastern US were randomized to group-based Mindful Self-Compassion for Teens (N = 30) or a newly developed active control Healthy Lifestyles group (N = 29) during 2018 and 2019. Participants attended 8 weekly "main" sessions followed by 6 monthly continuation sessions. The feasibility and acceptability of participation in both groups were measured using attrition, attendance, credibility, and satisfaction data. Depression scores were collected weekly, and self-compassion scores were collected five times across 36 weeks.

RESULTS

Both groups were equally feasible and acceptable during the 8-week program period; however, monthly continuation sessions were poorly attended in both groups. The risk of developing clinically significant depression was 2.6 times higher in the control group compared with the self-compassion group (p = .037) across 36 weeks. Depression significantly decreased in the self-compassion group, while it significantly increased in the control group. Both groups increased significantly in reports of self-compassion. These findings are on par with results noting the efficacy of cognitive-based interventions for high-risk adolescents; follow-up studies with larger sample sizes should be conducted to confirm these findings.

CONCLUSIONS

Initial examination suggests Mindful Self-Compassion for Teens programming is feasible, acceptable, and efficacious in preventing the development of clinically significant depression in adolescents with subsyndromal depression. Future studies may benefit from refinements to the self-compassion measurement and/or the attention control condition; moreover, larger sample sizes are needed to confirm results.

Reliability and validity evaluation of the stigma of loneliness scale in Chinese college students

BACKGROUND

The stigma of loneliness exacerbates the negative effect of loneliness, reduces the willingness to seek help, damages interpersonal relationships, and threatens health status. However, there is currently no valid scale for measuring the stigma of loneliness in China. The study aims to translate the Stigma of Loneliness Scale (SLS) and evaluate the reliability and validity of the Chinese version.

METHODS

The investigation was conducted in two phases. In the first phase, the SLS was used to conduct a questionnaire survey on 657 college students aged 17 to 24; in the second phase, the SLS, the UCLA Loneliness Scale (ULS-8), the Distress Disclosure Index (DDI), the Revised Cheek and Buss Shyness Scale (RCBS), the Self-Concealment Scale (SCS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Kessler Psychological Distress Scale (K10), and the Rosenberg Self-Esteem Scale (RSES) were used to conduct the questionnaire survey on 801 college and graduates students aged 18 to 39.

RESULTS

Two dimensions of Self-stigma of Loneliness and Public Stigma of Loneliness were extracted with a cumulative factor interpretation rate of 74.60% when conducting exploratory factor analysis on the first-stage data. The factor loading of each item ranged from 0.585 to 0.890, and the commonality ranged from 0.609 to 0.735. The confirmatory factor analysis and reliability and validity test were carried out on the data gathered in the second phase, indicating that the two-factor model fits well. In addition, the scores of SLS and all dimensions were significantly positively correlated with the total scores of ULS-8, RCBS, SCS, SIAS, SPS, and K10, and negatively correlated with those of DDI and RSES. The Cronbach's alpha coefficients for SLS and SSL and PSL dimensions were 0.957, 0.941, and 0.955. The cross-group invariance test found that the SLS was equivalent for males and females. Meanwhile, males scored significantly higher than females on both the total scores of SLS score and each dimension.

CONCLUSIONS

The Chinese version of SLS displayed satisfactory psychometric properties and can be a valid tool to assess the stigma of loneliness among Chinese young people.

Involving Persons With Lived Experience to Improve Vocational Students' Stigmatizing Attitudes Toward Mental Disorders: A Quasi-Experimental Study

BACKGROUND

Mental health problems are estimated to affect one in six individuals in the European Union. Fifty percent of mental disorders start in adolescence, around the age of 14. The stigma associated with having a mental health problem is one of the main barriers to seeking help for psychiatric and psychological disorders among adolescents and young adults. Interventions to reduce social stigma could contribute to increased help-seeking behavior in this population. AIMS: To assess the effectiveness of a direct contact intervention in the classroom by persons with lived experience to reduce vocational students' stigmatizing attitudes. METHOD: One person with lived experience and one first-degree relative implemented a classroom intervention lasting 90 min. Its effectiveness was measured using a quasi-experimental study with a pretest-posttest design and within-subject control. RESULTS: A total of 128 students from three different Vocational and Technical Schools from Spain participated in the study. After the intervention, statistically significant differences were observed in the scores of 11 of the 13 dimensions measured with the Spanish Mental Illness Stigma Attribution Questionnaire (AQ-27-E) and the Community Attitudes toward Mental Illness (CAMI) questionnaires. No differences associated with gender or familiarity with the mental disorder were observed. CONCLUSION: Vocational students' negative attitudes and emotions can be improved through a direct contact intervention in the classroom involving people who have experienced a mental disorder themselves. The age range for optimal results with this type of intervention appears to be 18 to 20 years.

Self and public stigma towards mental illnesses and its predictors among university students in 11 Arabic-speaking countries: A multi-site study

This study aimed to explore self and public stigma towards mental illness and associated factors among university students from 11 Arabic-speaking countries. This cross-sectional study included 4241 university students recruited from Oman, Saudi Arabia, the United Arab Emirates (UAE), Syria, Sudan, Bahrain, Iraq, Jordan, Lebanon, Palestine and Egypt. The participants completed three self-administrative online questionnaires-Demographic Proforma (age, gender, family income, etc.), Peer Mental Health Stigmatization Scale and Mental Health Knowledge Questionnaire. There was a significant difference in the average mean between the 11 countries (p < 0.01) based on stigma agreement (self) and stigma awareness (public). The mean stigma agreement towards mental illnesses among university students was 19.7 (SD = 6.0), with the lowest in Lebanon, 15.9 (SD = 5.1) and the highest in UAE, 24.1 (SD = 5.6). The factors associated with stigma agreement included poor knowledge, being male, high family income, age, weak cumulative grade point average (cGPA), mothers with primary education, an unemployed parent, students in scientific colleges and fathers who completed secondary or university degrees. Furthermore, the factors associated with stigma awareness included good knowledge, acceptable cGPA and having a father who has a low income and is illiterate. Stigma towards mental illness varies among university students across Arabic-speaking countries. There is a need to sensitize youngsters to the need for a humanitarian approach in society to individuals affected by mental health concerns. Major governmental reforms must be initiated for the provision of mental health services for individuals with mental illnesses.

Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study

BACKGROUND

Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited.

OBJECTIVE

This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents.

METHODS

A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8.

RESULTS

The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program's ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points.

CONCLUSIONS

The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681.

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi

Internalized stigma is common among individuals with sexually transmitted infections such as HIV and among those with mental health conditions such as major depressive disorder (MDD). As part of a cluster randomized trial, we investigated the prevalence and correlates of internalized stigma among adults living with comorbid HIV and MDD in rural Malawi (n = 339). We found heightened stigma toward HIV and mental illness among those in the cohort: more than half of respondents (54%) endorsed negative perceptions associated with each health condition. Internalized HIV-related stigma was higher among those with no education (p = 0.04), younger adults (p = 0.03), and those with less social support (p = 0.001). Mental illness-related stigma was elevated among those with no source of income (p = 0.001), and it was also strongly associated with HIV-related stigma (p < 0.001). Our findings highlight potential avenues for reducing internalized stigma associated with high-prevalence health conditions in Malawi.Trial registration: ClinicalTrials.gov identifier: NCT04777006.

Educational attainment of adolescents treated in psychiatric inpatient care: a register study over 3 decades

Mental disorders may for various reasons impair educational attainment, and with far-reaching consequences given the impact of education on subsequent employment, social life, life choices and even health and mortality. This register-based study addresses trends in educational attainment among Finnish adolescents aged 13-17 with mental disorders severe enough to necessitate inpatient treatment between 1980 and 2010. Our subjects (N = 14,435), followed up until the end of 2014, were at greater risk of discontinuing education beyond compulsory comprehensive school or of lower educational attainment than their age-peers in general population. Only 50.0% had completed any post-comprehensive education compared to 84.9% in same-aged general population. Those at highest risk were males and those with organic, intellectual disabilities and developmental, externalizing disorders or schizophrenia group diagnoses. Despite improvements in adolescent psychiatric care, school welfare services and pedagogical support, risks have remained high. Greater effort in psychiatric treatment, school welfare and pedagogy are needed to combat this severe inequality.

Review: Patient engagement in child, adolescent, and youth mental health care research - a scoping review

BACKGROUND

Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement.

METHOD

We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis.

RESULTS

Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample.

CONCLUSIONS

Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.

Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention

INTRODUCTION

Stigmatisation impedes health and quality of life. Evidence regarding stigma reduction interventions is, albeit growing, limited. There is a gap in the availability and evidence of interventions for reducing stigma among children and adolescents, especially in low- and middle-income countries. This paper describes the process that led to a stigma reduction intervention impacting children and adolescents in low- and middle-income countries, following previously conducted formative research.

METHODS

In this study, we conducted (i) online stakeholder consultations (FGD) (n = 43), including a survey assessing intervention acceptability, appropriateness, feasibility and scalability (n = 16); and (ii) preliminary field-testing of intervention content online and in a refugee settlement in Uganda.

FINDINGS

Stakeholder consultation showed the initial version of STRETCH (Stigma Reduction to Trigger Change for Children), albeit positively received, required adaptations. We made adjustments to i) take into account implementation duration, intervention flexibility and intersectionality; (ii) strengthen the involvement of individuals, including adolescents/youth, with lived stigma experience; (iii) target people close to individuals with lived stigma experience; and (iv) address feasibility and sustainability concerns. Preliminary field-testing simplified STRETCH while adding a community outreach component and revisiting the intervention setup, to ensure STRETCH can also be applied from a modular perspective.

CONCLUSION

We conducted a process to develop a child-focused multi-component stigma reduction intervention, with intended applicability across stigmas and settings. This paper provides an overview of the intervention development process, generating intervention-specific learnings with generic value. STRETCH aims to reduce stigmatisation at the implementing organisation, create community-wide reflection and stigma reduction demand, and reduce stigmatisation among various target groups.

Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls

Social anxiety can have an adverse effect on social connections, educational achievement, and wellbeing. However, the extent to which students stigmatize their peers with social anxiety disorder (SAD) in female educational settings remains unknown. This study investigated the relationship between SAD, peer-liking and stigma in a cohort of early adolescent girls. The sample was 103 sixth and seventh graders attending three girls' schools in Australia. The students, aged between 10- and 13-years, were randomly allocated to either a control (n = 52) or experimental (n = 51) group. Participants completed an online survey while at school to examine their responses to one of two age-and-gender matched vignettes: a hypothetical peer with SAD (experimental condition), or without SAD (control condition). Contrary to expectations, group comparisons revealed that students with the SAD vignette liked their peer more than students with the non-SAD vignette. Also, students endorsed higher levels of pity, lower levels of fear, but similar levels of anger when considering their SAD (versus non-SAD) peer. In the SAD group, higher levels of pity were associated with greater peer-liking. The opposite pattern was evident in response to the non-SAD peer. Importantly, students discriminated less (preferred less social distance) in response to their peer with SAD. This points to the potential benefit of adolescent peer programs that aim to promote positive peer-relationships as a protective factor for students with SAD. Future research may examine gender and socio-economically diverse students to increase the confidence with which findings can be generalized to other educational settings.

Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults

OBJECTIVES

There has been limited consideration of the role emotion self-stigma (i.e. beliefs that experiencing and expressing so called 'negative' emotions are unacceptable) may play in help-seeking for emotional distress. This study is the first to investigate whether emotion self-stigma uniquely predicts help-seeking intentions across two key emotion vulnerability periods in development: (a) early adolescence and (b) young adulthood.

METHODS AND DESIGN

Cross-sectional data were collected from secondary school (n = 510; M age = 13.96 years) and university students (n = 473; M age = 19.19 years) residing in Australia. Both samples completed measures online examining demographic characteristics, emotional competence, mental health and help-seeking stigma, emotion self-stigma, and help-seeking intentions. The Data were analysed using hierarchical multiple regression.

RESULTS

Emotion self-stigma was a significant unique predictor of help-seeking intentions in young adults but not adolescents. The strength of the relationship between increased emotion self-stigma and lowered help-seeking intentions was similar for both males and females, regardless of developmental period.

CONCLUSIONS

Addressing emotion self-stigma alongside mental illness and help-seeking stigma may be useful to improve help-seeking outcomes, particularly as young people transition into early adulthood.

Stigma toward internalizing and externalizing disorders: How do adolescents perceive their peers? A network analysis approach

This study's first aim was to explore whether stigma's facets differ between internalizing and externalizing disorders in adolescence. The second aim was to compare the relationships among stigma's facets toward these disorders. Two vignettes depicting a peer with Major Depressive Disorder (MDD) or Attention-Deficit Hyperactivity Disorder (ADHD) were used with 616 adolescents in Italy. A Repeated measure MANOVA showed biogenetic causes, social distancing, and discomfort were more attributed to depression, while dangerousness to ADHD. Furthermore, a Psychometric Network Analysis showed no differences between these disorders in the relations among stigma's components. However, dangerousness seemed to be among the nodes with the highest levels of "strength," confirming previous literature that shows that dangerousness plays a major role in stigma.

Understanding the Perspective of Youths on Undergoing Metabolic Monitoring While on Second-Generation Antipsychotics: Challenges, Insight, and Implications

Introduction: Prescription of second-generation antipsychotics (SGAs) in youths is rapidly increasing globally, despite the potential for significant adverse effects and long-term health consequences. A known adverse reaction resulting from SGAs is metabolic syndrome (MS). Youths exposed to antipsychotics are at higher risk than adults for adverse drug reactions, including adverse events such as MS (with weight gain as the most significant adverse outcome) and other long-term endocrinological abnormalities. This study aimed to explore the experiences of young patients on factors impacting barriers to metabolic monitoring of SGAs and the strategies to address those barriers thereby providing further guidance on policy and service delivery. Methods: Semi-structured interviews were conducted with patients (youths who were prescribed SGAs) who attended Child and Youth Mental Health Services. The interviews focused on barriers to monitoring and strategies to enhance rates of monitoring that could be customized across study sites. Results: Young patients revealed that none of them had any concerns or objections to receiving anthropometric metabolic measurements. However, they seemed concerned to undergo blood tests as part of the metabolic monitoring process. Specifically, youths cited their fear of the needles as barrier to undergo the required blood tests. Youths have also reported that their dislike to healthy foods and exercise being the most common challenge they face while trying to engage in a healthy lifestyle to manage the SGAs resulted weight gain. Conclusion: Prescribers are recommended to actively engage young patients about the expected SGAs-induced adverse effects, the importance of conducting metabolic monitoring, and how to prevent and minimize the expected adverse effects from the start of initiating SGAs. This could be a vital step toward a successful treatment as the insight of youths into the details of the chosen treatment can play a significant role into treatment adherence and recovery.

The effects of an adapted mental health literacy curriculum for secondary school students in Germany on mental health knowledge and help-seeking efficacy: results of a quasi-experimental pre-post evaluation study

Background

Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention's effects on mental health knowledge and help-seeking efficacy among 10th grade students in Germany.

Methods

10th grade students (aged 14-17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention's effects.

Results

Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574, p < 0.001, partial η2 = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311, p < 0.001, partial η2 = 0.09).

Conclusion

The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.

Experiencing (Shared) Decision Making: Results from a Qualitative Study of People with Mental Illness and Their Family Members

(1) Background: There is a fundamental shift in healthcare toward shared decision making (SDM). This study explores SDM from the perspective of individuals affected by mental illness and their family members and investigates factors which promote and hinder the process. (2) Methods: We conducted N = 15 telephone interviews (n = 4 adults affected by mental illness, n = 5 family members, n = 6 both applicable, the majority reporting experiences with affective and anxiety disorders). Data were recorded, transcribed, and analyzed according to procedures established by Mayring. (3) Results: Individuals affected by mental illness and their family members have a strong desire to be involved in treatment decisions and to participate in finding a diagnosis. Often these stakeholders are denied the opportunity to participate; sometimes enabling behaviors impede participation. The stigmatization of mental illnesses is a major barrier. There are also structural barriers to SDM within the healthcare system. Peer support, self-help associations, and psychosocial counseling services are important to empowering individuals and promoting SDM. (4) Conclusions: SDM has the potential to improve the quality of mental healthcare. Barriers can be mitigated and new approaches for interventions in the psychiatric sector have been identified. This study has also shown the importance of understanding SDM as a process that should begin at the diagnostic phase.

Clinician-led mental health conversations significantly associated with outcomes for scoliosis patients

BACKGROUND

The psychological impact of idiopathic scoliosis has been well established in the literature. While the diagnosis of scoliosis is concerning, bracing often compounds patients' stress, and patients have expressed wanting to discuss their feelings with their healthcare providers. Counseling can be an effective coping strategy for adolescents facing chronic illness, but it has not been studied in individuals diagnosed with scoliosis.

AIM

To assess the frequency and effect of counseling and clinician-led mental health discussions on individuals diagnosed with scoliosis in childhood and adolescence.

DESIGN

Cross-sectional study.

SETTING

Community-based research, online.

POPULATION

Individuals diagnosed with scoliosis in childhood and adolescence.

METHODS

The online survey included the SRS-22r, the BSSQ-Brace, questions about demographics, mental health, the Scolios-us Mentor Program, and general scoliosis experience. The survey was distributed to Scolios-us Mentor Program participants and to scoliosis clinicians to provide to their patients. Responses about mental health, experiences with healthcare providers, and counseling were analyzed for group differences and associations.

RESULTS

Fifty-five subjects participated in the study, with a median age of 13 (IQR: 3). Our results indicate that mental health is not being discussed as much as it is desired. A desire to discuss mental health was associated with lower function (P=0.005), mental health (P<0.001), SRS-22r total scores (P=0.002), and BSSQ-Brace scores (P=0.015). Subjects who engaged in a mental health discussion with one or more scoliosis healthcare providers exhibited higher management scores (P=0.002). Only 18.2% of subjects sought counseling, and two-thirds of these subjects found counseling to be very or extremely helpful.

CONCLUSIONS

Mental health is not discussed by scoliosis providers as often as patients desire it, and a desire to have these conversations is negatively associated with several clinical outcomes. Although clinicians are not regularly talking about mental health, the positive associations of mental health discussions with clinical outcomes are encouraging.

CLINICAL REHABILITATION IMPACT

The ability to acknowledge the desire to discuss mental health, begin these discussions, and refer patients to a mental health professional may improve patient outcomes.

"The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries

Background

Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them.

Methods

The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts.

Results

Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation.

Conclusions

Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.

Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms

BACKGROUND

Major depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people's feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms.

METHODS

We carried out in-depth, semi-structured interviews with N = 22 young people aged 17-25 (M_age = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships.

RESULTS

Participants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others' Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts.

CONCLUSIONS

Young people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: A systematic review and meta-analysis

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people's help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10-19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions.

Adolescents' Experiences of Participating in Sensitive Research: A Scoping Review of Qualitative Studies

Despite an increasing emphasis on adolescents' participation rights, there are concerns about their participation in research on sensitive topics, such as trauma and violence. This review reports findings of a scoping review that examined the nature and extent of qualitative studies conducted with adolescents about their experiences of participating in research on sensitive topics. Studies were identified by searching electronic databases and grey literature and reported on qualitative and mixed-methods studies eliciting adolescents' experiences of participating in research on sensitive topics. Seventeen (17) studies were included after screening 4426 records. The scoping review revealed significant adolescent benefits from participation, relating to positive emotions, skill acquisition and enhanced self-efficacy and interpersonal relationships. To a lesser extent, participants also experienced burdens relating to negative emotions, concerns about confidentiality and privacy and inconvenience of participation, which were mitigated by careful attention to research design and researcher engagement and training. Participants shared insights into their motivation to participate, and factors that impacted their experiences of research, such as ethical considerations, including consent procedures, safety and connection in research, study procedures and documentation and researcher characteristics. There were tangible benefits and some burdens involved in adolescents' participation in sensitive research. This review considers implications for research and practice, such as the need to regularly publish findings of consultations, assessing caregiver consent requirements, obtaining adolescent views on study documents and measures and building on existing research, differentiated by age, gender and dis/ability status, especially in diverse and under-represented regions.

Stigmatizing attitudes toward mental illness among caregivers of patients with mental disorders in China

Objective

This study aimed to investigate stigmatizing attitudes toward depression, schizophrenia, and general anxiety disorder (GAD) among caregivers of patients with mental disorders in China.

Methods

A cross-sectional study was conducted among 607 caregivers in China, using vignettes that described three mental illnesses. Data on the caregivers' attitudes and other people's attitudes toward individuals with mental disorders and their willingness to come in contact with people with mental disorders were collected.

Results

In the three vignettes, caregivers agreed that positive outcomes outnumbered negative outcomes. The top two statements endorsing the stigma were "the person could snap out of the problem" and "people with this problem are dangerous." In the section for perceived stigma, caregivers in the GAD vignette agreed that most people believed this problem is not a real medical illness, compared to schizophrenia. The rates of the statement endorsing unpredictability were significantly different in the schizophrenia (57.2%) and depression (45.5%) vignette, in comparison to the GAD (45.6%) vignette. For personal stigma, the caregivers tended to avoid people described in the depression vignette more often than in the GAD vignette. The caregivers were most unwilling to let the person described in the vignettes marry into their family, especially in the schizophrenia vignette.

Conclusion

Despite the stigma and desire for social distance associated with schizophrenia, depression, and GAD, caregivers often expect positive outcomes. Actions should be taken to improve caregivers' knowledge about mental health and reduce the stigma.

Improving the Scope of Child Mental Health Interventions in Our Modern World

Twenty years ago, an important systematic review showed that the empirical research evidence for interventions available for children and young people with mental health problems were rarely developed with their specific developmental needs in mind [...].

Suicidal Behaviors in Early Adolescence: The Interaction Between School Connectedness and Mental Health

Previous research has identified mental health symptoms such as depression and aggression as contributing factors associated with suicidal ideation and attempts in adolescence. However, much of this work has focused on older adolescents (ages > 14) resulting in a dearth of knowledge about early adolescents under 12 years. Moreover, much less is known about school connectedness as a protective factor in the relationship between mental health symptoms and suicidal behaviors. This study examined the interaction effect between school connectedness and mental health symptoms on suicidal behaviors among early adolescents aged 9-12 years. Data were drawn from the Fragile Families and Child Wellbeing Study and yielded an analytic sample (n = 2826) that was majority male (52%), Black (53%), and with an average age of 9.3 years. Data were analyzed using multivariate logistic regression. Among participants, 2% experienced suicidal ideation, and 2% experienced suicide attempts. Black adolescents were more than five times more likely to experience a suicide attempt compared to their White peers (AOR = 5.37; 95% CI = 1.71-16.95; p = .004). There was a significant interaction effect between withdrawn depressed symptoms and school connectedness (AOR = .95; 95% CI = .91-98; p = .006), and between aggressive behavior and school connectedness (AOR = 1.02; 95% CI = 1.01-1.03; p = .001) on suicide attempts. School connectedness did not moderate the relationship between mental health symptoms and suicidal ideation. The findings have important practical implications, which are discussed.

Validating the Children's Depression Inventory-2: Results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study

Childhood-onset depression has adverse consequences that are sustained into adulthood, which increases the significance of detection in early childhood. The Children's Depression Inventory (CDI) is used globally in evaluating depressive symptom severity in adolescents, and its second version, the CDI-2, was developed by taking into account advances in childhood depression research. Prior research has reported inconsistencies in its factor structure across populations. In addition, the CDI-2 has not yet been empirically validated with Southeast Asian populations. This study sought to empirically validate the CDI-2's psychometric properties and evaluate its factorial structure with a Singaporean community sample of non-clinical respondents. A total sample of 730 Singaporean children aged between 8.5 and 10.5 years was used. Psychometric properties of the CDI-2, including internal consistency as well as convergent and discriminant validity, were assessed. Factor analyses were conducted to assess the developers' original two-factor structure for a Southeast Asian population. This two-factor structure was not supported in our sample. Instead, the data provided the best fit for a hierarchical two-factor structure with factors namely, socio-emotional problems and cognitive-behavioural problems. This finding suggests that socio-cultural and demographic elements influence interpretation of depressive symptoms and therefore the emerging factor structure of the construct under scrutiny. This study highlights the need to further examine the CDI-2 and ensure that its interpretation is culture-specific. More qualitative work could also bring to light the idiosyncratic understanding of depressive symptomatology, which would then guide culture-specific validation of the CDI-2.

Interdisciplinary Children's Behavioral Health Workforce Development for Social Work and Nursing

This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program's initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.

Longitudinal Associations between Peer and Family Relationships, Emotional Symptoms, and Regional Brain Volume across Adolescence

The period of adolescence brings with it a dynamic interaction between social context and behaviour, structural brain development, and anxiety and depressive symptoms. The rate of volumetric change in the ventromedial prefrontal cortex (vmPFC) and amygdala have been implicated in socioemotional development in adolescence; typically, there is thinning of grey matter volume (GMV) in the vmPFC and growth in the amygdala during this time. The directionality of the associations between social, emotional, and neuroanatomical factors has yet to be untangled, such as the degree to which social variables impact regional brain development, and vice versa. To add, the differences between sexes are still up for debate. In this study, longitudinal associations between peer problems, family support, socioeconomic stress, emotional symptoms, amygdala volume, and vmPFC GMV were investigated for both sexes using latent change score models. Data from a multi-site European study at baseline (mean (SD) age = 14.40 (0.38) years; % female = 53.19) and follow-up 2 (mean (SD) age = 18.90 (0.69) years, % female = 53.19) were used. Results revealed that peer problems did not predict emotional symptoms, rather they changed together over time. For males only, there was positive correlated change between vmPFC GMV, peer problems and emotional symptoms, indicating that slower vmPFC GMV thinning was associated with poorer social and emotional functioning. Additionally, greater family support at age 14 years was associated with slower growth of amygdala volume between ages 14 and 19 years for males; previous research has related slower amygdala growth to resilience to mental health disorders. The findings have extended understanding of mutual social, emotional and brain development, and avenues to protect mental health.

Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause

The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.

Descriptive analysis of depression among adolescents in Huangshi, China

BACKGROUND

More adolescents suffered from depressive disorder, and what was worse, the morbidity increased annually. The situation was getting worse during COVID-19 pandemic. The prevalence of depression among adolescents in China has increased a lot due to social and economic development, family-associated reasons, academic stress, interpersonal relationships, and so on.

OBJECTIVE

This study aimed to determine the prevalence, gender differences, risk factors, and abnormal illness behaviors of depression among adolescents in Huangshi, China.

METHODS

A descriptive analysis was conducted based on the data from clinical interviews and self-reports by the patients. Depression was assessed and diagnosed using the DSM-5 Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

Depression was most frequently seen in 674 patients with mental illnesses (282, 41.84%). The male-to-female ratio was 1:2.44, and their age ranged from 9 to 18. The majority of patients are in high school (261/282, 92.55%), and the highest morbidity occurred at 16 years. More cases were diagnosed in urban than in rural areas. Genetic factors, school violence, academic stress, sleep disorders, and family-related factors were essential factors leading to depression among adolescents. Most patients had sleep disorders (84.75%). In family-related factors, left-behind children and unrecognized/misunderstood by their families were prominently diagnosed with depression. A large portion of individuals with depression felt apathetic, solitary, and sluggish and were unable to study, work, and live normally (212/282, 75.18%); they even committed suicide or attempted suicide (228/282, 80.85%) and inflicted self-harm (146/282, 51.77%).

CONCLUSIONS

An increasing trend of depression has been observed since 2018, especially in 2021. This depression has led to suicide or suicidal attempts and self-harm, reflecting the severity of mental health among adolescents in Huangshi. Therefore, this study aimed to draw the attention of society, families, and schools to the importance of mental health among adolescents, providing guidance and references for the prevention, diagnosis, and treatment of young depressive disorders in China.

Mental health awareness of secondary schools students: Mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health

Purpose

The mental health situation among adolescents in Malaysia has reached a worrying state with the rising number of cases. Despite a significant increase in the literature on mental health, there is a lack of studies that focused on mental health awareness. Therefore, this study aimed to investigate the factors affecting Malaysian youth's mental health awareness as well as the mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health.

Methods

Self-administered questionnaires were distributed to 450 secondary school students aged 15-19 years old in Kuala Lumpur and Melaka who were recruited via purposive sampling. Data analysis was performed using SPSS and SmartPLS to obtain the descriptive analysis, measurement model, and structural model.

Results

The results indicated that mental health awareness was influenced by knowledge on mental health and attitude towards mental health. The findings also revealed that familiarity and media exposure were important determinants of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Moreover, the results indicated that knowledge on mental health positively mediated the relationship between media exposure and mental health awareness. Besides, attitude towards mental health also found to play mediating roles between familiarity and mental health awareness, as well as between media exposure and mental health awareness.

Conclusion

This study contributed important knowledge to the limited literature in this contemporary domain. An effective public mental health campaign is needed to reduce the burden of disease and the cost of mental illness.

Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic

PURPOSE

The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice.

DESIGN AND METHODS

Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.

RESULTS

One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers.

PRACTICE IMPLICATIONS

Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.

Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana

BACKGROUND

Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana.

METHOD

This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana.

RESULTS

A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex.

CONCLUSIONS

A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.

Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach

Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010-2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.

Implicit and Explicit Stigma of Chronotype in Emerging Adults

BACKGROUND

Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults.

PARTICIPANTS

49 undergraduates (M_age = 19.9 [SD = 1.5], 83.7% female).

METHODS

Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded.

RESULTS

We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations.

CONCLUSIONS

Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.

The Relationship between Psychosocial Factors and Affiliate Stigma in Parents of Children with ADHD: Systematic Literature Review

The aim of this study is to identify the psychosocial factors which are related with affiliate stigma in parents of children with ADHD through a systematic literature review. This review includes English publications from 2008 to 2022, which present the results of quantitative studies on the relationship between psychosocial factors and affiliate stigma in parents of children with ADHD. According to eligibility criteria, 7 articles were included in the review. The results showed that higher parental affiliate stigma is associated with lower parents’ psychosocial functioning (higher expressed depression, anxiety, lower self-esteem). It was also found that higher parental affiliate stigma is related to unfavorable behavior towards a child (higher expressed negativity/ less constructive parenting). The results also showed that higher parental affiliate stigma is associated with more expressed child's difficulties (ADHD symptoms/ internalizing and externalizing difficulties).