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Witt K, Stewart A, Hawton K. Practitioner Review: Treatments for young people who self-harm - challenges and recommendations for research and clinical practice. J Child Psychol Psychiatry 2024. [PMID: 39194179 DOI: 10.1111/jcpp.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Self-harm is very common in young people and is associated with suicide. Rates of both self-harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self-harm. METHOD We significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self-harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world. RESULTS Currently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT-A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self-harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry-based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals. CONCLUSIONS Recommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT-A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural-based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self-harm in a person-centred and compassionate manner.
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Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
- Orygen, Parkville, Vic., Australia
| | - Anne Stewart
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
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Walker S, Kannan P, Bhawra J, Katapally TR. Evaluation of a longitudinal digital citizen science initiative to understand the impact of culture on Indigenous youth mental health: Findings from a quasi-experimental qualitative study. PLoS One 2023; 18:e0294234. [PMID: 38127846 PMCID: PMC10735025 DOI: 10.1371/journal.pone.0294234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Indigenous youth in settler nations are susceptible to poor mental health due to complex intergenerational systemic inequities. Research has shown benefits of cultural connectedness for improving mental health; however, there are few studies which have evaluated the impact of culturally relevant mental health interventions, particularly among Indigenous youth. The purpose of this study is to assess the impact of a culturally-responsive, land-based, active living initiative on the mental health of Indigenous youth. METHODS This quasi-experimental qualitative study is part of Smart Indigenous Youth (SIY), a mixed-methods 5-year longitudinal digital citizen science initiative. SIY embeds culturally responsive, land-based active living programs into the curricula of high schools in rural Indigenous communities in the western Canadian province of Saskatchewan. In year-1 (Winter 2019), 76 Indigenous youth citizen scientists (13-18 years) from 2 schools participated in the study. At the beginning of the term, each school initiated separate 4-month land-based active living programs specific to their culture, community, geography, and language (Cree and Saulteaux). Before and after the term, focus groups were conducted with the 2 Youth Citizen Scientist Councils, which included students from both participating schools. This study includes data from focus groups of one participating school, with 11 youth citizen scientists (5 boys, 6 girls). Focus group data were transcribed and analyzed by two independent reviewers using Nvivo to identify themes and subthemes. Both reviewers discussed their thematic analysis to reach consensus about final findings. RESULTS Baseline focus group analyses (before land-based programming) revealed themes demonstrating the importance of Indigenous culture, identity, history, and language. Youth emphasized the impact of loss of language and culture, the importance of being a helper, and the necessity of intergenerational knowledge transfer. Follow-up focus group analyses (post land-based programming) indicated that cultural school programming led to students expressing positive mental health benefits, increased interest in ceremonies, increased participation in physical activity, and greater knowledge of culture, identity, and ceremonial protocol. CONCLUSIONS This novel qualitative quasi-experimental study offers a window into the future of upstream interventions in partnership with Indigenous communities, where Indigenous youth can be engaged in real-time via their digital devices, while participating in culturally-sensitive, land-based school programming that promotes culture, identity, and mental health.
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Affiliation(s)
- Susannah Walker
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
| | - Prasanna Kannan
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
| | - Jasmin Bhawra
- CHANGE Research Lab, School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tarun Reddy Katapally
- DEPtH Lab, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
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Wang J, Xie Y, Xu H, Wan Y, Tao F. Moderating effects of smoking and drinking on the relationship between biological rhythm and psychological health and gender differences among adolescents. BMC Psychiatry 2023; 23:731. [PMID: 37817125 PMCID: PMC10566120 DOI: 10.1186/s12888-023-05253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES To determine whether smoking and drinking moderate the correlation between biological rhythm and mental health and the role of gender differences in these moderating effects. METHODS Adolescents from three cities, all twelve middle schools (N = 7,986), named Shenzhen, Nanchang and Shenyang in China, were asked to complete a standardized questionnaire including the details of biological rhythm, psychological health, and the status of smoking and drinking. The PROCESS program was used to analyze whether smoking and drinking moderated the relationship between biological rhythm and psychological health. RESULTS The analyses revealed poorer psychological health and greater likelihood of smoking and drinking in participants with higher scores for biological rhythm disorder (P < 0.001). Specifically, smoking and drinking accelerated the relationship between biological rhythm and psychological health in the total sample (B = 0.05, P < 0.05; B = 0.06, P < 0.001) and only the subgroup of girls (B = 0.09, P < 0.05; B = 0.12, P < 0.001), respectively. CONCLUSIONS As the findings suggest, attention should be given to smoking, drinking and gender-specific approaches employed to alleviate the psychological disorders of adolescents with biological rhythm disorders.
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Affiliation(s)
- Jiaojiao Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yang Xie
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
- Moe Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, China
| | - Huiqiong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
- Moe Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China
- Moe Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, Anhui, China.
- Moe Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, China.
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Read A, Lutgens D, Malla A. A Descriptive Overview of Mental Health Services Offered in Post-Secondary Educational Institutions Across Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:101-108. [PMID: 36200430 PMCID: PMC9923134 DOI: 10.1177/07067437221128168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Access to adequate mental health (MH) services is necessary for nearly half of Canadian youth (18-24 years) who enroll in post-secondary education given the relatively high risk of MH problems. Our objectives were to determine the status of MH services available to students in post-secondary institutions in Canada and to determine the extent to which these services are based on the principles of a high-quality youth MH (YMH) service. METHOD Information on MH services was collected from websites of a representative sample (N = 67) of post-secondary institutions across all provinces. Data were analysed descriptively according to four categories (universities with a Faculty of Medicine (FoM) n = 18, other large universities n = 15, small universities n = 16, and colleges n = 18). RESULTS Most institutions provided 24-h crisis line support (84%) and indicated the availability of free counselling or psychotherapy (n = 62 of 67, 92.5%), while only a minority indicated provision of an initial clinical assessment (25%) and provision of multiple sessions of therapy (37%). Wait time for first contact was impressively low (<72 h) in the minority of institutions (40%) which provided this information. Access to either a prescribing physician or psychiatrist was infrequent, though several mentioned an unexplained model of "stepped care" and outside referrals. While relevant information was not uniformly easy to access, larger institutions both with and without a FoM appear to be better poised to provide MH services. None of the institutions appeared to follow all the principles of service delivery recommended for a high-quality YMH, with only two showing early identification activities. CONCLUSIONS MH services in post-secondary institutions may need a transformation similar to YMH services, including a clear pathway to care, an initial clinical assessment, early identification of MHA disorders, and better utilization of institutional resources through greater collaboration and matching of timely interventions to the presenting problems.
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Affiliation(s)
- Alana Read
- Department of Psychology, 6082Capilano University, North Vancouver, British Columbia, Canada
| | - Danyael Lutgens
- Department of Psychology, 6082Capilano University, North Vancouver, British Columbia, Canada
| | - Ashok Malla
- Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
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Mathieson F, Garrett S, Stubbe M, Hilder J, Tester R, Fedchuk D, Dunlop A, Dowell A. Therapist Voices on a Youth Mental Health Pilot: Responsiveness to Diversity and Therapy Modality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1834. [PMID: 36767203 PMCID: PMC9914598 DOI: 10.3390/ijerph20031834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
This article explores therapists' views on a large youth mental health pilot project (for 18-25-year-olds), which included an individual cognitive behavior therapy (CBT)-informed individual therapy component. Therapists' views on cultural responsiveness, therapy (delivery, modality and duration) and working with LGBTQIA+ youth were explored using two surveys, individual interviews and focus groups at various stages of the life of the pilot. Some therapists saw the CBT approach as imposed on them, preferring familiar therapy modalities. Many therapists were positive toward CBT for its client-centered approach and reported using CBT-informed approaches with many of their clients to good effect. Some therapists felt pressured by their workplace to see clients for fewer sessions than they needed. Therapists wanted to see a more culturally diverse workforce, to increase their cultural competence through training and to have more easily available cultural supervision. There was some acknowledgement of the importance of training therapists to work competently with LGBTQIA+ young people. Involving therapists in co-design of services from the outset will likely benefit future service development.
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Affiliation(s)
- Fiona Mathieson
- Department of Psychological Medicine, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Jo Hilder
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Rachel Tester
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Dasha Fedchuk
- Department of Psychology, Massey University Wellington, Wellington 6140, New Zealand
| | - Abby Dunlop
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, School of Medicine and Health Sciences, Wellington 6242, New Zealand
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McCabe E, Amarbayan M(M, Rabi S, Mendoza J, Naqvi SF, Thapa Bajgain K, Zwicker JD, Santana M. Youth engagement in mental health research: A systematic review. Health Expect 2022; 26:30-50. [PMID: 36385452 PMCID: PMC9854331 DOI: 10.1111/hex.13650] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patient engagement in youth mental health research has the potential to inform research on the interventions, services and policies that will benefit youth. At present, there is little evidence to guide mental health researchers on youth engagement. This systematic review aims to describe the impacts of youth engagement on mental health research and to summarize youth engagement in mental health research. METHODS We searched the following databases: MEDLINE, EMBASE and PsycINFO, using a combination of subject headings, keywords and synonyms for the concepts 'patient engagement', 'youth' and 'mental health'. Articles that described engaging youth in mental health research were included. Two reviewers performed the study selection. Study characteristics, research activities performed by youth, impacts of youth engagement, challenges, and facilitators to engagement and recommendations for youth engagement described by authors were extracted. Quality appraisal involved determining the level of engagement of youth and the stage(s) of research where youth were involved. RESULTS The database search returned 2836 citations, 151 full-text articles were screened and 16 articles, representing 14 studies, were selected for inclusion. Youth were involved at nearly all stages of the research cycle, in either advisory or co-production roles. Youth engagement impacts included enhancing relevant research findings, data collection and analysis and dissemination to academic and stakeholder audiences. Both youth and academic researchers reported personal development across many domains. One negative impact reported was the increase in funding and resources needed for engagement. We produced a list of 35 recommendations under the headings of training, youth researcher composition, strategy, expectations, relationships, meeting approaches and engagement conditions. CONCLUSIONS This study provides an understanding of the impacts and recommendations of youth engagement in mental health research. The findings from this study may encourage researchers to engage youth in their mental health research and support youth engagement in funding applications. PATIENT AND PUBLIC CONTRIBUTION We consulted three youths with experience being engaged in mental health research about the review findings and the discussion. One youth designed a visual representation of the results and provided feedback on the manuscript. All youth's input informed the way the findings were presented and the focus of the discussion.
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Affiliation(s)
- Erin McCabe
- Department of Pediatrics, School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Sarah Rabi
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Justino Mendoza
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Syeda Farwa Naqvi
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Jennifer D. Zwicker
- Department of Social Policy and Health, School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | - Maria Santana
- Department of Pediatrics, Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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Malla A, Boksa P, Joober R. Meeting the challenges of the new frontier of youth mental health care. World Psychiatry 2022; 21:78-79. [PMID: 35015354 PMCID: PMC8751561 DOI: 10.1002/wps.20927] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Patricia Boksa
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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