Age of onset of mental disorders: a review of recent literature

Impact, feasibility, and acceptability of CREATORS: An arts-based pilot intervention to reduce mental-health-related stigma among youth in Hyderabad, India

Background

Mental-health-related stigma prevents youth from seeking help for mental health problems. Limited studies in low- and middle-income countries assess the effect of arts-based education in reducing such stigma among youth, thereby leaving a gap in evidence-based, age- and culturally-appropriate interventions.

Objective

To evaluate the impact, feasibility, and acceptability of CREATORS, an arts-based educational program on reducing mental-health-related stigma among youth in India.

Methods

We conducted a mixed-methods, pre-post control group study among college-going adolescents in Hyderabad, India. At baseline and post-intervention (after six weeks), we examined differences in intended behavior towards people with mental health problems.

Results

Our study involved 432 participants across three study groups: participants creating art on the theme of mental-health-related stigma over six weeks (n = 123), a student audience viewing 2-h arts show by participants (n = 244), and a control group (n = 65). Between baseline and post-test, participants creating art showed significantly lower stigma towards people with mental health problems compared to members of the control group (coefficient = 1.55, 95%CI 0.06-3.04, p = 0.041). Participants found the intervention useful and enjoyable (>95%; n = 773 across six weeks). Participants identified that collaborative creation of art made the subject of mental health interesting and relatable.

Conclusions

Participating in an arts-based educational program was associated with significantly lower mental-health-related stigma among youth compared to a control group in the short term. High acceptability of the program demonstrates the utility of arts-based education to address mental-health-related stigma. With community partners and artists as facilitators, our program may support mental health specialists in mental health promotion.

Young peoples' reflections about using a chatbot to promote their mental wellbeing in northern periphery areas - a qualitative study

An international research collaboration with researchers from northern Sweden, Finland, Ireland, Northern Ireland, Scotland and developed the ChatPal chatbot to explore the possibility of a multilingual chatbot to promote mental wellbeing in people of all ages. In Sweden the end users were young people. The aim of the current study was to explore and discuss Swedish young peoples' experiences of using a chatbot designed to promote their mental wellbeing. Young people aged 15-19 filled out an open-ended survey giving feedback on the ChatPal chatbot and their suggestions on improvements. A total of 122 survey responses were analysed. The qualitative content analysis of the survey responses resulted in three themes each containing two to three sub-themes. Theme 1, feeling as if someone is there when needed, which highlighted positive aspects regarding availability and accessibility. Theme 2, human-robot interaction has its limitations, which included aspects such as unnatural and impersonal conversations and limited content availability. Theme 3, usability can be improved, given technical errors due to lack of internet connection and difficulty navigating the chatbot were brought up as issues. The findings are discussed, and potential implications are offered for those designing and developing digital mental health technologies for young people.

Promoting mental health in higher education: towards a model of well-being factors in emerging adulthood

PURPOSE

This study aims to contribute to the development of a theoretical model that is useful for enhancing well-being/positive mental health with pedagogical resources that enable the acquisition of skills and knowledge, particularly during Emerging Adulthood.

METHODS

This paper enquires into the role of well-being promotion in higher education following the dual-factor model of mental health difficulties and wellbeing. The study narratively reviews the main well-being models and presents a compared theoretical synthesis examining the dimensions that promote or facilitate the presence of well-being using a promotion approach.

RESULTS

The study identifies 14 dimensions involved in wellbeing-emotional, psychological and social factors-that can be potentially improved through learning processes. Drawing on empirical and theoretical studies on emerging adult population, a factorial model is proposed. Preliminary factor interactions are examined paying close attention to the cognitive processes that explain or affect their relationship with well-being, the possible correlations between them and particularities of emerging adults.

CONCLUSION

Wellbeing factors can be particularly targeted by educational promotion, as they can be developed through learning processes. An integrative model that provides a broad perspective can assist in pedagogical design and defining educational goals for these learning processes involved in wellbeing promotion.

Epidemiology of Mental Health Challenges in Children and Adolescents

In this narrative review, we will discuss current understandings and evidence on child and adolescent mental health including epidemiologic research methods, prevalence rates of mental health difficulties before the coronavirus disease 2019 pandemic, changes in mental health challenges after the pandemic onset, and clinical implications.

Preschool Behavioral Problems: Links with Maternal Oxytocin and Caregiving Sensitivity in the Postnatal Period, and Concurrent Maternal Psychopathology and Attachment State-of-Mind

This study investigated maternal oxytocin, caregiving sensitivity and mother-to-infant bonding at 3-months postpartum as predictors of child behavior and psychological outcomes in the preschool years, when controlling for concurrent maternal negative emotional symptoms and adult attachment state-of-mind. Forty-five mother-child dyads were assessed at 3-months and 3.5 years postpartum using mix of questionnaires, observational, interview and biological methods. Results showed that lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted emotional reactivity in the child at 3.5 years. When maternal adult attachment state-of-mind and negative emotional symptoms were included, lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted withdrawn child behavior. In addition, unresolved adult attachment and maternal negative emotional symptoms were significantly associated child behavioral disturbance in a range of areas. Findings highlight maternal postnatal oxytocin as a potential indicator of children who may be more likely to show emotional reactivity and withdrawn behavior in the preschool years.

Dynamic Functional Connectivity Correlates of Trait Mindfulness in Early Adolescence

Background

Trait mindfulness-the tendency to attend to present-moment experiences without judgment-is negatively correlated with adolescent anxiety and depression. Understanding the neural mechanisms that underlie trait mindfulness may inform the neural basis of psychiatric disorders. However, few studies have identified brain connectivity states that are correlated with trait mindfulness in adolescence, and they have not assessed the reliability of such states.

Methods

To address this gap in knowledge, we rigorously assessed the reliability of brain states across 2 functional magnetic resonance imaging scans from 106 adolescents ages 12 to 15 (50% female). We performed both static and dynamic functional connectivity analyses and evaluated the test-retest reliability of how much time adolescents spent in each state. For the reliable states, we assessed associations with self-reported trait mindfulness.

Results

Higher trait mindfulness correlated with lower anxiety and depression symptoms. Static functional connectivity (intraclass correlation coefficients 0.31-0.53) was unrelated to trait mindfulness. Among the dynamic brains states that we identified, most were unreliable within individuals across scans. However, one state, a hyperconnected state of elevated positive connectivity between networks, showed good reliability (intraclass correlation coefficient = 0.65). We found that the amount of time that adolescents spent in this hyperconnected state positively correlated with trait mindfulness.

Conclusions

By applying dynamic functional connectivity analysis on over 100 resting-state functional magnetic resonance imaging scans, we identified a highly reliable brain state that correlated with trait mindfulness. This brain state may reflect a state of mindfulness, or awareness and arousal more generally, which may be more pronounced in people who are higher in trait mindfulness.

Coming of age in war: Early life adversity, age at menarche, and mental health

Armed conflict and forced migration (ACFM) represent a set of extreme environments that are increasingly common for children and adolescents to experience. Adolescence may constitute a sensitive period (puberty and psychoneurological maturation) through which ACFM adversity leaves a lasting mark. Adolescence has become a focal point for analysis and intervention as it relates to the effects of early life adversity on puberty, linear growth, and mental health. Research in public health and psychological science suggests early life adversity (ELA) may accelerate puberty, heightening risks for mental health disorders. However, it is not well substantiated whether ACFM-derived adversities accelerate or delay relative pubertal timing. Secondly, ACFM provides salient context through which to probe the relationships between nutritional, psychosocial, and demographic changes and their respective impact on puberty and mental health. We conducted a narrative review which 1) examined constructions of early life adversity and their proposed influence on puberty 2) reviewed empirical findings (n = 29 studies, n = 36 samples) concerning effects of ACFM ELA on age at menarche and 3) discussed proposed relationships between early life adversity, puberty, and mental ill-health. Contrary to prior research, we found war-derived early life adversity was more consistently associated with pubertal delay than acceleration and may exert counterintuitive effects on mental health. We show that ELA cannot be operationalized in the same way across contexts and populations, especially in the presence of extreme forms of human stress and resilience. We further discuss the ethics of puberty research among conflict-affected youth.

Clinical profiles of people enrolling in alcohol and other drug treatment in Australia: Do youth differ from young adults and adults?

INTRODUCTION

To examine and compare age groups on socio-demographic, substance use, mental health, social and risk behaviour profiles of people entering alcohol and other drug (AOD) treatment in a large non-government organisation (NGO) in Queensland and New South Wales, Australia.

METHODS

Design-Cross-sectional study; analysis of baseline routine outcome measures (ROM) and AOD minimum datasets for drug and alcohol treatment services. Setting and participants-People enrolling in Lives Lived Well, a large NGO AOD service between November 2020 and October 2022. Main outcome measures-Socio-demographic, substance use, mental health, social factors and risk behaviours, by youth (≤24 years), young adults (25-35 years) and adults (>35 years).

RESULTS

Between November 2020 and October 2022, 9413 clients enrolled in Lives Lived Well (LLW) AOD services and completed baseline ROMs. Over one-fifth (21.9%) were youth (n = 2066), one-third (32.4%) were young adults (n = 3052) and just under half (45.6%) were adults >35 years (n = 4295). The most common primary drug of concern was cannabis for youth, methamphetamine for young adults and alcohol for adults >35 years. Nearly two-thirds (61.3%) reported moderate to severe symptoms of depression and 55.0% reported moderate to severe anxiety. Just under half (47.2%) screened positive for PTSD and two-in-five (40.4%) reported recent suicidal ideation. Co-occurring mental health symptoms were more common in youth compared with young adults and adults >35 years.

DISCUSSION AND CONCLUSIONS

Co-occurring mental health symptoms were high in the sample, particularly among youth. All age groups present with unique and complex socio-demographic and clinical profiles that are important to understand to provide the most appropriate and effective treatment.

Mental Health Experiences Among Undergraduate Nursing Students in a New Zealand Tertiary Institution: A Time for Change

Nursing students in undergraduate programmes exhibit comparable, sometimes higher, levels of poor mental health and substance use compared to the general population; however, this area remains under-researched in New Zealand. The study involved 172 nursing students enrolled in the Bachelor of Nursing programme at one tertiary institution in Auckland, New Zealand. Employing a mixed-methodology approach, a 29-question survey comprising both open and closed questions was administered to explore the students' experiences with mental health and substance use, as well as their access to support services. Quantitative data were analysed using SPSS version 29 descriptive statistics, while a general inductive approach guided the qualitative analysis. A significant proportion of participants (75%) reported experiencing emotional distress during their studies, with anxiety being the most prevalent (78.5%). A smaller percentage disclosed substance use (8.1%) including excessive alcohol use, cannabis use, nicotine use, vaping cannabis and some refusal to reveal substance use. Surprisingly, less than 1% (n = 0.6) utilised institutional support services. Three qualitative themes were identified including emotional distress and associated effects, emotional and psychological impacts on nursing students' academic journey and tertiary support systems. The findings highlight the urgent need to address the mental health and addiction challenges experienced by nursing students, given their potential adverse effects on academic success and overall well-being. Urgent action is needed to integrate mental health training into the curriculum and provide faculty support. In this study, the underutilisation and inadequacy of institutional support services signal a need for institutional reforms to provide access and personalised mental health support to nursing students. Providing essential skills and support for student success contributes to the overall well-being of the nursing workforce.

Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study

BACKGROUND

The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects.

OBJECTIVE

This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process.

METHODS

In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses.

RESULTS

The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents' lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents.

CONCLUSIONS

Integrating observations of adolescents' recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system.

Social processes as the missing link: cross-sectionally testing a conceptual model on social mediators of early psychopathological development

BACKGROUND

Research suggests that most mental health conditions have their onset in the critically social period of adolescence. Yet, we lack understanding of the potential social processes underlying early psychopathological development. We propose a conceptual model where daily-life social interactions and social skills form an intermediate link between known risk and protective factors (adverse childhood experiences, bullying, social support, maladaptive parenting) and psychopathology in adolescents - that is explored using cross-sectional data.

METHODS

N = 1913 Flemish adolescent participants (Mean age = 13.8; 63% girls) were assessed as part of the SIGMA study, a large-scale, accelerated longitudinal study of adolescent mental health and development. Self-report questionnaires (on risk/protective factors, social skills, and psychopathology) were completed during class time; daily-life social interactions were measured during a subsequent six-day experience-sampling period.

RESULTS

Registered uncorrected multilevel linear regression results revealed significant associations between all risk/protective factors and psychopathology, between all risk/protective factors and social processes, and between all social processes and psychopathology. Social processes (social skills, quantity/quality of daily social interactions) were uniquely predicted by each risk/protective factor and were uniquely associated with both general and specific types of psychopathology. For older participants, some relationships between social processes and psychopathology were stronger.

CONCLUSIONS

Unique associations between risk/protective factors and psychopathology signify the distinct relevance of these factors for youth mental health, whereas the broad associations with social processes support these processes as broad correlates. Results align with the idea of a social pathway toward early psychopathology, although follow-up longitudinal research is required to verify any mediation effect.

Mental Health Among First-Year Students Transitioning to University in Australia: A Longitudinal Study

Objectives: Young people attending university for the first time may be at heightened risk of experiencing mental health problems. However, limited research has examined the mental health experiences of this cohort using longitudinal methods. This study aimed to examine mental health symptoms prior to commencing university, estimate changes in symptoms over the course of the first semester of study, and identify factors associated with initial symptom levels and changes. Methods: Australian first-year undergraduate students (N = 340) were recruited via social media and participated in a four-wave online longitudinal study conducted between February and June 2021. Symptoms of depression, anxiety, and psychological distress were assessed at each wave, along with psychosocial and lifestyle factors. Demographic characteristics were assessed at baseline. Results: Latent growth curve models indicated no significant linear change over time for depression (p = .26) or anxiety (p = .83) symptoms. However, a significant effect of time was observed for psychological distress (p = .03), indicating higher distress levels at wave 3 compared to baseline (p = .004). Financial stress, pressure to succeed, difficulty coping, greater loneliness, and more negative social interactions were each significantly associated with higher baseline depression, anxiety, and distress scores. Only greater loneliness and more negative social interactions were found to be associated with a greater increase in depression over time. Conclusion: The findings indicate that transition to university was not generally associated with an increase in poor mental health. However, several factors were associated with poorer mental health immediately prior to university commencement. Assisting students to manage financial distress, facilitating the development of social connections among students with limited social networks and skills training targeting coping and the development of realistic academic expectations may help support student mental health and promote improved wellbeing during transition to university.

In-person vs mobile app facilitated life skills education to improve the mental health of internally displaced persons in Nigeria: protocol for the RESETTLE-IDPs cluster randomized hybrid type 2 effectiveness-implementation trial

BACKGROUND

Internally displaced persons (IDPs) in Nigeria face a high burden of mental health disorders, with limited access to evidence-based, culturally relevant interventions. Life skills education (LSE) is a promising approach to promote mental health and psychosocial well-being in humanitarian settings. This study aims to evaluate the effectiveness and implementation of a culturally adapted LSE program delivered through in-person and mobile platforms among IDPs in Northern Nigeria.

METHODS

This cluster-randomized hybrid type 2 effectiveness-implementation trial will be conducted in 20 IDP camps or host communities in Maiduguri, Nigeria. Sites will be randomly assigned to receive a 12-week LSE program delivered either through in-person peer support groups or WhatsApp-facilitated mobile groups. The study will recruit 500 participants aged 13 years and older. Intervention effectiveness outcomes include the primary outcome of change in post-traumatic stress disorder (PTSD) symptoms assessed using the PCL-5 scale, and secondary outcomes of depression, anxiety, well-being, and life skills acquisition. Implementation outcomes will be assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Both sets of outcomes will be compared between the in-person and mobile delivery groups. Quantitative data will be analyzed using mixed-effects linear regression models, while qualitative data will be examined through reflexive thematic analysis. The study will be guided by the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework.

DISCUSSION

The RESETTLE-IDPs study addresses key gaps in the evidence base on mental health interventions for conflict-affected populations. It focuses on underserved IDP populations, evaluates the comparative effectiveness of in-person and mobile-delivered LSE, and incorporates implementation science frameworks to assess contextual factors influencing adoption, fidelity, and sustainability. The study employs a community-based participatory approach to enhance cultural relevance, acceptability, and ownership. Findings will inform the development and scale-up of evidence-based, sustainable mental health interventions for IDPs in Nigeria and other humanitarian contexts.

TRIAL SPONSOR

Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06412679  Registered 15 May 2024.

Survey of GP registrars' training experience and confidence in managing children and adolescents with mental health conditions in primary care

OBJECTIVES

The aim of this study is to assess General Practitioner (GP) trainees' training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland.

METHODS

An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants' training experiences and confidence levels in key areas of child and adolescent mental health in primary care.

RESULTS

Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders.

CONCLUSION

The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Building resilience among undergraduate health professions students: identifying influencing factors

BACKGROUND

Resilience contributes to mental well-being, hence expediting recovery from stressful events. Health professions students, in particular, often experience heightened levels of stress and anxiety due to academic demands and other stressors. This study aimed to explore the factors contributing to resilience and identify support systems that universities can implement to help undergraduate health professions students build resilience and manage their mental well-being.

METHODS

A total of 28 students from the fields of Medicine, Dentistry, Pharmacy, and Dietetics and Nutrition participated in semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. The interviews were stopped when data saturation was achieved. The data were analysed using thematic analysis.

RESULTS

Thematic analysis of the interviews identified five key themes contributing to resilience: life experience, socioeconomic factors, personal attributes, support resources, and role modelling. Universities play a crucial role in fostering resilience among health professions students through soft skills training, workplace-oriented training, mentoring, and extracurricular activities. These opportunities enable students to develop and strengthen resilience in both formal and informal settings. Such initiatives not only equip students to manage future career challenges but also support their overall personal and professional development.

CONCLUSIONS

This study provided a comprehensive understanding of the contributing factors to health professions students' resilience. The availability of support resources together with a nurturing environment provided by university are crucial. By fostering resilience, students are better prepared to navigate the challenges of the demanding professions and develop the emotional fortitude necessary for long-term success in healthcare.

Associations Between Psychological Stress and the Risk of First Onset of Major Depression Disorder: Results from a Longitudinal Study in 6,985 Chinese First-Year Students

Background

Youth and young adults have a high prevalence of major depressive disorder (MDD). Limited longitudinal research has explored the relationship between different dimensions of psychological stress and MDD. This study aimed to estimate the effect of psychological stress on the risk of first onset MDD in a sample of Chinese freshmen.

Methods

Using a longitudinal design, 8079 Chinese first-year students were recruited at baseline, and 6985 were followed up one year later. The Psychological Stress Scale for College Students was utilized to evaluate the levels of psychological stress. MDD was evaluated using the Chinese version of the Composite International Diagnostic Interview (CIDI-3.0). Logistic regression modeling was utilized to estimate the associations between dimensions of psychological stress and the risk of MDD.

Results

Two dimensions of psychological stress, namely learning stress (OR=1.05, 95% CI:1.01-1.09, P=0.017) and economic stress (OR=1.11, 95% CI:1.04-1.19, P=0.001), were significantly associated with the risk of MDD. Other dimensions of psychological stress (specify family stress, interpersonal stress, intimate relationship stress, employment stress and appearance stress) were not associated with MDD.

Conclusion

Psychological stress, especially learning and economic stresses, could increase the risk of MDD in university students. These factors should be incorporated into mental health prevention and intervention programs at universities to reduce the risks of MDD.

Adverse Childhood Experiences, maladaptive coping behaviours and protective factors in undergraduate students: A cross-sectional study

Objectives: The purpose is to examine the relationship between Adverse Childhood Experiences (ACEs), protective factors, and select maladaptive coping behaviors in postsecondary students. Participants: Undergraduate students attending Dalhousie University. Methods: An online anonymous survey was conducted. Zero order one-tailed correlations were computed to measure relationships between ACEs, levels of maladaptive coping behaviors and protective factors. A structural equation mediation model examined direct and indirect pathways between measures. Results: 42.5% of respondents (n = 327) reported ≥3ACEs. Higher ACEs were associated with higher expression of maladaptive coping behaviors. Respondents with high ACEs and low levels of protective factors reported lower levels of hope and forgiveness and higher levels of stress and rumination. Conclusion: Higher levels of protective factors were associated with lower levels of maladaptive coping behaviors in students with high ACEs.

Psychological well-being and the reversal of childhood overweight and obesity in the UK: a longitudinal national cohort study

OBJECTIVE

This study aimed to examine the prospective association between psychological well-being and overweight and obesity reversal.

METHODS

We analyzed data of UK children with overweight or obesity at ages 11 (n = 4556, baseline), 14 (n = 3791, baseline), and 17 years (follow-up). Psychological well-being-related measures were characterized into indexes of caregiver-reported child mental health and child-reported psychosocial well-being, with a higher score indicating better mental health or psychosocial well-being. Weight changes were presented as reversal versus persistence of overweight or obesity and residualized-change BMI z scores. Data were analyzed using regression analysis.

RESULTS

Better child mental health and psychosocial well-being at age 11 years were independently associated with increased odds of reversal versus persistence (odds ratio [OR] = 1.16, 95% CI: 1.03 to 1.29; OR = 1.29, 95% CI: 1.15 to 1.44, respectively) and decreased BMI z scores (β = -0.08, 95% CI: -0.13 to -0.03; β = -0.07, 95% CI: -0.11 to -0.03, respectively) at age 17 years. However, neither of the indexes was associated with weight changes when measured at age 14 years. Analyses between psychological well-being-related measures and timing of measures indicated that psychological well-being-related measures were more likely to prospectively predict weight changes when measured at age 11 versus age 14 years.

CONCLUSIONS

Better psychological well-being at age 11 years is a prognostic factor that may be associated with an increased likelihood of reversing childhood overweight and obesity by age 17 years.

Trajectories of work disability and unemployment before and after a common mental disorder diagnosis among young private sector employees in Sweden-a register-based longitudinal study

PURPOSE

To identify trajectory groups of work disability (WD), including sick leave and disability pension, and unemployment three years before and six years (from Y-3 to Y + 6) after a common mental disorder (CMD) diagnosis and to investigate associations of socio-demographic, work-related and clinical factors with trajectory membership.

METHODS

A longitudinal nationwide register-based study was conducted including individuals aged 22-29 years, gainfully employed in the private sector, with a CMD diagnosis in specialised healthcare or prescribed antidepressant (N = 12,121) in 2014 (Year 0/Y0), with follow-up from Y-3 to Y + 6. Group-based trajectory analyses identified groups of individuals who followed similar trajectories of months of WD and unemployment, respectively. Multinomial logistic regression determined associations between socio-demographic, work-related and clinical factors and trajectory membership.

RESULTS

In the CMD group, we identified three trajectory groups, each for WD and unemployment. Only 7% individuals belonged to a 'Fluctuant high' trajectory group with four months of WD in Y0, which peaked at 7 months in Y + 3 and reduced to 5 months in Y + 6. For unemployment, 15% belonged to an 'Increasing medium' trajectory group that steadily increased from 1.3 months in Y0 to 2.6 months in Y + 6. Sex, educational level and musculoskeletal disorders for WD, and educational level, living area and occupational class for unemployment, influentially determined the variance across the CMD trajectory groups.

CONCLUSIONS

Specific vulnerable groups regarding unfavourable WD (women, low education and musculoskeletal disorders) and unemployment (manual work, low education and rural residence) trajectories require special attention regarding their return-to-work process following a CMD diagnosis.

Mental health literacy of adolescents in Bermuda, according to age, gender and race

Mental health literacy (MHL) is an important part of the help-seeking process, yet there is a lack of knowledge about the MHL of adolescents in the Caribbean. This region is important to study as it is underrepresented in mental health research globally. The aim of this study is to explore the ability of adolescents in Bermuda to recognize depression and social phobia (social anxiety) and their beliefs about the sources of help for a peer with these mental health problems. This cross-sectional study surveyed middle and high school students aged 10-19 years in Bermuda. Online surveys conducted between November 2022 and June 2023 gathered demographic data including age, gender and race, and assessed the ability to recognize depression and social anxiety from descriptions provided in randomly assigned vignettes, and beliefs about sources of help. Across 15 middle and high schools, 2423 adolescents (out of 3593 eligible participants) completed all demographic and MHL survey questions (1139 males, 1272 females). Recognition rates for depression and social anxiety were 60% and 53%, respectively. Compared to females, males endorsed a greater variety of help sources. Reporting symptoms of depression or anxiety reduced the likelihood of endorsing multiple sources of help. MHL of adolescents in Bermuda is sub-optimal, particularly for social anxiety. Mental health promotion programs may be useful in improving recognition rates.

Investigating the feasibility of MePlusMe, an online intervention to support mental health, well-being, and study skills in higher education students

INTRODUCTION

While there are several web-based mental health interventions, few target higher education (HE) students. Importantly, more research is needed to establish their effectiveness. Here, we provide a pragmatic evaluation of an online intervention (MePlusMe) specifically designed to improve the mental health, well-being, and study skills of HE students.

METHODS

In accordance with the published protocol for a feasibility study, we recruited a convenience sample of 137 HE students to participate in an eight-week intervention, with 26 participants retained at week 8. Validated measures of mood (depression and anxiety), well-being, and self-efficacy were collected at baseline, 2, 4, and 8 weeks, alongside two feedback forms assessing design and functionality (baseline) and engagement (week 4 and 8).

RESULTS

We observed significant reductions in levels of anxiety and depression as well as increases in well-being, but no changes in self-efficacy. Participants rated the system design and functionality positively and qualitative findings indicated high levels of satisfaction with MePlusMe.

DISCUSSION

Findings support both the acceptability and the effectiveness of MePlusMe. Nonetheless, modest retention rates limit the precision and generalisability of these findings. Further investigation should ascertain optimal duration of engagement, most acceptable means of outcome assessment, and further detail about obstacles to utilisation.

Getting stress-related disorders under control: the untapped potential of neurofeedback

Stress-related disorders are among the biggest global health challenges. Despite significant progress in understanding their neurocognitive basis, the promise of applying insights from fundamental research to prevention and treatment remains largely unfulfilled. We argue that neurofeedback - a method for training voluntary control over brain activity - has the potential to fill this translational gap. We provide a contemporary perspective on neurofeedback as endogenous neuromodulation that can target complex brain network dynamics, is transferable to real-world scenarios outside a laboratory or treatment facility, can be trained prospectively, and is individually adaptable. This makes neurofeedback a prime candidate for a personalized preventive neuroscience-based intervention strategy that focuses on the ecological momentary neuromodulation of stress-related brain networks in response to actual stressors in real life.

The Dynamic Interplay Between Puberty and Structural Brain Development as a Predictor of Mental Health Difficulties in Adolescence: A Systematic Review

Puberty is a time of intense reorganization of brain structure and a high-risk period for the onset of mental health problems, with variations in pubertal timing and tempo intensifying this risk. We conducted 2 systematic reviews of articles published up to February 1, 2024, focusing on 1) the role of brain structure in the relationship between puberty and mental health, and 2) precision psychiatry research evaluating the utility of puberty in making individualized predictions of mental health outcomes in young people. The first review provides inconsistent evidence about whether and how pubertal and psychopathological processes may interact in relation to brain development. While most studies found an association between early puberty and mental health difficulties in adolescents, evidence on whether brain structure mediates this relationship is mixed. The pituitary gland was found to be associated with mental health status during this time, possibly through its central role in regulating puberty and its function in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal axes. In the second review, the design of studies that have explored puberty in predictive models did not allow for a quantification of its predictive power. However, when puberty was evaluated through physically observable characteristics rather than hormonal measures, it was more commonly identified as a predictor of depression, anxiety, and suicidality in adolescence. Social processes may be more relevant than biological ones to the link between puberty and mental health problems and represent an important target for educational strategies.

Cross-Sectional and Longitudinal Relations Among Irritability, Attention-Deficit/Hyperactivity Disorder Symptoms, and Inhibitory Control

OBJECTIVE

Irritability and attention-deficit/hyperactivity disorder (ADHD) symptoms frequently co-occur in youth. Although ADHD has been associated with inhibitory control deficits, the literature on irritability and inhibitory control is mixed. Examining how irritability, ADHD symptoms, and inhibitory control interrelate both cross-sectionally and longitudinally across development could shed light on common and distinct mechanisms of youth psychopathology.

METHOD

We utilized a cross-lagged panel model with data from 2 time points (at ages 10 and 12 years) of the Adolescent Brain and Cognitive Development (ABCD) Study (N = 7,444, or ∼63% of the baseline sample with full data at each time point) to test cross-sectional and longitudinal associations among parent-reported irritability and ADHD symptoms and behaviorally assessed inhibitory control. This was performed separately across discovery and replication subsamples, each n = 3,722.

RESULTS

As expected, irritability and ADHD symptoms exhibited strong cross-sectional and reciprocal cross-lagged associations. Higher ADHD symptoms at age 10 years were associated concurrently with poorer inhibitory control and predicted poorer inhibitory control at age 12. Contrary to predictions, inhibitory control was not significantly associated with irritability cross-sectionally, nor was it predictive of later irritability or ADHD symptoms.

CONCLUSION

These findings highlight strong links between irritability and ADHD. Although inhibitory control deficits were linked to ADHD and predictive of its symptom course, inhibitory control had no significant associations with irritability. Future research should investigate other candidate mechanisms of the co-occurrence of irritability and ADHD symptoms and predictors of their developmental trajectories.

PLAIN LANGUAGE SUMMARY

This study investigated how irritability, ADHD symptoms, and inhibitory control interrelate both cross-sectionally and longitudinally in a sample of youth from the Adolescent Brain and Cognitive Development (ABCD) Study (N = 7,444). Results indicate that irritability and ADHD symptoms exhibit strong reciprocal predictive relationships; however, inhibitory control does not predict later irritability or ADHD, though ADHD symptoms predicted later inhibitory control deficits. These findings corroborate the predictive relations between irritability and ADHD over development and highlight the need for continued exploration of mechanisms underlying their co-occurrence.

Critical Windows: Exploring the Association Between Perinatal Trauma, Epigenetics, and Chronic Pain

Chronic pain is highly prevalent and burdensome, affecting millions of people worldwide. Although it emerges at any point in life, it often manifests in adolescence. Given that adolescence is a unique developmental period, additional strains associated with persistent and often idiopathic pain lead to significant long-term consequences. While there is no singular cause for the chronification of pain, epigenetic modifications that lead to neural reorganization may underpin central sensitization and subsequent manifestation of pain hypersensitivity. Epigenetic processes are particularly active during the prenatal and early postnatal years. We demonstrate how exposure to various traumas, such as intimate partner violence while in utero or adverse childhood experiences, can significantly influence epigenetic regulation within the brain and in turn modify pain-related processes. We provide compelling evidence that the burden of chronic pain is likely initiated early in life, often being transmitted from mother to offspring. We also highlight two promising prophylactic strategies, oxytocin administration and probiotic use, that have the potential to attenuate the epigenetic consequences of early adversity. Overall, we advance understanding of the causal relationship between trauma and adolescent chronic pain by highlighting epigenetic mechanisms that underlie this transmission of risk, ultimately informing how to prevent this rising epidemic.

Addressing Child and Adolescent Mental Health Problems in the Community. Evaluation of a Consultation and Advise Team for Assessment, Support and Referral

Introduction

Youths with mental health problems are often not identified in primary healthcare, which may prevent or delay appropriate support. In the Netherlands, a Consultation and Advise expert team (CandA team) was implemented to support general practitioners (GPs), youth professionals and youths with mental health problems. This study investigates the team's scope, activities, stakeholders' and users' experiences.

Method

Interviews and focus groups with policymakers, healthcare professionals, parents and youths were analysed using ATLAS.ti. Demographics and mental health problems of 706 youths (0-18 years) consulting the CandA team, type of healthcare providers consulting the team, and type of care provided by the team (2015-2017) were analysed, using descriptive statistics and Chi-square tests.

Results

Youths consulted the CandA team for 'other behavioural/psychological complaints' (41%); irritable/angry behaviour (14%); anxious/nervous behaviour (10%); overactivity (8%); feeling down/depressed (6%). CandA team services were used by GPs, youth counsellors, and youth physicians/nurses. Most stakeholders were positive about the team's services.

Conclusion

The CandA team seems an adequate form of integrated assessment and support for youth mental health problems in the community. The team's composition, expertise and positioning are success factors. Cooperation with schools could be improved. Quantitative evaluation is needed to investigate effects of the team and adequacy of referrals.

Association of GAD1 gene polymorphism rs3749034 with the information processing and cognitive event-related potentials in schizophrenia patients and healthy subjects

OBJECTIVE

Glutamic acid decarboxylase, an enzyme in GABA biosynthesis, is encoded by the GAD1 gene, the transcriptional activity of which is affected by the rs3749034 polymorphism. The aim was to investigate the effects of rs3749034 on cognitive event-related potentials (P300) in healthy subjects and schizophrenic patients.

METHODS

Determination of rs3749034 polymorphism was performed in 89 healthy volunteers and 109 schizophrenic patients (males). Two-stimulus oddball task performance and P300 auditory evoked potentials were analyzed and patient symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

An increased frequency of C allele carriers was disclosed in patients. In controls, superior task performance was observed in cytosine-thymine carriers, while a greater P300 amplitude and shorter latency were found in C/C carriers. Analogous effects were found in patients with a disease onset before 25 years of age. Higher N5 and lower P3 and G5 PANSS scales were revealed in C/C homozygotes.

CONCLUSIONS

The findings substantiate an involvement of GABA-ergic mechanisms in maintaining an optimal excitatory-inhibitory balance and an association of rs3749034 with early-onset disorder and negative symptoms of schizophrenia.

SIGNIFICANCE

These results are important for understanding underlying mechanisms and the development of evidence-based methods for assessing the risk of schizophrenia.

Mindfulness-based family psychoeducation intervention for caregivers of young adults with first-episode psychosis: results at 9-month follow-up

Objectives

To investigate the effects of a mindfulness-based family psychoeducation (MBFPE) intervention on caregivers and the young adults with first-episode psychosis in mental health care.

Methods

Sixty-five caregivers were randomly assigned to the MBFPE program (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32). Eighteen young adults in recovery (YAIR) also participated in the study. All of the participants completed the assessments before participating in the intervention (T1), after the intervention (T2), and at 9-month follow-up (T3).

Results

Intention-to-treat analyses were conducted. The caregivers reported a significant and large effect size on positive caregiving experiences based on a Time × Group analysis (g = 0.862, p = 0.006). Among the YAIR participants, between-group differences were significant in their perceptions of caregivers' expressed emotions, including large effect sizes of perceived criticism (g = 1.396, p = 0.049) and hostility (g = 1.444, p = 0.043). Caregiver demographics, including age, education level, socioeconomic status, and number of family members, were found to moderate the effect sizes of the variables studied.

Conclusion

This study provides evidence of the effects of MBFPE programs on the outcomes of caregivers and the young adults with first-episode psychosis in their care. Specifically, the MBFPE program in this study played a greater role in promoting positive caregiving experiences and changing caregivers' expressed emotions, especially their expressed criticism of YAIR, compared with the regular FPE program. Therefore, the application of mindfulness training to promote family care and YAIR recovery should be encouraged.

Clinical trial registration

ClinicalTrials.gov, identifier NCT03688009.

Could a Growth Mindset Attenuate the Link Between Family Socioeconomic Status and Depressive Symptoms? Evidence from Chinese Adolescents

Purpose

The alleviating effects of a growth mindset on depression are promising. However, whether a growth mindset can attenuate the effect of low family socioeconomic status (SES) on depressive symptoms among adolescents remains unknown. Based on the Family Stress Model, the current study explores whether a growth mindset could moderate the associations between family SES, interparental conflict, and adolescent depressive symptoms.

Methods

The participants were 1572 Chinese adolescents (Mage = 13.35 years, SD = 1.16, 51.84% female). They completed the family SES questionnaire, Children's Perceptions of Interparental Conflict scale, Growth Mindset scale, and Center for Epidemiologic Studies Depression scale. We tested the moderation, mediation, and moderated mediation models using the SPSS macro program PROCESS.

Results

A growth mindset moderated the association between family SES and depressive symptoms. Family SES was significantly related to depressive symptoms in adolescents with a lower growth mindset, but not in those with a higher growth mindset. After incorporating the mediating effect of interparental conflict, the growth mindset did not exert a significant moderating influence on the direct path; however, it significantly moderated the mediating effect of interparental conflict on depressive symptoms. Specifically, while a lower growth mindset in adolescents was associated with an increased risk of depressive symptoms due to interparental conflict, those with a higher growth mindset showed a less pronounced effect.

Conclusion

A growth mindset attenuates the link between family SES and depressive symptoms among adolescents. These findings highlight the benefits of a growth mindset on mental health, especially for low-SES adolescents.

Factors related to help-seeking and service utilization for professional mental healthcare among young people: An umbrella review

The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others' support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people's needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.

RiskPath: Explainable deep learning for multistep biomedical prediction in longitudinal data

Predicting individual and population risk for disease outcomes and identifying persons at elevated risk is a key prerequisite for targeting interventions to improve health. However, current risk stratification tools for the common, chronic diseases that develop over the lifecourse and represent the majority of disease morbidity, mortality and healthcare costs are aging and achieve only moderate predictive performance. In some common, highly morbid conditions such as mental illness no risk stratification tools are yet available. There is an urgent need to improve predictive performance for chronic diseases and understand how cumulative, multifactorial risks aggregate over time so that intervention programs can be targeted earlier and more effectively in the disease course. Chronic diseases are the end outcomes of multifactorial risks that increment over years and represent cumulative, temporally-sensitive risk pathways. However, tools in current clinical use were constructed in older data and utilize inputs from a single data collection step. Here, we present RiskPath, a multistep deep learning method for temporally-sensitive biomedical risk prediction tailored for the constraints and demands of biomedical practice that achieves very strong performance and full translational explainability. RiskPath delineates and quantifies cumulative multifactorial risk pathways and allows the user to explore performance-complexity tradeoffs and constrain models as required by clinical use cases. Our results highlight the potential for developing a new generation of risk stratification tools and risk pathway mapping in time-dependent diseases and health outcomes by leveraging powerful timeseries deep learning methods in the wealth of biomedical data now appearing in large, longitudinal open science datasets.

"Suck it up, go play": Mental health stigma in college coaches and their use of mental illness microaggressions

Objective: This study explored the extent to which college athletic coaches endorse mental illness microaggressions toward their student-athletes and the importance of mental toughness in sports, and how these impact support for help-seeking among student-athletes. Methods: Fifty-eight coaches at Northeastern U.S. colleges in the National Collegiate Athletic Association completed an online survey, including measures of mental illness microaggressions, mental toughness, and questions about vignettes portraying scenarios with a physically injured athlete and an athlete with anxiety. Results: Multivariate analyses revealed that endorsement of mental illness microaggressions was negatively related to willingness to refer an athlete with anxiety to counseling services and positively related to willingness to allow a physically injured athlete to return to play. However, mental toughness was not predictive of microaggressions or vignette responses. Conclusions: Endorsement of mental illness microaggressions appears to be related to how coaches respond to athletes experiencing a mental health issue or physical injury.

The regulatory effect of the anterior cingulate cortex on helping behavior in juvenile social isolation model mice

Social isolation during adolescence negatively impacts the development of adult social behaviors. However, the exact link between social experiences during adolescence and social behaviors in adulthood is not fully understood. In the present study, we investigated how isolation during juvenility affects harm avoidance behavior in a mouse model of juvenile social isolation. We found that mice subjected to social isolation as juveniles display atypical harm avoidance behaviors and that neurons in the anterior cingulate cortex are involved in these abnormal behaviors. Furthermore, we discovered that the chemogenetic activation of anterior cingulate cortex pyramidal neurons can rescue impaired harm-avoidance behaviors in these mice. Our findings provide valuable insights into the potential mechanisms underlying the impact of social experiences on behavior and brain function. Understanding how social isolation during crucial developmental periods can lead to alterations in behavior opens up new avenues for exploring therapeutic interventions for neuropsychiatric disorders characterized by impaired prosocial behaviors.

Effectiveness of a universal resilience-focused intervention for children in the school setting: A randomized controlled trial

BACKGROUND

Psychological resilience can be augmented through the acquisition of specific cognitive or emotional regulation skills, enabling children to adapt to or recover from stressful events, disadvantages, or adversities. We aimed to evaluate the efficacy of a Tianchang Resilience-focused inTervention program (TRT1 program) on resilience and mental health conditions of Chinese children.

METHODS

This study was a two-arm cluster-randomized controlled trial, performed in Tianchang, a county in China. Students from 20 classes in a local primary school (aged 8.7-11.2 years) were randomly allocated to receive a resilience-focused intervention or waitlist group. The intervention comprised weekly 40-min sessions for 14 weeks and co-led by lay counsellors. Measures of emotional symptoms, behavioral difficulties, and resilience were collected at pre-, post-intervention, 6-months, and 12-months follow-up.

RESULTS

Between June 16, 2022, and September 4, 2022, 775 eligible students were recruited (mean age 9.93 years; 420 [54.2 %] boys). Relative to the waitlist group (N = 391), the intervention group (N = 384) reported a significant reduction in depressive and anxiety symptoms at post-intervention (all p < 0.001), 6-months (p = 0.007; p = 0.002) and 12-months follow-up (p = 0.018; p = 0.018), respectively. The intervention group effects were also observed on resilience at post-intervention follow-up (p = 0.006), and remained stable over 6-months (p < 0.001) and 12-months follow-up (p = 0.022).

CONCLUSIONS

This study demonstrated that the TRT program, a universal resilience-focused intervention for children in the school setting, showed long-term effectiveness in improving resilience and mental health conditions. This minimally trained laypersons-delivered intervention might enhance the program's generalizability to other communities.

Genetic overlap between schizophrenia spectrum disorders and Alzheimer's disease: Current evidence and future directions - An integrative review

Schizophrenia and Alzheimer's disease (AD) are distinct neurodegenerative disorders characterized by progressive cognitive deficits and structural alterations in the brain. Schizophrenia typically emerges in adolescence or early adulthood with symptoms such as hallucinations, delusions, and cognitive impairments, whereas AD primarily affects elderly individuals, causing progressive memory loss, cognitive decline, and behavioral changes. Delusional disorder, which often emerges later in life, shares some features with schizophrenia and is considered a schizophrenia spectrum disorder. Patients with schizophrenia or delusional disorder, particularly women and those aged 65 years or older, have an increased risk of developing AD later in life. In contrast, approximately 30 % of AD patients exhibit psychotic symptoms, which accelerate cognitive decline and worsen health outcomes. This integrative review explored the genetic overlap between schizophrenia spectrum disorders and AD to identify potential shared genetic factors. The genetic correlations between schizophrenia and AD were weak but positive (rg=0.03-0.10). Polygenic risk scores (PRSs) for schizophrenia and AD indicate some genetic predisposition, although findings are inconsistent among studies; e.g., PRS-schizophrenia or PRS-AD were associated with the risk of developing psychosis in patients with AD. A higher PRS for various developmental and psychiatric disorders was correlated with an earlier age at onset of schizophrenia. Research gaps include the need for studies on the impacts of PRS-AD on the risk of schizophrenia, genetic correlations between later-onset delusional disorder and AD, and genetic relationships between AD and late-onset schizophrenia (LOS) with a greater risk of progressing to AD. Further investigation into these genetic overlaps is crucial to enhance prevention, treatment, and prognosis for affected patients.

Test-Retest Reliability of a Physical Activity Behavior, Health and Wellbeing Questionnaire in Adolescents

Background

The aim of this study was to examine the test-retest reliability of the physical activity behavior, health and wellbeing questionnaire, in adolescent populations, administered by teachers in school settings, in the Republic of Ireland.

Methods

A cross-sectional, mixed sample of 55 participants (45.5% males: Age, 13.94 (±.40) years) were included. The participants completed the questionnaire on two occasions (T1 and T2), on the same day and time, one week apart following identical procedures. Variables for testing included physical activity behavior (n=13), health (n=11) and wellbeing (n=2). Test-retest reliability of the questionnaire's covariates, including family affluence and physical impairments were also examined.

Results

Systematic error (Bland-Altman plots) was found to be near to zero for each of the physical activity behavior, health and wellbeing variables. The combined mean coefficient of variation was lower for females (10.19%) in comparison to males (13.01%). The combined mean intraclass correlation coefficients were higher for females (0.901) than males (0.822). Similarly, the combined mean Cronbach alpha coefficient were higher for girls (0.908) than boys (0.821).

Conclusions

This study found the physical activity behavior, health and wellbeing questionnaire to be reliable for use in adolescent populations.

Recognising the Parental Caregiver Burden of Children With Mental Disorders: A Systematic Mixed-Studies Review

This review aims to consolidate and appraise evidence exploring the caregiver burden of parents of children with mental disorders. A mixed-studies review structure was adopted and six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until September 2023. Thomas & Harden's thematic analysis framework was utilised for data analysis. Twenty-three studies were included in this review. The results-based convergent integration method identified an overarching theme titled 'hiding behind the walls on fire, engulfed in chaos: dark and alone', three main themes named 'Invisible scars': role of psychological factors on caregiver burden, navigating through social and economic influences on caregiving burden, and influence of illness-related variables and nine subthemes. This review highlighted that the parents perceived insufficient support from healthcare providers and a lack of insight regarding their children's medical condition as the primary contributors to the burden experienced. It is imperative for healthcare professionals to collaboratively engage with parental caregivers, offering accessible treatment options for their children with mental disorders and providing comprehensive educational resources to facilitate a profound understanding of their children's mental health conditions. In addition to addressing caregivers' informational needs, the establishment of an integrated support system is advocated, one involving active participation from healthcare professionals, healthcare institutions, community resources, social services and policymakers. This holistic approach could better meet the multifaceted needs of caregivers, encompassing psychosocial, emotional and financial aspects. Trial Registration: International Prospective Register of Systematic Reviews: PROSPERO ID: CRD42022363420.

Mental health and well-being of elite youth athletes: a scoping review

BACKGROUND

There is increasing recognition of the prevalence and risk factors for mental health symptoms and disorders among adult elite athletes, with less research involving elite youth athletes. This scoping review aimed to characterise the mental health and well-being of elite youth athletes who travel internationally and compete for their sport.

METHOD

Four databases were searched in March 2023. Inclusion criteria were studies with elite youth athlete populations (mean age 12-17 years) reporting mental health and well-being outcomes. Data from included studies were charted by outcome, and risk/protective factors identified.

RESULTS

Searches retrieved 3088 records, of which 33 studies met inclusion criteria, encapsulating data from 5826 athletes (2538 males, 3288 females). The most frequently studied issue was disordered eating (k=16), followed by anxiety (k=7), depression (k=5) and mixed anxiety/depression (k=2). Caseness estimates (a symptom level where mental health treatment is typically indicated) for disordered eating were wide ranging (0%-14% for males; 11%-41% for females), whereas only two studies estimated caseness for depression (7% in a mixed-sex sample; 14% for males, 40% for females) and one for anxiety (8% for males, 28% for females). Common risk factors for mental ill-health included sex, athlete status (compared with non-athletes) and social/relationship factors (with coaches/parents/peers). Contradictory evidence was observed for elite/competition level, which was associated with higher and lower rates of disordered eating.

CONCLUSION

Further representative research into the mental health and well-being of elite youth athletes is needed to enhance understanding and guide prevention and intervention measures.

Psychotic Disorders and exosomes: An overview of current evidence and future directions

Due to its reliance on heterogeneous symptomatology, the accurate diagnosis of psychotic disorders remains a challenging task in clinical practice. Precise and early diagnosis of psychotic disorders facilitates early intervention, which has been shown to have substantial benefits for long-term outcomes. Still, the lack of specific biomarkers is an important limitation in early diagnosis and intervention. Exosomes, which act as messengers between cells, including brain cells, contain a vast array of molecules that hold promise for unveiling disorder-specific abnormalities. In this review, we discuss recent evidence highlighting the potential of circulating exosomes and brain-derived exosomes as valuable tools for the identification of accessible, non-invasive, and blood-based biomarkers of psychotic symptomatology and risk. We discuss current limitations in biomarker discovery studies focusing on exosomes. To enhance diagnosis specificity and treatment response, we also provide guidance for future investigations that need to target biomarkers of risk and relapse, as well as consider duration of untreated psychosis, biological sex, and other factors in the multifactorial biosignature of psychosis.

Does mental illness in adolescence/young adulthood predict intimate partner violence?

Experiences of intimate partner violence (IPV) are associated with a wide range of measures of poor mental health. While there is a body of evidence to suggest that IPV leads to poor mental health, there is some evidence to suggest the association between IPV and mental illness may be bi-directional. We take data from a long running cohort study to test the hypothesis that poor mental health experienced during the adolescent and young adult periods of the life course predict adult occurring IPV. At 14 years respondents were administered the Youth Self Report (YSR), and at 21 years they completed the Young Adult Self Report (YASR) as well as the Composite International Diagnostic Interview. At 30 years, respondents completed the Composite Abuse Scale (CAS), with five measures of IPV; Severe Combined Abuse, Physical Abuse, Emotional Abuse, Harassment and Coercive Control. After adjustment for possible confounding, measures of delinquency and substance use disorder at 21 years predicted all forms of IPV. For example, in the fully adjusted data, substance use disorders to 21 years predict Severe Combined Abuse (2.30:1.15, 4.61), Physical Abuse (1.67:1.11, 2.52), and Coercive Control (1.74:1.14, 2.65) at 30 years. The findings raise the possible benefits of early intervention programs to reduce adult occurring IPV.

Mental health-related service and medicine use among a cohort of urban Aboriginal children and young people: Data linkage study

OBJECTIVE

The objective was to describe mental health service and psychotropic medicine use among a cohort of Aboriginal young people and quantify their relation to sociodemographic, family and health factors.

METHODS

In a prospective cohort study with data linkage, 892 Aboriginal children aged 0-17 years living in urban and regional areas of New South Wales, Australia, were included. We assessed mental health-related service use, paediatric service use and psychotropic medicine dispensing claims covered by the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from July 2012 to June 2017.

RESULTS

Most children (71%) did not have a record of mental health service or psychotropic medication use. 18.7% had ⩾1 mental health-related service claim; 26.7% had ⩾1 paediatric service claim; and 20.3% had ⩾1 psychotropic medicine dispensing claim. General practitioner services were the most accessed mental health-related service (17.4%) and 12.7% had been dispensed attention-deficit hyperactivity disorder medicines. Child characteristics associated with treatment included emotional and behavioural problems (prevalence ratio: 1.97, 95% confidence interval = [1.46, 2.64] for mental health services; prevalence ratio: 2.87, 95% confidence interval = [2.07, 3.96] for medicines) and risky behaviour (prevalence ratio: 1.56, 95% confidence interval = [1.12, 2.16] for mental health services; prevalence ratio: 2.28, 95% confidence interval = [1.54, 3.37] for medicines). Parent-related factors included chronic illness (prevalence ratio: 1.42, 95% confidence interval = [1.03, 1.95] for mental health services; prevalence ratio: 2.00, 95% confidence interval = [1.49, 2.69] for medicines) and functional limitations (prevalence ratio: 1.61, 95% confidence interval = [1.16, 2.24] for mental health services; prevalence ratio: 1.86, 95% confidence interval = [1.34, 2.59] for medicines).

CONCLUSIONS

Most Aboriginal children and young people did not have claims for mental health services or medicines. Aboriginal children with emotional and behavioural problems, or parents with health problems were more likely to have mental health service or medicine claims.

Parental mental health and reporting of their child's behaviour: measurement invariance of the French version of the parental strengths and difficulties questionnaire

Symptomatic effects of mental disorders in parents could bias their reporting on their child's mental health. This study aimed to investigate the measurement invariance of the French version of the parental Strengths and Difficulties Questionnaire (SDQ) across parental mental health in a sample (N = 20,765) of parents of children aged 3 to 17 years in France. Confirmatory factor analysis (CFA) and Exploratory Structural Equation Modelling (ESEM) were used to evaluate the fit of three known alternative SDQ factor structures (five, three, or second-order factor structures). Invariance was tested across parental mental health (present anxiety and depressive symptoms, psychiatric history) and across socio-demographic characteristics (child's age, child's gender, parent's gender, parent's educational level). CFA models showed a poor fit, while all ESEM models achieved acceptable or good fit, with the five-factor model presenting the best fit. Invariance was observed for all characteristics tested, indicating that the SDQ can be used to study the links between parental mental health and their child's mental health without bias. However, ESEM showed that the hyperactivity/inattention and conduct problems dimensions were not well differentiated in the French version of the SDQ.

Global public concern of childhood and adolescence suicide: a new perspective and new strategies for suicide prevention in the post-pandemic era

BACKGROUND

Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years. Familial, social, psychological, and behavioral factors play important roles in suicide risk. As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people, there is a need to understand the current status of suicide in adolescents, including its epidemiology, associated factors, the influence of the pandemic, and management initiatives.

DATA SOURCES

We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization (WHO) regions. Additionally, we utilized electronic databases, including PubMed/MEDLINE and Scopus, and employed various combinations of terms such as "suicide", "adolescents", "youth", "children", "risk factors", "COVID-19 pandemic", "prevention", and "intervention" to provide a narrative review on suicide within the pediatric population in the post-pandemic era.

RESULTS

Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019, it remains high. The mortality rates from suicide by firearms or any other specified means were both greater in males. Additionally, Southeast Asia had the highest suicide rate among the six WHO regions. The COVID-19 pandemic seems to contribute to suicide risk in young people; thus, there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic.

CONCLUSIONS

The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic, risk factors, and intervention strategies. Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era, further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era. It is necessary to identify effective prevention strategies targeting young people, particularly those at high risk, and successful treatment for individuals already manifesting suicidal behaviors. Care for suicidal children and adolescents should be improved with parental, school, community, and clinical involvement.

The experience of seeking and accessing help from mental health services among young people of Eastern European backgrounds: A qualitative interview study

OBJECTIVES

Most lifetime mental health problems (MHP) start before the age of 25. Yet young people-particularly those of minority backgrounds-often do not seek or access professional help. In the UK, young people of Eastern European (EE) backgrounds represent a large minority group; however, little is known about their experiences of MHP and help-seeking. In this study, we aim to understand the help-seeking process from the perspectives of EE young people.

DESIGN

We used a qualitative study design with semi-structured individual interviews. The results were analysed using reflexive thematic analysis.

METHOD

Twelve young people (18-25 years) of EE backgrounds, living in Oxfordshire, UK, took part. All participants had experienced a severe MHP and were identified in the community.

RESULTS

EE young people's experiences of MHP and help-seeking were driven by a sense of being caught between different cultures and simultaneously needing to navigate the potentially contrasting expectations of both cultures. This process was reinforced or tempered by the perceived continuing influence of young people's families, that is, families with more open views about MHP made it easier for young people to navigate through the process of help-seeking. Young people's internalised cultural and familial beliefs about MHP affected their decision-making when experiencing difficulties, their levels of trust in services, and perceived sense of resourcefulness and ability to cope.

CONCLUSIONS

Recognising and responding to the cultural tension that young people of EE backgrounds may experience can help us to develop more accessible and inclusive mental health services.

Psychiatric polygenic risk scores: Experience, hope for utility, and concerns among child and adolescent psychiatrists

Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders' views to ensure responsible implementation of this technology.

A qualitative investigation into care-leavers' experiences of accessing mental health support

INTRODUCTION

People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services.

METHODS

We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up.

RESULTS

Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met.

CONCLUSIONS

We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.

Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review

BACKGROUND

Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers.

METHODS

Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis.

RESULTS

We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP.

CONCLUSIONS

Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users.

REGISTRATION

This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).

Validation and psychometric evaluation of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) among Czech adolescents using Item Response Theory

BACKGROUND

The topic of adolescent mental health is currently a subject of much debate due to the increasing prevalence of mental health problems among this age group. Therefore, it is crucial to have high-quality and validated mental well-being measurement tools. While such tools do exist, they are often not tailored specifically to adolescents and are not available in Czech language. The aim of this study is to validate and test the Czech version of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) on a large sample of Czech adolescents aged 15 to 18 years.

METHODS

The analysis is based on data from the first wave of the Czech Education Panel Survey (CZEPS) and was mainly conducted using Item Response Theory (IRT), which is the most appropriate method for this type of analysis. Specifically, the Graded Response Model (GRM) was applied to the data. This comprehensive validation study also included reliability and three types of validity (construct, convergent and criterion) testing.

RESULTS

The study found that the Czech version of the SWEMWBS for adolescents aged 15 to 18 years (N = 22,498) has good quality and psychometric properties. The data was analysed using the GRM model as it met the assumptions for the use of IRT. The estimated parameter values by GRM demonstrated good discriminant and informative power for all items, except for item 7, which showed poorer results compared to the others. However, excluding it from the scale would not enhance the overall quality of the scale. The five-category response scale functions effectively. Additionally, the results demonstrated high reliability, and all types of validity tested were also confirmed.

CONCLUSIONS

The Czech version of the SWEMWBS for adolescents has been validated as a psychometrically sound, reliable and valid instrument for measuring mental well-being. It can therefore be used with confidence in future studies.

A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial

BACKGROUND

Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population.

OBJECTIVE

This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed.

METHODS

University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention.

RESULTS

The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high.

CONCLUSIONS

The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146.