What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

Health behavioural change - the influence of social-ecological factors and health identity

Health behaviour is crucial for influencing health, making it a key component in health promotion. However, changing behaviours is complex, as many factors interact to determine health behaviours. Information, awareness, and knowledge are important but not enough. It is essential to move beyond focusing solely on individual psychological and cognitive factors to an understanding of the complex processes involved in health behaviour change. Social-ecological models account for these complex processes but risk being overly broad and all-encompassing. This qualitative grounded theory study explores how individual, interpersonal, and environmental factors interplay to influence health behaviour, and examines how social-ecological models in health promotion can be tailored to address different ecological needs. Participants were recruited from a community-based cardiovascular disease-prevention program in Northern Sweden. Data was collected through in-depth interviews about health and health behaviours throughout the life course among middle-aged men and women. The results illustrate how factors obstructing or enabling health behaviours vary in patterned ways for individuals with different health identities. Social-ecological interventions could be more effective if adapted to the specific needs of people with different health identities. In addition to screening for various risk factors, screening for health identities could be helpful in designing social-ecological health-promoting interventions.

The impact of extended reality cognitive behavioral therapy on mental disorders among children and youth: A systematic review and meta-analysis protocol

BACKGROUND

The prevalence of mental disorders among children and youth has significantly increased, with rising rates of anxiety, depression, and other psychological disorders globally. Despite the widespread adoption of cognitive behavioral therapy (CBT) as a standardized treatment for various mental disorders, its efficacy can be constrained due to limited patient engagement, lack of commitment, and stigma, all challenges pronounced among children and youth. In this context, extended reality (XR) technologies (including virtual, augmented, and mixed reality) have emerged as innovative therapeutic tools offering immersive and engaging environments to overcome the limitations of traditional CBT.

OBJECTIVES

This protocol aims to outline the methodology for conducting a systematic review and meta-analysis to evaluate the impact of XR-CBT on symptoms of mental disorders among children and youth.

METHODS

This systematic review and meta-analysis will follow PRISMA-P 2015 guidelines. A comprehensive search will be conducted in PsycINFO, PubMed, EMBASE, Scopus, and Web of Science to identify relevant studies published between January 2014 and June 2024. Eligible studies must involve children and youth (ages 24 years or younger) diagnosed with a mental disorder (e.g., anxiety, depression, ADHD, PTSD) and compare XR-CBT interventions (virtual, augmented, or mixed reality) with traditional therapy or control groups (e.g., no treatment). The primary outcome will be the change in symptoms of mental disorders, measured using standardized instruments (e.g., PHQ-9, GAD-7, PSS). Data will be extracted on post-intervention means, standard deviations, and 95% confidence intervals. Effect sizes, calculated using Hedges' g, will be pooled with a random-effects model. Moreover, an a priori meta-regression within a random-effects framework will be conducted to examine how study-level characteristics influence effect sizes and address heterogeneity across studies. Heterogeneity will be assessed using the I2 statistic and the Cochran's Q test. Risk of bias in individual studies will be evaluated using the Cochrane risk-of-bias tool.

CONCLUSIONS

This protocol establishes a structured approach for assessing the efficacy of XR-CBT interventions on mental disorders among children and youth. The results of the systematic review and meta-analysis will fill a gap in current research and inform future therapeutic applications for mental health interventions among children and youth.

Impact of the Life is Precious™ Program on Academic Performance and School Functioning Among Latina Adolescents at Risk of Suicide

This exploratory study examines the impact of Life is Precious™ (LIP), a treatment-adjacent afterschool program, on academic performance and school functioning among Latina adolescents at risk of suicide. Utilizing a quasi-experimental design, the study compared the outcomes of LIP participants with individuals receiving usual care (UC) over a 12-month period. Results included a statistically significant group-by-time interaction on academic performance, indicating that the LIP group's grades improved over time while the UC group's grades declined. Though LIP was not significantly associated with school functioning, the direction of the estimated impact of LIP was positive, with a medium effect size. Combined with prior research, these results highlight the potential benefits of culturally responsive, community-based interventions like LIP in addressing both educational and mental health needs among Latina adolescents at high risk of suicide. Further research with larger samples is needed to substantiate these findings and explore long-term outcomes.

"My family won't let me." Adolescent-reported barriers to accessing mental health care

Depression is the leading cause of disability among adolescents. Fewer than 50% of youth with depression access mental healthcare services. Leveraging a mixed-methods approach, this pre-registered study characterized youths' self-reported barriers to accessing mental healthcare in a socio-demographically diverse sample of 123 United States adolescents (ages 13-16, identifying as Asian (n = 19), Hispanic (n = 23), Black (n = 7), White (n = 65), or other race (n = 9); man (n = 9), woman (n = 58), or gender minority (n = 56); heterosexual (n = 19) or sexual orientation minority (n = 104)). All participants were experiencing elevated depression symptoms (Patient Health Questionnaire-2 score of ≥2) and endorsed wanting mental health support but being unable to access it. We asked participants an open-ended question gauging perceived barriers to accessing care ("what has kept you from getting support when you wanted it?"), and a binary item gauging perceived current need for mental health support ("right now, do you feel that you need support for emotional or mental health problems?"). Via thematic analysis of responses to the perceived barriers question, we identified a total of 13 categories of barriers. Across all participants, 42.48% (n = 52) endorsed family-related barriers and 31.71% (n = 39) endorsed financerelated concerns. We conducted Chi-square analyses, examining rates of endorsing specific barriers as a function of (a) perceived current support need and (b) demographic variables (e.g. race/ethnicity, gender). In the current study, all adolescents endorsed similar categories of treatment access barriers, regardless of race/ethnicity, gender, sexual orientation, and level of depression. Implications for increasing mental healthcare access for adolescents with elevated depression symptoms are discussed.

Experiential Learning in Mental Health Diversion: Interdisciplinary Approaches Using Kolb's Learning Theory

PURPOSE

This study evaluated student responses to an interprofessional experiential learning opportunity (ELO) grounded in Kolb's Learning Theory.

MATERIALS AND METHODS

Students from several disciplines, including Social Work, Criminal Justice, Communication, and Teacher Education, were placed in various internship roles within the court system to provide interventions, services, and resources to low-level offenders and families as an alternative to criminal consequences. Qualitative data from student discussions and reflections was reviewed using a thematic approach. The research sought to find meaningful patterns that emerged and better understand student experiences and perspectives as they developed throughout the project.

RESULTS

Students who participated in this study demonstrated increased empathy, critical thinking, self-efficacy, and enhanced professional skills.

DISCUSSION

This project offered students a real-world experience to develop practical knowledge and skills for increasing mental health literacy and effectively serving those with mental health issues within the criminal justice system.

Mental Health Literacy and Professional Psychological Help-Seeking Attitudes Among Primary Healthcare Workers: The Mediating Role of Social Support and Mental Illness Stigma

Background

Research highlights poor mental health among healthcare workers, but limited attention has been given to the mental health literacy and professional psychological help-seeking attitudes of primary healthcare workers.This study investigates the relationship between primary healthcare workers' mental health literacy and their attitudes toward professional psychological help-seeking. It also explores the chain mediating roles of social support and mental illness stigma in this relationship.

Methods

We conducted the study among primary healthcare workers in Shapingba District, Chongqing, China. The study utilized demographic questionnaires, the Multiple Mental Health Literacy Scale, Social Support Rating Scale, Perceived Devaluation-Discrimination Scale, and Attitudes Toward Seeking Professional Psychological Help Scale. We applied Pearson correlation, multiple linear regression, and structural equation modeling (SEM) for data analysis.

Results

Correlation analysis revealed positive associations between mental health literacy and help-seeking attitudes, while stigma negatively impacted these attitudes. The regression analysis demonstrated that mental health literacy, social support, and mental illness stigma significantly influenced attitudes toward professional psychological help-seeking, with the adjusted R square being 0.402. Specifically, social support and stigma acted as partial mediators in the relationship between mental health literacy and help-seeking attitudes. SEM confirmed a significant chain mediation effect, with social support and stigma jointly mediating the link between mental health literacy and help-seeking attitudes, explaining 27.46% of the variance.

Conclusion

This study underscores the critical role of mental health literacy, social support, and mental illness stigma in shaping primary healthcare workers' attitudes toward professional psychological help-seeking. Strengthening these factors can enhance their mental health outcomes and encourage more proactive help-seeking behavior. Implementing targeted interventions in training programs to reduce stigma and promote social support could improve help-seeking behaviors and overall mental health within healthcare settings.

Utilization of mental health services and associated factors among residents of southern Ethiopia; a community based cross-sectional study

BACKGROUND

In 2019, nearly one billion individuals worldwide were estimated to be living with some form of mental illness. This staggering figure underscores not only the widespread prevalence of mental health issues but also their significant negative impact. Despite the critical impact of mental health problems, there is a substantial gap in treatment at the global scale. Particularly in rural Ethiopia, there is a notable lack of data regarding the use of mental health services by community residents. This study was conducted with the aim of evaluating the utilization of mental health services and identifying factors that influence access to these services among the population of rural southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted on randomly selected adults in southern Ethiopia. A semi-structured questionnaire assessing the sociodemographic status of the participants was used. Depression and anxiety were measured with the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorders Scale (GAD-7), respectively. The data were then analyzed using StataMP version 18. Statistical tests such as frequency, percentage, mean, bivariate logistic regression, and multivariate analysis were performed. P values and confidence intervals were used to determine statistical significance.

RESULTS

A total of 971 participants were enrolled in this study, and the mean age was 34.9 (± 11) years. A minority of the participants (152 [15.5%]) sought some form of help for mental health-related reasons. Only 24 (2.5%) of the participants used biomedical mental health services. The perceived need for any mental health service was 96 (9.9%). Thirty-three percent of the respondents with mild to moderate depression and 37.1% of those with severe depression sought care for their concerns. Similarly, 37% and 35% of individuals with mild to moderate anxiety and severe anxiety, respectively, utilized mental health services. A higher monthly income, psychoactive substance use, perceived need, and symptoms of depression and anxiety were significantly associated with mental health service utilization.

CONCLUSION

Our study revealed a significantly low level of utilization of mental health services among the residents of rural southern Ethiopia. More efforts to address the treatment gap for mental health problems in the country are needed.

German college students' mental health state and their willingness to use mental health prevention: An online survey during the COVID-19 pandemic

The number of college students suffering from mental illnesses has been rising for several years. The COVID-19 pandemic has disproportionately affected young adults. Mental health prevention is essential in order to effectively reduce the incidence of mental disorders and may help to counteract chronic mental disorders in the long term. Data were derived from a German online survey of 1334 college students (M AGE = 24.75, SD AGE = 3.32, [19-42] years) conducted in autumn 2021. Besides validated questionnaires (PHQ-2, ASI-3, CD-RISC-10) to assess their mental health status, we asked specific questions on students' general interest in mental health prevention, whether students knew where to get help, and how many activities they engaged in to maintain their mental health. Students' overall interest in mental health prevention was high. Participants with clinically relevant scores were significantly more interested in prevention offers compared to those with clinically normal scores. Females engaged in significantly more activities to strengthen their mental health during the pandemic, and showed significantly higher anxiety scores and significantly lower resilience scores compared to their male counterparts. According to our results, students show decreasing mental health and resilience in times of crisis. Overall, motivation to seek professional support is high but knowledge about where to find such support is low. Based on these results, we conclude that easily accessible and low-threshold mental health prevention offers should be integrated into university curricula.

Personal and perceived public stigma toward students seeking help for alcohol use among undergraduate students in the southeastern United States

Objective: Stigma is a known barrier to seeking behavioral health support and treatment. This study assesses college students' stigma toward students seeking help for alcohol use. Participants: 237 students from a diverse major at a private university in the southeastern United States. Method: Respondents reported personal stigma and public stigma (i.e., the estimated prevalence of personal stigma among peers). We compared public stigma estimates with the prevalence of respondents' personal stigma. Logistic regression models were fit to estimate correlates of overestimating public stigma. Results: More than 70% overestimated public stigma. Estimates from regression models indicated that consuming alcohol 3+ days per week (aOR = 4.63; 95% CI 1.39-15.41; p = 0.012) and personal stigma (aOR = 14.06; 95% CI 3.64-54.36; p < 0.001) were associated with overestimating public stigma. Conclusions: Students overestimated public stigma toward students seeking help for alcohol use. Future research should assess whether correcting overestimates increases help-seeking for alcohol use.

Investigating factors influencing utilization of trauma-focused cognitive behavioral therapy among unaccompanied young refugees: an exploratory analysis

BACKGROUND

Unaccompanied young refugees (UYRs) exhibit elevated levels of mental distress, including posttraumatic stress symptoms (PTSS), depression and anxiety. Despite the considerable psychological burden, UYRs frequently lack access to mental health care (MHC). The factors that contribute to higher rates of treatment utilization among UYR remain poorly understood. Untreated PTSS can result in chronic impairment, underscoring the importance of identifying these factors. The aim of this study is to investigate factors associated with the intention and actual utilization of MHC of UYRs living in child and youth welfare facilities in Germany.

METHOD

This study is part of the multi-site project BETTER CARE which aims to implement a stepped and collaborative care approach. A sample of N = 139 UYRs who had received a treatment recommendation for trauma-focused cognitive behavioral therapy (TF-CBT) was analyzed. Binomial logistic regression was performed to identify factors predicting the likelihood of intention to seek MHC. In addition, the association between intention to seek MHC and actual utilization was determined using a chi square test.

RESULTS

The results demonstrated a significant correlation between age (η = 0.25, p <.01), length of stay in Germany (η = 0.28, p <.01), and severity of PTSD symptoms (η = 0.26, p <.01) with intention to use MHC. In the logistic regression analysis, PTSD emerged as a significant predictor of intended use (B = 2.66, p <.05). The utilization of MHC was found to be closely associated with the initial intention to use (χ²(1) = 88.846, p <.001).

CONCLUSIONS

The findings contribute to an expanding body of literature on the mental health requirements and service utilization patterns among UYRs, offering insights for policymakers, mental health professionals, and child welfare services striving to enhance care for this vulnerable population.

The Relationship Between Family Dynamics and Help-Seeking and Disclosure of Adolescent Self-Harm and Suicidality: A Population-Representative Study: Relation entre dynamique familiale et recherche d'aide, et dévoilement des actes d'automutilation et de la suicidalité chez les adolescents : étude représentative de la population

BACKGROUND

Few studies have explored the potential for family dynamics to hinder or promote help-seeking and disclosure behaviours among adolescents who self-harm or experience suicidality. We sought to examine whether family dynamics may influence self-harm-related disclosure to parents or other family members and online help-seeking.

METHODS

We identified youths, 14-17 years, in the 2014 Ontario Child Health Study (OCHS) who self-reported past-year suicidal ideation (with or without a suicide plan or past suicide attempt[s]) and/or non-suicidal self-harm. The OCHS is a provincially representative, cross-sectional survey. The person most knowledgeable about the adolescent, usually the mother, reported family dynamics: family dysfunction and positive and negative parenting practices. We used logistic regression to generate adjusted odds ratios.

RESULTS

A total of 359 adolescents positively endorsed past-year suicidal ideation and/or non-suicidal self-harm. Disclosure and help-seeking were common (≥67.3% and ≥25.6%, respectively). Adolescents experiencing suicidal ideation and greater family dysfunction were more likely to share their suicidal thoughts with non-family compared to not telling anyone (OR = 1.09, 95% CI: 1.01 to 1.18) and were less likely to tell their parents or other family members about their suicidal thoughts when compared to non-family such as teachers, partners, or friends (OR = 0.82, 95% CI: 0.71 to 0.94). Positive parenting was not associated with any form of disclosure or online help-seeking for non-suicidal self-harm or suicidal ideation. As adolescent exposure to negative parenting increased, so did the likelihood that they would seek help online for their suicidal thoughts (OR = 1.22, 95% CI: 1.08 to 1.37). Sensitivity analyses replicated or were very similar to findings from the main models.

CONCLUSION

We found that negative family dynamics were related to reduced sharing of suicidal thoughts with parents or other family members and greater online help-seeking. Our findings suggest that the importance of negative family dynamics to disclosure and support-seeking for adolescent suicidality may be under-recognized.

Clusters of Patient Empowerment and Mental Health Literacy Differentiate Professional Help-Seeking Attitudes in Online Mental Health Communities Users

OBJECTIVES

Grounded in the Health Empowerment Model, which posits that health literacy and patient empowerment are intertwined yet distinct constructs, this study investigates how the interplay of these factors influences attitudes toward seeking professional psychological help in members of online communities for mental health (OCMHs). This while acknowledging the multidimensionality of patient empowerment, encompassing meaningfulness, competence, self-determination, and impact.

DESIGN AND METHODS

A cluster analysis of data gathered from 269 members of Italian-speaking OCMHs on Facebook has been performed.

RESULTS

Four profiles have been identified: dangerous self-managers (11.2%), effective self-managers (21.2%), disempowered (40.5%) and ambivalent empowered (27.1%). Clusters provided meaningful variations in help-seeking attitudes, also when controlling for depression and anxiety severity, F3, 265 = 11.910, p < 0.001.

CONCLUSIONS

The findings provided further evidence of the multidimensionality of patient empowerment. Considering the results, we discussed potential interventions aimed at enhancing the quality of OCMHs, tailoring to the unique characteristics of each cluster.

PATIENT OR PUBLIC CONTRIBUTION

Administrators and moderators of mental health Facebook communities-whether expert-led by mental health professionals or peers-played a key role in this study. They provided valuable insights during the questionnaire design process to ensure the questions were both relevant and appropriate for community members. These administrators and moderators also actively facilitated participant recruitment by creating and sharing posts, either video- or text-based, on community homepages. Furthermore, after completing the questionnaire, participants were encouraged to comment on the Facebook posts where the survey link was shared, mentioning that they participated and inviting other members to take part. This approach aimed to foster a sense of involvement and further promoted the survey within the community.

Exploring the Effect of Brief Preventive Videos on Mental Health Help-Seeking for Early Psychosis in a Young Community Sample

INTRODUCTION

A key factor influencing the duration of untreated psychosis is that young individuals typically do not seek help during their initial psychotic experiences. This online study aimed to explore the efficacy of preventive video interventions providing information on psychosis on the attitudes towards seeking mental health care among young adults from the general population.

METHODS

Participants (N = 147) were randomised to one of the following online conditions: a short 3-min video of an empowered patient or of a psychiatrist describing different aspects of mental illness, a short control video or no video. Then, participants answered the Inventory of Attitudes to Seeking Mental Health Services (IARSSM) to measure attitudes towards seeking mental health.

RESULTS

A Kruskal-Wallis one-way ANOVA on the total IARSSM score revealed no significant effect of the group on attitude towards mental health care (χ2(3) = 6.52, p = 0.09). A small but statistically significant effect was found for the IARSSM factor "indifference to stigma" (χ2(3) = 8.50, p = 0.04), with slightly lower levels of indifference to stigma in the patient video group (M = 20.5, SD = 6.50) compared to the psychiatry video group (M = 24.5, SD = 4.35).

CONCLUSION

Emphasising nonconformity with mental health stereotypes, portraying positive aspects and utilising short video formats on social media platforms can potentially reduce stigma in the short term. Long-term effectiveness and identification of specific factors optimising attitudes towards mental health help-seeking warrant further investigation.

"We are here too": Experiences and perceived support needs of adolescent siblings of Paediatric oncology inpatients

BACKGROUND

Adolescent siblings of children and young people (CYP) with cancer are at increased risk of psychosocial difficulties, yet many remain overlooked and unsupported. This project aimed to explore the experiences and perceived needs of adolescent siblings of paediatric oncology inpatients to inform service improvement recommendations for sibling support.

METHODS

Semi-structured interviews were conducted with 10 siblings of CYP previously admitted to a paediatric oncology ward. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. The findings were reviewed in consultation with staff and used to identify pragmatic/feasible recommendations for improving sibling support, organized using the three-tier 'Pediatric Psychosocial Preventative Health Model' (PPPHM; Families, Systems & Health, 2006, 24, 381).

RESULTS

An overarching narrative of siblings wanting to feel part of the cancer journey was found, including their family's experience on the ward, with three key themes: (i) "what about me?": overlooked and unseen, (ii) "always changing, never knowing": the challenge of uncertainty and (iii) "let me be part of it all": togetherness, communication and connection. These findings informed sibling support recommendations. Such recommendations included providing psychosocial screening, resources and opportunities for family time/communication and developmentally appropriate information to all siblings (universal support), monitoring psychosocial difficulties, siblings having someone to talk to and fostering family and peer connection for siblings requiring additional support (targeted support) and offering one-to-one psychological support and family therapy for persistent and/or escalating distress (clinical/treatment support).

CONCLUSIONS

Based on the experiences of siblings, a range of sibling support recommendations have been identified. Implementation and evaluation of these recommendations are warranted.

How does stigma impact acts of compassion among people with borderline personality disorder

Borderline personality disorder (BPD) is a highly stigmatised mental disorder. A variety of research exists highlighting the stigma experienced by individuals with BPD and the impacts of such prejudices on their lives. Similarly, much research exists on the benefits of engaging in compassionate acts, including improved mental health recovery. However, there is a notable gap in understanding how stigma experienced by people with BPD acts as a barrier to compassion and by extension recovery. This paper synthesises these perspectives, examining common barriers to compassionate acts, the impact of stigma on people with BPD, and how these barriers are exacerbated for individuals with BPD due to the stigma they face. The synthesis of perspectives in the article highlights the critical role of compassion in supporting the recovery of individuals with BPD, while also revealing the significant barriers posed by stigma. Addressing these challenges requires a comprehensive understanding of the intersection between compassion and stigma, informing the development of targeted interventions to promote well-being and recovery for individuals with BPD.

Awareness of peers in recovery and of a campus collegiate recovery community at a university in the southeastern United States

Objective: Little is known about the extent of student awareness about collegiate recovery communities (CRCs) and of peers in recovery. Participants: A convenience sample of 237 undergraduate students from a diverse major at a private university participated in an anonymous online survey in Fall 2019. Methods: Participants reported whether they knew about the local CRC, whether they knew a peer in recovery, sociodemographic characteristics, and other information. Multivariable modified Poisson regression models were fitted to estimate correlates of awareness of the CRC and of peers in recovery. Results: Overall, 34% were aware of the CRC and 39% knew a peer in recovery. The latter was associated with being a member of Greek life, a junior or senior, using substances regularly, and personally being in recovery. Conclusions: Future research should explore ways to increase awareness of CRCs and assess the role of connections between students in recovery and peers across campus.

Why Teens Don't Talk: Understanding the Role of Stigma Within Barriers to Help Seeking

The stigma of mental illness, among a larger set of barriers to help seeking, has been understudied among teens. These barriers and the sources of support were examined through an online survey with 1,428 U.S. 13- to 17-year-olds. Data were analyzed using Q, with indexing and Z tests calculated for significant group differences. Parents were cited as the top support source for depression compared with mental health professionals. Nonstigma barriers were the top barriers for teens, including discomfort with difficult emotions and being misunderstood when reaching out for support. Stigma barriers were significantly higher for Hispanic and LGBTQ+ teens, and stigma-adjacent barriers were significantly higher among Black/African American teens. Results are discussed in terms of the differential support that teens need to navigate emotional challenges and for further understanding barriers to help seeking that are not weighed heavily by stigma, as in past studies.

Real-World Adoption of Mental Health Support Among Adolescents: Cross-Sectional Analysis of the California Health Interview Survey

OBJECTIVE

We aim to examine: (a) the extent to which patterns of adoption of counseling services and digital mental health interventions (DMHIs) shifted in recent years (2019-2021); (b) the impact of distress on adoption of mental health support; and (c) reasons related to adolescents' low adoption of DMHIs when experiencing distress.

METHODS

Data were from three cohorts of adolescents aged 12-17 years (n = 847 in 2019; n = 1,365 in 2020; n = 1,169 in 2021) recruited as part of the California Health Interview Survey. We estimated logistic regression models to examine the likelihood of using mental health support as a function of psychological distress, sociodemographic characteristics, and cohorts. We also analyzed adolescents' self-reported reasons for not trying DMHIs as a function of distress.

RESULTS

The proportion of adolescents reporting elevated psychological distress (∼50%) was higher than those adopting counseling services (<20%) or DMHIs (<10%). A higher level of distress was associated with a greater likelihood of receiving counseling (OR = 1.15), and using DMHIs to connect with a professional (Odds ratio (OR) = 1.11) and for self-help (OR = 1.17). Among those experiencing high distress, adolescents' top reason for not adopting an online tool was a lack of perceived need (19.2%).

CONCLUSION

Adolescents' main barriers to DMHI adoption included a lack of perceived need, which may be explained by a lack of mental health literacy. Thoughtful marketing and dissemination efforts are needed to increase mental health awareness and normalize adoption of counseling services and DMHIs.

Association between gambling disorder and suicide mortality: a comparative cohort study using Norwegian health registry data

Background

Gambling disorder has been consistently linked to suicidal ideation and suicide attempts, but few studies have investigated the association between gambling disorder and suicide mortality. This study examined the risk of suicide mortality associated with gambling disorder compared to the general population and other patient groups.

Methods

A registry-based cohort study was conducted employing individual-level linked and aggregated data from Norwegian nationwide health registries. The study population comprised all patients with gambling disorder in Norway (n = 6899) for the period 2008 to 2021. Standardized mortality ratios were estimated to assess suicide risk among gambling disorder patients against the adult Norwegian general population. Cox regressions were used to estimate hazard ratios comparing suicide risk among patients with gambling disorder to 12 comparison groups comprising patients treated for other conditions (n = 391,897).

Findings

Suicide was the leading cause of death among patients with gambling disorder (37 of 148 deaths; 25%). Patients with gambling disorder had a higher suicide risk than the general population (standardized mortality ratio = 5.12, 95% CI [3.71; 7.06]), and 5 of 12 patient groups with other conditions. Suicide risk was not significantly different when compared to that of patients with anxiety disorders, personality disorders, or depression. However, suicide risk was lower among patients with gambling disorder than patients with substance use disorders, alcohol dependence, psychotic disorders, or mood disorders.

Interpretation

Norwegian patients with gambling disorder have an elevated risk of suicide mortality but the risk is similar to or lower than other patient groups known to be at increased suicide risk.

Funding

Norwegian Competence Center for Gambling and Gaming Research and the Faculty of Psychology at the University of Bergen (no specific grant).

Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review

Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.

Translation, Validity, and Reliability of Depression Literacy Questionnaire in Iranian Young Adults

Background

Depression literacy has notable advantages in the early identification and treatment of depression. The current study was conducted with the aim of translating and investigating the validity and reliability of the Depression Literacy Questionnaire (D-Lit) in Iranian young adults.

Methods

The current study entailed a descriptive-analytical study in which the translation, validation, and preparation of the Persian version of D-Lit were conducted. It had two stages: translation and validation. In order to check the composite reliability, the statistical population consisted of Iranian adults in the city of Mashhad, and 300 people participated in this study in the form of a census. The content validity ratio (CVR) and content validity index (CVI) indices were used for content validity.

Results

The results of the content validity evaluation of this questionnaire indicated that both the CVR and CVI indices have higher-than-average coefficients (0.78 and 0.83). Furthermore, the Cronbach's alpha value for the components of the D-Lit was found to be higher than 0.70. In the present study, the questionnaire's reliability was assessed using the intra-cluster correlation coefficient (ICC), and the difficulty coefficient for the whole questionnaire and its sub-components was at a favorable level. Out of 22 questions, 17 questions of this questionnaire were retained and questions 1, 17, and 22 were removed due to low CVR and CVI in the validity stage, and questions 5 and 13 were removed due to common factor load in the factor analysis stage.

Conclusion

According to the content validity and reliability in this study, this tool can be used to identify underlying factors, etiology, and treatment of depression.

Predictors of seeking mental health services among Iranian middle-aged people based on health belief model: evidence from a cross-sectional study in a developing country

BACKGROUND

There is limited information about people's beliefs regarding how they deal with mental health problems, especially in developing countries. This study was conducted with the aim of determining predictors of seeking mental health services (SMHS) among Iranian middle-aged people.

METHOD

The current study is a cross-sectional study on 384 middle-aged people from Jahrom city that was selected with random cluster sampling. The data collection tool is a researcher-made questionnaire consisting demographic information and health beliefs about SMHS based on the health belief model. To examine the prediction of variables explaining SMHS, a linear regression analysis was carried out. P-value < 0.05 was considered statistically significant.

RESULTS

Perceived susceptibility (β = 0.22; p < 0.001), perceived severity (β = 0.13; p = 0.002), perceived barriers (β = 0.39; p < 0.001) and perceived self-efficacy (β = 0.37; p < 0.001) could explain 44% of variance of SMHS (F = 61.46; p < 001).

CONCLUSION

SMHS was related to people's perceptions and beliefs, and middle-aged people's perceived barriers were stronger predictors. It is necessary for health planners to develop and implement educational intervention programs that include health beliefs.

After the buzzer sounds: Adults unveil the consequences of concussions sustained during adolescence

Concussions are commonly occurring injuries in sport. The short-term impacts of concussions, including symptoms and recovery trajectories, often are the focus of concussion research. However, limited studies have explored the long-term consequences of concussions, especially in adolescents. The purpose of this study was to explore adults' experiences with concussions sustained during their adolescence (5-15 years prior). This qualitative study was guided by an interpretivist philosophy. Twenty young adults (11 men, 9 women, median age 26) who had sustained at least one sport-related concussion during their adolescence participated in a one-on-one semi-structured interview. We aimed to explore their experiences with their concussion at the time of injury and any consequences they experienced as a result of their concussion. We organized participants' concussion experiences into six main themes: (1) Concussion diagnosis and experiences with health care providers; (2) Emotional symptoms following concussion; (3) Concussion recovery; (4) Change in sport participation and engagement; (5) Concern about the potential long-term consequences; and (6) Impact on social relationships. We used the Biopsychosocial Model of Sport Injury Rehabilitation to organize the themes. Future research should explore how acute multi-disciplinary support could reduce the negative long-term consequences of concussion in adolescents.

Mental Health Awareness: Stigma and Help-Seeking Among Portuguese College Students

BACKGROUND/OBJECTIVES

Help-seeking-that is, the attempt to attain external help for mental health, be it from formal or informal sources-can be described as an adaptive coping process. Mental illness stigma is the most frequently identified barrier that prevents students from seeking psychological help. This study analyzed college students' beliefs about mental illness and attitudes toward formal psychological help-seeking.

METHODS

Two hundred and eighty-two students from the first and third undergraduate years of Psychology, Sociology, Fashion Design, and Sports Science courses participated. The majority of the sample (75.4%) was female, while only 24.6% was male, with a mean age of 20.04 years. The scales used were the Inventory of Beliefs about Mental Illness (IBMI), the Inventory of Attitudes Toward Seeking Mental Health Services (IATSMHS), and a sociodemographic questionnaire.

RESULTS

The results revealed that females, third-year students, and Psychology students had fewer stigmatizing beliefs about mental illness and more positive attitudes towards help-seeking. Moreover, there were statistically significant differences in beliefs and attitudes in relation to psychological support and familiarity with mental illness. We also glimpsed the impact of the COVID-19 pandemic on students' mental health, and observed a change in opinions and attitudes toward mental illness during this period. Correlation analysis showed negative correlations between stigmatizing beliefs and attitudes toward seeking help. Finally, a cluster analysis identified two profiles of individuals that reflected different levels of stigma and help-seeking attitudes.

CONCLUSIONS

This study delineated two distinct groups of students, which is relevant as it allows us to trace profiles to outline more uniform intervention groups and, in turn, implement new and improved interventions that are better adapted to the specific needs of college students.

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

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

Public health unit engagement in school mental health programs and adolescent mental health during the COVID-19 pandemic: COMPASS, 2018-2022

BACKGROUND

Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic.

METHODS

We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic.

RESULTS

The sample included 23 894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B = -0.01, 95% CI = -0.04, 0.02), but was protective against anxiety symptoms (B = -0.03, -0.06, 0.001) during the COVID-19 pandemic.

DISCUSSION

The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery.

Association between interpersonal resources and mental health professional help-seeking among Chinese adolescents with probable depression: mediations via personal resources and active coping

BACKGROUND

Globally, adolescent depression is prevalent. There is, however, a dearth of studies investigating behavioral intention to professional help-seeking regarding mental health problems among adolescents having probable depression. Based on the Stress Coping Theory, the hypothesis that personal resources and active coping would mediate between interpersonal resources and behavioral intention to professional help-seeking was investigated.

METHODS

Students from five junior middle schools, three senior high schools, and one vocational school were selected to participate in the survey from February to March 2022 via convenient sampling. The questionnaire collected participants' characteristics, depression, peer acceptance/support, resilience, self-compassion, active coping, and behavioral intention to professional help-seeking. The final sample included 1,425 Chinese adolescents having probable depression (Patient Health Questionnaire score ≥ 10). SPSS 23.0 and Mplus 8.3 were employed to analyze the data.

RESULTS

The prevalence of behavioral intention to professional help-seeking was 15.4%. Adjusted for background factors, peer acceptance, resilience, self-compassion, and active coping were significantly associated with behavioral intention to professional help-seeking (ORa ranged from 1.05 to 1.31). The indirect effects via active coping (β = 0.020) and a serial indirect effect via personal resources and active coping (β = 0.029) were statistically significant. The direct effect from interpersonal resources to behavioral intention to professional help-seeking was non-significant.

CONCLUSION

The prevalence of behavioral intention to professional help-seeking among adolescents with probable depression was low and might render early detection/intervention ineffective. It is important to increase the intention to seek help from professionals. One possibility is to enhance interpersonal/personal resources and active coping.

Exploring mental health literacy and formal and informal help-seeking intentions among Palestinian adolescents in Israel: insights from the MHLS-Arabic-adolescents tool

Background

Mental health literacy (MHL) is a crucial concept in mental health because it promotes positive mental health outcomes and behaviors across various demographics, including adolescents.

Aims

This study utilized the MHLS-Arabic-Adolescents tool to investigate MHL among Palestinian adolescents in Israel, aiming to explore its significance in determining intentions to seek formal and informal mental health help separately.

Methods

A cohort of 172 adolescents (with a mean age of 16.25 ± 1.25 years, comprising 64% females) completed assessments measuring their intention for both formal and informal help-seeking, levels of psychological distress, MHL, and various sociodemographic and clinical characteristics. This study uses the same dataset from previous research on formal help-seeking, with an expanded focus on informal help-seeking and MHL using an adapted tool.

Results

Participants reported medium to high levels of MHL factors, demonstrating stronger intentions to seek informal help compared to formal. "Knowledge of where to seek information" and "Attitude toward mental illness" emerged as the significant MHL factors determining formal help-seeking intentions, whereas 'attitudes toward mental illness' was identified as the sole determinant of intentions to seek informal help.

Conclusions

This study highlights the importance of MHL factors in shaping adolescents' intentions to seek formal and informal mental health help. It emphasizes the need to strengthen informal support networks, improve adolescents' attitudes toward mental illness, and facilitate access to mental health information. These insights offer valuable guidance for intervention programs aimed at promoting both formal and informal help-seeking behaviors among Palestinian Arab adolescents in Israel and similar groups.

Psychosocial predictors of adolescent depression and mental health referral in an urban mobile medical unit programme

Introduction: Given worsening youth mental health over the past years, mobile medical units are a potential avenue to increase access to mental healthcare services.Methods: This 1-year retrospective study examined a self-administered psychosocial assessment, and referrals made to mental health services for adolescent patients served by a mobile medical unit. We extracted psychosocial assessment responses, Patient Health Questionnaire (PHQ-9) scores, and mental health referral information for patients seen by the mobile medical unit in 2022 and examined rates and predictors of depression and referral to mental health services.Results: Of the 326 patients who completed the psychosocial assessment, one in five had moderate to severe depression symptoms based on PHQ-9 scores. Factors associated with referral to mental healthcare included female gender identity, LGBTQ+ identity, and several factors from the psychosocial assessment. Additionally, 13.8% wanted a mental health referral, and 16.6% were referred to mental healthcare. Patients who desired to see a mental health provider had higher odds of being referred (p < 0.0001). All patients with moderate to severe depression who were not already connected to mental healthcare and wanted a referral were referred.Conclusion: This study documents the impact of a mobile medical unit programme in identifying adolescent patients with mental health needs and referring them to mental healthcare.

Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol

Adolescence increases vulnerability to mental ill-health, particularly anxiety disorders like Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD). Still, the understanding of Psychological Flexibility/Inflexibility (PF/PI) as a transdiagnostic framework relevant to explaining these difficulties and the efficacy of Acceptance and Commitment Therapy (ACT) in addressing adolescent SAD and GAD remains limited. Hence, this study has two aims: examining the role of PI/PF on adolescents' mental health and assessing ACT's efficacy for adolescent SAD and GAD. We will collect data from 400 community adolescents and employ network analysis to explore connections between PI/PF processes, anxiety, and flourishing. We will also investigate pathways linking PI/PF processes with flourishing and anxiety across samples (clinical SAD, clinical GAD, and mentally healthy groups), expecting to find similar patterns. Furthermore, a Randomized Controlled Trial with three groups (control, SAD experimental and GAD experimental), each comprising 29 participants, and four assessment moments (pre- and post-intervention and 3- and 6-months follow-up) will be conducted. Similar improvements are anticipated in both experimental groups, driven by changes in PI/PF processes. Findings from this work will provide valuable evidence to PI/PF as accurate conceptualizations of human suffering and expand the transdiagnostic application of ACT to adolescents with anxiety disorders.

Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need. We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators. The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence. Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Understanding the transdiagnostic mechanisms underlying emerging psychopathology in adolescence: study protocol of a 1-year prospective epidemiological (EMERGE) study

INTRODUCTION

Adolescent mental health is a global public health challenge as most cases remain undetected and untreated, and consequently, have a high likelihood of persistence or recurrence. It is critical to improve early detection of mental disorders and to target individuals experiencing subclinical symptoms. However, most indicated prevention approaches have been developed for risk syndromes of specific mental disorders. This contradicts the increasing recognition of emerging psychopathology as a complex system characterised by rapid shifts in subclinical symptoms, cutting across diagnostic categories and interacting with each other over time. Therefore, this study aims to examine the dynamic course, pattern and network of subclinical symptoms and transdiagnostic mechanisms over time.

METHOD AND ANALYSIS

The EMERGE-study is a prospective, naturalistic, 1-year follow-up study. A general population sample of 1196 adolescents will be recruited. Inclusion criteria are age between 11 and 17 years, German language skills, main residency in Switzerland and access to internet. Individuals will be excluded if they have a current or lifetime axis I mental disorder. Assessments of subclinical symptoms of several mental disorders and potential transdiagnostic mechanisms will be conducted at baseline and at 3-month, 6-month, 9-month and 12-month follow-up. Structural equation modelling will be used to estimate the homotypic and heterotypic patterns of subclinical symptoms and the associations with transdiagnostic mechanisms. Latent growth mixture modelling and growth mixture survival analysis will be carried out to identify subclasses of individuals with different trajectories of subclinical symptoms that may be predictive of an onset of a mental disorder. Network analysis will be applied to assess the centrality of subclinical symptoms and how networks of emerging psychopathology change over time.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Bern Cantonal Ethics Committee (ID 2020-02108). All findings will be disseminated by publication in peer-reviewed scientific journals and by presentation of the results to conferences and stakeholder organisation events.

Mental health literacy in secondary school teachers and interventions to improve it - a systematic review and narrative synthesis

BACKGROUND

Adolescent mental health problems have increased in prevalence. Teachers' Mental Health Literacy (MHL) may play an important role in public mental health prevention approaches. This systematic review and narrative synthesis aimed to identify what is known globally about the extent of secondary school teachers' MHL and the types and effectiveness of MHL interventions for secondary school teachers.

METHODS

PsycINFO, PubMed, ERIC, EBSCO-Psychological and behavioural sciences collection, Web of Science, and Google Scholar were searched to identify studies until 29/04/2024. Two independent reviewers screened the returns.

RESULTS

Twenty eligible studies were reviewed. Most intervention studies were from high-income countries and used a psycho-educative approach. Pre-intervention, teachers' levels of MHL were mixed across MHL domains. Post-intervention, increases in mental health knowledge and attitudes and decreases in mental health stigma were reported. Low use of standardised MHL measures, lack of randomised controlled trials, and lack of follow-up data affect evidence quality.

CONCLUSION

Interventions to improve secondary school teachers' MHL can be effective, at least in the short term. Evidence quality needs to be improved to inform recommendations on whether they should be part of a public mental health approach for adolescents.

Prevalence of risk factors among adolescents who attempted suicide: a cross-sectional study

OBJECTIVE

To analyze the prevalence of risk factors among adolescents treated at an emergency department due to suicide attempt.

METHOD

A cross-sectional, documentary, and retrospective study, conducted through the analysis of medical records of adolescents treated at an emergency department in a Brazilian teaching hospital from January 2015 to May 2023. Risk factors were divided into behavioral, health, violence, conflict, and stress. Data were subjected to descriptive and inferential analysis.

RESULTS

A total of 140 adolescent medical records were analyzed. Family conflicts (47.8%), previous suicide attempt (47.1%) and self-harm (30.7%) were the most prevalent risk factors. Risk factors were associated with age, sex, race, education, previous mental disorder and use of psychotropic medication (p < 0.05).

CONCLUSION

A high prevalence of risk factors for suicide attempt in adolescents was observed, which was associated with sociodemographic characteristics. It is expected that this study will promote reflections on the translation of Brazilian public policies into care, especially in health promotion, with interventions that aim to reduce risk factors and enhance protective factors.

Psychological difficulties and the needs for psychological services for high school students

Adolescents experience numerous changes, both psychologically and physically, and they are also the age group with a high prevalence of mental problems that need counseling help. The study aims to assess the difficulties and the needs for psychological support, factors affecting the need to use psychological services among adolescents. A cross-sectional study was conducted on 672 high school students in Thu Duc City, Vietnam. The results showed that there was a statistically significant difference between grades 10-12 in student's difficulties (DS) and a statistically significant difference in needs for psychological services (NPS, RPS). Additionally, there was a statistically significant difference in academic performance for DS. The findings also implied that RPS was predicted by a DS, NPS, and factors affecting the need to use psychological services (FA), in which NPS and DS were mediators in the relationship between FA and RPS. The study significantly contributes to research practices and the theoretical framework that the parliament and the government use to make counselors mandatory in schools. Meanwhile, the study suggested that school counselors, educators, and teachers must appropriately evaluate students' counseling needs and psychological difficulties; this is essential to providing support and interventions when students deal with challenges promptly.

Patient Perspectives of Integrated Behavioral Health in Primary Care: A Mixed Methods Analysis

Integrated and collaborative care models, in which mental/behavioral health providers work closely with primary care providers within a primary care setting, help support the quadruple aim of improved health outcomes, patient satisfaction, provider experience, and lower cost. In this paper, we describe patients' general perspectives of integrated care and their unique experiences accessing this care within one health system. Qualitative (interviews with patients) and quantitative (surveys with patients) methods were used to collect and analyze these results separately and together. The results highlight important features to the provision of integrated care from the perspective of patients using integrated care. They include the importance and experience of access, whole-person care and a team-based approach, the availability and use of telehealth when appropriate, having high quality mental health providers, scheduling and service usage suggestions, and means to connect with longer-term services for ongoing mental health care when needed.

Youth Epidemiology and Resilience (YEAR) in a student population: prevalence and predictors of mental health symptoms

Background

Adolescence is a pivotal developmental phase, marked by a high prevalence of mental health issues. The Singapore Youth Epidemiology and Resilience (YEAR) study aims to assess the prevalence of mental health symptoms, sociodemographic risk factors, and the protective role of resilience in a multi-ethnic, Asian school-going adolescent population.

Methods

School-based adolescents aged 11-18 and their parents were invited from a stratified sample of national schools, designed to be demographically representative of the mainstream school-going population. In the screening phase, adolescents completed a battery of questionnaires including the Youth Self-Report (YSR), Child Behaviour Checklist (CBCL), and the Singapore Youth Resilience Scale (SYRESS). Thereafter, diagnostic interviews were conducted on high-risk and control participants. Data analysis was conducted to establish prevalence rates of mental health symptoms, and to examine the associations between mental health symptoms, sociodemographic factors, and resilience.

Results

The final study sample consisted of 3336 adolescents and 2475 parents. Based on adolescents' response on the YSR, 37.3%, 13.1% and 27.7% of the YEAR Study population scored in the clinical range for internalizing, externalizing and total problems respectively. Based on parents' reporting on their children on the CBCL, 15.9%, 4.0% and 11.2% scored in the clinical range for internalizing, externalizing and total problems respectively. Sociodemographic risk factors for specific mental health symptoms were identified, including belonging to the age category of 15-16 (OR, 1.8-2.2) and those living in either a 4-, 5-room or executive flat (OR, 0.6-0.7), or in condominiums and other apartments (OR, 0.4-0.6). Total resilience scores were moderately correlated with total [rs(3334) = -.49, p <.01] and internalizing [rs(3334) = -.50, p <.01] problem scores on the YSR.

Conclusion

This study illustrates the state of mental health of school-going adolescents aged 11-18. The greater prevalence of internalizing symptoms indicates the need for stronger attention for identifying internalizing problems and targeted interventions for those at risk of such symptoms. The association between mental health symptoms and resilience factors highlights the protective potential of resilience building for adolescents.

Increasing Follow-up for Adolescents With Depressive Symptoms

BACKGROUND

Prompt follow-up for positive depression screen results is important in providing high-quality care for adolescents. We sought to improve follow-up within 30 days for adolescents (≥12 years) with Patient Health Questionnaire-9 scores ≥10, or those with a positive question 9, from 25% to 40%.

METHODS

We conducted a quality improvement project at 6 primary care locations serving ∼33,300 patients (70% Black, 7.3% Hispanic, 80% Medicaid-enrolled). Our team identified key drivers and iteratively tested interventions, including contacting patients after antidepressant medication initiation, scheduling patients for follow-up during index visits, collaborating with integrated psychologists to expedite therapy for higher-risk patients, and reaching out to patients without scheduled follow-ups.

RESULTS

Pre-intervention, 13.3% (589 of 4427) of adolescent encounters met the criteria for follow-up within 30 days, and 25.8% had a documented follow-up within 30 days. During the intervention period, 12.3% (764 of 6224) of adolescent encounters met the criteria for follow-up within 30 days, and the mean follow-up rate increased to 43.1%. By monitoring process measures, we scheduled follow-up visits for 18.9% of patients during the index encounter. Outreach to the remainder led to 32.6% of these patients completing follow-up. Our balancing measure of monitoring integrated psychology visit volumes remained stable.

CONCLUSIONS

The application of quality improvement methods in primary care practices increased the frequency of follow-up care for high-risk adolescents after a positive depression screen.

Community Mental Health Workers: Their Workplaces, Roles, and Impact

Mental health care in the U.S. is at a critical crisis, compounded with a severe shortage of providers. The cost burden is immense, with severe disparity seen in traditionally marginalized communities and rural populations. Community health workers have been used to increase access to physical health care in the U.S. for over seventy years-and have been used abroad for centuries. Their use in mental health care is more recent and can increase access, but raises policy, reimbursement, triage, and scopes-of-practice considerations. They are especially beneficial for many at-risk populations including communities of color, those with serious mental illness, rural communities, the elderly, and youth. This literature review searched PubMed, EMBASE, and Google Scholar and provides a broad review of the different types of community mental health workers (community health workers/promotores de salud, peer support, peer navigators, and lay counselors), how they increase access to care, skill sets, practice locations, and uses for specific at-risk populations. Increasing and expanding the use of community mental health workers expands much needed mental health care to those at risk by task-shifting the burden on the traditional professional workforce, offering a solution to both the workforce shortage and the lack of equity in mental health care.

Barriers and facilitators to help-seeking for common mental disorders among university students: a systematic review

Objectives: Common mental disorders affect high proportions of university students. This systematic review aims to summarize the barriers and facilitators to help-seeking for depression and anxiety among university students and provide evidence to improve mental health services. Methods: EMBASE, MEDLINE, and PsycINFO were searched for eligible papers. Inclusion criteria: (1) published between 1990 and 2021, (2) written in English, (3) had qualitative or quantitative methodology, (4) involved university students, (5) students had depression or anxiety, (6) students were explicitly asked about barriers and facilitators, (7) >60% of study population had mental illness. Results: Ten studies were included into this review. The most common barriers were self-reliance, stigma, and poor mental health literacy. Good mental health literacy and social encouragement were significant facilitators. Conclusions: Universities could encourage help-seeking by targeting stigma and increasing mental health literacy. Future research could explore the role of self-reliance in help-seeking and identify more facilitators.

Inequitable access to mental healthcare for socially excluded adolescents

BACKGROUND

Adolescence is a critical period for mental health and social exclusion, a key social determinant of mental health. Early intervention approaches are key to mitigating the impact of mental ill-health during adolescence, however social exclusion can create additional barriers to accessing care.

AIM

We aimed to better understand help-seeking experiences of adolescents facing co-occurring social exclusion and mental ill-health, including sources of support, barriers and preferences for service provision.

METHOD

Cross-sectional data were analysed, from the 2022 Mission Australia Youth Survey (N = 18,800). Adolescents aged 15 to 19 years were recruited from around Australia, through schools, community organisations and digital platforms. Indices of four domains of social exclusion (housing, finances, relational and education/employment) were created using existing Youth Survey variables, and supplemented with demographic characteristics, psychological distress and help-seeking behaviours (perceived need, mental health supports, barriers to access and preferences). Relationships between social exclusion domains, mental health concerns and help-seeking behaviours were explored using logistic regression models.

RESULTS

A total of 9,743 young people reported having needed mental health support, yet only 58.1% reportedly sought support (n = 5,565). Social exclusion domains were associated with different help-seeking behaviours: housing challenges with higher help-seeking (OR = 1.28; 95% CI [1.15, 1.42]); relational difficulties and edu-employment issues with lower (OR = 0.75; 95% CI [0.68, 0.83] and OR = 0.82; 95% CI [0.75, 0.89]). Stigma, confidentiality concerns, cost and not knowing where to seek help were common barriers to help-seeking; those experiencing social exclusion more likely to report these. Participants reported a strong preference for face-to-face support.

CONCLUSIONS

This study highlights the additional needs and challenges faced by adolescents dealing with both social exclusion and mental ill-health. With greater barriers to help-seeking, concerted efforts are needed to reduce stigma, improve mental health literacy and increase access to trusted information sources. Further initiatives should focus on structural factors that socially exclude young people and exacerbate inequitable access to mental healthcare.

[Utilization of Psychosocial Support for Young Adults with Suicidal Thoughts and Behaviors]

The study explores the utilization of psychosocial support by young adults facing suicidal ideation or impulses, considering a comprehensive spectrum of psychosocial services. The study sheds light on help utilization and gaps in service use among different groups. The data is derived from the baseline assessment of the research project "Outcome Evaluation [U25]". The sample includes 888 young adults who reported suicidal thoughts and behaviors. Among the participants, 55% accessed at least one psychosocial service. Medical/psychotherapy services were the most utilized (54%), followed by professional counseling (34%) and non-professional self-help services (22%). Gender differences were observed, with males using help less frequently than females and individuals with diverse gender identities. Participants in relationships were less likely to seek help than singles. A migrant background showed no consistent impact on service utilization. Psychological distress and suicide literacy were associated with increased service utilization. Regression analysis revealed that gender and relationship status remained predictors of service utilization even when considering mental distress, suicidal thoughts and behaviors, and suicide literacy.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effectiveness of a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark: an observational study and a propensity score-matched comparison

Objective

This study investigated the effectiveness of a 7-weeks peer-to-peer program for young people aged 15 to 25 years with depression or anxiety symptoms in Denmark.

Methods

A total of 483 participants (72% women) participated in the program and the evaluation. The participants completed questionnaires at baseline, postintervention, and at 5-month follow-up to assess changes in depression symptoms (using Beck's Depression Inventory-II), anxiety symptoms (using Spielbergers State-Trait Anxiety Inventory for Adults) and self-efficacy in controlling or managing the illness (using the personal control subscale from the Illness Perception Questionnaire-Revised). Analyses were done using repeated measures mixed linear regression models. Moreover, a register-based matched comparison group was derived as a comparison to assess changes in being in education and employment at 8-month follow-up.

Results

Within the intervention group, both depression and anxiety scores declined across the 5-month follow-up compared to baseline (b = -9.6, 95% CI: -11.2, -8.1 for depression symptoms). The self-efficacy score increased from baseline to post-intervention (b = 1.4, 95% CI: 1.0, 1.8) and this level was maintained at follow-up. More than half of the participants were in education at baseline while 24% received social transfer payments. Compared with matched comparison group, a lower proportion of the intervention group remaining in education (71% vs. 80%). Among participants who were employed at baseline, a higher proportion of the intervention group were enrolled in education (27% vs. 19%) and were unemployed (14% vs. 4%) compared to the matched comparison group.

Conclusion

This study supports the effectiveness of a peer-to-peer intervention for depression and anxiety symptoms, and self-efficacy in symptom control. However, mixed effects on education and employment were observed, indicating a negative impact on education among those initially enrolled and a higher proportion of employed participants starting education.

"I can't escape my scars, even if I do get better": A qualitative exploration of how adolescents talk about their self-harm and self-harm scars during cognitive behavioural therapy for depression

Emerging evidence indicates that perceptions of self-harm behaviours and self-harm scars may thwart recovery from depression, yet limited research has explored adolescent accounts of their self-harm and scars during therapy. This study sought to explore how adolescents describe their self-harm behaviours and scars during Cognitive Behavioural Therapy (CBT) and explore the sociocultural discourses that may influence these descriptions. The participants were six female adolescents (aged 14-17 years old) with clinical depression, who were engaging in self-harm. All participants accessed CBT as part of clinical trial evaluating three psychological treatments for major depressive disorder in Child and Adolescent Mental Health Services. Audio-taped CBT sessions were analyzed using discourse analysis. Within CBT sessions, adolescents drew upon stigma discourses in talking about their self-harm. Adolescent also described their self-harm scars as shameful and stigmatizing, and as "proof" of the legitimacy of their depression. It is important for CBT practitioners to understand the context of sociocultural discourses around self-harm behaviours and self-harm scars, which are reflected in how adolescents with depression describe these within therapy and may serve to maintain distress. The study indicates that awareness of use of language and intersecting sociocultural discourses can inform CBT practice.

Desirable design: What aesthetics are important to young people when designing a mental health app?

Objectives: Smartphone apps can be highly effective in supporting young people experiencing mood disorders, but an appealing visual design is a key predictor of engagement with such apps. However, there has been little research about the interaction between visual design, mood and wellbeing in young people using a mental health app. This study aimed to explore young people's perspectives on colour and visual design in the development of a music-based app for mood management. Methods: Workshops were conducted with 24 participants (aged 13-25 years) with data analysis following a general inductive approach. Results: Results indicated that colour could impact wellbeing in both positive and negative ways. Participants favoured a subtle use of colour within sophisticated, dark palettes and were influenced by a complex interplay of common semiotic values, experiences with other apps, and mood. Conclusions: These findings highlight the highly contextual nature of the relationship between colour and mood, emphasising the importance of co-design in app development.

The effects of a teacher-led online mental health literacy program for high school students: a pilot cluster randomized controlled trial

BACKGROUND

Adolescents are vulnerable to mental health problems, and this vulnerability may be enhanced in situations such as the present COVID-19 pandemic. Online mental health literacy (MHL) education may help adolescents maintain/improve their mental health, especially in situations where face-to-face education is difficult.

AIMS

To evaluate the effects of a teacher-led "online Short MHL Program (o-SMHLP)" delivered online to grade 10 students in their classrooms.

METHODS

Students (age 15-16) were randomly assigned to an o-SMHLP group (n = 115 (3 classes)) or a control group (n = 155 (4 classes)) at the class level. The program consisted of a 20-minute session which included an animated video. The students completed a self-report questionnaire pre- and post-intervention assessing outcomes including: "Knowledge about mental health/illnesses", "Recognition of necessity to seek help", "Intention to seek help", and "Unwillingness to socialize with people having mental illness". Mixed effects modeling was employed for analyses.

RESULTS

All outcomes were significantly improved in the intervention group compared to the control group post-intervention, except for "intention to seek help".

CONCLUSIONS

The present study shows the effectiveness of an online MHL intervention while identifying the need for the development of effective online programs targeting adolescents' "intention to seek help".

Help-Seeking Behaviors of Young People with Problematic Sexualized Behaviors

A substantial proportion of all reported child sexual abuse is perpetrated by other young people, though it is challenging to accurately depict its prevalence. Even less is known about the help-seeking behaviors of young people. Understanding how they seek help for their own problematic sexualized behavior is crucial to better inform therapeutic interventions and early intervention opportunities. This study used an administrative dataset of contacts (N = 901) received by Kids Helpline over nine years. Given the paucity of research on this topic, our approach to draw upon the contacts made to Kids Helpline by young people concerned about their own sexualized interests or behaviors is innovative and exploratory. Descriptive analyses were conducted to examine the characteristics of each contact as well as the demographics of the young people making contact. The present study examined the characteristics of 695 males and 206 females (aged 10 to 25) seeking help for their own problematic sexualized behaviors. Young people who contacted Kids Helpline for problematic sexualized behavior reported the following specific concerns: sexual behaviors (40.50%) and pornography use (38.20%). A quarter of contacts (25.86%) raised multiple concerns. Results suggest that intervention should be provided early and in an age-graded way. Several implications for theory and practice are discussed.

Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review

BACKGROUND

Adolescents comprise one-sixth of the world's population, yet there is no clear understanding of the features that promote adolescent-friendly services (AFS). The lack of clarity and consistency around a definition presents a gap in health services.

METHODS

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a scoping review of peer-reviewed empirical studies to explore AFS in low-income and middle-income countries (LMICs) published between January 2000 and December 2022. The databases searched were CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) and PsycINFO (n=156). The title, abstract and full text were double screened by three independent reviewers. Three independent reviewers assessed the study's quality using the Joanna Briggs Initiative Quality Appraisal and Cochrane Risk of Bias 2 tools.

RESULTS

We identified the key components, barriers and facilitators of AFS. The following emerged from our review: a non-judgmental environment, culturally appropriate and responsive interventions and a focus on supporting marginalised communities often living in high-poverty settings. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS.

INTERPRETATION

As LMICs are heterogeneous and unique, it was assumed that the operational definition of 'adolescent-friendly' might vary depending on different contexts, but there must be core components that remain consistent. Possible limitations of our review include a lack of grey literature. Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines.

KEY HIGHLIGHTS

Our review has mapped the research framing of AFS and provided a comprehensive review of barriers and facilitators to implementing a holistic outlook of AFS set-up in a tightly controlled research and real-world context. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS.