Stability and change in the mental health of New Zealand secondary school students 2007-2012: results from the national adolescent health surveys

Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys

AIM

Research has indicated a rise in the prevalence of depression and anxiety among adolescents over the past three decades. However, the factors underpinning increases in mental health difficulties remain poorly understood. This study examines psychological, social and environmental risk and protective factors that may explain changes in depression and anxiety among adolescents.

METHODS

Data were taken from two nationally representative My World Surveys of adolescents aged 12-19 years in 2012 (N = 5,490) and 2019 (N = 9,844). Survey data on depression and anxiety and a range of potential risk (e.g., alcohol use, psychotic symptoms) and protective factors (e.g., resilience, self-esteem) were assessed at both time points. Multiple group analyses assessed whether the predictive ability of risk/protective factors changed from wave 1 to wave 2.

RESULTS

Results showed that the prevalence of depression and anxiety increased significantly between 2012 and 2019, particularly among females. Predictors accounted for between 37% and 61% of the variance in outcomes across waves. While some risk/protective factors were consistent predictors of depression and anxiety at both waves (e.g., bullying, discrimination, optimism), reporting female gender and having higher formal help-seeking tendencies more strongly predicted anxiety at wave 2, while lower self-esteem and lower resilience (personal competence) strongly predicted both depression and anxiety at wave 2.

CONCLUSION

Findings highlight the need to prioritize adolescent mental health service provision, especially in females. Self-esteem and resilience are potentially important targets for supporting adolescent mental health. Further research is required to understand the causal factors associated with increases in anxiety and depression.

Universal, school-based transdiagnostic interventions to promote mental health and emotional wellbeing: a systematic review

OBJECTIVE

This systematic review aims to evaluate the effectiveness of universal school-based transdiagnostic interventions in promoting the mental health of children and adolescents. It compares and discusses interventions targeting the prevention of mental disorders versus the promotion of mental health. Additionally, the roles of teachers and psychologists as intervention conductors are examined.

METHODS

A comprehensive search of the Psycinfo, Pubmed, and Web of Science databases was conducted without any time restrictions to identify relevant literature on universal school-based transdiagnostic interventions promoting children and adolescents' mental health.

RESULTS AND DISCUSSION

The findings reveal that universal school-based transdiagnostic promotion/prevention programs have a small to medium overall effect size. These interventions demonstrate a broad coverage of different aspects of children and adolescents' mental health. However, the relative effectiveness of teacher-led versus psychologist-led interventions remains unclear. Interventions focused on preventing mental disorders exhibit a higher effect size, albeit on a narrower range of mental health aspects for children and adolescents.

SIGNIFICANCE

This study enhances our understanding of universal school-based transdiagnostic interventions and their impact on children and adolescents' mental health. Further research is needed to elucidate the comparative efficacy of teacher-led and psychologist-led interventions and to explore the specific dimensions of mental health targeted by these interventions.

Poorer self-reported mental health and general health among first year upper secondary school students do not predict school dropout: a five-year prospective study

Introduction

Education is important for socioeconomic, work and health status; thus, dropping out of secondary school is of major concern. In Norway, 1 out of 5 is dropping out from upper secondary education. Academic performance is a known predictor for dropout, but the role of mental and general health status is studied less.

Methods

By use of student data collected during the first school year we examined the accumulated risk of school dropout over 5 years. Students entering upper secondary school in a North-Norwegian region (Troms County) completed a comprehensive questionnaire during August 2010 (N = 1,676, 69% response rate). The contribution of mental and general health problems in predicting five-year dropout was of primary interest, adjusted for demographics and academic performance.

Results

One-third of the students had dropped out after 5 years. A logistic regression analysis showed no significant effect of mental and general health problems on dropout. Among the covariates, higher grades from lower secondary education reduced the chance of dropping out (OR = 0.31; p < 0.001). Subgroup analyses showed that students in the vocational track reported poorer mental and general health, compared to students in the general track, but this difference was not related to dropout. General track students were also less likely to drop out than vocational track students (OR for dropout 0.66; p < 0.05).

Discussion

In conclusion, lower grades from lower secondary education represented a warning flag for school dropout during upper secondary education whereas mental health issues were not.

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

The influence of media use degree on public depressive symptoms: mediating role of big five personality

BACKGROUND

Mixed results have been found regarding the relationship between media use degree and depressive symptoms. The purpose of this study is to explore the relationship between media use degree, big five personality and depressive symptoms with a mediation model.

METHOD

This was a cross-sectional study. With 9-item Patient Health Questionnaire (PHQ-9), 10-item Big Five Inventory (BFI-10) and self-designed media usage scale, 11,031 participants aged 12 and above in 120 cities in China were collected. Pearson correlation analysis and regression analysis were performed on the data. The Process plug-in was used to construct the mediation model and explore the relationship among media use degree, big five personality and depressive symptoms. The nonparametric percentile Bootstrap method was used to test the mediating effect of personality traits.

RESULTS

The degree of media use was positively correlated with depressive symptoms (r = 0.20, P < 0.001), and big five personality played a mediating role between the degree of media use and depressive symptoms. Among five traits, extroversion (r=-0.12, P < 0.001), conscientiousness (r=-0.23, P < 0.001), openness (r=-0.03, P < 0.01) and agreeableness (r=-0.22, P < 0.001) were negatively correlated with depressive symptoms, and neuroticism (r = 0.25, P < 0.001) were positively correlated with depressive symptoms. In addition, extraversion (-0.004, -0.001), conscientiousness (-0.015, -0.008), agreeableness (-0.008, -0.001) and neuroticism (-0.015, -0.007) in big five personality played a mediating role between media use and depressive symptoms.

CONCLUSION

The degree of media use positively predicted depressive symptoms, and excessive media use may bring risks to mental health. People with high neuroticism, low agreeableness, low conscientiousness and low extroversion are more likely to suffer from depressive symptoms.

Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys

OBJECTIVE

To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students.

METHODS

Representative cross-sectional youth health surveys with 2-4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548).

RESULTS

In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale-Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Māori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students.

CONCLUSION

Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Māori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened.

Eating disorders, disordered eating, and body image research in New Zealand: a scoping review

BACKGROUND

The prevention and treatment of eating disorders relies on an extensive body of research that includes various foci and methodologies. This scoping review identified relevant studies of eating disorders, body image, and disordered eating with New Zealand samples; charted the methodologies, sample characteristics, and findings reported; and identified several gaps that should be addressed by further research.

METHODS

Using scoping review methodology, two databases were searched for studies examining eating disorders, disordered eating, or body image with New Zealand samples. Snowball methods were further used to identify additional relevant articles that did not appear in initial searches. Two independent reviewers screened the titles and abstracts of 473 records. Full text assessment of the remaining 251 records resulted in 148 peer-reviewed articles being identified as eligible for the final review. A search of institutional databases yielded 106 Masters and Doctoral theses for assessment, with a total of 47 theses being identified as eligible for the final review. The included studies were classified by methodology, and the extracted information included the study foci, data collected, sample size, demographic information, and key findings.

RESULTS

The eligible studies examined a variety of eating disorder categories including binge-eating disorder, bulimia nervosa, and anorexia nervosa, in addition to disordered eating behaviours and body image in nonclinical or community samples. Methodologies included treatment trials, secondary analysis of existing datasets, non-treatment experimental interventions, cross-sectional observation, case-control studies, qualitative and mixed-methods studies, and case studies or series. Across all of the studies, questionnaire and interview data were most commonly utilised. A wide range of sample sizes were evident, and studies often reported all-female or mostly-female participants, with minimal inclusion of males and gender minorities. There was also an underrepresentation of minority ethnicities in many studies, highlighting the need for future research to increase diversity within samples.

CONCLUSION

This study provides a comprehensive and detailed overview of research into eating disorders and body image in New Zealand, while highlighting important considerations for both local and international research.

Media use degree and depression: A latent profile analysis from Chinese residents

Background

Previous studies have emphasized the media as an essential channel for understanding information about depression. However, they have not divided groups according to the degree of media use to study their differences in depression. Therefore, this study aims to explore the influence of media use on depression and the influencing factors of depression in people with different media use degrees.

Methods

Based on seven items related to media use, a total of 11, 031 respondents were categorized by the frequency of media use using latent profile analysis (LPA). Secondly, multiple linear regression analyzes were conducted to analyze the effects of depression in people with different degrees of media use. Finally, factors influencing depression among people with different degrees of media use were explored separately.

Results

All respondents were classified into three groups: media use low-frequency (9.7%), media use general (67.1%), and media use high-frequency (23.2%). Compared with media use general group, media use low-frequency (β = 0.019, p = 0.044) and media use high-frequency (β = 0.238, p < 0.001) groups are significantly associated with depression. The factors influencing depression in the population differed between media use low-frequency, media use general, and media use high-frequency groups.

Conclusion

The government and the appropriate departments should develop targeted strategies for improving the overall health status of people with different media use degrees.

Prefrontal cortex neural activity predicts reduction of non-suicidal self-injury in adolescents with major depressive disorder: An event related potential study

Background

Non-suicidal self-injury (NSSI) is common in adolescent MDD, which is also a risk factor for suicide. However, there is few research on biomarkers and predictors about treatment response of NSSI. The purpose of this study was to find the difference of P300 between adolescent MDD with NSSI and healthy controls, and to explore whether the baseline electrophysiological level can predict the change of NSSI after treatment.

Methods

We collected 62 first-episode drug-naïve MDD adolescents with NSSI (MDD with NSSI group) and 44 healthy controls (HC group). The demographic data, HAMD score, self-injury frequency and electrophysiological level of NSSI group and HC group were collected. The HAMD score, frequency of NSSI in was also collected after 8 weeks of antidepressant treatment.

Results

Compared to HC, the latency of the N2, P3a, and P3b components were significantly prolonged, whereas the amplitude of P3a and P3b were decreased in the MDD with NSSI group (P < 0.001). The frequency of self-injury decreased significantly after treatment (P < 0.001). Regression analysis showed that the amplitudes of P3b had a significant positive predictive effect on the rate of change of NSSI frequency after 8 weeks.

Conclusion

P3b at baseline can be used as potential predictor for the reduction of NSSI in adolescent MDD.

Development of guidelines for school staff on supporting students who self-harm: a Delphi study

OBJECTIVE

Self-harm is a major public health issue that significantly impacts communities, making early intervention and prevention paramount in addressing this public health issue. This study aimed to develop evidence-based, culturally responsive, safe, and practical guidelines to assist school staff in effectively supporting students who self-harm.

METHODS

This Delphi study comprised of a five-step process, oversighted by a Rōpū Mātanga Māori (Māori clinical and cultural governance group), and drawing on the expertise and knowledge gained from existing literature, interviews with stakeholders, and two panels of experts (youth and stakeholders). The Rōpū Mātanga Māori ensured accountability to the principles of Te Tiriti o Waitangi (Treaty of Waitangi) and kept Māori processes central to the research aims. The panels completed two rounds of questionnaires, rating their endorsement of each statement. Statements rated as important or essential by 80% or more of both panels and Māori participants were included in the final guidelines. The Rōpū Mātanga Māori reviewed any remaining statements to determine inclusion.

RESULTS

Following the five-step process, 305 statements were included in the guidelines. These statements provided guiding actions that endorsed communication, collaborative responsibility, and wellbeing and a student-centred approach.

CONCLUSION

The guidelines provide guidance to all school staff that is culturally responsive and safe, consensus-based, and evidence-based. It is informed by the voices and experiences of young people and those who support them.

Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study

INTRODUCTION

Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines.

METHODS

The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and 25 years, and 81.8% identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0% identified as female, and 37.0% as male. The data were analyzed using thematic analysis to identify key themes.

RESULTS

Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students' agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach.

CONCLUSION

The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.

The Explanatory Role of Sedentary Screen Time and Obesity in the Increase of Chronic Back Pain among European Adolescents: The HBSC Study 2002-2014

Background

Previous research has shown that chronic back pain amongst European adolescents is increasing. Determining the factors associated with this increasing trend is crucial for developing prevention strategies. In this study, we used data from the Health Behaviour in School‐aged Children (HBSC) survey to examine whether increases in screen time and/or obesity between 2002 and 2014 were associated with the increase in the prevalence of chronic back pain amongst European adolescents during the 12‐year period.

Methods

Data from 423,092 adolescents from 27 European countries/regions were drawn from the HBSC questionnaire‐based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson–Holm–Breen method was used to examine the explanatory role of increases in screen time and obesity on the increase in the prevalence of chronic back pain whilst controlling for sex and age.

Results

Increases in both screen time and obesity between 2002 and 2014 were associated with increases in the prevalence of chronic back pain (p < 0.001). The percent of chronic back pain prevalence increase accounted for by screen time and obesity was 3.98% and 1.65%, respectively.

Conclusions

The increase in the prevalence of chronic back pain amongst European adolescents may be explained, in part, by the rising trends in both sedentary screen time and obesity. The fact that screen time and obesity only accounted for a small part of the increase in the prevalence of chronic back pain indicates that other unmeasured factors also play a role.

Significance

More screen time and obesity are slightly associated with more chronic back pain (CBP) prevalence in adolescents across the WHO European Region. The findings may be used to identify ways to prevent or reduce the rising trend of CBP in adolescents.

Well-being app to support young people during the COVID-19 pandemic: randomised controlled trial

OBJECTIVES

To evaluate the efficacy and acceptability of 'Whitu: seven ways in seven days', a well-being application (app) for young people.

DESIGN

Prospective randomised controlled trial of Whitu against waitlist control, with 45 participants in each arm.

PARTICIPANTS

90 New Zealand young people aged 16-30 recruited via a social media advertising campaign.

SETTING

Participants' homes.

INTERVENTIONS

Developed during the COVID-19 pandemic, and refined from a prototype version that was evaluated during a smaller qualitative study, 'Whitu: seven ways in seven days' is a well-being app that, as its name suggests, contains seven modules to help young people (1) recognise and rate emotions, (2) learn relaxation and mindfulness, (3) practice self-compassion and (4) gratitude, (5) connect with others, (6) care for their physical health and (7) engage in goal-setting. It can be completed within a week or as desired.

MAIN OUTCOME MEASURES

Primary outcomes were changes in well-being on the WHO 5-item Well-Being Index and Short Warwick-Edinburgh Mental Well-Being Scale. Secondary outcomes were changes in depression on the Centre for Epidemiological Studies Depression Scale, anxiety on the Generalised Anxiety Disorder 7-item Scale, self-compassion on the Self Compassion Scale-Short Form, stress on the 10-item Perceived Stress Scale, sleep on the single-item Sleep Quality Scale and user engagement on the end-user version of the Mobile Application Rating Scale and via qualitative feedback during an online survey. Outcomes were evaluated at baseline, 4 weeks (primary study endpoint) and 3 months, and analysed using linear mixed models with group, time and a group-time interaction.

RESULTS

At 4 weeks, participants in the Whitu group experienced significantly higher emotional (Mean difference (md) 13.19 (3.96 to 22.42); p=0.005) and mental (md 2.44 (0.27 to 4.61); p=0.027) well-being, self-compassion (md 0.56 (0.28 to 0.83); p<0.001) and sleep (md 1.13 (0.24 to 2.02); p=0.018), and significantly lower stress (md -4.69 (-7.61 to -1.76); p=0.002) and depression (md -5.34 (-10.14 to -0.53); p=0.030), compared with the waitlist controls. Group differences remained statistically significant at 3 months for all outcomes. Symptoms of anxiety were also lower in the intervention group at 4 weeks (p=0.096), with statistically significant differences at 3 months (md -2.31 (-4.54 to -0.08); p=0.042). Usability of Whitu was high (subjective ratings of 4.45 (0.72) and 4.38 (0.79) out of 5 at 4 weeks and 3 months, respectively) and qualitative feedback indicated individual and cultural acceptability of the app.

CONCLUSIONS

Given the evolving psychological burden of the COVID-19 pandemic, Whitu could provide a clinically effective and scalable means of improving the well-being, mental health and resilience of young people. Replication of current findings with younger individuals and in other settings is planned.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12620000516987).

Adapting a codesign process with young people to prioritize outcomes for a systematic review of interventions to prevent self-harm and suicide

Background

Research and clinical outcomes that matter to people with lived experience can significantly differ from those outcomes studied by researchers. To inform a future Cochrane review of suicide and self‐harm prevention interventions, we aimed to work with young people with relevant lived experience to agree on priority outcomes.

Design

Four participatory codesign workshops were completed across two sites (New Zealand, United Kingdom) with 28 young people in total. We iteratively adapted the methods over the course of the study.

Results

‘Improved coping’ and ‘safer/more accepting environment to disclose’ were the final top‐rated outcomes. ‘Reduction of self‐harm’ was considered a low priority as it could be misleading, stigmatizing and was considered a secondary consequence of other improvements. In contrast to typical research outcomes, young people emphasized the diversity of experience, the dynamic nature of improvement and holistic and asset‐based framing. Methodologically, dialogue using design materials (personas) to thematically explore outcomes was effective in overcoming the initial challenge of disparate quantitative ratings.

Discussion

The results will directly inform the development of a Cochrane review, enabling identification of whether and how outcomes of most importance to young people are measured in trials. Rather than producing discrete measurable outcomes that could be easily added to the systematic review, the young people challenged the academic conceptualization of outcomes, with implications for future evidence synthesis and intervention research, and for future codesign.

Patient or Public Contribution

Young people with lived experience were codesigners of the outcomes, and their feedback informed iterative changes to the study methods.

Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial

BACKGROUND

We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki.

OBJECTIVE

The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome).

METHODS

We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup.

RESULTS

The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71).

CONCLUSIONS

This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori-centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/24792.

Cross-national trends of chronic back pain in adolescents: results from the HBSC study, 2001-2014

Chronic back pain is a common problem that negatively impacts the wellbeing of many adolescents. Prior research suggests that the prevalence of chronic back pain has increased over the last decades, but research on this issue is scarce, single country-based, and has yielded inconsistent results. This study aimed to examine trends in the prevalence of chronic back pain over time in adolescents aged 11, 13 and 15, using data from the Health Behavior in School-aged Children (HBSC) survey. We conducted a secondary analysis of data from 650,851 adolescents, retrieved from four waves (2001/02, 2005/06, 2009/10 and 2013/14) of HBSC data from 33 countries or regions. The prevalence of back pain was higher (1) in each successive survey over time (18.3% in 2001/02, 19.3% in 2005/06, 20.4% in2009/10 and 21.6% in 2013/14), (2) in girls (21.9%) compared to boys (17.8%), and (3) in older adolescents compared to younger ones (14.5% in 11-year-olds, 19.6% in 13-year-olds and 25.5% in 15-year-olds). The increase in prevalence from 2001/02 to 2013/14 was more marked in older girls compared to younger girls, and in older boys compared to younger boys, and it ranged between 1% for 11-year-old boys and 7% for 15-year-old girls. More resources should be allocated to the prevention and treatment of chronic back pain in adolescents, especially for older girls.

Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents

Background

Self-harm is prevalent among adolescents and associated with mental health problems and negative life-events. Few studies have examined changes in its prevalence related to these factors. This study explored whether changes in prevalence of self-harm among adolescents had occurred, and to what extent changes in associated factors may have contributed.

Methods

Two cross-sectional school-based surveys among adolescents (grades 8–10) in Norway were conducted in 2002 (N = 5842) and in 2017/18 (N = 29 063). Past year prevalence of self-harm and identical variables on risk factors was analyzed in hierarchical logistic regression to examine whether and to what extent changes in self-harm correlates could explain periodical change in prevalence of self-harm.

Results

An increase from 4.1% to 16.2% in self-harm prevalence was observed from 2002 to 2017/18. The increase was relatively larger among girls compared to boys and among 8th graders compared to 10th graders. Among the assessed risk factors for self-harm, depressive symptoms increased, while anti-social behavior, exposure to violent acts and drinking to intoxication decreased. The increase in depressive symptoms contributed to explain increase in self-harm. This contribution was outweighed by the decrease in other risk factors.

Conclusions

Self-harm prevalence increased 4-fold among Norwegian adolescents over a 15-year period. While exposure to several risk factors for self-harm changed substantially in this period, these risk factors could in sum not explain any of the increase in self-harm.

A Global Decline in Adolescents' Subjective Well-Being: a Comparative Study Exploring Patterns of Change in the Life Satisfaction of 15-Year-Old Students in 46 Countries

There is a growing body of research that demonstrates declines in subjective well-being and increases in mental health problems among children and young people in recent decades. However, there is little comparative research examining changes in adolescents' life satisfaction (LS) across a large number of countries, and critically, how this differs across sociodemographic groups. This study addresses this question by investigating changes in the LS of 15-year-old students between 2015 and 2018, with particular attention given to differences by gender, socio-economic status, immigrant background and urbanity. Data for this study come from the Programme for International Student Assessment (PISA). Due to the skewed nature of LS scale variables, the current study includes both mean levels of LS in a 0 to 10 scale, and the proportion of students reporting low LS (5 points or less). Linear regression models were used. Results demonstrate a global decline in mean levels of LS in 39 out of the 46 countries. In most countries, mean LS declined more among girls than among boys. Mean LS declined more, and the proportion of students reporting low LS increased more, among non-immigrant students and those of higher SES in the majority of countries. Findings regarding rural or urban communities were mixed. We advise that heterogeneity across all sociodemographic groups needs to be accounted for in public policy efforts to increase LS among young people.

National estimates from the Youth '19 Rangatahi smart survey: A survey calibration approach

BACKGROUND

Significant progress has been made addressing adolescent health needs in New Zealand, but some areas, such as mental health issues remain, particularly for rangatahi Māori (indigenous Māori young people). Little is known about how contemporary Māori whānau (families) and communities influence health outcomes, health literacy and access to services. Previous nationally representative secondary school surveys were conducted in New Zealand in 2001, 2007 and 2012, as part of the Youth2000 survey series. This paper focuses on a fourth survey conducted in 2019 (https://www.youth19.ac.nz/). In 2019, the survey also included kura kaupapa Māori schools (Māori language immersion schools), and questions exploring the role of family connections in health and wellbeing. This paper presents the overall study methodology, and a weighting and calibration framework in order to provide estimates that reflect the national student population, and enable comparisons with the previous surveys to monitor trends.

METHODS

Youth19 was a cross sectional, self-administered health and wellbeing survey of New Zealand high school students. The target population was the adolescent population of New Zealand (school years 9-13). The study population was drawn from three education regions: Auckland, Tai Tokerau (Northland) and Waikato. These are the most ethnically diverse regions in New Zealand. The sampling design was two-stage clustered stratified, where schools were the clusters, and strata were defined by kura schools and educational regions. There were four strata, formed as follows: kura schools (Tai Tokerau, Auckland and Waikato regions combined), mainstream-Auckland, mainstream-Tai Tokerau and mainstream-Waikato. From each stratum, 50% of the schools were randomly sampled and then 30% of students from the selected schools were invited to participate. All students in the kura kaupapa schools were invited to participate. In order to make more precise estimates and adjust for differential non-response, as well as to make nationally relevant estimates and allow comparisons with the previous national surveys, we calibrated the sampling weights to reflect the national secondary school student population.

RESULTS

There were 45 mainstream and 4 kura schools included in the final sample, and 7,374 mainstream and 347 kura students participated in the survey. There were differences between the sampled population and the national secondary school student population, particularly in terms of sex and ethnicity, with a higher proportion of females and Asian students in the study sample than in the national student population. We calculated estimates of the totals and proportions for key variables that describe risk and protective factors or health and wellbeing factors. Rates of risk-taking behaviours were lower in the sampled population than what would be expected nationally, based on the demographic profile of the national student population. For the regional estimates, calibrated weights yield standard errors lower than those obtained with the unadjusted sampling weights. This leads to significantly narrower confidence intervals for all the variables in the analysis. The calibrated estimates of national quantities provide similar results. Additionally, the national estimates for 2019 serve as a tool to compare to previous surveys, where the sampling population was national.

CONCLUSIONS

One of the main goals of this paper is to improve the estimates at the regional level using calibrated weights to adjust for oversampling of some groups, or non-response bias. Additionally, we also recommend the use of calibrated estimators as they provide nationally adjusted estimates, which allow inferences about the whole adolescent population of New Zealand. They also yield confidence intervals that are significantly narrower than those obtained using the original sampling weights.

Global trends in the prevalence and incidence of depression:a systematic review and meta-analysis

BACKGROUND

There is mixed evidence regarding the change in the prevalence of depression in the general population over time. This study aimed to synthesise the evidence on studies that use equivalent approaches in equivalent populations across different time points.

METHODS

A systematic review was conducted to identify studies focused on the change over time in depression incidence and prevalence in the general population. A random-effects meta-analysis was performed to obtain a pooled effect for the change in the prevalence estimates between the first and last time points considered. Subgroup and meta-regression analyses were used to ascertain differences in the effect sizes by gender, age group, prevalence type, elapsed time between cross-sections, and depression operationalisation.

RESULTS

19 studies provided information on the change in depression prevalence over time, whereas none provided such information regarding incidence. The pooled odds ratio (OR) and confidence interval (CI) were estimated by using 17 studies: OR=1.35 (95% CI: 1.14, 1.61). Similar pooled effects were obtained for females and males, separately. The high heterogeneity across studies was not explained by any of the design variables considered. No evidence for publication bias was found.

LIMITATIONS

The review included published articles up to August 2018, and the information of studies with more than two time points was summarised in a single estimate of change.

CONCLUSIONS

There is a predominant increasing trend in the likelihood of experiencing depression over time that seems not to be explainable by study design differences or publication bias alone.

Early adolescent physical activity, sleep and symptoms of depression at 16 years of age

AIM

To examine early adolescent physical activity and risk of later depressive symptoms at age 16 years in a prospective cohort study.

METHODS

Participants were children and parents enrolled at birth of the child. Approximately half the children enrolled in the Auckland Birthweight Collaborative Study were small for gestational age at birth (SGA ≤10th percentile for sex and gestation) and half were appropriate for gestational age (AGA >10th percentile). Maternal demographic data were collected at birth, and children were followed through to age 16 years. Depression at 16 was assessed using the Center for Epidemiological Studies Depression Scale for Children. Accelerometer measures of physical activity and sleep were measured at 11 years of age.

RESULTS

Moderate to severe depression was present in 15.6% of the 467 16-year-olds. Objectively measured physical activity and sleep at 11 years were not significantly associated with depressive symptoms at 16 years of age.

CONCLUSION

Prospectively collected objective measures of physical activity levels and sleep were not predictive of depressive symptoms later in adolescence in a healthy community cohort. While interventions to promote increased physical activity and sleep in adolescents who are depressed may be effective, physical activity and sleep in the general population of adolescents does not protect against future depression.

National Trends in Mental Health Care for US Adolescents

Importance

The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined.

Objective

To examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Design, Setting, and Participants

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019.

Main Outcomes and Measures

Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions and Relevance

This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Self-Evaluation Differences Among Swedish Children and Adolescents Over a 30-Year Period

International research has found changes in how today’s young people evaluate themselves. The present Swedish research contributes with new findings by distinguishing different patterns of change in self-evaluation in two age groups. The study investigates generational and gender differences in five self-evaluation dimensions in two samples, one from 1983 (N = 3052 10–16-year-old students) and one from 2013 (N = 1303 10–18-year-old students). Three age groups were analyzed. The generational comparison for primary school (ages 10–12) showed higher scores in 2013 than in 1983 for all five self-evaluation dimensions. Interactions between generation and gender were found for psychological well-being, relations to others, school competence evaluations, and the total score, demonstrating, in contrast to international research, a greater increase for girls than for boys. Noteworthy is that girls in primary school had higher scores in 2013. The generational comparison for lower secondary school (ages 13–15) demonstrated higher scores for school competence, relational self-evaluations, and a total higher score in 2013. Interactions between generation and gender were found for total, physical, and psychological well-being evaluation scores, indicating an increase for boys and a decrease for girls in 2013 compared to 1983. The gender comparison for secondary school (ages 16–18, 2013), showed gender differences for physical, psychological well-being, school competence evaluations, and for the total score to the advantage of boys. The study discusses changes in self-evaluation in relation to phenomena such as permissive child-rearing, decreased demands in school, increased self-enhancement behavior through social media, and narrow body ideals in today’s society. The study recommends that interventions directed toward groups with low self-evaluation scores should be considered.

Rural youth in distress? Youth self-harm presentations to a rural hospital over 10 years

Introduction Despite growing awareness of increasing rates of youth suicide and self-harm in New Zealand, there is still little known about self-harm among rural youth. Aim This study compared: (1) rates of youth self-harm presentations between a rural emergency department (ED) and nationally available rates; and (2) local and national youth suicide rates over the decade from January 2008 to December 2017. Methods Data were requested on all presentations to Ashburton Hospital ED coded for 'self-harm' for patients aged 15-24 years. Comparative data were obtained from the coroner, Ministry of Health and the 2013 census. Analyses were conducted of the effects of age, time, repetition, method, ethnicity and contact with mental health services on corresponding suicide rates. Results Self-harm rates in Ashburton rose in the post-earthquake period (2013-17). During the peri-earthquake period (2008-12), non-Māori rates of self-harm were higher than for Māori (527 vs 116 per 100000 youth respectively), reflecting the national trend. In the post-earthquake period, although non-Māori rates of self-harm stayed stable (595 per 100000), there was a significant increase in Māori rates of self-harm to 1106 per 100000 (Chi-squared = 14.0, P < 0.001). Youth living within the Ashburton township showed higher rates than youth living more rurally. Discussion Youth self-harm behaviours, especially self-poisoning, have increased since the Canterbury earthquakes in the Ashburton rural community. Of most concern was the almost ninefold increase in Māori self-harm presentations in recent years, along with the increasing prevalence among teenagers and females. Possible explanations and further exploratory investigation strategies are discussed.

Case identification of mental health and related problems in children and young people using the New Zealand Integrated Data Infrastructure

Background

In a novel endeavour we aimed to develop a clinically relevant case identification method for use in research about the mental health of children and young people in New Zealand using the Integrated Data Infrastructure (IDI). The IDI is a linked individual-level database containing New Zealand government and survey microdata.

Methods

We drew on diagnostic and pharmaceutical information contained within five secondary care service use and medication dispensing datasets to identify probable cases of mental health and related problems. A systematic classification and refinement of codes, including restrictions by age, was undertaken to assign cases into 13 different mental health problem categories. This process was carried out by a panel of eight specialists covering a diverse range of mental health disciplines (a clinical psychologist, four child and adolescent psychiatrists and three academic researchers in child and adolescent mental health). The case identification method was applied to the New Zealand youth estimated resident population for the 2014/15 fiscal year.

Results

Over 82,000 unique individuals aged 0–24 with at least one specified mental health or related problem were identified using the case identification method for the 2014/15 fiscal year. The most prevalent mental health problem subgroups were emotional problems (31,266 individuals), substance problems (16,314), and disruptive behaviours (13,758). Overall, the pharmaceutical collection was the largest source of case identification data (59,862).

Conclusion

This study demonstrates the value of utilising IDI data for mental health research. Although the method is yet to be fully validated, it moves beyond incidence rates based on single data sources, and provides directions for future use, including further linkage of data to the IDI.

Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial

Background

Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS

Objective

This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students.

Methods

A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses.

Results

YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues.

Conclusions

This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check.

Trial Registration

Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422.

Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm

Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to obtain their views on the use of guidelines in their work. Twenty-six pastoral care staff from New Zealand were interviewed. Interviews were analyzed and coded using thematic analysis. Three themes emerged: The burden of the role; discrepancies in expectations, training, and experience; and the need for guidelines to support their work. This research, therefore, demonstrated a need for guidelines to support school staff to provide support around decision making and response to self-harm in the school environment.

Associations between cognitive errors and mental health status in New Zealand adolescents

BACKGROUND

Cognitive models of psychopathology suggest that negatively biased thinking styles are involved in the development and maintenance of emotional disturbances.

AIMS

The present study examined the relationships between negative cognitive errors and indices of mental health status (i.e. anxiety and depression) in New Zealand adolescents.

METHOD

A community sample of 490 youth aged 16-18 years completed an anonymous online survey consisting of the Children's Negative Cognitive Error Questionnaire (CNCEQ), the Trait subscale of the State-Trait Anxiety Inventory (STAI-T) and the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Negative cognitive errors correlated positively with greater levels of anxious and depressive symptoms. Hierarchical regression analyses indicated that overall cognitive error score was a strong predictor of adolescents' self-reported anxious symptoms and, to a lesser extent, depressive symptoms. Moreover, cognitive errors significantly differentiated between adolescents with high scores from adolescents with low scores on both the anxiety (STAI-T) and the depression (CES-D) scales.

CONCLUSIONS

These findings lend support to the generalizability of Beck's cognitive theory to a New Zealand adolescent population and highlight the importance of focusing on prevention and early intervention programmes that directly target these faulty or biased ways of thinking in adolescents with anxious and/or depressive symptoms before meeting diagnostic criteria.

The importance of social capital for young People's active transport and independent mobility in rural Otago, New Zealand

Social capital influences adolescents' licenses for active transport and independent mobility, through parental decision making and safety concerns, and may contribute to increasing adolescents' physical activity. Drawing on 20 parental interviews and 11 focus groups (73 adolescents) from rural New Zealand, this paper shows the importance of social capital and social trust for active transport and independent mobility in an under researched rural context. Change over time in social capital, social trust and parental safety concerns limited adolescents' active transport and independent mobility. Health policy should incorporate social capital measures to increase adolescents' active transport, independent mobility and physical activity.

Cross-cohort change in adolescent outcomes for children with mental health problems

BACKGROUND

Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40-year period.

METHODS

Three cohorts were utilized: The National Child Development Study (NCDS: N = 14,544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8,188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13,192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent-reported Rutter-A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health.

RESULTS

Child mental health problems were common in each cohort (boys: 7.0%-9.7%; girls: 5.4%-8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d' = 0.55 (0.38, 0.72), ALSPAC d' = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d' = 0.50 (0.34, 0.65), ALSPAC d' = 0.99 (0.78, 1.20); interaction p < .001).

CONCLUSIONS

Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations.

YouthCHAT as a Primary Care E-Screening Tool for Mental Health Issues Among Te Tai Tokerau Youth: Protocol for a Co-Design Study

Background

In New Zealand (NZ), 1 in 4 adolescents is affected by mental health issues (eg, depression and anxiety) and engages in risk behaviors (eg, harmful drinking and substance abuse), with rates among Māori youth being significantly higher. The majority of NZ secondary school students visit their local primary health care providers (PHPs) at least annually, yet most do not seek help for mental health and risk behavior (MHB) concerns. While youth think it acceptable to discuss sensitive issues during a consultation with their PHPs, unless problems are severe, such conversations are not initiated by PHPs. Early intervention for MHB concerns can prevent long-term health and well-being issues. However, this relies on the early identification of developing problems and youth being offered and accepting help. YouthCHAT is an electronic, multi-item screening tool developed in 2016 to assess MHB concerns among youth. YouthCHAT is completed before a consultation with the PHP, who can access a summary report straight away. A help question allows young people to identify issues that need addressing. A resource pack uses stepped care pathways to guide providers to use appropriate brief interventions.

Objective

This study aimed to explore the utility, feasibility, and acceptability of YouthCHAT when tailored for use with youth in primary care settings with large Māori populations. Objectives of the study are to evaluate the implementation of YouthCHAT in nurse-led youth clinics, school-based clinics, and general practice in Te Tai Tokerau (Northland, NZ); to develop a framework for the scaling up of YouthCHAT across further settings; to assess health provider and youth acceptability of the tool; to improve screening rates for mental health and help-seeking behavior; to enable early identification of emerging problems; and to improve brief intervention delivery.

Methods

Using a bicultural mixed-methods co-design approach, 3 phases over a 3-year period will provide an iterative evaluation of the utility, feasibility, and acceptability of YouthCHAT, aiming to create a framework for wider-scale rollout and implementation.

Results

Recruitment for the first phase began in September 2018. YouthCHAT was implemented at the first site in October 2018 and is expected to be at a further two sites in late January to early February 2019. The study is due for completion at the end of 2021.

Conclusions

YouthCHAT has potential as a user-friendly, time efficient, and culturally safe screening tool for early detection of MHB issues in NZ youth. The resource pack assists the clinician to provide appropriate interventions for emerging and developed youth mental health and lifestyle issues. Involving input from community providers, users, and stakeholders will ensure that modifiable elements of YouthCHAT are tailored to meet the health needs specific to each context and will have a positive influence on future mental, physical, and social outcomes for NZ youth.

International Registered Report Identifier (IRRID)

PRR1-10.2196/12108

The Associations Between Cultural Identity and Mental Health Outcomes for Indigenous Māori Youth in New Zealand

Objectives: To explore the relationships between Māori cultural identity, ethnic discrimination and mental health outcomes for Māori youth in New Zealand.

Study Design: Nationally representative, anonymous cross-sectional study of New Zealand secondary school students in 2012.

Methods: Secondary analysis of Māori students (n = 1699) from the national Youth'12 secondary school students survey was undertaken. Theoretical development and exploratory factor analysis were undertaken to develop a 14-item Māori Cultural Identity Scale (MCIS). Māori students reporting > 8 items were classified as having a strong MCIS. Prevalence of indicators were reported and logistic regression models were used to explore how wellbeing (WHO-5), depressive symptoms (Reynolds Adolescent Depression Scale-SF), and suicide attempts were associated with the MCIS.

Results: After adjusting for age, sex, ethnic discrimination and NZ Deprivation Index (NZDep), a strong Māori cultural identity (MCIS) was associated with improved wellbeing scores (OR 1.53, 95% CI 1.18–2.01) and fewer depressive symptoms (OR 0.53, 95% CI 0.38–0.73). Experiencing discrimination was associated with poorer wellbeing scores (OR 0.50, 95% CI 0.39–0.65), greater depressive symptoms (OR 2.2, 95% CI 1.55–3.18), and a previous suicide attempt (OR 2.47, 95% CI 1.71–3.58). Females less frequently reported good (WHO-5) wellbeing (OR 0.33, 95% CI 0.26–0.42), increased (RADS-SF) depressive symptoms (2.61, 95% CI 1.86–3.64) and increased suicide attempts [OR 3.35 (2.07–5.41)] compared to males. Wellbeing, depressive symptoms and suicide attempts did not differ by age or neighborhood level socio-economic deprivation, except those living in neighborhoods characterized as having medium level incomes, were less likely to have made a suicide attempt (OR 0.49, 95% CI 0.27–0.91).

Conclusions: Māori youth who have a strong cultural identity were more likely to experience good mental health outcomes. Discrimination has a serious negative impact on Māori youth mental health. Our findings suggest that programmes, policies and practice that promote strong cultural identities and eliminate ethnic discrimination are required to improve mental health equity for Māori youth.

Health and wellbeing of Māori secondary school students in New Zealand: Trends between 2001, 2007 and 2012

OBJECTIVE

To describe the health status over time of Māori secondary school students in New Zealand compared to European students.

METHODS

Anonymous representative health surveys of New Zealand secondary school students were conducted in 2001, 2007 and 2012 (total n=27,306 including 5,747 Māori).

RESULTS

Compared to 2001, Māori students in 2012 experienced improved health, family and school connections. However, considerable inequity persists with Māori students reporting poorer health, greater exposure to violence and socioeconomic adversity compared to European students. When controlling for socioeconomic deprivation, inequity was substantially reduced, although worse Māori health outcomes remained for general health, mental health, contraceptive use, healthy weight, substance use, access to healthcare and exposure to violence. There was some evidence of convergence between Māori and European students on some indicators.

CONCLUSIONS

There have been significant improvements for Māori youth in areas of health where there has been investment. Priority areas identified require adequate resourcing alongside addressing systematic discrimination and poverty. Implications for public health: Socioeconomic contexts, discrimination, healthcare access and identified priority health areas must be addressed to improve equity for Māori youth. Building on these gains and hastening action on indicators that have not improved, or have worsened, is required.

Validation of the Mood and Feelings Questionnaire (MFQ) and Short Mood and Feelings Questionnaire (SMFQ) in New Zealand help-seeking adolescents

OBJECTIVE

This study examines the reliability and validity of the Mood and Feelings Questionnaire (MFQ) and Short Mood and Feelings Questionnaire (SMFQ) for measuring depression in New Zealand help-seeking adolescents.

METHOD

A sample of 183 adolescents completed the 33-item MFQ, which includes all 13 items on the SMFQ, at three time points during a trial of a computerized intervention for depression.

RESULTS

Both the MFQ and SMFQ demonstrated good to excellent Cronbach's alphas, moderate to strong item-total score correlations, moderate to strong correlations with quality of life and anxiety measures, and strong correlations with the clinician-rated Children's Depression Rating Scale-Revised and the Reynolds Adolescent Depression Scale 2 at all time points, indicating good reliability and content, convergent, and concurrent validities, respectively. Favoring sensitivity over specificity, the optimal cut-off value for differentiating depressed from nondepressed cases for the MFQ was ≥28 and for the SMFQ was ≥12. Both instruments demonstrated satisfactory diagnostic accuracy and sensitivity to change.

CONCLUSION

The MFQ and SMFQ are free and simple instruments that can be used to identify depression and measure symptom change in New Zealand help-seeking adolescents.

Screening for mental health needs of New Zealand youth in secure care facilities using the MAYSI-2

BACKGROUND

Young people admitted to secure facilities generally have particularly high rates of mental, emotional and behavioural problems, but little is known about the mental health needs of this group in New Zealand.

AIMS

To describe prevalence of probable mental health disorder and related needs among young people in secure facilities in New Zealand.

METHODS

Massachusetts youth screening instrument - second version (MAYSI-2) data were obtained from the records of young people admitted to one secure care facility (n = 204) within a 12 month period. We used descriptive statistics to determine prevalence of problems overall and multivariate analysis of variance to compare MAYSI-2 scores between gender and ethnic groups.

RESULTS

Nearly 80% of these young people scored above the 'caution' or 'warning' cut-off on the MAYSI-2, a substantially higher proportion than reported in studies in other countries. There was a tendency for girls and for Maori and Pacific Islander subgroups to have a higher rate of probable psychopathology.

CONCLUSIONS

Young people in secure facilities in New Zealand have substantial service needs. Early intervention that engages them in services upon first contact with the youth justice system might help reduce this burden. Further validation of the MAYSI-2 in New Zealand may be warranted because of the unique ethnic make-up of these young offenders. Copyright © 2017 John Wiley & Sons, Ltd.

[Gender-specific Differences in the Degree of Burden on Children and Adolescents Taken into Custody]

Gender-specific Differences in the Degree of Burden on Children and Adolescents Taken into Custody Children and adolescents who were taken into care are a high-risk group for mental disorders such as externalizing problems or conduct disorders. 95 children and adolescents who were taken into care were tested with the Screening Child Trauma Questionnaire (CTQ) and the Massachusetts Youth Screening Instrument 2 (MAYSI-2). In a large proportion of those children and adolescents emotional and physical neglect and abuse was identified. There were sex differences in suicidal thoughts, somatoform disorders, and emotional abuse. The knowledge of mental disorders as well as the gender-specific characteristics is important for specialists of inhospital institutions, in order to optimize their quality of care.

Co-design of eHealth Interventions With Children and Young People

Co-design, defined as collective creativity across the entire design process, can lead to the development of interventions that are more engaging, satisfying, and useful to potential users. However, using this methodology within the research arena requires a shift from traditional practice. Co-design of eHealth interventions with children and young people has additional challenges. This review summarizes the applied core principles of co-design and recommends techniques for undertaking co-design with children and young people. Three examples of co-design during the development of eHealth interventions (Starship Rescue, a computer game for treating anxiety in children with long-term physical conditions, a self-monitoring app for use during treatment of depression in young people, and HABITS, the development of an emotional health and substance use app, and eHealth platform for young people) are provided to illustrate the value and challenges of this contemporary process.

Is ADHD Really Increasing in Youth?

OBJECTIVE

It would be useful to compare temporal changes in the diagnostic prevalence of ADHD obtained from identical population surveys with time-trend survey findings based on individual ADHD features.

METHOD

Changes in the diagnostic prevalence of ADHD over time were recorded from parent reports and from physician office visit data. Associated features of ADHD were temporally recorded from standardized teacher, parent, and youth surveys.

RESULTS

Time-trend diagnostic findings on ADHD prevalence based on 6 parent surveys and 12 outpatient physician office visit surveys revealed consistent rate increases. By contrast, 26 sets of standard ratings of the primary and associated features of ADHD assessed systematically by different teachers, parents, and students during different years indicated little change.

CONCLUSION

Time-trend national surveys of ADHD in youth over the last two decades reveal consistent increases in its diagnostic prevalence, whereas time-trend findings for individual ADHD-related symptoms remained relatively stable.

The growth of suicide ideation, plan and attempt among young adults in the Mexico City metropolitan area

AIMS

Low and middle income countries share a heavy burden of suicide with about three in every four suicides occurring in these countries. Mexico has witnessed a growing trend in suicide deaths; if this trend is not simply a reflection of better reporting of suicide on death certificates, then this increase should logically be accompanied by an increasing trend in suicide ideation, plan and attempts, but we lack information on the trends for suicide ideation, plan and attempt for this period. We therefore aim to report changes for suicidal behaviour for the period 2001-2013 in the Mexico City Metropolitan Area.

METHOD

Using two cross-sectional surveys conducted in Mexico in 2001 and 2013, we report the lifetime and 12-month prevalence of suicide ideation, plan and attempt and changes in treatment for these problems among respondents aged 19-26 living in the Mexico City Metropolitan Area 12 years apart. To estimate the changes in prevalence for each outcome, we used generalised linear models to calculate prevalence ratios (PR; the prevalence rate in the exposed (year 2013) divided by the prevalence rate in the unexposed (year 2001-2002), adjusting for sociodemographic variables.

RESULTS

While increases in the prevalence are noted everywhere, statistical comparisons only found differences for lifetime ideation (PR = 3.1; 95% CI = 1.7-5.8) and a borderline difference for suicide attempt (PR = 2.2; 95% CI = 1.0-4.9). No attempt within the last 12-months was reported in 2001, but the prevalence in 2013 reached 1.5% (18 cases). While PRs for 12-month prevalence were all above the null, none reached statistically significant differences. During this 12-year period, the distribution of mental disorders and the use of services for mental disorders among suicide ideators, planners and attempters did not change in any noticeable way.

CONCLUSIONS

The limitations of our data are the small number of participants in the 2001 survey, the low follow-up rate for the survey in 2013 and that while representative from one city it does not represent the whole country. These findings suggest that suicide ideation and attempt may have increased during this 12-year period in the Mexico City metropolitan area, but this increase did not lead to more use of mental health care services. This information, coupled with the long-term trend of increasing suicide death rates in the country, draw a worrisome and neglected scenario for our youth in this region. Urgent measures, following the recent WHO guidelines for suicide prevention, must not be postponed.

Modus operandi and affect in Sweden: the Swedish version of the Regulatory Mode Questionnaire

Background

The Regulatory Mode Questionnaire (RMQ) is the most used and internationally well-known instrument for the measurement of individual differences in the two self-regulatory modes: locomotion (i.e., the aspect of self-regulation that is concerned with movement from state to state) and assessment (i.e., the comparative aspect of self-regulation). The aim of the present study was to verify the independence of the two regulatory modes, as postulated by the Regulatory Mode Theory (Kruglanski et al., 2000), and the psychometric properties of the RMQ in the Swedish context. Furthermore, we investigated the relationship between regulatory modes (locomotion and assessment) and affective well-being (i.e., positive affect and negative affect).

Method

A total of 655 university and high school students in the West of Sweden (males = 408 females = 242, and five participants who didn’t report their gender; age_mean = 21.93 ± 6.51) responded to the RMQ and the Positive Affect Negative Affect Schedule. We conducted two confirmatory factor analyses using structural equation modeling (SEM). A third SEM was conducted to test the relationship between locomotion and assessment to positive affect and negative affect.

Results

The first analyses confirmed the unidimensional factor structure of locomotion and assessment and both scales showed good reliability. The assessment scale, however, was modified by dropping item 10 (“I don’t spend much time thinking about ways others could improve themselves”.) because it showed low loading (.07, p = .115). Furthermore, the effect of locomotion on positive affect was stronger than the effect of assessment on positive affect (Z = −15.16, p < .001), while the effect of assessment on negative affect was stronger than the effect of locomotion on negative affect (Z = 10.73, p < .001).

Conclusion

The factor structure of the Swedish version of the RMQ is, as Regulatory Mode Theory suggests, unidimensional and it showed good reliability. The scales discriminated between the two affective well-being dimensions. We suggest that the Swedish version of the RMQ, with only minor modifications, is a useful instrument to tap individual differences in locomotion and assessment. Hence, the present study contributes to the validation of the RMQ in the Swedish culture and adds support to the theoretical framework of self-regulatory mode.

Temporal trends in adolescents' self-reported psychosomatic health complaints from 1980-2016: A systematic review and meta-analysis

OBJECTIVE

There is increasing concern that mental health may be deteriorating in recent generations of adolescents. It is unclear whether this is the case for self-reported psychosomatic health complaints (PSHC).

METHOD

We conducted a systematic review and meta-analysis of published primary studies on PSHC in the general adolescent population over time. The primary databases were MEDLINE, Embase and PsycINFO, which were searched from inception to November 2016. Studies were included if they involved an observational design, presented self-reported data from participants aged 10-19 years and included data from at least two time points, five years apart. Inclusion and study quality were assessed by two independent reviewers.

RESULTS

Twenty-one studies were included; 18 reported trends on the prevalence of PSHC in a single country, while three studies reported on multiple countries. In total, over seven million adolescents from 36 countries in Europe, North America, Israel and New Zealand were represented, covering the period 1982-2013. In the descriptive analysis, 10 studies indicated a trend of increasing PSHC, eight showed a stable trend and three showed a decreasing trend at certain points in time. The results from the meta-analysis showed a mean odds ratio (OR) of 1.04 (K = 139, 95% CI 1.01-1.08) for PSHC from 1982 to 2013, thus indicating a minor increase in general. In the subgroup analysis, this minor increase was observed mainly between the 1980s and 2000s, while the trend appeared to be more stable between the 2000s and 2010s. Some differences were also found between multinational subregions. Findings from subgroup analysis, however, only supported a significant increasing trend in Northern Europe.

CONCLUSION

There may have been a minor increasing trend in adolescent self-rated PSHC between the 1980 and 2000s, but has become more stable since the 2010s, from a multinational perspective. Northern Europe was the only region to show a clearly significant minor increasing trend, without being the region with the highest total prevalence of PSHC at the present time. The discrepant trends regarding PSHC between regions and the reliance on self-reported data may reflect true changes in the occurrence of PSHC in the adolescent population. However, they may also reflect changes in how adolescents perceive and report health complaints.

OTHER

PROSPERO registration 2016: CRD42016048300.

Screening for risky behaviour and mental health in young people: the YouthCHAT programme

BACKGROUND

The prevalence of mental health concerns and risky health behaviours among young people is of global concern. A large proportion of young people in New Zealand (NZ) are affected by depression, suicidal ideation and other mental health concerns, but the majority do not access help. For NZ indigenous Māori, the burden of morbidity and mortality associated with mental health is considerably higher. Targeted screening for risky behaviours and mental health concerns among youth in primary care settings can lead to early detection and intervention for emerging or current mental health and psychosocial issues. Opportunistic screening for youth in primary care settings is not routinely undertaken due to competing time demands, lack of context-specific screening tools and insufficient knowledge about suitable interventions. Strategies are required to improve screening that are acceptable and appropriate for the primary care environment. This article outlines the development, utilisation and ongoing evaluation and implementation strategies for YouthCHAT.

YOUTHCHAT

YouthCHAT is a rapid, electronic, self-report screening tool that assesses risky health-related behaviours and mental health concerns, with a 'help question' that enables youth to prioritise areas they want help with. The young person can complete YouthCHAT in the waiting room prior to consultation, and after completion, the clinician can immediately access a summary report which includes algorithms for stepped-care interventions using a strength-based approach. A project to scale up the implementation is about to commence, using a co-design participatory research approach to assess acceptability and feasibility with successive roll-out to clinics. In addition, a counter-balanced randomised trial of YouthCHAT versus clinician-administered assessment is underway at a NZ high school.

CONCLUSION

Opportunistic screening for mental health concerns and other risky health behaviours during adolescence can yield significant health gains and prevent unnecessary morbidity and mortality. The systematic approaches to screening and provision of algorithms for stepped-care intervention will assist in delivering time efficient, early, more comprehensive interventions for youth with mental health concerns and other health compromising behaviours. The early detection of concerns and facilitation to evidence-based interventions has the potential to lead to improved health outcomes, particularly for under-served indigenous populations.

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms

In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Dietary behaviours and the mental well-being of New Zealand adolescents

AIM

To examine the associations between diet and mental health indicators in adolescents.

METHODS

Data were drawn from the Youth 2012 survey, a national survey of the health and well-being of adolescents in New Zealand (n = 8500). Multiple regression models were used to determine the associations between healthy and unhealthy eating and mental health indicators while adjusting for sex, age, ethnicity, small area deprivation and household poverty as covariates.

RESULTS

Approximately 30% of young people in the lowest quartile for healthy eating reported significant depressive symptoms. Greater healthy eating was significantly associated with fewer depressive symptoms, better well-being and fewer emotional difficulties (all P < 0.001 after adjusting for covariates). Greater unhealthy eating was significantly associated with greater depressive symptoms, poorer well-being and greater emotional difficulties (all P < 0.001 after adjusting for covariates).

CONCLUSIONS

Findings from this study contribute to a growing body of literature that indicate that eating behaviours are associated with mental health indicators among adolescents. Findings from the current study suggest that efforts to enhance healthy eating may also have a positive impact on mental health.