Parent and family factors associated with service use by young people with mental health problems: a systematic review

Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review

Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.

The Ws of Parental Help-Seeking: When, Where, and for What Do Parents Seek Help for Child Mental Health

Parental help-seeking preferences may help explain the treatment gap in child mental health. This study examined mothers' and fathers' help-seeking behaviors for child mental health to further understand their individual preferences for treatment. A total of 394 mothers and fathers completed questionnaires assessing the types of help sought for mental health concerns for a target child (age 3-7 years), as well as measures representing illness profile, predisposing characteristics, and barriers/facilitators proposed to influence help-seeking. Parents often sought informal rather than professional help. Regression modelling indicated mothers' different help-seeking behaviors were significantly associated with illness profile (marital quality, child mental health, parental education), predisposing factors (parental attributions, child age), and family income, while fathers' different help-seeking behaviors were significantly associated with child demographics (age, gender). The results support expanding treatments into nonclinical settings and improving child mental health literacy to improve appropriate parental help-seeking for child mental health concerns.

Determinants of unmet needs for mental health services amongst adolescents in Shiraz, Iran: a cross-sectional study

Background

Mental disorders are increasingly prevalent among adolescents without appropriate response. There are a variety of reasons for unmet mental health needs, including attitudinal and structural barriers. Accordingly, we investigated perceived mental health needs, using mental health services, and their barriers in adolescents.

Method

This cross-sectional study was conducted in 2022 in Shiraz, Iran. Demographic characteristics, the Adolescent Unmet Needs Checklist, and the Young Schema Questionnaire were administered to 348 adolescents aged 13-19 years. Adolescents were classified as having no needs, fully met needs, partially met needs, or wholly unmet needs. Logistic regression analysis was used to determine factors associated with perceived unmet need and refer participants to healthcare centers.

Results

193 (55.5%) adolescents reported perceived need for mental healthcare out of whom, 21.6% reported fully and 21.6% partially unmet needs. Noticeably, only 12.4% of needy participants reported met need. "Reluctance to seek mental healthcare" and "asked but not receiving help" were common barriers to using the services.

Conclusion

The present study reveals unmet mental healthcare needs as a significant public health concern among the adolescents. To address this significant concern, reorientation of primary care, removing economic barriers from mental healthcare services, and improving health literacy in the community are recommended.

Sociodemographic, psychological, and clinical characteristics associated with health service (non-)use for mental disorders in adolescents and young adults from the general population

Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14-21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p < .001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p < .01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts.

Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity

AIMS

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students.

METHODS

We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS).

RESULTS

Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91).

CONCLUSIONS

Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study

Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.

Parent attributions and attention deficit/hyperactivity disorder knowledge as predictors of specific help-seeking interests

Many children diagnosed with attention deficit/hyperactivity disorder (ADHD) do not receive appropriate services following diagnosis. Although information about ADHD is widely available and abundant, sometimes conflicting information may impede parent help-seeking. The present study examined parent knowledge of ADHD and attributions of child behavior as predictors of interest in formal and informal help seeking at the point of child evaluation for possible ADHD. Participants (89 caregivers of children ages 5-12) completed a measure of ADHD knowledge, rated attributions of child behavior in response to vignettes depicting ADHD symptoms, and indicated their interest in a range of formal and informal services that could be recommended following the child's evaluation. Parents reported strongest interest in academic services followed by medication, child focused therapy, and informal services (e.g., seeking information about ADHD). Family income, ADHD knowledge and attributions that child behavior will persist over time were associated with all types of help-seeking interest except academic services. Perceptions of child control over behavior predicted greater interest in medication. Findings suggest that increasing parent knowledge of ADHD and exploring parent goals and preferences for treatment may increase service utilization for children following assessment/diagnosis of ADHD.

Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on patient and parent care experiences in Germany

BACKGROUND

Paediatric inflammatory bowel disease (PIBD) patients require chronic care over the lifespan. Care for these patients is complex, as it is adapted for childrens' life stages and changing disease activity. Guideline based care for this patient group recommends a multidisciplinary approach, which includes in addition to paediatric gastroenterologists, nutritional and psychological care services. For PIBD patients, a discrepancy between available guideline-based multidisciplinary care and actual care has been found from the provider side, but to what extent patients experience this is unclear.

OBJECTIVES

To identify which healthcare services were used and whether socio-demographic, geographic or disease related factors have an influence on health service utilisation.

METHODS

A standardised questionnaire (CEDNA) was distributed amongst parents of children aged 0-17 diagnosed with PIBD and adolescents (aged 12-17) with a PIBD. Items related to health service use were analysed, these included specialist care, additional care services, reachability of services and satisfaction with care. Logistic regression models on additional service use were calculated. Service availability and reachability maps were made.

RESULTS

Data was analysed for 583 parent and 359 adolescent questionnaires. Over half of the respondents had Crohn's Disease (CD, patients n = 186 parents n = 297). Most patients and parents reported their paediatric gastroenterologist as their main care contact (patients 90.5%; parents 93%). Frequently reported additional services were nutritional counselling (patients 48.6%; parents 42.2%) and psychological support (patients 28.1%; parents 25.1%). Nutritional counselling was more frequently reported by CD patients in both the patient (OR 2.86; 95%CI 1.73-4.70) and parent (OR 3.1; 95%CI 1.42-6.71) sample. Of the patients, 32% reported not using any additional services, which was more likely for patients with an illness duration of less than one year (OR 3.42; 95%CI 1.26-9.24). This was also observed for the parent population (OR 2.23; 95%CI 1.13-4.4). The population-based density of specialised paediatric gastroenterologists was not proportionate to the spatial distribution of patients in Germany, which may have an influence on access.

CONCLUSIONS

Parents and children reported highly specialised medical care. Multidisciplinary care offers do not reach the entire patient population. Access to multidisciplinary services needs to be ensured for all affected children.

Adolescents' difficulties, strengths and feelings of insecurity: a cross-sectional descriptive survey in Finland

The present study aimed to describe adolescents' self-reported emotional and behavioural strengths and difficulties, as well as their insecurity feeling. In addition, the aim was to examine the association with background characteristics, and explore the association between strengths and difficulties and insecurity factors. The study was conducted among 114 secondary school pupils in Finland, using an online questionnaire. Adolescents' emotional and behavioural difficulties and strengths, were mostly classified as normal. Strengths and Difficulties Questionnaire total score as well as internal and external score, were inversely associated with insecurity factors. Girls had significantly higher prosocial behavior compared to boys (P = 0.0007). The age of adolescents was found to be related to their internal difficulties (P = 0.02) and prosocial behavior (P = 0.01). Adolescent's perception of their family relations as poor was associated with external difficulties (P = 0.04). The current results, can be helpful for mental health professionals who work with adolescents in order to implement appropriate and needs specific mental health promotion interventions at individual but also community level. Finally, more research is needed to validate measures for insecurity. This will support mental health professionals in their clinical practice by providing them with all the important factors needed to support adolescents.

Referring students for professional psychological help: A qualitative study of teachers' experience in Hong Kong

Teachers have frequent interaction with students and are well positioned to refer students for mental health assistance when needed. Twelve secondary schoolteachers in Hong Kong were interviewed about their experience referring students to mental health professionals (MHPs). Using consensual qualitative research, multiple factors were found to influence teachers' referral decisions, including problem severity, students' willingness, stigma of help-seeking, parent/guardian's beliefs, teacher-parent/guardian relationship, MHPs' effectiveness and availability, quality of interaction with MHPs, and teachers' self-efficacy in handling student issues. Based on the findings, we propose a conceptual model of factors influencing teachers' referral decisions. Implications for research, practice, and training are discussed.

Treatment Engagement in Adolescents: The Associations of Sociodemographic Characteristics, Caregiver Perceived Barriers, and Clinical Impairment

OBJECTIVE

To examine the associations between sociodemographic characteristics, perceived barriers to treatment, clinical impairment, and youth treatment engagement.

METHOD

Participants included 196 families (youth: ages 12 to 18; 64.3% cis-gender female; 23.5% Black, 60.7% White, and 12.2% Mixed/Other race; 41.3% Hispanic or Latinx ethnicity) recruited as part of a comparative effectiveness trial for adolescent anxiety and depression. Self-report measures of sociodemographic characteristics and caregiver perceived barriers were completed at intake. Youth clinical impairment was assessed at baseline via clinical interview. Measures of engagement were collected throughout treatment, including initiation status, session attendance, and termination status. Relationships were examined using analyses of variances and hierarchal linear and logistic modeling.

RESULTS

Perceived barriers did not differ by sociodemographic characteristics. Greater perceived stressors and obstacles predicted fewer sessions attended and a lower likelihood of successful termination. Youth of caregivers with an advanced degree and those with caregivers who were employed part time attended more sessions and were more likely to initiate and terminate treatment successfully compared to youth with caregivers of a lower education level or student or unemployed status. At higher levels of youth clinical impairment, greater perceived treatment demands and issues predicted reduced likelihood of treatment initiation.

CONCLUSIONS

Perceived barriers, sociodemographic characteristics, and clinical impairment were all associated with levels of engagement in the treatment process. Baseline and continued assessment of perceived and experienced barriers to treatment may promote individualized strategies for families identified as at-risk for reduced engagement.

Mental Health Literacy for Supporting Children: A Systematic Review of Teacher and Parent/Carer Knowledge and Recognition of Mental Health Problems in Childhood

The level of mental health literacy (MHL) in adults who work with or care for children is likely to influence the timeliness and adequacy of support that children receive for mental health problems. The aim of this study was to systematically review the literature on mental health literacy for supporting children (MHLSC, recognition/knowledge) among parents and teachers of school aged children (5 to 12 years old). A systematic search was conducted for quantitative studies published between 2000 and June 2021 using three databases (MEDLINE, PsycINFO and ERIC) and relevant citations reviewed in Scopus. To be included, studies needed to measure at least either 'mental health knowledge' or 'recognition'. Synthesis proceeded according to study design, adult population, child MHP, then MHL outcome. Study quality was assessed using AXIS. 3322 documents were screened, 39 studies met inclusion criteria. 49% of studies examined teachers' knowledge or recognition of ADHD; only five studies reported on parent samples. Synthesis found a nascent field that was disparate in definitions, methods and measures. Little research focussed on knowledge and recognition for internalizing problems, or on parents. Methods used for measuring knowledge/recognition (vignette vs screening) were associated with different outcomes and the quality of studies was most often low to moderate. Adults appear to have good recognition of childhood ADHD but their knowledge of internalizing disorders is less clear. Further research is required to develop standard definitions and validated measures so gaps in MHLSC can be better identified across populations who have a role in supporting children with their mental health.

Understanding parental knowledge, attitudes and self-efficacy in professional help-seeking for child anxiety

BACKGROUND

Child anxiety disorders are highly prevalent yet undertreated. As parents are often 'gatekeepers' to children receiving treatment and support, this study aimed to investigate modifiable parental factors affecting professional help-seeking for their children from general practitioners (GPs), psychologists, and paediatricians.

METHODS

In this study, 257 Australian parents of children aged 5-12 years with elevated anxiety symptoms completed a cross-sectional online survey. The survey assessed help-seeking from a GP, psychologist, and paediatrician (General Help Seeking Questionnaire), as well as anxiety knowledge (Anxiety Literacy Scale), help-seeking attitudes (Attitudes Toward Seeking Professional Psychological Help), personal stigma (Generalised Anxiety Stigma Scale) and self-efficacy (Self-Efficacy in Seeking Mental Health Care).

RESULTS

66.9 % of participants had sought help from a GP, 61.1 % from a psychologist, and 33.9 % from a paediatrician. Help-seeking from a GP or psychologist was associated with lower personal stigma (p = .02 and p = .03 respectively). Participants who sought help from a psychologist also had more positive attitudes toward seeking professional support (p = .01). Conversely, knowledge of anxiety disorders and self-efficacy were not associated with help-seeking from any source.

LIMITATIONS

Limitations of the study include the representativeness of our sample (female gender, higher education level); unexplained variance potentially accounted for by other factors (e.g., structural barriers); lack of prior validation of measures in a parent sample.

CONCLUSIONS

This research will inform the development of public health policy and psychoeducation interventions for parents, to reduce personal stigma and increase positive attitudes toward professional help-seeking, in turn improving help-seeking for child anxiety.

Determinants of depression, problem behavior, and cognitive level of adolescents in China: Findings from a national, population-based cross-sectional study

Introduction

We aimed to assess the associated factors for adolescent depression, problem behavior and cognitive level in China.

Methods

A total of 2,584 adolescents aged from 10 to 15 years old in 2018 were included for analyses. Information on a comprehensive set of potential determinants was collected by the questionnaire, including demographic, health-, school- and family-related factors. Differences in average scores of depression, problem behavior, and cognitive level across subgroups were assessed by two independent sample t-tests and one-way analysis of variance (ANOVA). The clinical relevance among subgroups was assessed by the effect size. Multivariate linear regression models were applied to identify the statistically significant determinants.

Results

School-related factors and parental depressive status were strongly associated with depression. Low maternal education, poor/bad health of adolescents, high academic pressure, and parental depression were significantly associated with behavior problems. The socioeconomic factors, poor academic performance and father's depression were significantly associated with adolescent cognitive level.

Discussion

Multiple associated factors were identified for depression, problem behavior, and cognition of Chinese adolescents, which will provide insights into developing more targeted public health policies and interventions to improve their mental health.

The Help-Seeking Experiences of Family and Friends Who Support Young People With Mental Health Issues: A Qualitative Study

Little has been documented of the journey that family and friends (F&F) undertake when supporting a young person aged 12-25 years struggling with mental illness. The experiences of family and friends were explored using an online qualitative survey (N = 58) and semi-structured interviews (n = 15). Recruitment was through a national youth mental health service Facebook page and website. An experiential thematic analysis was conducted focusing on participants' experiences and sense of their world.Strong feelings and challenging life circumstances made the context of help-seeking complicated. Despite following usual avenues for advice or support, F&F still came across professionals and a health/mental health system that compounded their distress. It was the simpler things that some professionals did that made their journey more bearable. Useful insights derived from the narratives allow service improvement recommendations such as reminding professionals of the multiplicity of stressors commonplace to families and the value of validation and acknowledgement.

Accessing and re-accessing mental health walk-in clinics for children and families

Background

Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs).

Objectives

(1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit.

Design

Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns.

Methods

In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively.

Results

About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit.

Conclusion

MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.

Factors associated with caregiver help seeking behavior among at-risk children

BACKGROUND

Few at-risk school-age children receive needed psychological help, and our understanding of predictors of service use in this population is limited. Many broader contextual factors have received little attention including caregiver's trauma history and social support, father involvement, family functioning, and neighborhood satisfaction. The links between types of and cumulative maltreatment have also been inconsistent, and prior work has not always accounted for children's symptoms.

OBJECTIVE

The current study examined child, caregiver, family, neighborhood, and maltreatment factors in relation to past-year mental health service use among at-risk eight-year-old children. Cumulative and types of maltreatment were both investigated to help elucidate the role of these experiences.

PARTICIPANTS/SETTING/METHOD

Eight hundred and forty-five eight-year-old at-risk children (48.3 % male; 59.5 % Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) were included.

RESULTS

A small portion of children (12.4 %) received psychological help in the previous year. Children's externalizing symptoms, residing with a non-biological caregiver, cumulative maltreatment and sexual and emotional abuse were associated with seeking psychological services, whereas physical abuse, neglect, and domestic violence exposure were not. Other caregiver factors, and family and neighborhood factors were also unrelated.

CONCLUSIONS

Non-biological caregivers as well as caregivers of children with higher levels of externalizing symptoms may be more inclined to seek out mental health services, along with greater, and specific, maltreatment experiences. These findings indicate that child factors may be key in understanding help seeking, however, it is important to further consider other broader contextual factors in future work.

Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children

Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.

Implicit attitudes toward psychotherapy and explicit barriers to accessing psychotherapy in youths and parent–youth dyads

Background

Few studies have investigated implicit and explicit attitudes toward psychotherapy in youths (Study 1), although information about attitudes would improve interventions that aim to decrease barriers to accessing psychotherapy including parents (Study 2), who facilitate the help-seeking process of youths.

Method

The Study 1 sample comprised 96 youths (14–21 years) and the Study 2 sample 38 parent–youth dyads. Differences in implicit attitudes regarding psychotherapy and a medical treatment were measured with the Implicit Association Test, and psychotherapy knowledge and self-reported barriers to psychotherapy were assessed with questionnaires. The actor-partner interdependence model was used to test the dyadic effects of implicit attitudes on explicit attitudes in parents and youths.

Results

We did not find evidence for an implicit bias toward psychotherapy compared to a medical treatment, neither in youths, nor in parents. Self-reported barriers were a predictor for lower help-seeking intentions. Deficits in psychotherapy knowledge were more relevant in younger participants. Having a prior or current experience with psychotherapy and having a friend or family member with a prior or current experience with psychotherapy were predictors for better psychotherapy knowledge, but was not for lower barriers to accessing psychotherapy. Partner effects (degree to which the individual’s implicit attitudes are associated with explicit attitudes of the other dyad’s member) were not found.

Conclusion

Specific deficits in psychotherapy knowledge should be addressed in interventions to lower barriers accessing psychotherapy. Parents should be included in interventions as a valuable resource to support youths in seeking psychotherapy for mental disorders.

Chinese adolescents' depression, anxiety, and family mutuality before and after COVID-19 lockdowns: Longitudinal cross-lagged relations

Objective

This study aimed to investigate the longitudinal cross-lagged association between family mutuality, depression, and anxiety among Chinese adolescents before and after the COVID-19 lockdown in 2020.

Background

Limited attention has been paid to the longitudinal links between family mutuality, depression, and anxiety in the context of the COVID-19 pandemic.

Method

We used self-administered questionnaires to collect data from three high schools and two middle schools in Chengdu City at two time points: Time 1 (T1), December 23, 2019-January 13, 2020; Time 2 (T2), June 16-July 8, 2020. The sample consisted of 7,958 participants who completed two wave surveys before and after the COVID-19 lockdown. We analyzed the data using cross-lagged structural equation modeling.

Results

The longitudinal cross-lagged model showed family mutuality at T1 significantly predicted depression, anxiety, and family mutuality at T2. We observed a decreasing prevalence of depression and anxiety after the COVID-19 lockdown.

Conclusion

Family mutuality plays an important role in mitigating long-term mental health disorders, such as depression and anxiety. More family-centered psychological interventions could be developed to alleviate mental health disorders during lockdowns.

Implications

Improving family mutuality (e.g., mutual support, interaction, and caring among family members) could be beneficial for reducing mental health disorders among Chinese adolescents during the COVID-19 pandemic.

Lived experiences of parents providing care to young people who self-harm: a protocol for a meta-aggregative synthesis of qualitative studie

INTRODUCTION

The self-harm of young people can cause tremendous distress to their parents/carers and impair parents' ability to provide care. At the same time, parents play an essential role in supporting their child during the management and treatment of self-harm. The synthesis of evidence about parental experiences and needs can inform mental health practice and the development of interventions to provide better care to young people who self-harm and their parents.

METHODS AND ANALYSIS

A comprehensive search will be conducted across several information sources, including multiple electronic databases (eg, PubMed, Embase, CINAHL, PsycINFO, ProQuest, CNKI, Wanfang, VIP and SinoMed), grey literature, the websites of specific organisations and hand-searched reference lists of all the relevant studies. Qualitative studies published in English or Chinese and focusing on the lived experiences of parents whose child self-harms will be included. Two reviewers will independently screen all the retrieved articles according to the flow diagram proposed by PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two independent reviewers will then appraise the methodological quality of all the included articles using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. The meta-aggregation approach will be used to synthesise the findings of the included qualitative studies, and the level of confidence in the synthesised findings will be assessed using the Confidence in the Qualitative synthesised finding approach.

ETHICS AND DISSEMINATION

No additional ethical clearance is required since this review is a secondary analysis of published primary studies. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42021265525.

Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors

Objectives: Emerging adulthood-spanning 18-29 years of age-is associated with the highest risk for onset of certain behavioral health disorders (e.g. major depression, bipolar disorder, psychosis, substance use disorders) and high prevalence of many behavioral health disorders. Yet, rates of mental health service use remain low in this age range. Racial/ethnic minorities are particularly impacted by individual, cultural/linguistic, and community-level barriers to mental health care. This study examined community-level factors associated with mental health service use and investigated whether these associations varied by race/ethnicity.Design: This study analyzed individual- and county-level data for emerging adults in the United States (N=3,294) from the nationally representative Collaborative Psychiatric Epidemiological Surveys (CPES). Using the Andersen Model of Health Care Utilization, analyses examined predisposing, enabling, and need factors utilized in prior studies with adult samples as well as novel community characteristics hypothesized to impact service use among emerging adults of diverse racial/ethnic backgrounds. Past-year use of both specialty and any mental health services were assessed, controlling for individual- and community-level variables, and adjusting for presence of past-year mental health disorder, overall health status, and functional impairment. Differences between racial/ethnic minority groups and Non-Latino Whites were tested through a multilevel model incorporating random intercepts logistic regression, with analysis focusing on the interaction between race/ethnicity and community-level supply variables.Results: For past-year use of specialty mental health services, density of hospitals with child wellness programs was linked to service use among Black emerging adults, whereas density of hospitals with linguistic/translation services was linked to service use among Latino emerging adults.Conclusions: This study expands on previous research in behavioral health disparities to examine ways to improve behavioral health services for an emerging adult population with unmet service needs and identifies specific community-level factors that can improve mental health for racial/ethnic minority emerging adults.

Correlates of caregiver's help seeking behavior among young maltreated children

BACKGROUND

Relatively few maltreated children receive mental health services, despite the importance of treatment in combating the deleterious impact of maltreatment. Characteristics of the child, caregiver, and family have been investigated in relation to caregiver's help seeking behavior for children's psychological difficulties; yet, these associations have been inconsistent, and are very understudied among younger maltreated children. Other aspects of the child's environment, such as father involvement, negative life events, and neighborhood risk and satisfaction have not been examined. It is also uncertain how cumulative maltreatment and the specific forms of maltreatment - sexual, physical, and emotional abuse, neglect, and domestic violence, are associated with mental health consultation.

OBJECTIVE

The aim of the current study was to utilize an ecological model that included child, caregiver, family, neighborhood, and maltreatment factors to better understand caregiver's help seeking behavior.

PARTICIPANTS/SETTING/METHOD

The study relied upon 448 six-year-old maltreated children (47.5% male; 48.7% Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study.

RESULTS

Several factors, including child's gender and externalizing symptoms, and caregiver educational attainment and depression and were associated with mental health consultation. Cumulative maltreatment, however, was unrelated. When the specific forms of maltreatment were included, none of the individual maltreatment types were tied to help seeking behavior.

CONCLUSIONS

Child and caregiver factors, such as child's level of behavioral challenges as caregiver's level of education and depression, may contribute to decisions regarding seeking services for young, maltreated children. However, neither cumulative nor the forms of maltreatment may correspond with help seeking among young, maltreated children.

Young help-seeker profiles in Israel: The case of the first Israeli headspace centre

AIM

To describe clinical and demographic characteristics of youths who seek help at the first Headspace centre in Israel and their families.

METHODS

A sample of 291 (65%) of the youths (12- to 25-year-olds) who applied to Headspace between March 2016 and June 2018 completed an assessment, including reasons for referral and clinical status; the Kessler Psychological Distress Scale, evaluating psychological distress; and the Strengths and Difficulties Questionnaire, measuring emotional and behavioural difficulties. Their families reported burden of care via the Burden Assessment Scale.

RESULTS

Of the sample, 75% were between the ages of 12 and 17 years (equal gender distribution); for 45%, Headspace was their first encounter with mental health services. Participants' most-reported referral source was school counsellors (27%), and presenting concern (51%) was emotional problems, mainly depression (18%) and anxiety (16%). Female and older participants had more emotional difficulties than did males and younger participants, respectively. Overall, most help-seekers expressed high distress levels upon entry, and their family's burden was associated with those levels.

CONCLUSIONS

This first study of the first Headspace centre in Israel sheds light on and broadens knowledge about young help-seekers of Headspace outside of Australia. It emphasizes the trend across all ages of help-seeking youths with high psychological-distress levels and the role of family and school staff in the help-seeking process. Establishing youth services that improve access and deliver early intervention to a widely underserved population at times of high distress can be a global trajectory.

Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis

Background

A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear.

Objectives

The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved.

Methods

Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0.

Results

The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma.

Conclusion

The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics

OBJECTIVES

New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein.

SETTING

Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics.

PARTICIPANTS

Data on 126 095 youth (0-18 years) were available for analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary, specialised and residential youth care use were the primary outcomes.

RESULTS

Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time.

CONCLUSION

Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Oxytocin receptor gene (OXTR) polymorphisms and social, emotional and behavioral functioning in children and adolescents: a systematic narrative review

This study systematically reviewed available evidence regarding associations between polymorphisms of the oxytocin receptor (OXTR) gene and socio-emotional and behavioral functioning in children and adolescents. The search yielded 69 articles, which were grouped into nine categories: depression, anxiety, and internalizing symptoms, alcohol abuse, borderline personality disorder, conduct disorder symptoms or diagnosis, autism spectrum disorder, Attention deficit hyperactivity disorder, early childhood attachment and behavior, pro-social skills, and resilience. Direct and/or gene x environment interactions were identified in over half of the studies. ASD and conduct disorder (including callous unemotional traits) were the diagnoses that were most studied and for which there was the strongest evidence of direct links with OXTR polymorphisms. In most studies identifying gene x environment interactions, the candidate OXTR polymorphism was rs53576. Results suggest that OXTR polymorphisms are associated with social, emotional or behavioural functioning in children and adolescents. The mixed findings do, however, highlight the need for further research.

The black hole of the transition process: dropout of care before transition age in adolescents

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

Teacher-reported emotional and behavioural problems and ethnic background associated with children's psychosocial care use: a longitudinal population-based study

Approximately, 15% of children in Western countries suffer from emotional and behavioural problems. However, not all children receive the psychosocial care they need, especially children with a non-Western background experience an unmet need for care. This might be because parents of non-Western children report a lower need for care than parents of Western children, unrelated to the actual need. This study examined the association between teacher-reported problems and psychosocial care use, independent of mother-reported problems. Further, the role of ethnic background in this association was investigated. The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3084), a prospective, population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured via questionnaire when the children were  6/7 years old. Psychosocial care use was mother-reported at the research centre when children were 9 years old (8.1%). Hierarchical logistic regressions showed significant positive associations between teacher-reported total, externalising and internalising problems and later psychosocial care use. These associations were independent of mother-reported problems. Children with a non-Western background used less care, but ethnic background did not moderate the association between teacher-reported problems and care use. Our findings suggest that teachers might have an important role, next to parents, in the identification of problems and children's access to care. This may be particularly important for non-Western children, as they use less psychosocial care than Western children, despite other research showing that they generally display higher levels of problems. Directions for future research and implications are discussed.

Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review

INTRODUCTION

Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents.

METHODS

PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies.

RESULTS

Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others.

CONCLUSIONS

A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.

The Child Mental Health Treatment Gap in an Urban Low-Income Setting: Multisectoral Service Use and Correlates

OBJECTIVE

To efficiently target capacity-building efforts for child mental health services in low- and middle-income countries (LMICs), it is critical to define how care is structured across sectors and individual-level factors.

METHODS

In a community-based sample of 1,408 children and adolescents (ages 6-15 years) from Itaboraí, Brazil, the authors assessed need and service use across four care systems (mental health specialty, health, welfare, and informal). Individual-level factors included child gender and age, maternal perception of child mental health need, paternal absence, maternal education, and maternal anxiety and depression.

RESULTS

The mental health treatment gap was 88%, with only 12% of children with psychiatric problems using mental health services. Children with mental health problems were more likely than those without these problems to use health and other sectors of care and to use services in more than one sector of care. Overall, 46% of the children with any clinical mental health problems and 31% of those with only internalizing problems were identified by their mothers as having a mental health need. Among those with clinical mental health problems, factors associated with mental health service use were being a boy and paternal absence but not mental health problem type or maternal awareness.

CONCLUSIONS

Closing the child mental health treatment gap in urban settings in LMICs where resources are scarce will likely require system-level changes, such as engagement of diverse service sectors of care. Interventions need to target increased maternal awareness about mental health problems and encourage provision of mental health services to girls.

Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers' parental attributions on professional help-seeking intentions

There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers' attributions about their child's problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers' anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β =  - .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β =  - .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.

Children's use of psychosocial care in a population-based longitudinal study: less likely for girls, children with a non-Western background and children with a high quality of life

Knowledge on determinants of children's psychosocial care use is important to improve their access to care. This study examined the independent contributions of need and predisposing factors to psychosocial care use in 9-year-old children, guided by the Gateway Provider Model. Data of the Generation R Study, a prospective cohort of children born in Rotterdam, the Netherlands, were analysed using multivariable logistic regression (n = 4714). Need (quality of life, presence and type of emotional/behavioural problems) and predisposing factors (sex, ethnic background and maternal educational level) were measured using parent questionnaires at multiple time points between ages 1.5 and 9 years. Psychosocial care use was parent-reported at 9 years old (9.6% among children with Western background, 7.3% among children with non-Western background). Having emotional/behavioural problems at 5 and 9 years old was associated with more care use, while having a higher quality of life, being a girl and having a Moroccan/Turkish or other non-Western background were associated with less care use. Externalising and internalising problems, as well as several types of problems, at 5 and 9 years old were associated with psychosocial care use. Stratified analyses revealed that, in children with non-Western backgrounds, only a poorer psychosocial quality of life was associated with psychosocial care use. To conclude, girls with a Western background and children with a non-Western background were less likely to receive care compared to their peers. Children with parent-reported emotional/behavioural problems at 5 and 9 years old and decreased quality of life at 5 years old were more likely to receive psychosocial care use at 9 years old. Our findings hold relevance for preventive policies.

Professional and informal help-seeking among low-income adolescents exposed to violence in the community and at school

BACKGROUND

Adolescents may seek help for many reasons beyond health needs, such as personal stress due to violence exposure.

OBJECTIVE

To investigate factors associated with receiving professional assistance and informal help due to violence exposure in the community and at school.

PARTICIPANTS AND SETTING

This study was conducted in Itaboraí, a low-income medium-size city in the State of Rio de Janeiro, Southeast Brazil, characterized by poverty, inequality and violence. It analyses data reported by 669 in-school adolescents (11-15-years, 51.7% girls).

METHODS

This is a cross-sectional study nested in a longitudinal study (Itaboraí Youth Study). The Itaboraí Youth Study involved a probabilistic community-based sample of 1409 6-to-15-year-olds based on a 3-stage probabilistic sampling plan that included a random selection of census units, eligible households and the target child.

RESULTS

Professional assistance was mainly received from psychologists (the Brazilian population has free access to health services). Family members were the main source of informal help. Correlates of professional assistance were having clinical emotional problems and not counting on an adult (if needing help) for community violence victims, and absent father for community and school violence victims. Correlates of informal help were female sex, maternal anxiety/depression and absent father for community violence victims, and younger age and higher maternal education for school violence victims.

CONCLUSIONS

The mental health needs of violence victims, and maternal difficulties to deal with the adolescent distress resulting from violence exposure (maternal increased burden due to father absence and/or having anxiety/depression) are important influences on the help-seeking process.

Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care

The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.

Examining social context and the pathways to mental wellness in young adults during social movement: A parallel mediation analysis

BACKGROUND

Good family relationships are important for mental health. However, the mechanism linking family perceptions to mental wellness during political and social turmoil remains unclear. This study aimed to examine whether psychological and social factors could protect university students from detrimental mental health conditions in a time of social chaos.

METHODS

Participants included young adults (n = 1874, mean age = 22.19 years) who had been enrolled in Hong Kong local tertiary intuitions during Hong Kong's 2019 social movement. An online survey assessing various conditions, including family satisfaction, social support, personal resilience, negative moods, sense of school belonging, and mental health conditions before and during the movement, was administered to these students. Mediation analyses were performed to examine the role of negative affect, support from family, and school belongingness as mediators of the association between family satisfaction and mental health condition during the movement overall and by resilience subgroups.

RESULTS

Higher levels of satisfaction with family relationships before the onset of movement was associated with lower levels of negative affect and higher levels of support from family and school belongingness during the movement, in turn benefiting the student's mental health. The links of family satisfaction and school belongingness with mental wellness were particularly strong among low-resilient students.

LIMITATIONS

Mediation analysis using retrospective survey data CONCLUSIONS: Family conditions would interact with personal resilience to influence mental health status during social turmoil. The findings underscore the importance of early interventions particularly for those students facing family difficulties to enhance their social chaos and emergency preparedness.

The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial

Background

Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments.

Method

Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT.

Discussion

This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments.

Trial registration

This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00213-x.

Adolescents' symptoms of anxiety and depression before and during the Covid-19 outbreak - A prospective population-based study of teenagers in Norway

BACKGROUND

Lockdown policies related to the Sars-Cov-2 pandemic has potential negative consequences for mental health in youths.

METHODS

Anxiety and depressive symptoms were assessed in 3 572 adolescents, age 13 to 16 using the Hopkins Symptom Checklist (HSCL-10), in a representative longitudinal survey of Norwegian youths between February 2019 (T1) and June 2020 (T2). Predictors for symptom change were analysed with linear mixed-effects models.

FINDINGS

Overall, clinical levels of anxiety and depression increased slightly from 5.5% at T1 to 6.3% at T2; Chi square 224.4 (df = 1), p<.001. However, the observed change was driven by the increase in age between assessments. Being a girl, having pre-existing mental health problems, and living in a single-parent household at T1, predicted higher levels of anxiety and depressive symptoms at T2 (p<.001). Living in a single-parent household was associated with a significant increase in symptoms, also when age was controlled for (p<.001). Living in a poor family however, or having a history of maltreatment, was associated with a significantly lower increase in symptoms (p<.001).

INTERPRETATION

Anxiety and depressive symptoms increased slightly in Norwegian youths between 2019 and 2020, but this change seemed to be driven by increase in age rather than pandemic-related measures. Symptom levels were unevenly distributed across demographic groups both before and during the pandemic outbreak, indicating that health disparities persist for adolescents in risk groups during a pandemic . Health inequities related to living conditions need to be addressed in future action plans, and intensified measures to mitigate inequities are needed.

FUNDING

The study was funded by the Norwegian Directorate for Children, Adolescents and Family affairs (Bufdir).

Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11): A Validation Study

Caregiver strain is associated with caregiver and child well-being and clinical outcomes. The present study examined the psychometric properties of a revised 11-item measure of caregiver strain, the Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11). In a sample of 962 caregivers, we found support for a three-factor model of the CGSQ-SF11, consisting of objective (e.g., financial impact), subjective internalized (e.g., sadness about the child's problems), and subjective externalized (e.g., anger directed toward the child) strain factors. Measurement invariance was supported across multiple demographic and clinical groups, and all three subscales displayed high internal consistency. Convergent validity was also supported through positive correlations with measures of child psychopathology symptoms and psychosocial impairment. Moreover, caregiver strain was associated with number of child disorders as well as breadth of child symptoms across both internalizing and externalizing domains. Findings provide initial validation of the CGSQ-SF11 as a comprehensive yet brief measure of caregiver strain.

The Missing Link(age): Multilevel Contributors to Service Uptake Failure Among Youths on Community Justice Supervision

OBJECTIVES

Youths in the juvenile justice system often do not access needed behavioral health services. The behavioral health services cascade model was used to examine rates of substance use screening, identification of substance use treatment needs, and referral to and initiation of treatment among youths undergoing juvenile justice system intake and to identify when treatment access is most challenged. Characteristics associated with identification of behavioral health needs and linkage to community services were also examined.

METHODS

Data were drawn from administrative records of 33 community justice agencies in seven states participating in Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System, funded by the National Institute on Drug Abuse (N=8,307 youths). Contributions of youth, staff, agency, and county characteristics to identification of behavioral health needs and linkage to community services were examined.

RESULTS

More than 70% (5,942 of 8,307) of youths were screened for substance use problems, and more than half needed treatment. Among those in need, only about one-fifth were referred to treatment, and among those referred, 67.5% initiated treatment. Overall, <10% of youths with identified needs initiated services. Multivariable multilevel regression analyses revealed several contributors to service-related outcomes, with youths' level of supervision being among the strongest predictors of treatment referral.

CONCLUSIONS

Community justice agencies appear to follow an approach that focuses identification and linkage practices on concerns other than youths' behavioral health needs, although such needs contribute to reoffending. Local agencies should coordinate efforts to support interagency communication in the referral and cross-system linkage process.

Parent-perceived barriers to accessing services for their child's mental health problems

BACKGROUND

Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS.

METHOD

In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child.

RESULTS

The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking.

CONCLUSION

Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.

Conceptual causal models of socioeconomic status, family structure, family functioning and their role in public health

Social determinants of health frameworks are standard tools in public health. These frameworks for the most part omit a crucial factor: the family. Socioeconomic status moreover is a prominent social determinant of health. Insofar as family functioning is poorer in poor families and family structure and functioning are linked to health, it is critical to consider the pathways between these four constructs. In this correspondence, we reflect on how empirical studies of this conceptual nexus mirror two causal models. We conclude by reflecting on future directions for research in this field.

Re-Accessing Community Mental Health Services for Children and Adolescents

A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario (N = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.

Treatment for Adolescent Depression: National Patterns, Temporal Trends, and Factors Related to Service Use Across Settings

PURPOSE

Untreated major depression can lead to various negative health and social consequences among adolescents. This study aimed to examine national patterns, temporal trends, and factors related to U.S. adolescents' mental health service use for 12-month major depression across service settings.

METHODS

Data on adolescents aged 12-17 years who received treatment for their 12-month major depression were drawn from the National Survey on Drug Use and Health, 2011-2018. Patterns, trends, and factors related to adolescents' service use in specialty mental health, educational, and general medical settings and multiple settings were examined using bivariate and multivariate logistic regression.

RESULTS

Across the survey years, service use in specialty mental health settings was the most common, followed by educational and general medical settings. A significant increase was observed in adolescents' specialty mental health service use (p < .001) over time, whereas the rates of service use in educational and general medical settings remained stable. Approximately 40% of adolescents who were treated for 12-month depression received services in multiple settings each year, with no significant change over time. Among multisetting service users, combined service use in specialty mental health and educational settings was the most common. Adolescents' age, race, gender, insurance status, family income, and school experiences significantly influenced their service use across settings.

CONCLUSIONS

Continued efforts are needed to improve service provision for adolescents with depression, especially in educational and general medical settings. Strengthened funding and policy support are warranted to expand safety-net mental health services for uninsured, low-income, and racial/ethnic minority adolescents.

Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use

OBJECTIVE

Adolescents at risk for suicide are highly heterogeneous in terms of psychiatric and social risk factors, yet there has been little systematic research on risk profiles, which would facilitate recognition and the matching of patients to services. Our primary study aims were to identify latent class profiles of adolescents with elevated suicide risk, and to examine the association of these profiles with mental health service use (MHSU).

METHOD

Participants were 1,609 adolescents from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) cohort. Participants completed baseline surveys assessing demographics, MHSU, and suicide risk. Telephone follow-up interviews were conducted at 3 months to assess suicide attempts. Participants met pre-established baseline criteria for suicide risk.

RESULTS

Using latent class analysis, we derived 5 profiles of elevated suicide risk with differing patterns of eight risk factors: history of multiple suicide attempts, past-month suicidal ideation, depression, alcohol and drug misuse, impulsive-aggression, and sexual and physical abuse. In comparison to adolescents who did not meet baseline criteria for suicide risk, each profile was associated with increased risk of a suicide attempt within 3 months. The MHSU was lowest for adolescents fitting profiles with previous (but no recent) suicidal thoughts and behavior, and for adolescents from racial and ethnic minority groups.

CONCLUSION

Adolescents at elevated risk for suicide present to emergency departments with differing profiles of suicide risk. MHSU varies across these profiles and by race/ethnicity, indicating that targeted risk recognition and treatment linkage efforts may be necessary to reach some adolescents at risk.