A New Normal: Integrating Lived Experience Into Scientific Data Syntheses

Development of a Scale to Measure Planned Behavior in Inclusive Science Communication: Validity Evidence in Undergraduate STEM Students

Science communication has historically been inequitable, with certain voices and perspectives holding the power and dominant ways of knowing being promoted over others. Recently, there has been a push toward inclusive science communication, which values diverse perspectives and ways of knowing in collaborative conversations to solve complex socioscientific issues. However, there is a lack of both trainings in inclusive science communication for undergraduate science, technology, engineering, and mathematics (STEM) students as well as established ways to evaluate the efficacy of these trainings. To address this need, we designed a new multifactorial survey based on the Theory of Planned Behavior to assess students' attitudes/norms, self-efficacy, behavioral intents, and behaviors in inclusive science communication, which we termed the Planned Behaviors in Inclusive Science Communication (PB-ISC) Scale. We utilized expert review, exploratory factor analysis, confirmatory factor analysis, cognitive interviews, and quantitative measures to gather evidence of validity supporting the proposed use of the final 4-factor, 26-item survey. This survey can be used as a tool by science communication educators and researchers to assess students' planned behavior in inclusive science communication in response to trainings or experiences in science communication or related topics like socioscientific issues, civic engagement, and citizen science.

Enhancing Research Involvement of Young People With Lived Expertise: Reflecting on Experiences in Digital Mental Health Research

Given the rapid development of digital mental health technologies and a focus on connecting with youth, there is an urgent need to enhance the engagement of young people with lived expertise in research. Even so, youth with lived experience of accessing mental health services are particularly affected by power imbalances and may receive limited compensation in academic settings. Therefore, an emphasis on how research engagement not only improves the work but can benefit young people themselves is required. Here, 5 young people with lived expertise report on their experience of being employed as researchers at the University of Sydney's Brain and Mind Centre. As such, this team is uniquely placed to offer reflections from their work across multiple stages of research. This led to four key insights, including (1) creating accepting work cultures, (2) providing diverse opportunities for involvement, (3) giving young people agency and flexibility around sharing lived experiences, and (4) creating accommodating work environments for all researchers. We suggest that these insights can support more diverse ways of engaging young people and maximizing the value of participation for both researchers and young people themselves.

Three things we learned along the way: lessons for training in psychiatric epidemiology

The coronavirus disease 2019 (COVID-19) pandemic, and its associated mortality, morbidity, and deep social and economic impacts, was a global traumatic stressor that challenged population mental health and our de facto mental health care system in unprecedented ways. Yet, in many respects, this crisis is not new. Psychiatric epidemiologists have recognized for decades the need and unmet need of people in distress and the limits of the public mental health services in the United States. We argue that psychiatric epidemiologists have a critical role to play as we endeavor to address population mental health and draw attention to 3 areas of consideration: elevating population-based solutions; engaging equitably with lived experience; and interrogating recovery. Psychiatric epidemiology has a long history of both responding to and shaping our understanding of the relationships among psychiatric disorders and society through evolving methods and training, and the current sociohistorical moment again suggests that shifts in our practice can strengthen our field and its impact. This article is part of a Special Collection on Mental Health.

Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.

Recovered or Not Recovered? A First Person Narrative Case for Non-Abstinent Recovery

PURPOSE

The purpose of this paper was to explore interlocking questions relating to how we deal with drugs and medication in crisis residential mental health settings. In particular, it examines issues related to overly medical and simplistic explanations of the relationship between cannabis and psychosis, the positive effects of drugs, the effects of having standard rules for diverse groups of people and the concept of non-abstinent recovery.

BACKGROUND

I have used mental health and addiction services for 25 years and I have 6 years' experience as a peer worker, working with many people who use drugs.

METHOD

This is an opinion piece built around a first-person narrative.

KEYPOINTS

Drugs can have positive effects and an appreciation and understanding of these effects is essential to understanding persistent drug use. How can we integrate non-abstinent recovery as a valid and positive choice of recovery pathway?

Lived experiences of children who stutter in their own voices

INTRODUCTION

Significant research has explored the lived experiences of adults who stutter, but less research exists regarding the lived experiences of children who stutter. The opinions and ideas of children who stutter may differ from those of adults, making it important for clinicians and researchers to obtain information directly from children who stutter. Asking children directly can lead to treatment outcomes and research questions that better align with the children's needs and values.

METHOD

Interviews with 18 children who stutter (9 girls/9 boys) ages 8-17 were sourced from the Voices of Children Who Stutter database located at Talkbank.org. Interview questions asked the children about living with a stutter, participating in stuttering support organizations (SSOs), and their perspectives on treatment. Qualitative, phenomenological analysis was performed on their answers following standardized qualitative procedures.

RESULTS

Analysis of 910 total utterances yielded 7 themes and 9 subthemes. Themes indicated that the children: (a) had significant knowledge regarding their own stuttering, (b) had opinions regarding what constituted worthwhile treatment outcomes, (c) were clear about desirable clinician characteristics for working with kids who stutter, and (d) saw the benefits of being part of a community.

CONCLUSIONS

Themes revealed that overall, children who stutter exhibit deep understanding regarding their experiences with stuttering, which clinicians can harness in person-centered goal setting. Additionally, the participants express the importance of participating in stuttering support organizations.

The impact of psychiatric facility design on reducing aggressive behaviours in an adult population: a narrative literature review

OBJECTIVES

This review examines the literature to determine whether physical design features of psychiatric facilities can help reduce aggressive behaviours in an adult patient population.

METHODS

Using PRISMA's methodology, we conducted a narrative review of peer-reviewed primary studies on the physical design features and aggressive behaviours in psychiatric facilities. The Joanna Briggs Institute's (JBI) critical appraisal tool was used to assess the quality of included studies.

RESULTS

A total of eight studies were identified. The findings revealed underlying themes in physical design efforts to reduce the incidences of aggressive behaviours, which included changes in structural design (e.g. single rooms; visiting/living/recreational areas; views of outdoors/nature; and uncrowded spaces) and changes in interior design (e.g. art and home-like/comforting environment). There were varying measures of patient aggression.

CONCLUSIONS

There was mixed evidence that superficial or structural design changes to psychiatric wards reduced patient aggression. Some studies found reduced aggression; others found no changes, while one study found increased aggression following the implementation of physical design changes. The methodological limitations of the available studies made it difficult to draw causative links and further research on the topic is needed.

Listening Sessions to Shape the Innovative NIH ComPASS Common Fund Program to Advance Health Equity

The National Institutes of Health (NIH) recognized the need for a research program to address the underlying structural factors that impact health. To inform the development of the NIH Common Fund Community Partnerships to Advance Science for Society (ComPASS) Program, NIH obtained input through community listening sessions. Through its design, ComPASS recognizes the essential role of community organizations as the lead in addressing persistent structural and social challenges to accelerate progress toward advancing health equity. (Am J Public Health. 2024;114(7):685-689. https://doi.org/10.2105/AJPH.2024.307656).

Identifying the priorities for supervision by lived experience researchers: a Q sort study

BACKGROUND

Lived experience researchers draw on their lived and living experiences to either lead on or inform research. Their personal experiences are relevant to the research topic and so they must manage the interplay of their health and healthcare experiences with the research, population, and data they work with, as well as the more general challenges of being a researcher. Lived experience researchers must navigate these dilemmas in addition to queries over their competency, due to issues relating to intersectionality and epistemic injustice. This justifies a motivation to better understand the experiences of lived experience researchers and develop appropriate and personalised supervision based on their preferences and needs.

METHODS

Q methodology was used to identify a collection of identity-related issues that impact lived experience researchers during PhD research in the context of the UK. These issues were presented in the form of 54 statements to 18 lived experience researchers to prioritise as topics to explore in supervision.

RESULT

It was found that lived experiences researchers could be grouped into three distinct factors following an inverted factor analysis: Factor 1: Strengthening my identity, skills, growth, and empowerment; Factor 2: Exploring the emotional and relational link I have with the research and Factor 3: Navigating my lived and professional experiences practically and emotionally. The findings suggest that there may be three types of lived experience researchers, each with different needs from supervision, suggesting the population is heterogeneous.

CONCLUSION

The research identified a deeper understanding of the needs of lived experience researchers and highlights the importance of personalised supervision according to the individual needs of the researcher and their preferences for supervision. The findings reinforce the importance of integrating a clinical dimension into supervision to support the needs of all lived experience researchers.

"There's room to do more": a mixed-methods study of the Temporary Assistance for Needy Families (TANF) diversion program and intimate partner violence in Georgia

Introduction

Intimate partner violence (IPV) is a risk factor for homicides and suicides. As poverty is both a predictor and a consequence of IPV, interventions that alleviate poverty-related stressors could mitigate IPV-related harms. Temporary Assistance for Needy Families (TANF), a monthly cash assistance program, is one such potential intervention. In the state of Georgia, the TANF diversion program, which provides a non-recurrent lump-sum payment to deter individuals from monthly TANF benefits, is an understudied component of TANF that may influence the effectiveness of state TANF programs in supporting IPV survivors.

Aim

This study quantifies and qualifies the role of Georgia's TANF diversion program in shaping IPV-related mortality.

Methods

This study relies on a mixed-methods sequential explanatory design. Using data from the Georgia Violent Death Reporting System (GA-VDRS), an interrupted time series analysis was conducted to estimate the effect of TANF diversion on IPV-related homicides and suicides. Semi-structured interviews were then administered with TANF policy experts and advocates, welfare caseworkers, and benefit recipients (n = 20) to contextualize the quantitative findings.

Results

The interrupted time series analysis revealed three fewer IPV-related deaths per month after implementing TANF diversion, compared to pre-diversion forecasts (coefficient = -3.003, 95%CI [-5.474, -0.532]). However, the qualitative interviews illustrated three themes regarding TANF diversion: (1) it is a "band-aid" solution to the access barriers associated with TANF, (2) it provides short-term relief to recipients making hard choices, and (3) its limitations reveal avenues for policy change.

Discussion

While diversion has the potential to reduce deaths from IPV, it may be an insufficient means of mitigating the poverty-related contributors to IPV harms. Its limitations unveil the need for improved programs to better support IPV survivors.

Participatory approaches for developing a practical handbook integrating health information for supporting individuals with mild cognitive impairment and their families

AIM

This study aimed to develop a patient-centred handbook that integrates information on lifestyle modifications and psychological support strategies for individuals with mild cognitive impairment (MCI). This article provides a comprehensive record of the development process.

METHODS

We adopted a participatory research model for the methodology, which comprised five phases and involved an interdisciplinary team specializing in dementia and health literacy. Data were initially collected via interviews conducted among patients with MCI (n = 5) and their families (n = 5). Given the study's preliminary nature, depth and richness of the qualitative data were the key concerns for determining the sample size, rather than broad generalizability. We ensured the inclusion of diverse experiences and perspectives by facilitating the creation of patient questions (PQs) that merged scientific evidence with patient perspectives. To enhance the handbook's accessibility and utility, we continuously evaluated the same using patient interviews, health literacy tool assessments and team discussions. This comprehensive approach harmonized scientific knowledge and patient experience, leading to the development of a personalized MCI management guide.

RESULTS

The handbook comprises nine domains, encompassing 38 selected PQs: MCI, lifestyle, lifestyle-related diseases, exercise, nutrition, social participation, cognitive training, psychological care and family support. The health literacy handbook was evaluated based on Clear Communication Index scores. The results revealed that 73.7% of the PQs were deemed difficult prerevision, whereas only 5.3% remained challenging postrevision. The formative evaluation underscored the need for more detailed explanations prerevision, whereas postrevision comments focused primarily on editorial suggestions.

CONCLUSION

The inclusion of patients' perspectives right from the outset ensured that the handbook met their specific needs. The final version, which reflects all stakeholders' inputs, is now slated for imminent publication.

PATIENT OR PUBLIC CONTRIBUTION

Patients and the public participated extensively throughout the project, from initial interviews to material evaluation and refinement.

Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study

BACKGROUND

Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma.

METHODS

Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions.

RESULTS

We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness.

CONCLUSION

This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.

Kailo: a systemic approach to addressing the social determinants of young people's mental health and wellbeing at the local level

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

Interventions for Young Children's Mental Health: A Review of Reviews

To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.

Enabling data sharing and utilization for African population health data using OHDSI tools with an OMOP-common data model

The COVID-19 pandemic has spurred the use of AI and DS innovations in data collection and aggregation. Extensive data on many aspects of the COVID-19 has been collected and used to optimize public health response to the pandemic and to manage the recovery of patients in Sub-Saharan Africa. However, there is no standard mechanism for collecting, documenting and disseminating COVID-19 related data or metadata, which makes the use and reuse a challenge. INSPIRE utilizes the Observational Medical Outcomes Partnership (OMOP) as the Common Data Model (CDM) implemented in the cloud as a Platform as a Service (PaaS) for COVID-19 data. The INSPIRE PaaS for COVID-19 data leverages the cloud gateway for both individual research organizations and for data networks. Individual research institutions may choose to use the PaaS to access the FAIR data management, data analysis and data sharing capabilities which come with the OMOP CDM. Network data hubs may be interested in harmonizing data across localities using the CDM conditioned by the data ownership and data sharing agreements available under OMOP's federated model. The INSPIRE platform for evaluation of COVID-19 Harmonized data (PEACH) harmonizes data from Kenya and Malawi. Data sharing platforms must remain trusted digital spaces that protect human rights and foster citizens' participation is vital in an era where information overload from the internet exists. The channel for sharing data between localities is included in the PaaS and is based on data sharing agreements provided by the data producer. This allows the data producers to retain control over how their data are used, which can be further protected through the use of the federated CDM. Federated regional OMOP-CDM are based on the PaaS instances and analysis workbenches in INSPIRE-PEACH with harmonized analysis powered by the AI technologies in OMOP. These AI technologies can be used to discover and evaluate pathways that COVID-19 cohorts take through public health interventions and treatments. By using both the data mapping and terminology mapping, we construct ETLs that populate the data and/or metadata elements of the CDM, making the hub both a central model and a distributed model.

The "vicious circle" of chronic cough: the patient experience - qualitative synthesis

Aim

The aim of this study was to systematically search and synthesise findings from peer-reviewed qualitative studies describing the experiences of those living with chronic cough.

Methods

A systematic search was conducted to identify all studies that used qualitative methodology to report on the experiences of adults living with chronic cough. A thematic synthesis of the first-hand narratives was undertaken. Key themes in relation to personal perspectives and experiences of living with chronic cough were identified and grouped into analytical themes.

Results

Six studies met the inclusion criteria. The thematic synthesis generated three analytical themes: 1) "It's just a cough"; 2) "Constant cough and constant worry"; and 3) "No light at the end of the tunnel", highlighting the biopsychosocial nature of chronic cough. The synthesis highlights chronic cough as a heterogeneous experience that may appear idiosyncratic, completely consuming the lives of those living with it.

Conclusion

This is to our knowledge the first qualitative synthesis reporting on the perceptions and experiences of adults living with chronic cough. Our review draws attention to the paucity of literature that utilises qualitative methodology to explore the experience of living with chronic cough. We highlight the missing voice of people living with chronic cough in the contemporary literature. There is now a requirement for research exploring the narratives of those living with chronic cough, to gain an understanding of the condition beyond simple quantification.

Understanding the identity of lived experience researchers and providers: a conceptual framework and systematic narrative review

BACKGROUND

Identity is how we understand ourselves and others through the roles or social groups we occupy. This review focuses on lived experience researchers and providers and the impact of these roles on identity. Lived experience researchers and providers use their lived experience of mental or physical disability either as experts by experience, researchers, peer workers, or mental health professionals with lived experience. They must navigate both professional and personal aspects to their roles which can be complex. Performing roles simultaneously embodying professional and lived experiences contribute towards a lack of clarity to identity. This is not adequately explained by the theoretical evidence base for identity.

MAIN BODY

This systematic review and narrative synthesis aimed to provide a conceptual framework to understand how identity of lived experience researchers and providers is conceptualised. A search strategy was entered into EBSCO to access Academic search complete, CINAHL, MEDLINE, PsycINFO, Psych Articles, and Connected papers. Out of the 2049 yielded papers, thirteen qualitative papers were eligible and synthesised, resulting in a conceptual framework. Five themes explained identity positions: Professional, Service user, Integrated, Unintegrated and Liminal. The EMERGES framework, an original conception of this review, found themes of: Enablers and Empowerment, Motivation, Empathy of the self and others, Recovery model and medical model, Growth and transformation, Exclusion and Survivor roots contributed to lived experience researcher and provider identities.

CONCLUSIONS

The EMERGES framework offers a novel way to understand the identities of lived experience researchers and providers, helping support effective team working in mental health, education, and research settings.

The importance of including occupational therapists as part of the multidisciplinary team in the management of eating disorders: a narrative review incorporating lived experience

The literature demonstrates the importance of utilizing a multidisciplinary approach in the treatment of eating disorders, however there is limited literature identifying the optimal team of professionals for providing comprehensive and effective care. It is widely accepted that the multidisciplinary treatment team should include a physician, a mental health professional, and a dietitian, but there is minimal literature explaining what other professionals should be involved in the medical assessment and management of eating disorders. Additional team members might include a psychiatrist, therapist, social worker, activity therapist, or occupational therapist. Occupational therapists are healthcare professionals who help their clients participate in the daily activities, referred to as occupations, that they have to do, want to do, and enjoy doing. Many factors (e.g., medical, psychological, cognitive, physical) can impact a person's ability to actively engage in their occupations. When a person has an eating disorder, it is likely that all four of the aforementioned factors will be affected, thus individuals undergoing treatment for an eating disorder benefit from the incorporation of occupational therapy in supporting their recovery journey. This narrative review strives to provide education on the role of the occupational therapist in treating eating disorders and the need for increased inclusion of this profession on the multidisciplinary team. Additionally, this narrative review offers insight into an individual's personal experience with occupational therapy (i.e., lived experience) during her battle for eating disorder recovery and the unique value that occupational therapy offered her as she learned to manage her eating disorder. Research suggests that occupational therapy should be included in multidisciplinary teams focused on managing eating disorders as it empowers individuals to return to activities that bring personal meaning and identity.

Effectiveness of Social Inclusion Interventions for Anxiety and Depression among Adolescents: A Systematic Review

BACKGROUND

Adolescents who are socially excluded are at increased risk of mental health problems such as depression and anxiety. Promoting social inclusion could be an effective strategy for preventing and treating adolescent depression and anxiety.

METHODS

We conducted a systematic review of intervention studies which aimed to prevent or treat adolescent depression and/or anxiety by promoting social inclusion. Throughout the review we engaged a youth advisory group of 13 young people (aged 21-24) from Uganda, Turkey, Syria, South Africa, and Egypt.

RESULTS

We identified 12 studies relevant to our review. The interventions tested use a range of different strategies to increase social inclusion and reduce depression and anxiety, including social skills training, psychoeducation, teaching life skills training, and cash transfers. Pooled standardised mean differences (SMDs) based on random-effects models showed medium-to-large benefits of interventions on improving depression and anxiety symptoms (n = 8; SMD = -0.62; 95% CI, -1.23 to -0.01, p < 0.05).

CONCLUSION

Although there are not many studies, those which have been done show promising results that strongly suggest that social inclusion could be an important component of programmes to promote adolescent mental health.

A scoping review investigating the use of exposure for the treatment and targeted prevention of anxiety and related disorders in young people

Background

Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people; however, the efficacy of individual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny.

Aims

This scoping review, informed by three stakeholder groups and a scientific advisory group, aimed to identify the nature and extent of the available research literature on the efficacy of exposure to feared stimuli, moderators of effectiveness in young people aged 14-24 years.

Method

Three international stakeholder groups composed of clinicians (N = 8), parents/carers (N = 5) and youth with lived experience of anxiety (N = 7) provided input into study design and results. Using the PRISMA extension for scoping reviews, a search of MEDLINE/Ovid, PsycINFO, PubMed, CINAHL, SCOPUS, EMBASE, ERIC, and Health Collection (informit) was conducted using terms related to anxiety, ages 14-24, and exposure.

Results

From 3508 unique abstracts, 64 papers were included for the review. While there was evidence for the efficacy of exposure as a treatment for youth anxiety disorders, fundamental gaps in knowledge of exposure in this age group were identified. Most studies examined post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias with no randomised clinical trials uniquely evaluating exposure for the treatment of DSM-5 anxiety disorders. Exposure was typically delivered accompanied by other anxiety management techniques. A multitude of optimisation strategies have been tested, yet only one of these effects (timing relative to sleep) showed preliminary evidence of replication.

Conclusions

A systematic and theoretically driven program of research investigating the efficacy of exposure in young people and factors that moderate its efficacy, along with methods to overcome barriers for delivery, is urgently needed.

The effects of neighbourhood social cohesion on preventing depression and anxiety among adolescents and young adults: rapid review

BACKGROUND

Research suggests that increasing neighbourhood social cohesion can prevent mental health problems, including depression and anxiety. However, it is unknown whether this is the case for adolescents and young adults.

AIMS

To investigate whether neighbourhood social cohesion can prevent depression and anxiety, and identify interventions that can increase neighbourhood cohesion in young people.

METHOD

We conducted a rapid review for an overview of the available literature. PubMed, Campbell Collaboration, KSR Ltd and grey literature databases were searched from inception up to 10 July 2020. When synthesising the results, we applied a hierarchy of evidence, prioritising study designs that allowed for the most ability to infer causality. Risk of bias was assessed with the ROBIS tool and Joanna Briggs Institute risk-of-bias assessment. A narrative review and two workshops with young people were conducted to inform what future interventions may look like.

RESULTS

Forty-two peer-reviewed publications, including two systematic reviews, 13 longitudinal studies and 27 cross-sectional studies, were identified. Prospective longitudinal studies found that neighbourhood social cohesion factors (safety, trust, positive social connections, helping others and a lack of crime and violence) were associated with fewer depressive symptoms. Future interventions to increase neighbourhood cohesion should involve creating safe and attractive community centres, accessible and safe outdoor spaces, community activity groups and online communities.

CONCLUSIONS

Neighbourhood social cohesion has the potential to protect mental health. The next step is to conduct intervention studies to evaluate the effects on onset prevention. Clinicians should consider the impact cohesion can have on mental health, and signpost to community initiatives.

Self-reported COVID-19 vaccination acceptance and hesitancy among autistic adults

Identifying factors associated with COVID-19 vaccination acceptance among vulnerable groups, including autistic individuals, can increase vaccination rates and support public health. The purpose of this study was to determine differences among autistic adults who reported COVID-19 vaccination acceptance from those who did not. In this study we describe COVID-19 vaccination status and self-reported preferences among autistic adults and identify related factors. Vaccine accepters were more likely to report increased loneliness during COVID-19, lived in more populous counties (p = 0.02), and lived in counties won by President Biden in the 2020 US presidential election (p < 0.001). Positive correlations were found between desire to protect others, concern about contracting COVID-19, and trusting vaccine safety (p < 0.001). Concern about vaccine safety was common among the vaccine hesitant, while lack of concern about COVID-19 overall was not. Identifying health promotion strategies based on self-reported, lived experiences about COVID-19 among vulnerable groups is key for public health impact.

A Call to Action: Using and Extending Human-Centered Design Methodologies to Improve Mental and Behavioral Health Equity

Mental health disparities directly tie to structural racism. Digital mental health (DMH), the use of technologies to deliver services, have been touted as a way to expand access to care and reduce disparities. However, many DMH fail to mitigate the persistent disparities associated with structural racism that impact delivery (e.g., costs, dependable internet access)-and may even exacerbate them. Human-centered design (HCD) may be uniquely poised to design and test interventions alongside, rather than "for," marginalized individuals. In employing HCD methodologies, developers may proceed with a vested interest in understanding and establishing empathy with users and their needs, behaviors, environments, and constraints. As such, HCD used to mindfully address structural racism in behavioral health care may address shortcomings of prior interventions that have neglected to elevate the voices of marginalized individuals. We argue that a paradigm shift in behavioral health services research is critically needed-one that embraces HCD as a key methodological framework for developing and evaluating interventions with marginalized communities, to ultimately promote more accessible, useful, and equitable care. The current commentary illustrates practical examples of the use of HCD methodologies to develop and evaluate DMH designed with marginalized populations, while also highlighting its limitations and need for even greater inclusivity. Following this, calls to action to learn from and improve upon HCD methodologies will be detailed. Acknowledging potential limitations of current design practices, methodologies must ultimately engage representative voices beyond research participation and invest in their active role as compensated and true collaborators to intervention design.