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Shao S, Zhang Y, Yang M, Li C, Zhao R, Liu Z, Wu M, Liu Y, Zhu Z, Cui L. The effectiveness of the DNA-V program on reducing anxiety among Chinese adolescents: Outcomes of the face-to-face and web-based versions. J Sch Psychol 2024; 106:101357. [PMID: 39251313 DOI: 10.1016/j.jsp.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/11/2024]
Abstract
Many studies have indicated an alarming prevalence of anxiety among Chinese adolescents, highlighting the critical need for prevention protocols. DNA-V (Discoverer, Noticer, Advisor-Values model) is an adapted version of Acceptance and Commitment Therapy designed to prevent mental health problems in adolescents. This study investigated the effects and underlying mechanisms of DNA-V. The DNA-V prevention program was culturally adapted and optimized in both content and form specifically for Chinese adolescents, with the aim of reducing anxiety levels. A total of 139 participants (59 females) from six eighth-grade classes at an average middle school in Beijing were randomly assigned to one of three groups consisting of the DNA-V face-to-face group (two classes), the DNA-V web-based group (two classes), or the active control group (two classes). Adolescents' anxiety and cognitive fusion were measured before (Time 1), immediately after (Time 2), and 2 months after (Time 3) the program using the Chinese Secondary School Students Anxiety Scale (CSSSAS) and Cognitive Fusion Questionnaire (CFQ). Results showed that in the DNA-V face-to-face group, the anxiety score at Time 3 was significantly lower than the scores at Time 1 (p < .001, Cohen's drm = 0.56) and Time 2 (p = .043, Cohen's drm = 0.24). The cognitive fusion score at Time 3 was significantly lower than the scores at Time 1 (p = .001, Cohen's drm = 0.51) and Time 2 (p = .003, Cohen's drm = 0.37). The results of the study suggest that the DNA-V prevention program could serve as an effective tool for reducing anxiety in adolescents.
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Affiliation(s)
- Siyang Shao
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China
| | - Ye Zhang
- Peking Academy High School, Beijing, China
| | - Mo Yang
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China
| | - Chieh Li
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Ruonan Zhao
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China
| | - Zidi Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Mengxue Wu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Yinghui Liu
- Zhichun Branch of the Zhongguancun Middle School in Beijing, Beijing, China
| | - Zhuohong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Lixia Cui
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China.
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Nishimura T, Wakuta M, Osuka Y, Tsukui N, Hirata I, Takahashi M, Adachi M, Katayama T, Aizaki K, Sumiya M, Kawakami S, Iwabuchi T, Senju A. Early detection of students' mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization. Front Public Health 2024; 12:1430011. [PMID: 39314787 PMCID: PMC11416938 DOI: 10.3389/fpubh.2024.1430011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Objective The implementation of school-based mental health screening offers promise for early detection of mental health issues in children; however, various barriers hinder its widespread adoption. This study aimed to investigate the predictive value of digital data obtained from an established daily health observation scheme in Japanese schools to identify later mental health issues in children. Methods Data for the analysis were obtained from 2,433 students enrolled in five public schools. The data acquisition period spanned 76 school days, from September 1, 2022, to December 23, 2022, and student absences were recorded during this period. Depressive and anxiety symptoms were assessed in January 2023. The students' daily physical and emotional health status was recorded as "daily health issue" scores and group-based trajectory modeling was employed to classify the long-term trends in these scores. Additionally, rolling z-scores were utilized to capture variability in daily health issue scores, with z-scores above +1 considered unusual responses. Results After 4 months of daily health observations, students' response trends were classified into five trajectory groups. The group experiencing the highest number of daily health issues (Group 5; 5.4% of the sample) exhibited more subsequent depressive and anxiety symptoms compared to the group with fewer issues (Group 1; 47.5%) (incident rate ratio [IRR] = 5.17; 95% confidence interval [CI]: 3.82, 6.99). Group 5 also demonstrated significantly more days of absence than Group 1 (IRR = 2.14, 95% CI: 1.19, 3.85). The average daily health issue scores for the entire period were associated with both depressive/anxiety symptoms and the number of days absent from school (IRR = 1.59, 95% CI: 1.45, 1.73; IRR = 1.18, 95% CI: 1.04, 1.35, respectively). Furthermore, a higher number of unusual responses during the entire period was also associated with more depressive/anxiety symptoms (IRR = 1.10, 95% CI: 1.07, 1.12). Conclusion The current study is the first to demonstrate the predictive capability of a traditional daily health observation scheme to identify mental health issues in children. This study highlights the scheme's potential to screen and safeguard children's mental health, emphasizing the importance of digitalization and collaboration with various stakeholders.
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Affiliation(s)
- Tomoko Nishimura
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute of Child Developmental Science Research, Hamamatsu, Japan
| | - Manabu Wakuta
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Institute of Child Developmental Science Research, Hamamatsu, Japan
| | - Yuko Osuka
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Institute of Child Developmental Science Research, Hamamatsu, Japan
| | - Nobuaki Tsukui
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute of Child Developmental Science Research, Hamamatsu, Japan
| | - Ikue Hirata
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Michio Takahashi
- Institute of Child Developmental Science Research, Hamamatsu, Japan
- Smart-Aging Research Center, Tohoku University, Sendai, Japan
| | - Masaki Adachi
- Institute of Child Developmental Science Research, Hamamatsu, Japan
- Department of Psychology, Meiji Gakuin University, Tokyo, Japan
| | - Taiichi Katayama
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute of Child Developmental Science Research, Hamamatsu, Japan
| | - Kyoko Aizaki
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Motofumi Sumiya
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Sayaka Kawakami
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Toshiki Iwabuchi
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Atsushi Senju
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
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Tsuda S, Maruyama Y, Muroka C, Kondo C, Takada S. Assessing the effectiveness of menstrual health education in Japan: A non-randomized comparative study of adolescent girls with typical development and those with intellectual disabilities and high support needs. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241281394. [PMID: 39222028 DOI: 10.1177/17446295241281394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This study elucidates the effectiveness of a menstrual education program with segmented MHM procedure on the MHM skills of girls with intellectual disabilities/HSN compared with those with typical development. Participants in a nonrandomized comparative study included nine adolescent girls with intellectual disabilities/HSN and ten with typical development. They practiced MHM on dolls three times: before, immediately after, and three months after participating in the educational program. Although the total MHM scores were significantly higher after both groups attended the program, the girls with intellectual disabilities/HSN had significantly lower total and mean scores on MHM items than girls with typical development. They still required instruction on the majority of the items after 3 months. Meanwhile, girls with intellectual disabilities/HSN showed a significant improvement in napkin changing skills and maintained post-course scores 3 months later, similar to those with typical development.
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Affiliation(s)
- Satoko Tsuda
- College of Life and Health Sciences, Chubu University, Japan
| | - Yuki Maruyama
- Graduate school of Health Sciences, Kobe University, Japan
| | - Chika Muroka
- School of Nursing, Seirei Christopher University, Japan
| | - Chie Kondo
- Faculty of Nursing, Tokyo Women's Medical University, Japan
| | - Satoshi Takada
- Graduate school of Health Sciences, Kobe University, Japan
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Cohen KA, Ito S, Ahuvia IL, Yang Y, Zhang Y, Renshaw TL, Larson M, Cook C, Hill S, Liao J, Rapoport A, Smock A, Yang M, Schleider JL. Brief School-Based Interventions Targeting Student Mental Health or Well-Being: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2024; 27:732-806. [PMID: 38884838 DOI: 10.1007/s10567-024-00487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/18/2024]
Abstract
Brief, school-based mental health interventions hold promise for reducing barriers to mental health support access, a critical endeavor in light of increasing rates of mental health concerns among youth. However, there is no consensus on whether or not brief school-based interventions are effective at reducing mental health concerns or improving well-being. This systematic review and meta-analysis aims to provide consensus and determine directions for future work. Articles were included if they examined a brief (≤ four sessions or 240 min of intervention time) psychosocial intervention, were conducted within a Pre-K through 12th-grade school setting, included at least one treatment outcome evaluating mental health or well-being, and were published since 2000. A total of 6,702 papers were identified through database searching, of which 81 papers (k studies = 75) were ultimately selected for inclusion. A total of 40,498 students were included across studies and a total of 75 unique interventions were examined. A total of 324 effect sizes were extracted. On average, interventions led to statistically significant improvements in mental health/well-being outcomes versus control conditions up to one-month (g = .18, p = .004), six-month (g = .15, p = .006), and one-year (g = .10, p = .03) post-intervention. There may be benefits to brief school-based interventions from a preventative public health standpoint; future research may focus on how to optimize their real-world utility. Prospero pre-registration: CRD42021255079.
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Affiliation(s)
- Katherine A Cohen
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Sakura Ito
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | - Isaac L Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | | | - Yanchen Zhang
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa, USA
| | | | | | | | - Shannon Hill
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica Liao
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Andy Rapoport
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Amanda Smock
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Michelle Yang
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA.
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Finning K, Haeffner A, Patel S, Longdon B, Hayes R, Ukoumunne OC, Ford T. Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months? Eur Child Adolesc Psychiatry 2024; 33:3111-3121. [PMID: 38356042 PMCID: PMC11424695 DOI: 10.1007/s00787-024-02385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4-9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97-3.89) and 18 months (1.96, 1.07-3.59) but not 30 months (0.94, 0.54-1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation.
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Affiliation(s)
- Katie Finning
- Public Policy Analysis, Office for National Statistics, Newport, UK
| | - Amy Haeffner
- Exeter Medical school, University of Exeter, Exeter, UK
| | - Sohum Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bryony Longdon
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Hayes
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
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6
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Ghose SS, Patel NA, Marshall T, George P, Taylor J, Karakus M, Crocker L, Hoey T, Goldman HH. Assessing the Evidence Base for School-Based Promotion and Prevention Interventions: Introduction to the Series. Psychiatr Serv 2024; 75:888-894. [PMID: 38736359 DOI: 10.1176/appi.ps.20230542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB series used the rating criteria derived from the 2014 AEB series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.
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Affiliation(s)
- Sushmita Shoma Ghose
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Nikhil A Patel
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Tina Marshall
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Preethy George
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Jeffrey Taylor
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Mustafa Karakus
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Laura Crocker
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Tabitha Hoey
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
| | - Howard H Goldman
- Westat (Ghose, Marshall, George, Taylor, Karakus, Crocker, Hoey) and Substance Abuse and Mental Health Services Administration (SAMHSA) (Patel), Rockville, Maryland; Department of Psychiatry, University of Maryland, College Park (Goldman)
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7
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McKay EA, Mattheus D, Fontenot HB. Mental Health Interventions in Middle Schools: A 10-Year Review of Research. J Sch Nurs 2024:10598405241265904. [PMID: 39090789 DOI: 10.1177/10598405241265904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.
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Affiliation(s)
- Elizabeth Anne McKay
- University of Massachusetts, Lowell, Solomont School of Nursing, Lowell, MA, USA
| | - Deborah Mattheus
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
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8
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Lewer D, Gilbody S, Lewis G, Pryce J, Santorelli G, Wadman R, Watmuff A, Wright J. How do schools influence the emotional and behavioural health of their pupils? A multi-level analysis of 135 schools in the Born in Bradford inner city multi-ethnic birth cohort. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1335-1346. [PMID: 38195962 PMCID: PMC11291525 DOI: 10.1007/s00127-023-02608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To estimate variation in emotional and behavioural problems between primary schools in Bradford, an ethnically diverse and relatively deprived city in the UK. METHODS We did a cross-sectional analysis of data collected from 2017 to 2021 as part of the 'Born In Bradford' birth cohort study. We used multilevel linear regression in which the dependent variable was the Strengths and Difficulties Questionnaire (SDQ) total score, with a random intercept for schools. We adjusted for pupil-level characteristics including age, ethnicity, socioeconomic status, and parental mental health. RESULTS The study included 5,036 participants from 135 schools. Participants were aged 7-11 years and 56% were of Pakistani heritage. The mean SDQ score was 8.84 out of a maximum 40. We estimated that the standard deviation in school-level scores was 1.41 (95% CI 1.11-1.74) and 5.49% (95% CI 3.19-9.37%) of variation was explained at school level. After adjusting for pupil characteristics, the standard deviation of school-level scores was 1.04 (95% CI 0.76-1.32) and 3.51% (95% CI 1.75-6.18%) of variation was explained at school level. Simulation suggested that a primary school with 396 pupils at the middle of the distribution has 63 pupils (95% CI 49-78) with a 'raised' SDQ score of 15 + /40; and shifting a school from the lower to the upper quartile would prevent 26 cases (95% CI 5-46). CONCLUSION The prevalence of emotional and behavioural problems varies between schools. This is partially explained by pupil characteristics; though residual variation in adjusted scores may suggest that schools have a differential impact on mental wellbeing.
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Affiliation(s)
- Dan Lewer
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department for Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Simon Gilbody
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Joseph Pryce
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Ruth Wadman
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Aidan Watmuff
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
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9
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Hamdani SU, Huma ZE, Malik A, Tamizuddin-Nizami A, Javed H, Minhas FA, Jordans MJD, Sijbrandij M, Suleman N, Baneen UU, Bryant RA, van Ommeren M, Rahman A, Wang D. Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:559-570. [PMID: 39025557 PMCID: PMC11254783 DOI: 10.1016/s2352-4642(24)00101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. METHODS In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. FINDINGS From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. INTERPRETATION The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. FUNDING UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. TRANSLATION For the Urdu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Syed Usman Hamdani
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Zill-E Huma
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Aiysha Malik
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - Asad Tamizuddin-Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Hashim Javed
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mark J D Jordans
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Suleman
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Um-Ul Baneen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Duolao Wang
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
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10
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Bhugra D, Liebrenz M, Ventriglio A, Ng R, Javed A, Kar A, Chumakov E, Moura H, Tolentino E, Gupta S, Ruiz R, Okasha T, Chisolm MS, Castaldelli-Maia J, Torales J, Smith A. World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health. Asian J Psychiatr 2024; 98:104105. [PMID: 38861790 DOI: 10.1016/j.ajp.2024.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/22/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London SE5 8AF, United Kingdom.
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | | | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | | | | | - Susham Gupta
- East London NHS Foundation Trust, London, United Kingdom
| | - Roxanna Ruiz
- University of Francisco Moaroquin, Guatemala City, Guatemala
| | | | | | | | | | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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11
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Kirk H, Spencer-Smith M, Jobson L, Nicolaou E, Cornish K, Melzak E, Hrysanidis C, Moriarty C, Davey B, Whyman T, Bird L, Bellgrove MA. A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial. Sci Rep 2024; 14:14065. [PMID: 38890384 PMCID: PMC11189556 DOI: 10.1038/s41598-024-63473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6-8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2 . The approved Stage 1 protocol is available here: https://osf.io/kzfwn .
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Affiliation(s)
- Hannah Kirk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.
| | - Megan Spencer-Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Nicolaou
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Kim Cornish
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Ebony Melzak
- Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Caitlin Hrysanidis
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Cassie Moriarty
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Belinda Davey
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Theoni Whyman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Laura Bird
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Mark A Bellgrove
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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12
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López-López JA, Tilling K, Pearson RM, Fazel MS, Washbrook E, Zhu Y, Smith BJ, Dunn EC, Smith ADAC. Depressive symptoms in adolescence and adult educational and employment outcomes: a structured life course analysis. Psychol Med 2024:1-8. [PMID: 38818779 DOI: 10.1017/s0033291724001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Depression is a common mental health disorder that often starts during adolescence, with potentially important future consequences including 'Not in Education, Employment or Training' (NEET) status. METHODS We took a structured life course modeling approach to examine how depressive symptoms during adolescence might be associated with later NEET status, using a high-quality longitudinal data resource. We considered four plausible life course models: (1) an early adolescent sensitive period model where depressive symptoms in early adolescence are more associated with later NEET status relative to exposure at other stages; (2) a mid adolescent sensitive period model where depressive symptoms during the transition from compulsory education to adult life might be more deleterious regarding NEET status; (3) a late adolescent sensitive period model, meaning that depressive symptoms around the time when most adults have completed their education and started their careers are the most strongly associated with NEET status; and (4) an accumulation of risk model which highlights the importance of chronicity of symptoms. RESULTS Our analysis sample included participants with full information on NEET status (N = 3951), and the results supported the accumulation of risk model, showing that the odds of NEET increase by 1.015 (95% CI 1.012-1.019) for an increase of 1 unit in depression at any age between 11 and 24 years. CONCLUSIONS Given the adverse implications of NEET status, our results emphasize the importance of supporting mental health during adolescence and early adulthood, as well as considering specific needs of young people with re-occurring depressed mood.
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Affiliation(s)
- José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology and Speech Therapy, University of Murcia, Murcia, Spain
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
| | - Kate Tilling
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rebecca M Pearson
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Mina S Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Yiwen Zhu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brooke J Smith
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School and the Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
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13
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Zhang Y, Larson M, Ehrhart MG, King K, Locke J, Cook CR, Lyon AR. Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study. Implement Sci 2024; 19:36. [PMID: 38802827 PMCID: PMC11129427 DOI: 10.1186/s13012-024-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH. METHODS SBMH clinicians from community-based organizations (CBOs; nclinician = 27) and their proximal student-support school staff (nschool = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes. RESULTS The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors. CONCLUSIONS This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.
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Affiliation(s)
- Yanchen Zhang
- College of Education, University of Iowa, 240 S Madison St, Iowa City, IA, 52242, USA.
| | - Madeline Larson
- Center for Applied Research and Educational Improvement, University of Minnesota, Minneapolis, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | - Kevin King
- Department of Psychology, University of Washington, Seattle, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, Minneapolis, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
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14
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Soneson E, Howarth E, Weir A, Jones PB, Fazel M. Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study. J Med Internet Res 2024; 26:e46764. [PMID: 38652534 PMCID: PMC11077415 DOI: 10.2196/46764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. OBJECTIVE We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health. METHODS We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. RESULTS A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. CONCLUSIONS The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Emma Howarth
- School of Psychology, University of East London, London, United Kingdom
| | - Alison Weir
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
- Howard Community Academy, Anglian Learning multi-academy trust, Bury St Edmunds, United Kingdom
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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15
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Vaillant-Coindard E, Briet G, Lespiau F, Gisclard B, Charbonnier E. Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial. BMC Psychol 2024; 12:204. [PMID: 38615007 PMCID: PMC11016224 DOI: 10.1186/s40359-024-01723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.
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Affiliation(s)
| | - Gaëtan Briet
- UNIV. NIMES, APSY-V, F-30021, Nîmes Cedex 1, France
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16
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Castro MS, Meira GDF, Mendes RGF, Castilho AVSS, Trench LDA, Segalla CR, Vettore MV, Sales-Peres SHDC. The Relationship between Professional Variables and Burnout Syndrome in Brazilian Dentists during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:435. [PMID: 38673346 PMCID: PMC11050417 DOI: 10.3390/ijerph21040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Burnout syndrome (BS) is a highly prevalent occupational disease among dentists who, during the COVID-19 pandemic, have been at greater risk of contracting the disease, generating stress and distancing. The aim of this study was to assess the association of social conditions, professional factors and perceptions of COVID-19 with Burnout Syndrome. This was a cross-sectional study of 302 Brazilian dentists working in the clinical and private sectors. The professionals completed the Oldenburg Burnout Inventory online and answered sociodemographic and professional questions and questions related to their perception of the pandemic. Poisson regression with unadjusted and adjusted robust variance was used to estimate the association between burnout syndrome (dependent variable) and the independent variables. The presence of BS was strongly associated with age, training in a private institution, professionals who claimed to have sufficient protective knowledge and fear of being contaminated by SARS-CoV-2 during patient care (p < 0.05). The findings of this study show that there has been an impact of the COVID-19 pandemic on the occurrence of Burnout syndrome in dentists, especially, those who worked in the public sector and those who were afraid to work with other health professionals.
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Affiliation(s)
- Marcelo Salmazo Castro
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
| | - Gabriela de Figueiredo Meira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
| | - Rharessa Gabrielly Ferreira Mendes
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
| | - Ana Virgínia Santana Sampaio Castilho
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
| | - Leonardo de Aguiar Trench
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
| | | | - Mario Vianna Vettore
- Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000 Aarhus, Denmark;
| | - Silvia Helena de Carvalho Sales-Peres
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil; (M.S.C.); (G.d.F.M.); (R.G.F.M.); (A.V.S.S.C.); (L.d.A.T.)
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Maxwell D, Praetorius RT. "Gutting It Out" Does Not Work: Why Mental Health Days are Needed. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:221-233. [PMID: 38426694 DOI: 10.1080/19371918.2024.2322589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
College student mental health issues negatively impact academic performance. Over half of college students in the U.S. report a mental health issue, with 60% reporting one at the two-year mark. Even when aware of such mental health issues, students are still hesitant to seek treatment. As such, investigating perceptions of mental health time off may illuminate perceived usefulness of such policies as well as potential processes for defining and implementing such policies. This study sought to answer the question, "What are the perspectives of time-off for mental health?" Using Reddit's responses, this study extracted (N = 392) quotes and used thematic analysis to identify four main themes. Implications include the need for school-level mental health time-off policies or integration of instructors' policies into their syllabi for transparency to students, which may alleviate student stress and further stigmatization.
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Affiliation(s)
- December Maxwell
- Thompson School of Social Work & Public Health, University of Hawaii at Manoa, Honolulu, HI, USA
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18
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Platt IA, Hochard KD, Tytherleigh M, Kannangara C, Carson J, McFaul C, North C. The Hummingbird Project year 2: decreasing distress and fostering flourishing in a pragmatic pre-post study. Front Psychol 2024; 15:1257446. [PMID: 38596339 PMCID: PMC11003473 DOI: 10.3389/fpsyg.2024.1257446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/26/2024] [Indexed: 04/11/2024] Open
Abstract
Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored. The current study, therefore, was designed to replicate the effects of the Hummingbird Project mPPI on positive mental health and to also explore the effects on symptoms of mental distress. Secondary school-aged children (N = 614; mean age = 11.46 years) from a sample of secondary schools located across the North West of England (N = 7) participated in the study; the majority of children were in Year 7 (94%). The PP concepts explored included happiness, hope, resilience, mindfulness, character strengths, growth mindset, and gratitude. The results showed significant improvements associated with the mPPI in well-being (as measured by the World Health Organization Well-Being Index; WHO-5), hope (as measured by the Children's Hope Scale; CHS), and symptoms of mental distress (as measured by the Young Person's Clinical Outcomes in Routine Evaluation; YP-CORE) from pre- to post-intervention. While acknowledging the limits due to pragmatic concerns regarding the implementation of a control group, the effectiveness of the Hummingbird Project mPPI on well-being was replicated alongside reducing the symptoms of mental distress. Future evaluation, however, will need to implement more robust designs and consider follow-up duration to assess the longer-term effects of the Hummingbird Project mPPI.
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Affiliation(s)
| | - Kevin D. Hochard
- School of Psychology, University of Chester, Chester, United Kingdom
| | | | | | - Jerome Carson
- School of Education and Psychology, University of Bolton, Bolton, United Kingdom
| | - Claudine McFaul
- School of Psychology and Counselling, The Open University, Walton Hall, Milton Keynes, United Kingdom
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Zheng H, Gao H, Li J, Li S, Chen L, Li Z, Chen X, Sun Y, Wang C, Liu J, Zhuang J. Social support systems involved in suicide prevention and intervention among adolescents: A Delphi study in Shanghai. Prev Med Rep 2024; 39:102654. [PMID: 38384963 PMCID: PMC10879809 DOI: 10.1016/j.pmedr.2024.102654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
The rotes of attempted and completed suicide among adolescents are increasing globally. Social support can help decrease the risk of adolescent suicide, but this aspect has been rarely studied in China. The present study aimed to use the Delphi methodology to establish a set of guidelines for the development of social support resources, with the goal of collectively reducing suicide risks among adolescents in Shanghai. We commenced the study in April 2021, established a research team, searched the keywords using Web of Science from 2016 to 2021 and ultimately designed a pre-evaluation index. Next, following Donabedian's Structure-Process-Outcome model, the research developed a questionnaire comprising 3 level-1, 12 level-2, and 73 level-3 indicators. Ten experts were enlisted to conduct three rounds of e-mail inquiries in order to finalize the indicator system, resulting in 2 level-1, 11 level-2, and 52 level-3 indicators, as well as expert consensus. Our findings indicate that the social support systems should include parents, schools, psychiatric hospitals, social organizations, and government departments, with the government sector being the most important ((M = 9.4). Furthermore, our study revealed that school counselors and psychologists play similar roles to psychiatrists within the interdisciplinary team (M ± S = 9.2 ± 1.1). As per the expert consensus, social support systems should strengthen government-led and interdisciplinary collaboration, prioritize suicide prevention in schools and encourage greater involvement from social organizations.
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Affiliation(s)
- Hong Zheng
- Shanghai Changning Mental Health Center, Shanghai, 200335, China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Hui Gao
- Shanghai Changning District Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Jiahui Li
- Fengxian Hospital Affiliated with Anhui University of Science and Technology, Shanghai, 201499, China
| | - Su Li
- School of Journalism and Communication, Wuhan University, Wuhan Province, 430072, China
| | - Liangliang Chen
- Shanghai Changning Mental Health Center, Shanghai, 200335, China
| | - Ziyan Li
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Xuanxuan Chen
- Shanghai Changning Mental Health Center, Shanghai, 200335, China
| | - Yiting Sun
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Chenyu Wang
- Shanghai Changning Mental Health Center, Shanghai, 200335, China
| | - Junsheng Liu
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Jianlin Zhuang
- Shanghai Changning District Center for Disease Control and Prevention, Shanghai, 200051, China
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Arango C, Martín-Babarro J, Abregú-Crespo R, Huete-Diego MÁ, Alvariño-Piqueras M, Serrano-Marugán I, Díaz-Caneja CM. A web-enabled, school-based intervention for bullying prevention (LINKlusive): a cluster randomised trial. EClinicalMedicine 2024; 68:102427. [PMID: 38318124 PMCID: PMC10839589 DOI: 10.1016/j.eclinm.2024.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Background There is a need for more sustainable interventions and for assessing the effectiveness of school-based universal anti-bullying programmes in vulnerable populations. We assessed the efficacy of a multicomponent, web-enabled, school-based intervention that aims to improve school climate and reduce bullying (LINKlusive) relative to conventional practices (control condition). Methods We conducted a cluster randomised controlled trial in primary and secondary schools in Madrid, Spain. The primary outcome measure was peer-reported bullying victimisation after the 12-week intervention (study endpoint). We analysed data using longitudinal mixed-effects models. The trial was registered with the ISRCTN registry (15719015). Findings We included 20 schools (10 in each group); 6542 students participated at baseline; 6403 were assessed at study endpoint. After the intervention, there was a statistically significant reduction in bullying victimisation in both the intervention (OR 0.61, 95% CI [0.41, 0.90]) and control groups (OR 0.69, 95% CI [0.51, 0.92]), with no evidence of differences in the whole sample (OR 0.89, 95% CI [0.58, 1.36]; aOR 0.89, 95% CI [0.58, 1.37]). Subgroup analyses showed a statistically significant effect of LINKlusive on bullying victimisation in primary education (aOR 0.68, 95% CI [0.47, 0.98]). In students with peer-reported bullying victimisation at baseline, LINKlusive showed a statistically significant effect on depression (-1.43, 95% CI [-2.46, -0.40], adjusted standardised mean difference (SMD) -0.41) and quality of life (2.18, 95% CI [0.80, 3.56], adjusted SMD 0.45). Interpretation LINKlusive could be effective in reducing bullying victimisation in primary school students. Sustainable whole-school interventions to promote mental health and reduce risk factors are warranted to improve outcomes in young people, especially in the early years of education. Funding Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
| | - Javier Martín-Babarro
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Campus de Somosagua, Ctra. de Húmera, s/n, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Renzo Abregú-Crespo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
- Department of Personality, Assessment, and Psychological Treatments, School of Psychology, Universidad Nacional de Educación a Distancia, C/ Juan del Rosal, 10, 28040, Madrid, Spain
| | - Miguel Á. Huete-Diego
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
| | - María Alvariño-Piqueras
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Campus de Somosagua, Ctra. de Húmera, s/n, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Isabel Serrano-Marugán
- Consejería de Educación, Ciencia y Universidades, Comunidad de Madrid, Calle General Díaz Porlier 35, 28001, Madrid, Spain
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
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21
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Radez J, Johns L, Waite F. Understanding unusual sensory experiences: a randomised experimental study of a school-based intervention for adolescents. Child Adolesc Ment Health 2024; 29:14-21. [PMID: 36959519 PMCID: PMC10877969 DOI: 10.1111/camh.12651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND One in ten young people experience unusual sensory experiences (USE), such as hallucinations. From a cognitive perspective, the appraisal of USE determines the impact of these experiences. Negative appraisal, as well as other psychological processes (e.g. thinking flexibility, maladaptive schemas, anxiety/depression), is associated with more distress. Our aim was to (a) develop a universal single-session school-based intervention on USE for adolescents and (b) evaluate the effect of the intervention on appraisals of and help seeking intentions for USE. METHODS A randomised controlled experimental design with a one-month follow-up was used to test the effectiveness of the intervention in one school. Students (n = 223) aged 12-13 were randomised by class to a single-session intervention on USE or a control intervention (generic mental wellbeing). Participants completed measures of appraisals of and help-seeking intentions for USE at pre- and postintervention and at one-month follow-up. They also completed measures of schemas, thinking flexibility and anxiety/depression at preintervention. RESULTS Overall, 190 adolescents completed the main outcome measures at all three points. The intervention on USE led to a significant (p < .05) increase of positive appraisals of USE compared with the control, with effects sustained at one-month follow-up. The intervention on USE did not lead to significantly greater help-seeking intentions for USE (p = .26). Adolescents' schemas were associated with appraisals and slow thinking and anxiety/depressive symptoms with help-seeking behaviour for USE. CONCLUSIONS A single-session universal school-based intervention shows promise by improving appraisals of USE. Further research is required across different school populations.
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Affiliation(s)
- Jerica Radez
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences DivisionUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Louise Johns
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences DivisionUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Felicity Waite
- Oxford Health NHS Foundation TrustOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
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22
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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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23
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Sanders JE, Seale A, Lewis V, Arundel M, Csiernik R. A Feasibility Study of the SAFE Pilot Program: A University-School Board Partnership in Ontario. RESEARCH ON SOCIAL WORK PRACTICE 2024; 34:201-216. [PMID: 38047058 PMCID: PMC10691957 DOI: 10.1177/10497315231159059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The Support and Aid to Families Electronically (SAFE) pilot program was developed through a community-university partnership to support parents of elementary students in Ontario, while providing stable practicums for social work students in the midst of COVID-19 restrictions. Purpose: The aim of the current study was to examine the feasibility of the SAFE pilot program as a mental health support to families by examining three feasibility objectives: demand, acceptably, and implementation. Method: Qualitative data from interviews, focus groups, and qualitative surveys involving service users, social work students, referring school board and university professionals (n = 37) were examined. Results: Demand for SAFE extended beyond the pandemic. A high-level of acceptance of SAFE was identified. Areas of success and considerations for implementation are outlined. Discussion: This study provides practice guidance on implementing this unique program, with potential to address gaps in service provision and the ongoing crisis in field education.
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Affiliation(s)
- Jane E. Sanders
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Ariel Seale
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Victoria Lewis
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - M.K. Arundel
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Rick Csiernik
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
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24
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Zhang Y, Larson M, Ehrhart MG, King K, Lyon AR, Locke J, Cook C. Inter-Organizational Alignment and Implementation Outcomes in Integrated Mental Healthcare for Children and Adolescents: A Cross-Sectional Observational Study. RESEARCH SQUARE 2024:rs.3.rs-3745830. [PMID: 38260462 PMCID: PMC10802742 DOI: 10.21203/rs.3.rs-3745830/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOAs in general and implementation context factors are associated with implementation outcomes in integrated SBMH. Methods SBMH clinicians from community-based organizations (CBOs; nclinician=27) and their proximal student-support school staff (nschool=99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes. Results The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors. Conclusions This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.
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Affiliation(s)
| | - Madeline Larson
- University of Minnesota Twin Cities College of Education and Human Development
| | | | | | - Aaron R Lyon
- University of Washington Seattle Campus: University of Washington
| | - Jill Locke
- University of Washington Seattle Campus: University of Washington
| | - Clayton Cook
- University of Minnesota Twin Cities College of Education and Human Development
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25
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Lyon AR, Cook CR, Larson M, Hugh ML, Dopp A, Hamlin C, Reinke P, Bose M, Law A, Goosey R, Goerdt A, Morrell N, Wackerle-Hollman A, Pullmann MD. Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming. Implement Sci 2024; 19:2. [PMID: 38167046 PMCID: PMC10763475 DOI: 10.1186/s13012-023-01330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. METHODS This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. DISCUSSION This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- Character Strong, 4227 S Meridian, Puyallup, WA, 98373, USA
| | | | - Maria L Hugh
- University of Kansas, 1122 W Campus Rd, Lawrence, KS, 66045, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 91604, USA
| | - Corinne Hamlin
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Peter Reinke
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Mahasweta Bose
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Amy Law
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Roger Goosey
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Annie Goerdt
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Nicole Morrell
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | | | - Michael D Pullmann
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
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26
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Fazel M, Soneson E. Current evidence and opportunities in child and adolescent public mental health: a research review. J Child Psychol Psychiatry 2023; 64:1699-1719. [PMID: 37771261 DOI: 10.1111/jcpp.13889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents. METHODS This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions. RESULTS In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements. CONCLUSIONS There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
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27
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Weist MD, Hoover SA, Daly BP, Short KH, Bruns EJ. Propelling the Global Advancement of School Mental Health. Clin Child Fam Psychol Rev 2023; 26:851-864. [PMID: 37247024 PMCID: PMC10225778 DOI: 10.1007/s10567-023-00434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/30/2023]
Abstract
Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth "where they are," with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research.
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28
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Khan MR, Al-Nuaimi S. Empowering resettled child and adolescent refugees through school-based mental health programs: Building a more inclusive community. Asian J Psychiatr 2023; 89:103766. [PMID: 37757539 DOI: 10.1016/j.ajp.2023.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Affiliation(s)
| | - Saleem Al-Nuaimi
- Child and Adolescent Psychiatry Department Hamad Medical Corporation, Doha, Qatar
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29
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Tran TD, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. School-based universal mental health promotion intervention for adolescents in Vietnam: Two-arm, parallel, controlled trial. Glob Ment Health (Camb) 2023; 10:e69. [PMID: 38024797 PMCID: PMC10643236 DOI: 10.1017/gmh.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/25/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
The aim of this study was to evaluate the effects of Happy House, a universal school-based programme, in reducing adolescents' depressive symptoms and improving their mental well-being, coping self-efficacy and school connectedness. This was a school-based, two-arm parallel controlled trial. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale. Data were collected at recruitment, and at 2 weeks and 6 months post-intervention. Mixed-effect models were conducted to estimate the effects of the intervention on the outcomes. A total of 1,084 students were recruited. At 2 weeks post-intervention, the effect size on depressive symptoms was 0.11 (p = 0.011) and the odds of having clinically significant depressive symptoms were lower in the intervention compared to the control (0.56, p = 0.027). Both of these were no longer significant at 6 months post-intervention. Psychological well-being mean scores in the intervention were significantly higher than in the control at 2 weeks post-intervention (effect size 0.13). Coping self-efficacy mean scores were significantly higher in the intervention group at both 2-week and 6-month post-intervention (effect sizes from 0.17 to 0.26). Data support the potential of Happy House to reduce the prevalence of adolescent mental health problems and to promote positive mental health in the school context in Vietnam.
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Affiliation(s)
- Thach Duc Tran
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Huong Nguyen
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ian Shochet
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nga Nguyen
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nga La
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Astrid Wurfl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jayne Orr
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hau Nguyen
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ruby Stocker
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Scherer N, Hussein R, Eaton J, Kabaja N, Kakuma R, Smythe T, Polack S. Development of mental health and psychosocial support (MHPSS) guidelines for deaf and hard of hearing children in the Gaza Strip. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002427. [PMID: 37844020 PMCID: PMC10578574 DOI: 10.1371/journal.pgph.0002427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/02/2023] [Indexed: 10/18/2023]
Abstract
Deaf and hard of hearing children in the Gaza Strip may be at risk of mental health conditions and psychological distress, as a result of social exclusion and limited accessible communication. This article presents the process and research methods used to develop guidelines for schools in the Gaza Strip on mental health and psychosocial support for deaf and hard of hearing children. The process was guided by the GIN-McMaster guideline development checklist across four steps: (1) priority settings; (2) searching for evidence; (3) developing recommendations; (4) evaluation. Priority setting was spearheaded by local and international researchers, and a local steering committee comprised of deaf and hard of hearing representatives, school administration and staff, mental health specialists, family members and government officials. In searching for evidence, and in order to generate evidence-based recommendations for the guidelines, we utilised a scoping review of global mental health support for deaf and hard of hearing children and qualitative research with deaf and hard of hearing children and adults, families and teachers. Two pilot studies were conducted in mainstream and specialist educational settings as way of evaluation. The scoping review and qualitative research identified various content for the guidelines, including the importance of information on disability and deafness, promoting social inclusion and self-esteem, and accessible learning environments. The pilot studies demonstrated feasibility and acceptability among teachers and deaf and hard of hearing children, although teachers need sufficient support and resources to implement. Now finalised, the guidelines are being distributed to schools in the Gaza Strip to support the mental health and wellbeing of deaf and hard of hearing children.
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Affiliation(s)
- Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ramadan Hussein
- Atfaluna Society for Deaf Children, Gaza City, Palestinian Territories
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- CBM Global Disability Inclusion, London, United Kingdom
| | - Naim Kabaja
- Atfaluna Society for Deaf Children, Gaza City, Palestinian Territories
| | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Landry H, Kingsbury M, Hamilton HA, Colman I. Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1483-1492. [PMID: 36932238 DOI: 10.1007/s00127-023-02450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. METHODS Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. RESULTS High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). CONCLUSION Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.
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Affiliation(s)
- Hannah Landry
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308C, Ottawa, ON, K1G 5Z3, Canada.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
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Redelfs AH, Smith M, Merrill JA, Grimsley S, Jenkins HE, Tederick JS, Butler AG, Dueck K, Eastham Thomas M, Perez DA, Whigham LD. The Commit to Be Fit framework: a community case study of a multi-level, holistic school-based wellness initiative in rural Virginia. Front Public Health 2023; 11:1067454. [PMID: 37663842 PMCID: PMC10468599 DOI: 10.3389/fpubh.2023.1067454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Public health interventions that target children's physical, mental, and emotional health will enhance their ability to learn and grow. Although more complex, school initiatives that address multiple ecological levels and take a holistic view may be more effective and likely to lead to lasting change. Aims This article presents the framework of Commit to Be Fit (C2BF) as an example of how schools can integrate multi-level and holistic approaches for health. This innovative school-based intervention includes activities addressing individual, home, school, and community to create a culture of wellness. We describe the implementation of C2BF and its basis in ecological models and give examples of activities across three components: cafeteria, classroom, and community. We discuss challenges and note that leadership engagement and alignment were critical elements for C2BF's success thus far. Discussion C2BF uses a school-based multi-level approach to creating a culture of wellness and holistic health for students, teachers, and community members. C2BF is unique compared to other school-based programming and includes activities that address all eight domains posited for program sustainability within public health. Built to be flexible and adaptive, C2BF was able to successfully pivot during the COVID pandemic and also follow new science. Conclusion C2BF and other multi-level holistic approaches are more likely to achieve long-term change by utilizing strategies across the multiple levels of the ecological model to improve health and wellbeing.
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Affiliation(s)
- Alisha H. Redelfs
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - Madeleine Smith
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - Jacinda A. Merrill
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - Shannon Grimsley
- District Central Office, Rappahannock County Public Schools, Washington, VA, United States
| | - Hollyann E. Jenkins
- District Central Office, Rappahannock County Public Schools, Washington, VA, United States
| | - Jacqueline S. Tederick
- District Central Office, Rappahannock County Public Schools, Washington, VA, United States
| | - Amanda G. Butler
- District Central Office, Rappahannock County Public Schools, Washington, VA, United States
| | | | | | | | - Leah D. Whigham
- Center for Community Health Impact, The University of Texas Health Science Center at Houston (UTHealth), El Paso, TX, United States
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) - School of Public Health, El Paso, TX, United States
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Wendel F, Bender S, Breitinger E, Coenen M, Hummel J, Immich G, Kirschneck M, Klünder V, Kunzler AM, Lieb K, Movsisyan A, Li LY, Ravens-Sieberer U, Rehfuess E, Voss S, Jung-Sievers C. Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02280-y. [PMID: 37573565 DOI: 10.1007/s00787-023-02280-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
The psychosocial health of children and adolescents has been particularly affected by the COVID-19 pandemic. Containment measures have restricted social development, education and recreational activities, may have increased family conflicts and, in many cases, led to feelings of loneliness, sleep disturbances, symptoms of anxiety and depression. We conducted a systematic review to identify interventions that seek to ameliorate these detrimental effects of the COVID-19 pandemic and to build resilience in children and adolescents. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO COVID-19 Global literature on coronavirus disease and Cochrane COVID-19 Study Register (up to 30 June 2022). The searches retrieved 9557 records of which we included 13 randomized-controlled trials (RCTs) for evidence synthesis. Included studies predominantly implemented online group sessions for school-aged children with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of seven studies on anxiety and five on depressive symptoms provided evidence for a positive effect of interventions by reducing anxiety (Standardized Mean Difference (SMD) (95% CI): - 0.33 (- 0.59; - 0.06)) and depressive symptoms (SMD (95% CI): - 0.26 (- 0.36; - 0.16)) compared to the control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental and psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that (i) are of higher frequency and duration, (ii) enable personal interaction (face-to-face or virtually), and (iii) include a physical activity component. Almost all studies were judged to be at high risk of bias and showed considerable heterogeneity. Further research may focus on the contribution of different intervention components or distinct subgroups and settings, and should examine children and adolescents over longer follow-up periods.
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Affiliation(s)
- Flora Wendel
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Eva Breitinger
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia Hummel
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Gisela Immich
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Kirschneck
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Vera Klünder
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Institute for Evidence in Medicine, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lydia Y Li
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Research Unit Child Public Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Research Unit Child Public Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology IBE, Faculty of Medicine, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Lee YY, Skeen S, Melendez-Torres GJ, Laurenzi CA, van Ommeren M, Fleischmann A, Servili C, Mihalopoulos C, Chisholm D. School-based socio-emotional learning programs to prevent depression, anxiety and suicide among adolescents: a global cost-effectiveness analysis. Epidemiol Psychiatr Sci 2023; 32:e46. [PMID: 37434513 PMCID: PMC10477081 DOI: 10.1017/s204579602300029x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 07/13/2023] Open
Abstract
AIMS Preventing the occurrence of depression/anxiety and suicide during adolescence can lead to substantive health gains over the course of an individual person's life. This study set out to identify the expected population-level costs and health impacts of implementing universal and indicated school-based socio-emotional learning (SEL) programs in different country contexts. METHODS A Markov model was developed to examine the effectiveness of delivering universal and indicated school-based SEL programs to prevent the onset of depression/anxiety and suicide deaths among adolescents. Intervention health impacts were measured in healthy life years gained (HLYGs) over a 100-year time horizon. Country-specific intervention costs were calculated and denominated in 2017 international dollars (2017 I$) under a health systems perspective. Cost-effectiveness findings were subsequently expressed in terms of I$ per HLYG. Analyses were conducted on a group of 20 countries from different regions and income levels, with final results aggregated and presented by country income group - that is, low and lower middle income countries (LLMICs) and upper middle and high-income countries (UMHICs). Uncertainty and sensitivity analyses were conducted to test model assumptions. RESULTS Implementation costs ranged from an annual per capita investment of I$0.10 in LLMICs to I$0.16 in UMHICs for the universal SEL program and I$0.06 in LLMICs to I$0.09 in UMHICs for the indicated SEL program. The universal SEL program generated 100 HLYGs per 1 million population compared to 5 for the indicated SEL program in LLMICs. The cost per HLYG was I$958 in LLMICS and I$2,006 in UMHICs for the universal SEL program and I$11,123 in LLMICs and I$18,473 in UMHICs for the indicated SEL program. Cost-effectiveness findings were highly sensitive to variations around input parameter values involving the intervention effect sizes and the disability weight used to estimate HLYGs. CONCLUSIONS The results of this analysis suggest that universal and indicated SEL programs require a low level of investment (in the range of I$0.05 to I$0.20 per head of population) but that universal SEL programs produce significantly greater health benefits at a population level and therefore better value for money (e.g., less than I$1,000 per HLYG in LLMICs). Despite producing fewer population-level health benefits, the implementation of indicated SEL programs may be justified as a means of reducing population inequalities that affect high-risk populations who would benefit from a more tailored intervention approach.
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Affiliation(s)
- Y. Y. Lee
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mental Health Evaluation Research Stream, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - S. Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | | | - C. A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - M. van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - A. Fleischmann
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - C. Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - C. Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D. Chisholm
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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35
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Miller E, Crane C, Medlicott E, Robson J, Taylor L. Non-Positive Experiences Encountered by Pupils During Participation in a Mindfulness-Informed School-Based Intervention. SCHOOL MENTAL HEALTH 2023; 15:851-872. [PMID: 37720164 PMCID: PMC10504121 DOI: 10.1007/s12310-023-09591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 09/19/2023]
Abstract
Mindfulness-informed school-based mental health curricula show much promise in cultivating a positive school climate which supports the well-being and mental health of pupils and staff. However, non-positive pupil outcomes and experiences of school-based mental health interventions are often under-recognised and under-reported. This study sought to capture non-positive pupil experiences of a popular mindfulness-informed curriculum. Some pupils across all schools in the study described non-positive experiences, including having troubling thoughts and emotions, and not finding the programme effective. Contexts surrounding these experiences are explored and linked to existing literature, and subsequent recommendations for improvements are made, including the importance of having clear programme structure, definitions and aims, acknowledging and accommodating fidelity issues as best as possible, and better highlighting the potential for non-positive experiences and how they may be reduced.
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Affiliation(s)
- E.J. Miller
- University of Auckland, Auckland, New Zealand
- University of Oxford, Oxford, UK
| | - C. Crane
- University of Oxford, Oxford, UK
- OxfordHealth NHS Foundation Trust, Oxford, UK
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Kågström A, Juríková L, Guerrero Z. Developmentally appropriate mental health literacy content for school-aged children and adolescents. Glob Ment Health (Camb) 2023; 10:e25. [PMID: 37854395 PMCID: PMC10579665 DOI: 10.1017/gmh.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/22/2023] [Accepted: 04/26/2023] [Indexed: 10/20/2023] Open
Abstract
Although improving the mental health of children and adolescents has become a global priority, resources outlining developmentally appropriate content for improving mental health literacy (MHL) across school-aged children are scarce. A comprehensive, life-course approach to building MHL is needed to address the evolving competencies, needs, capacities, and risk factors for mental health, especially to establish school-based interventions that can be equitably and sustainably implemented. We conducted a theoretical review highlighting the relation of research and practice in building MHL through developmentally appropriate knowledge and competencies for children and adolescents. A two-pronged review of the literature was conducted to provide an overview of (1) research with a focus on neurobiological, psychological, cognitive, and social developmental milestones of school-aged children relevant for building MHL and (2) evidence-based and theory-driven content for the development of universal MHL interventions for children and adolescents considering the four components of MHL. A map of relevant key milestones highlights the range of development that occurs and ample opportunity for increasing universal MHL during these sensitive years primed for learning. We reflect on current understandings and global considerations for MHL interventions with an emphasis on applying developmental science to the future strengthening of intervention development, uptake, adaptation, implementation, evaluation, and scale-up.
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Affiliation(s)
- Anna Kågström
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Klecany, Czech Republic
| | - Laura Juríková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Klecany, Czech Republic
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Zhang Y, Cook CR, Azad GF, Larson M, Merle JL, Thayer J, Pauls A, Lyon AR. A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:552-566. [PMID: 36367633 PMCID: PMC10258873 DOI: 10.1007/s11121-022-01464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., "intentions to implement" (ITI)) to target increasing providers' responsiveness to training and consultation. This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; ntreatment = 22) or active control condition (administrative meeting; ncontrol = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) at baseline, immediately after training, and 6 weeks afterward. A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers' ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Findings suggest that theory-informed pragmatic PIES targeting providers' ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered. https://clinicaltrials.gov/show/NCT05240222.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Gazi F Azad
- Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Madeline Larson
- Center for Applied Research and Educational Improvement, University of Minnesota, 1954 Buford Ave, Suite 425, St. Paul, MN, 55108, USA
| | - James L Merle
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jordan Thayer
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Alex Pauls
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Box 354920, 6200 NE 74Th Street, Suite 110, Seattle, WA, 98115, USA
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Bruns EJ, Lee K, Davis C, Pullmann MD, Ludwig K, Sander M, Holm-Hansen C, Hoover S, McCauley EM. Effectiveness of a Brief Engagement, Problem-Solving, and Triage Strategy for High School Students: Results of a Randomized Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:701-714. [PMID: 36930402 DOI: 10.1007/s11121-022-01463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 03/18/2023]
Abstract
Schools offer an advantageous setting for the prevention, early identification, and treatment of mental health problems for youth. However, school mental health (SMH) services are typically not based on evidence for effectiveness, nor are they efficiently delivered, with SMH practitioners (SMHPs) able to only treat a small number of students in need. The current study evaluated the feasibility, acceptability, efficiency, and outcomes of a four-session assessment, engagement, problem-solving, and triage strategy for SMHPs that aimed to improve efficiency while being based on elements of evidence-based care. The study, conducted in 15 US school districts in three states, used stratified random assignment to assign 49 high schools and their participating SMHP(s) to either the Brief Intervention for School Clinicians (BRISC; N = 259 students) or services as usual (SAU; N = 198 students). SMHPs implemented BRISC elements with adequate to excellent fidelity and reported the strategy was feasible and well-aligned with presenting problems. Students assigned to BRISC reported significantly greater engagement in SMH at 2 months and completion of SMH treatment by 6 months. BRISC-assigned SMHPs reported significantly greater treatment completion after four sessions (53.4%) compared to SAU (15.4%). Students in the BRISC condition also reported significantly greater reduction in problem severity as evaluated by the Youth Top Problems Assessment. No differences were found for anxiety or depression symptoms or overall functioning. Results indicate that BRISC is a feasible early intervention and triage strategy that may aid in more efficient provision of SMH services with no compromise to SMH effectiveness.
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Affiliation(s)
- Eric J Bruns
- University of Washington School of Medicine, Seattle, USA.
| | - Kristine Lee
- University of Washington School of Medicine, Seattle, USA
| | - Chayna Davis
- University of Washington School of Medicine, Seattle, USA
| | | | - Kristy Ludwig
- University of Washington School of Medicine, Seattle, USA
| | - Mark Sander
- Midwest Center for School Mental Health, St. Paul, USA
| | | | - Sharon Hoover
- University of Maryland School of Medicine, Baltimore, USA
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Miller AL, Gerardi N, Mazza JJ, Dexter‐Mazza E, Graling K, Rathus JH. Delivering comprehensive school‐based dialectical behavior therapy (CSB‐DBT). PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Alec L. Miller
- Cognitive & Behavioral Consultants White Plains New York USA
| | - Nora Gerardi
- Cognitive & Behavioral Consultants White Plains New York USA
| | | | | | - Kelly Graling
- Cognitive & Behavioral Consultants White Plains New York USA
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Thabrew H, Biro R, Kumar H. O is for Awesome: National Survey of New Zealand School-Based Well-being and Mental Health Interventions. SCHOOL MENTAL HEALTH 2023. [DOI: 10.1007/s12310-023-09577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
AbstractAlthough student well-being and mental health are government-identified responsibilities for New Zealand schools, the extent to which school-based well-being and mental health interventions are currently delivered is unknown. This survey of a nationally representative sample of schools was undertaken to identify: what well-being and mental health interventions are currently used by primary (elementary) and secondary (high) schools; what gaps exist between current practice and the evidence base; what ideas staff have for improving student well-being and mental health; and what barriers staff can identify for implementing evidence-based interventions and suggestions for how these may be overcome. Forty staff from 37 (22 primary, 13 secondary and 2 composite) schools participated in semi-structured interviews. Seven key themes were identified: (1) awareness and enthusiasm about student well-being and mental health; (2) existence of specific interventions to support student well-being and mental health; (3) support for government-sponsored programmes; (4) limitations of existing programmes; (5) drivers of new interventions; (6) perceived barriers to the implementation of new interventions; and (7) suggestions for future interventions and their implementation. Currently, a wide range of primarily non-evidence based well-being and mental health interventions are delivered in a variable manner by school-based and external providers. Despite current enthusiasm by schools, there is room for improvement in the quality and equity of intervention delivery.
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41
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Ni Y, Jia F. Promoting Positive Social Interactions: Recommendation for a Post-Pandemic School-Based Intervention for Social Anxiety. CHILDREN (BASEL, SWITZERLAND) 2023; 10:491. [PMID: 36980049 PMCID: PMC10047710 DOI: 10.3390/children10030491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
The purpose of this perspective article is to identify problematic behaviors during the COVID-19 pandemic and recommend a school-based intervention (e.g., self-reflection, motivational interview, and workbook) to address post-COVID social anxiety among children and adolescents. The recommendations involve comparing students' social interaction behaviors pre-pandemic, during the pandemic, and post-pandemic, and evaluating any behavioral changes in social relationships six months later. We also discuss the evaluation criteria and surveys used to assess the impact of the intervention on behavioral changes. Our evaluation criteria are based on students' beliefs and abilities and aim to demonstrate that the intervention improves in-person social interactions and helps students adapt to the transition back to school. The proposed perspectives and strategies of the intervention can be modified to meet the needs of the researchers and professionals. By working together, global policymakers from the fields of education and public health can create school-based interventions that enhance students' physical, mental, and spiritual well-being. This program aims to mitigate the negative effects of school closures and social isolation and to broaden the role of schools in supporting students in the challenging post-pandemic world by addressing their holistic needs.
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Affiliation(s)
- Yang Ni
- School of International and Public Affairs, Columbia University, New York, NY 10027, USA
| | - Fanli Jia
- Department of Psychology, Seton Hall University, South Orange, NJ 07079, USA
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Fazel M, Soneson E, Sellars E, Butler G, Stein A. Partnerships at the Interface of Education and Mental Health Services: The Utilisation and Acceptability of the Provision of Specialist Liaison and Teacher Skills Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4066. [PMID: 36901077 PMCID: PMC10001585 DOI: 10.3390/ijerph20054066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Partnerships between school staff and mental health professionals have the potential to improve access to mental health support for students, but uncertainty remains regarding whether and how they work in practice. We report on two pilot projects aimed at understanding the implementation drivers of tailored strategies for supporting and engaging front-line school staff in student mental health. The first project provided regular, accessible mental health professionals with whom school staff could meet and discuss individual or systemic mental health concerns (a school 'InReach' service), and the other offered a short skills training programme on commonly used psychotherapeutic techniques (the School Mental Health Toolbox; SMHT). The findings from the activity of 15 InReach workers over 3 years and 105 individuals who attended the SMHT training demonstrate that school staff made good use of these services. The InReach workers reported more than 1200 activities in schools (notably in providing specialist advice and support, especially for anxiety and emotional difficulties), whilst most SMHT training attendees reported the utilisation of the tools (in particular, supporting better sleep and relaxation techniques). The measures of acceptability and the possible impacts of the two services were also positive. These pilot studies suggest that investment into partnerships at the interface of education and mental health services can improve the availability of mental health support to students.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Elise Sellars
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK
| | - Gillian Butler
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford OX3 7JX, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
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Robinson-Link P, Fowler D, Daniels B, Battal J. Social, Emotional and Behavioral Screening Profiles Among Students in a Large Urban School District. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2023. [DOI: 10.1177/07342829231157474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Social, emotional, and behavioral (SEB) screening frequently employs a variable-based approach wherein individual scale scores indicate risk. However, a person-centered approach wherein risk is indicated by profiles, or constellations of scores across all scales, could help schools prioritize students based on the pervasiveness of SEB needs and match students to appropriate interventions. This study used latent profile analysis (LPA) to identify profiles within two diverse student samples ( n = 16,270 in year one; n = 4019 in year two) based on teacher ratings on the Behavior Intervention Monitoring Assessment System, Second Edition (BIMAS-2). Results suggested four profiles including one profile with elevated risk across all scales, one profile with low behavioral risk and above average social functioning, one profile with borderline risk across all scales, and one profile with typical scores across most scales. Implications for linking universal screening to intervention are discussed. Impact and Implications: Many school districts employ universal screening to prevent and address wide-ranging student needs. Grouping students based on shared sets of needs has the potential to efficiently identify and prioritize students with pervasive risk in order to match them to comprehensive services. Results from this study capture the first attempt to identify student need profiles using BIMAS-2 scores. Future research should refine this process to derive more usable and consistent student profiles allowing direct links to comprehensive student services.
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Baffsky R, Ivers R, Cullen P, Wang J, McGillivray L, Torok M. Strategies for Enhancing the Implementation of Universal Mental Health Prevention Programs in Schools: A Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:337-352. [PMID: 36098892 PMCID: PMC9938015 DOI: 10.1007/s11121-022-01434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
A number of school-based mental health prevention programs have been found to be effective in research trials, but little is known about how to support implementation in real-life settings. To address this translational problem, this systematic review aims to identify effective strategies for enhancing the implementation of mental health prevention programs for children in schools. Four electronic databases were searched for empirical, peer-reviewed articles in English from January 2000 to October 2021 reporting the effects of implementation strategies for school-based universal mental health programs. Twenty-one articles were included in the narrative synthesis and assessed for quality using the Mixed Methods Appraisal Tool. Twenty-two strategies were found to be effective at improving program fidelity or adoption. The strategies with the strongest positive evidence base were those that involved monitoring and provision of feedback, engaging principals as program leaders, improving teachers' buy-in and organising school personnel implementation meetings. We recommend school-based practitioners trial strategies with positive findings from this review as part of their continuous quality improvement. This review highlights the pressing need for large-scale, randomised controlled trials to develop and trial more robust strategies to enhance adoption, as the five implementation studies found to measure adoption used qualitative methods limited by small samples sizes and case study designs.
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Affiliation(s)
- Rachel Baffsky
- School of Population Health, UNSW Sydney, Samuels Building F25 Samuel Terry Ave, Kensington, NSW, Australia.
| | - Rebecca Ivers
- School of Population Health, UNSW Sydney, Samuels Building F25 Samuel Terry Ave, Kensington, NSW, Australia
| | - Patricia Cullen
- School of Population Health, UNSW Sydney, Samuels Building F25 Samuel Terry Ave, Kensington, NSW, Australia
| | - Jessica Wang
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
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Booth A, Doyle E, O'Reilly A. School-based health promotion to improve mental health literacy: a comparative study of peer- versus adult-led delivery. J Ment Health 2023; 32:226-233. [PMID: 34994294 DOI: 10.1080/09638237.2021.2022621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND School-based youth mental health promotion is increasingly recognised as a useful tool to improve mental health knowledge and help-seeking among adolescents. Peer-led initiatives are emerging as a potentially viable mode of delivering this material. Yet, there is limited evidence on the effectiveness of these initiatives compared to more traditional, adult-led, forms of mental health promotion. AIMS This study aimed to compare improvements in students' mental health knowledge and help-seeking after attending either a peer- or adult-led youth mental health promotion workshop. It also sought to examine differential effects by gender. METHOD A within- and between-group comparative design was used to examine secondary school students' (N = 536) mental health knowledge and help-seeking intentions before and after attending a school-based mental health promotion workshop. RESULTS Students' mental health knowledge and help-seeking intentions significantly improved in both peer- and adult-led groups. Outcomes did not differ across modes of delivery, although the impact of adult-led workshops on mental health knowledge was moderated by gender. CONCLUSIONS Peer-led youth mental health promotion appears to be as effective as traditional adult-led delivery, and seems to be particularly beneficial for male students who respond more favourably to content communicated through their peers.
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Affiliation(s)
- Ailbhe Booth
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Elizabeth Doyle
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Aileen O'Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland.,UCD School of Psychology, University College Dublin, Dublin, Ireland
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Khombo S, Khombo K, Stoddart RS, Sifelani I, Sibanda T. Knowledge, attitudes, and uptake of mental health services by secondary school students in Gweru, Zimbabwe. Front Psychol 2023; 14:1002948. [PMID: 36818083 PMCID: PMC9930152 DOI: 10.3389/fpsyg.2023.1002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction The study sought to investigate and examine knowledge, attitudes, and uptake of mental health services by secondary school students in the Gweru district. Methods Using a qualitative approach, 15 students from three secondary schools in Gweru were purposively sampled for inclusion in this study. Data collection was through semi-structured interviews. The study utilized thematic data analysis and the following themes emerged from the study; ignorance, misinformation, indifference, lack of trust, gender differences, and alternative support. Results Generally, the research findings revealed that most secondary school students were aware of the existence of mental health services although they had distorted information on the same. Poor utilization of services was largely attributed to the consideration of "formal" mental health services as the last resort for remedy after the failure of "informal" services to yield positive results. Thus, mental health services were not on the priority list of intervention measures used by secondary students in light of mental health issues. The study recommends psycho-education sessions to promote the utilization of mental health services by secondary school students. Discussion Notably, the current study revealed that participants lacked correct information about MHS and its related utility. Munson et al. (2009) concur by stating that some adolescents believed that their mental health challenges such as mood disorders were chronic, and as such, they thought that any form of intervention could not control or remedy their illness.
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Affiliation(s)
- Sibusiso Khombo
- Department of Applied Psychology, Midlands State University, Gweru, Zimbabwe,Department of Psychology, University of Limpopo, Limpopo, South Africa,*Correspondence: Sibusiso Khombo, ✉
| | - Kennedy Khombo
- Centre for Film and Media Studies, University of Cape Town, Cape Town, South Africa
| | | | - Innocent Sifelani
- Department of Psychology, Manicaland State University of Applied Sciences, Mutare, Zimbabwe
| | - Theresi Sibanda
- Department of Psychology, Manicaland State University of Applied Sciences, Mutare, Zimbabwe
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Grande AJ, Hoffmann MS, Evans-Lacko S, Ziebold C, de Miranda CT, Mcdaid D, Tomasi C, Ribeiro WS. Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: A systematic review and meta-analysis. Front Psychiatry 2023; 13:1012257. [PMID: 36684024 PMCID: PMC9852982 DOI: 10.3389/fpsyt.2022.1012257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Implementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are. Methods We conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6-18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results We found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37-0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = -0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = -0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = -0.47 to 2.07). For CD the sample size was very small, so the results are imprecise. Conclusion A significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376].
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Affiliation(s)
- Antonio Jose Grande
- Department of Medicine, Universidade Estadual de Mato Grosso do Sul, Campo Grande, Brazil
| | - Mauricio Scopel Hoffmann
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Carolina Ziebold
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - David Mcdaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Cristiane Tomasi
- Department of Public Health, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Merle JL, Cook CR, Locke JJ, Ehrhart MG, Brown EC, Davis CJ, Lyon AR. Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895221151026. [PMID: 37091537 PMCID: PMC9924278 DOI: 10.1177/26334895221151026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. Method School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample ( n = 441) of general education teachers (grades K—5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. Results After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Conclusions Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices. Plain Language Summary The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers’ attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP -agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt.
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Affiliation(s)
- James L. Merle
- Department of Population Health Science, University of Utah, Salt Lake City, UT, USA
| | - Clayton R. Cook
- Department of Organizational Leadership, Policy, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Jill J. Locke
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Mark G. Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Eric C. Brown
- Department of Public Health Science, University of Miami, Coral Gables, FL, USA
| | - Chayna J. Davis
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
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Jaspers-van der Maten ML, Rommes EWM, Scholte RHJ. Early Identification of Social, Emotional, and Behavioral Difficulties by School Staff: A Qualitative Examination of Dutch Primary School Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:654. [PMID: 36612975 PMCID: PMC9819244 DOI: 10.3390/ijerph20010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
About 16% of Dutch children are reported to have social, emotional, and behavioral difficulties (SEBDs). SEBDs generate distress and pose risks for various negative outcomes; thus, their timely identification is deemed important to respond appropriately to children's needs and avoid such negative outcomes. Primary schools are considered convenient places to implement early SEBD identification, but the ways in which schools achieve this in practice may be inadequate, although the issue remains under-researched. Although there are several systematic school-based early identification methods (e.g., universal or selective screening), primary schools predominantly rely on school staff to recognize children at risk for, or experiencing, SEBDs. As differences in identification practices could impact whether and when (signs of) SEBDs are identified, this study aimed to increase our understanding of differences in identification practices used by school staff and their potential implications for early identification effectiveness. Thirty-four educational and clinical professionals working at nine primary schools participated in in-depth semi-structured interviews. We used MAXQDA to thematically code and analyze the data. Our analysis of these interviews illustrated that schools' identification practices differed on three elements: the frequency of observations, maintaining a four-eyes principle, and the utilization of specialist knowledge. We argue that differences in these elements have potential consequences for the timeliness and quality of SEBD identification.
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Affiliation(s)
- Marloes L. Jaspers-van der Maten
- Department of Gender & Diversity Studies, Radboud Social Cultural Research, Radboud University Nijmegen, P.O. Box 1908, 6500 VC Nijmegen, The Netherlands
| | - Els W. M. Rommes
- Department of Gender & Diversity Studies, Radboud Social Cultural Research, Radboud University Nijmegen, P.O. Box 1908, 6500 VC Nijmegen, The Netherlands
| | - Ron H. J. Scholte
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 VC Nijmegen, The Netherlands
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Ter-Minassian L, Viani N, Wickersham A, Cross L, Stewart R, Velupillai S, Downs J. Assessing machine learning for fair prediction of ADHD in school pupils using a retrospective cohort study of linked education and healthcare data. BMJ Open 2022; 12:e058058. [PMID: 36576182 PMCID: PMC9723859 DOI: 10.1136/bmjopen-2021-058058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/08/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) is a prevalent childhood disorder, but often goes unrecognised and untreated. To improve access to services, accurate predictions of populations at high risk of ADHD are needed for effective resource allocation. Using a unique linked health and education data resource, we examined how machine learning (ML) approaches can predict risk of ADHD. DESIGN Retrospective population cohort study. SETTING South London (2007-2013). PARTICIPANTS n=56 258 pupils with linked education and health data. PRIMARY OUTCOME MEASURES Using area under the curve (AUC), we compared the predictive accuracy of four ML models and one neural network for ADHD diagnosis. Ethnic group and language biases were weighted using a fair pre-processing algorithm. RESULTS Random forest and logistic regression prediction models provided the highest predictive accuracy for ADHD in population samples (AUC 0.86 and 0.86, respectively) and clinical samples (AUC 0.72 and 0.70). Precision-recall curve analyses were less favourable. Sociodemographic biases were effectively reduced by a fair pre-processing algorithm without loss of accuracy. CONCLUSIONS ML approaches using linked routinely collected education and health data offer accurate, low-cost and scalable prediction models of ADHD. These approaches could help identify areas of need and inform resource allocation. Introducing 'fairness weighting' attenuates some sociodemographic biases which would otherwise underestimate ADHD risk within minority groups.
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Affiliation(s)
| | - Natalia Viani
- Department of Psychological Medicine, King's College London, London, UK
| | - Alice Wickersham
- Department of Psychological Medicine, King's College London, London, UK
| | - Lauren Cross
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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