Journal of Child and Adolescent Mental Health

Response to "Developing and Validating a Scale to Measure Trauma-Informed Practices Used by Teachers in Inclusive Schools in Ghana and the United Arab Emirates"
Dewanti SR, Wu Y and Sanyata S
Why them? A systematic review on common factors among youth who receive compulsory treatment for anorexia nervosa
Offringa TM, Nooteboom LA, Versluijs BK and Vermeiren RRJM
Compulsory interventions, including compulsory nasogastric tube feeding, are sometimes necessary for youth with life-threatening anorexia nervosa. However, these interventions are also potentially traumatic for patients and clinicians alike. To improve early recognition and prevention of compulsory interventions, we evaluated common factors among youth with anorexia nervosa who receive compulsory treatment. We conducted a systematic literature search of peer-reviewed studies in PubMed, Embase, Medline, PsycINFO, and WOS core collection. Two authors independently screened 7 447 articles and conducted a quality appraisal of the included studies. We thematically synthesised patient, contextual, and treatment factors of youth (≤ 24 years) who received compulsory treatment for anorexia nervosa. We included 16 studies and five themes, with ten subthemes, emerged from the data, most with a medium strength of evidence. Patients exhibited common character traits, various comorbidities, and lives marked by instability or adversity. Furthermore, patients experienced complicated contextual factors, including family dysfunction and social isolation. Prolonged and inconsistent treatment histories may increase social isolation and anorexia identification, which in turn may lead to increased treatment resistance and a higher likelihood of compulsory interventions. The diversity of presented factors in this systematic review emphasises the importance of personalised care. Early acknowledgement of factors associated with the illness is crucial for working towards recovery and preventing further deterioration. Furthermore, even when anorexia nervosa diverts all attention to dangerous levels of weight loss, attention to quality of life may help a patient find treatment motivation.
Which personal and social resources help adolescents to recover from negative affect in daily life? An experience sampling study
Holt NJ, Flórez-Varela Á, Gómez-Restrepo C, Godoy-Casasbuenas N, Toyama M, Hidalgo-Padilla L, Diez-Canseco F, Brusco LI, Olivar N, Lucchetti S, Sureshkumar DS, Fung C and Priebe S
Reducing anxiety and depression in adolescents is a global health priority. Personal and social resources (e.g., hobbies and socialising) may reduce distress. Yet, there is insufficient understanding of how adolescents use such resources to reduce distress. To identify resources that reduced distress in the everyday lives of adolescents and whether resource use differed according to symptoms of anxiety and depression. The experience sampling method was used, a longitudinal method requiring participants to report on context and mood at randomly selected moments across a week. A total of 5 558 reports were contributed by 151 adolescents, including 90 with symptoms of anxiety and/or depression. The study was conducted in the poorest neighbourhoods of Bogotá, Buenos Aires, and Lima. Multi-level modelling indicated that using resources was significantly associated with less nervousness and sadness. Adolescents with symptoms of anxiety and/or depression were less likely to use some resources (e.g., sport). Cross-level interactions showed the efficacy of resources differed according to the severity of symptomatology. For adolescents with symptoms of anxiety and depression, some resources (e.g., peer support) improved mood, while others (e.g., music listening) did not. Personal and social resources are important for reducing distress in the everyday life of adolescents, giving insight into potential interventions to help mitigate symptoms of anxiety and depression before escalation. Further research could assess the quality of experiences (e.g., appraisal) to deepen understanding of how engagement promotes resilience. Care must be taken when recommending resource use, since some forms (e.g., music listening) may be unhelpful to adolescents with symptoms of anxiety and depression.
The experiences of oppression among transgender and gender expansive young people in Australia: An interpretative phenomenological study
Abela D, Patlamazogou L and Lea S
Transgender and gender expansive (TGE) people experience poorer mental health outcomes compared to their cisgender counterparts. There is limited research on understanding the experiences of TGE school-aged young people from an Australian perspective. Since each country and state has different cultures, laws, and access to gender-affirming care research considering these differences is imperative. To address this gap, we used a qualitative design to explore the oppression of Australian TGE young people. Sixteen TGE participants (aged 14-17) completed individual semi-structured interviews. Data were analysed using interpretive phenomenological analysis. Three superordinate themes were identified: (1) oppression within the education system; (2) oppression within the medical and allied health system; and (3) oppression within the family system. The findings highlight the various settings and contexts of oppression young people encounter. We identified what must change for a more equitable society and advocate for the implementation of gender-affirming change. This study contributes to the dearth of TGE adolescents's experiences and provides practical implications for society, especially in relation to the education, medical, and family systems. The implications include advocacy for more research in Australia and the inclusion of adolescents in policy reform. Limitations of this study and future directions are discussed.
Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV
Barr EA, Baltrusaitis K, Kennard BD, Emslie GJ, Krotje C, Knowles K, Buisson S, Bergam L, Deville JG, Gillespie SL, Shikora M, Townley E, Shapiro DE and Brown LK
Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians. Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests. Both COMB-R ( = 69) and ESC ( = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC ( = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R ( = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms ( = 0.52). Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care. While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.
Protective and risk factors for social and emotional well-being of Indigenous children and adolescents: A rapid review
Fauk NK, Dent E, Aylward P, Ward PR, Tyndall J, Kirwan L and Mwanri L
Indigenous children and adolescents experience life circumstances that significantly affect their social and emotional well-being (SEWB) and limit their capacity to fulfil their potential. This contributes to inequities in health, education, employment, and justice system involvement. We aimed to synthesise the existing literature to comprehensively understand the protective and risk factors for SEWB of Indigenous youth in Canada, Australia, New Zealand, and the United States (CANZUS). We conducted a systematic search of English literature using Google Scholar, Scopus, Informit, HealthInfonet, and PubMed. Sixty-nine articles met the inclusion criteria. The identified risk and protective factors were mapped according to seven thematic and interconnected areas including connection to the (a) body; (b) mind and emotions; (c) family and kinship; (d) community; (e and f) culture, country, and land (place/space); and (g) ancestry and spirituality. Indigenous peoples' perceptions of SEWB differ from traditional Western conceptualisations of health. Their perceptions carry a culturally distinct meaning, which is largely shared by Indigenous peoples across the CANZUS societies. An understanding of risk and protective factors for SEWB can inform targeted policy and public health practice frameworks aimed at improving Indigenous youth's health and well-being.
Exam anxiety in connection with life orientation in upper secondary education students
Gajdošová M, Haláková Z, Adámková R and Kubiatko M
Exam anxiety is beginning to affect an increasing number of students. We sought to examine whether there is an association between exam anxiety and life orientation in secondary school learners. We used the Suinn's Test Anxiety Behavior Scale questionnaire to assess exam anxiety and the Life Orientation Test-Revised questionnaire to determine students' life orientation. Results revealed that the participants experienced a level of exam stress that could motivate them and prepare them for the evaluation situation. Female and secondary grammar school students had more exam anxiety than males and business school students. There was a moderate relationship between exam anxiety and life orientation, which was slightly pessimistic. A pessimistic or optimistic life orientation is one of the factors that may influence exam anxiety levels of secondary school learners.
Psychosocial predictors of adolescent depression and mental health referral in an urban mobile medical unit programme
Richardson A, Cade-Bell I, DeRoo M, Foushi B, Wang E, Knitter A and Volerman A
Given worsening youth mental health over the past years, mobile medical units are a potential avenue to increase access to mental healthcare services. 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. 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 ( < 0.0001). All patients with moderate to severe depression who were not already connected to mental healthcare and wanted a referral were referred. 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.
Mental health and post-school transitions for young people with Intellectual and Developmental Disabilities (IDD): A scoping review
Dimov S, Shields M, Dickinson H, Kavanagh AM, White B and Sutherland G
Young people with an Intellectual and Developmental Disability (IDD) often face ineffective and exclusionary post-school transition practices, leading to poor mental health in early adulthood. This scoping review aimed to map existing literature on mental health for young people with IDD during the post-school transition period including how IDD and mental health are characterised in this context and the extent to which community members with lived experience are included in the design and/or production of research. In collaboration with a co-researcher, we used the JBI framework and PRISMA guidelines in accordance with a published protocol. A tiered search was conducted in PsycINFO, Medline, ERIC, Web of Science, and Family and Society Studies Worldwide. The search identified 28 articles that met the inclusion criteria. Articles were published between 2011 and 2023 and conducted across four countries. Thirteen applied a quantitative study design, eight were qualitative, three used a mixed-methods design, and the remaining were reviews. Most articles focused on autism. The majority discussed mental health in terms of its impact on transitioning from school or as a co-occurring condition. There is a growing body of literature highlighting the challenges young people with disabilities face when transitioning from high school. However, there is a notable gap in the representation of diverse IDD populations and mental health emerged variably, often as an incidental finding rather than a primary focus.
Is psychological resilience associated with changes in youth sport participants' health-related quality of life during the COVID-19 pandemic?
Graham CT, Shepherd HA, Galea O, Kopala-Sibley DC, Emery CA and Yeates KO
This study investigated the quality of life of youth sport participants over the COVID-19 pandemic as moderated by psychological resilience. Participants included 93 high school sport participants (53.76% female, mean age = 15.59 ± 0.74) in a three-year longitudinal cohort study (SHRed Concussions) who completed the Connor-Davidson Resilience Scale (CD-RISC), Pediatric Quality of Life Scale (PedsQL), and Strengths and Difficulties Questionnaire (SDQ) at Year 1 (pre-pandemic, 2019-2020) and Year 2 (pandemic, 2020-2021). Change in quality of life and mental health symptoms from Year 1 to Year 2 was examined using paired -tests and Year 1 resilience was examined as a predictor of Year 2 quality of life and mental health symptoms using linear regression. Among participants with Year 1 scores before the pandemic onset, mean PedsQL ( = 74, = -0.26 [-2.63, 2.03], = 0.80) and SDQ ( = 74, = 0.030 [-0.90, 0.93], = 0.98) scores did not significantly change between Year 1 and Year 2. In unadjusted analyses, Year 1 CD-RISC scores were positively associated with predicted Year 2 PedsQL scores when Year 1 scores were controlled (β = 0.31 [0.0062, 0.61], Δ = 0.02) but not with residual change in SDQ scores (β = 0.035 [-0.11, 0.18], Δ = 0.001). Quality of life did not change significantly after the pandemic onset, and resilience was modestly protective.
LovesCompany: evaluating the safety and feasibility of a mental health-focused online community for adolescents
Van Meter A and Agrawal N
: Adolescents are at risk for mental health (MH) disorders but are unlikely to seek services and may be reluctant to talk about their MH. An anonymous, online MH-focused community could help reduce suffering. However, online forums can also promote negative behaviours such as cyberbullying. This study aimed to evaluate the safety and feasibility of an online community - LovesCompany - to improve MH outcomes for adolescents.: American adolescents (14-17 years) were recruited through social media. Eligible participants were randomised to LovesCompany or a placebo MH resource site. Outcomes were assessed every other week for six months, and at twelve months. Multilevel models assessed group differences in depression, anxiety, and suicidal ideation. A subgroup of participants participated in qualitative interviews.: Participants ( = 202) were mostly female (70%), White non-Hispanic (69%), and cisgender (80%). There were no instances of inappropriate behaviour such as bullying or posting explicit content. Symptoms for both groups improved over time. Participants appreciated hearing others' experiences and valued the opportunity to offer support.: Although adolescents are often resistant to MH treatment, they appear to be interested in anonymous, online, MH-focused conversation, and can benefit from giving and seeking support. Finding a balance between an appealing user experience, ethical considerations, and resource needs is challenging.
Creative arts interventions to enhance adolescent well-being in low-income communities: an integrative literature review
Bux DB and van Schalkwyk I
Globally many young people, especially from lower socioeconomic backgrounds, face significant barriers to achieving optimal life chances. Creative arts interventions are a way of reaching out to adolescents in low-income communities, to encourage positive functioning and enhanced well-being. We need information on the efficacy - or otherwise - of such interventions to optimise future efforts. An integrative, descriptive literature review was conducted to explore and describe creative arts interventions for adolescents in low-income communities. Data were synthesised by comparing evidence from 12 studies that met the inclusion criteria, and combining ideas using logical reasoning to present what is known or yet to be known about the study topic. Themes emerged regarding the structure and content of interventions; the characteristics of adolescent participants; the countries and contexts in which interventions were carried out; and overall outcomes for adolescent well-being as well as pedagogy. There are worthy outcomes for adolescents living in low-income communities who participate in structured creative arts interventions. However, research evidence is limited, and more research should be undertaken to investigate the development and evaluation of creative arts interventions for the well-being of adolescents in adverse contexts.
Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years
Mugisha J, Van Damme T and Vancampfort D
The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda. Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney -tests were applied. Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems ( = -0.23, < 0.001), lower PHQ-9 (ρ = -0.26, < 0.001), and lower GAD-7 (ρ = -0.22, < 0.001) scores. Those with emotional problems (SDQ ≥ 5) ( = 86) were significantly less physically active than those without ( = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, < 0.001]. Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.
Prevalence of psychotic-like experiences and its predictors among early adolescents from rural areas in Indonesia
Vitriyanti , Rozi NA and Turnip SS
Psychotic symptoms are present in a wide range of both clinical and non-clinical populations. Psychotic symptoms in adolescents often take the form of psychotic-like experiences (PLEs), which are considered a risk factor for numerous serious mental illnesses. Socioeconomic disadvantages are across rural areas, and poverty is known as the third most important risk factor of PLEs. However, there have been limited studies on PLEs which focus on populations in rural areas. The aim of this study was to assess the prevalence of PLEs and investigate their predictors among early adolescents living in rural areas. Data from 629 early adolescents from two rural areas in Indonesia were analysed using descriptive statistics to determine the prevalence of PLEs. Multiple logistic regression analysis was used to assess the predictors of PLEs. This was a school-based cross-sectional study, and data were collected using a paper questionnaire. The results showed that the prevalence of PLEs among early adolescents in rural areas is 24.5%. Four significant predictors of PLEs were identified after controlling for sex: emotional problems, age, the number of caregivers in daily life, and psychological well-being.
On return to school: disorder symptoms, stress at home and evaluations of school COVID-19 measures
Lam VL and O'Driscoll MF
: Social restrictions during the COVID-19 pandemic had a major impact on the mental health of children. Yet, analyses on the mental health of younger children in the later course of the pandemic are scarce. The present study assessed 8- to 11-year-olds' internalising disorder symptoms during the last three weeks, from the third week of February through to the first week of March, of the 2021 national lockdown.: One hundred and forty-five pupils, including a subset of keyworkers' children who had face-toface schooling, completed the validated Revised Child Anxiety and Depression scales, items on COVID-related stress at home, and evaluations of home-learning and school's measures for reopening.: Symptoms increased with age in months and/or number of siblings. Girls reported more symptoms and home stress than boys did. Pupils who had face-to-face schooling were more satisfied with school measures and less satisfied with home learning compared with those who only had home learning. Hierarchical regression analyses corroborated the contributions of sociodemographic characteristics and found that home stress and school measures evaluations were associated most with major depression, generalised anxiety, and social phobia.: Findings can contribute to mental health practice by promoting school communications and family and educator awareness of stressors, vulnerabilities and symptoms to boost pupils' readiness for school returns.
Does self-compassion protect adolescents with non-suicidal self-injury from developing borderline features? A two-wave longitudinal study
Carreiras D, Castilho P and Cunha M
Adolescence is a vulnerable developmental stage for the onset of non-suicidal self-injury (NSSI) and borderline features, which are related psychological phenomena. Self-compassion reflects a sensitivity to own suffering and a motivation to relieve it, consisting of a more positive and beneficial self-to-self relationship. The aim of the present study was to test the effect of self-compassion between borderline features at baseline and six months with a sample of adolescents with a history of NSSI. At assessment wave one, participants were 139 Portuguese adolescents with an NSSI history (mean age = 15.52 years, SD = 0.87). Of these, 87 were re-assessed six months later (mean age = 15.46 years, SD = 0.86). Data were analysed through SPSS and PROCESS Macro. The moderation model explained 56% of borderline features six months later, and the interaction between initial borderline features and the low and medium levels of self-compassion was significant. Youth with lower initial borderline features presented higher borderline features six months later if they had low self-compassion. These findings suggest that among adolescents with a history of NSSI, those with lower levels of self-compassion tend to exhibit higher borderline features in six-month when compared to their peers with higher levels of self-compassion. This observation emphasises the potential beneficial effect of self-compassion within this population.
Examining the relationship between social withdrawal motivations and symptoms of
Amendola S and Cerutti R
: This study aimed to examine the association between social withdrawal motivations (peer isolation, shyness, unsociability, low mood, and avoidance) and symptoms of using both variable- and person-oriented analyses.: Adolescents ( = 212) participated in this cross-sectional study. Data were collected using the Social Withdrawal Motivations Scale and the Avoidance subscale of the Child Social Preference Scale-Revised, the 25-item Hikikomori Questionnaire, the Personality Inventory for the DSM-5 Brief Form, and the Interpersonal sensitivity subscale of the Brief Symptom Inventory.: Path analysis revealed that peer isolation, shyness, unsociability, and avoidance were associated with symptoms of while covarying for age, sex, maladaptive personality, and interpersonal sensitivity. Cluster analysis based on social withdrawal motivations identified four subtypes of adolescents. The group with high social withdrawal motivations showed the highest level of overall personality dysfunction and interpersonal sensitivity. Additionally, the group with high social withdrawal motivations and the group with high avoidance demonstrated higher symptoms of compared to the other two groups, after accounting for the effects of the covariates.: The findings highlight that the evaluation of co-occurrent social withdrawal motivations may improve the ability to identify those adolescents most in need of support.
Play therapy efficacy in ADHD-symptom reduction as measured by the Test of Variables of Attention (TOVA)
Bangun SR, Putra BS, Atmojo WT, Sevriana ES, Hanifa YNM and Pangestuti RCA
We aimed to investigate the effect of play therapy combined with the standard psychotropic medication treatment, compared to only standard psychotropic medication treatment in ADHD children as measured by the test of variables of attention (TOVA). This is a case-control study conducted at Soerojo Hospital, Magelang, Indonesia. Children ( = 66) were purposively recruited. The children were divided into two groups based on the intervention received: the experimental group (play therapy and standard psychotropic medication) and control group (standard psychotropic medication only). Methylphenidate was used as the standard psychotropic therapy. The TOVA was performed before and after intervention. The pre-intervention and post-intervention mean difference (MD) in the Attention Comparison Score (ACS) and Comparison to the Normative Sample (CNS) for each group was compared and statistically analysed using -tests and Wilcoxon tests. There was a significant difference between the ACS score of the experimental group's MD and the control group's MD ( < 0.05). For most TOVA parameters on CNS scores, the experimental group had a significantly higher MD than the control group. Play therapy coupled with psychotropic medication reduced ADHD symptoms, including inattention and impulsivity, as objectively measured by the TOVA.
Gender differences in the pathway of childhood trauma, impulsivity and adult eating behaviour: a cross-sectional study
Bonfada Collares Machado A, Teruya KI, Friedman R, Weydmann GJ, Remor E and Bizarro L
The current cross-sectional study aimed to examine the association between childhood trauma, impulsivity, binge eating symptoms, and body mass index (BMI) in a sample of males and females. We also aimed to investigate the indirect association of childhood trauma with binge eating through impulsivity while controlling for BMI. Participants were 410 young adults (mean age = 20.9 years, range 18-24; female = 73.9%) who completed online measures of childhood trauma, impulsivity, binge eating symptoms, and self-reported height and weight. Mediation models were tested using multi-group structural equation modelling. Childhood trauma and impulsivity were associated with an increased risk of binge eating symptoms in females but not males, corroborating previous studies. There was a significant difference in the binge eating symptoms index between sexes, but not regarding the index of childhood trauma and impulsivity. Additionally, adverse childhood experiences were associated with impulsivity and the association of childhood trauma with binge eating was mediated by impulsivity in the female sample. Our results suggest sex-dependent patterns and risk factors that may impact binge eating symptoms. The implications of our results suggest that impulsivity might be a vulnerability factor for binge eating, especially for females.
Experimental evaluation of a neurophysiological intervention designed to increase student resilience: a pilot study
Kresovich A, MacLean K, Lancaster CM, Torres ED, Temple JR and Mumford EA
Social and emotional learning (SEL) interventions have shown promise for building resilience and protecting youth from adverse outcomes. This study reports on an experimental pilot evaluation of the Smart Brain Wise Heart SEL intervention during the 2021-2022 school year. Smart Brain Wise Heart (SBWH) uses a neurophysiological approach among ninth-grade students to evaluate the intervention's impact on youth resiliency, self-compassion, peer violence exposure, internalising disorders, and hyperactivity. Results did not indicate any significant universal changes in target outcomes. These null findings regarding universal impact may be explained by the unprecedented difficulty of implementing a school-based intervention amid ongoing COVID-19 restrictions and administrative issues. Despite these obstacles, students with lower academic achievement in the intervention condition scored significantly higher for resilience and self-compassion and lower on depressive symptoms than their peers in the comparison condition, even when controlling for baseline scores, sex, attachment (father, mother, peer), and exposure to adverse childhood experiences. Our findings suggest SBWH programming may have important implications for the trajectories of students exhibiting lower academic achievement, at a minimum, by significantly improving their emotional resilience, self-compassion, and depressive symptoms during a vital developmental stage. More research is urgently needed under optimal conditions to assess the universal implementation of the program.
Perceived causal symptom network of adolescent mental health issues
Bångstad A, Fellman J, Rosendahl C, Bellander M, Cervin M, Bjureberg J and Klintwall L
Adolescent mental health is difficult to capture in categories such as depression or specific anxiety disorders. An alternative is to approach psychiatric symptoms as causal networks, potentially revealing feedback loops that maintain a pathological state. One approach to creating such networks, implemented in the PECAN methodology, is to ask adolescents about their perceptions of the causes to their symptoms. For this purpose, a transdiagnostic item list was created, and adolescents who screened positive for depression ( = 55) completed twice in two weeks a survey quantifying perceptions of causality between their mental health problems. A network that was averaged across all participants was reliable and revealed three strong feedback loops: a first loop running through stress, insomnia, fatigue, procrastination, and back to stress; a second loop between stress and overthinking; and a third loop between stress and procrastination. Although all adolescents in the study screened positive for depression, symptoms of depression were not particularly central to the network. Instead, the most central symptoms were procrastination and overthinking. The average test-retest reliability for individual networks was low, limiting clinical application. In conclusion, PECAN was found to be reliable and useful when creating a group-level network of adolescent mental health problems. While informative at a group level, the method should be improved before it can be used to inform treatment at the individual level.
Adolescent psychiatric inpatients' perceptions of treatment and seclusion
Yurtbasi MK, Gordon M, Fisher L, Haslam R, Prakash C, Blatchford B, Pavlou C, Darmanin D, Verstandig S, Blake A, Cornell W, Cameron L and Melvin G
: A great deal of attention is being directed at the use of seclusion in adolescent inpatient psychiatric units due to its forceful nature and negative impact on inpatients and staff. This mixed methods study aimed to explore and compare the level of satisfaction with the services received and perspectives on seclusion in secluded and non-secluded adolescent inpatients.: This study included 188 participants, across three adolescent inpatient psychiatric units in Australia; 17% reported having experienced seclusion. A mixed methods approach was employed. Participants completed the Consumer Satisfaction Questionnaire-8 and Perceptions of Treatment and Seclusion Questionnaire shortly before or at discharge. Qualitative data was analysed using thematic analysis.: Secluded participants were more likely to report issues with broader care experiences on the Consumer Satisfaction Questionnaire-8. Secluded individuals reported ongoing negative effects from seclusion but were more likely than non-secluded participants to believe seclusion is necessary. Qualitative analyses showed that both secluded and non-secluded individuals considered seclusion to be traumatic, many did not agree with its use.: Communication between inpatients and staff regarding seclusion needs to be improved and there needs to be ongoing support in relation to seclusion during and after discharge. Many adolescent inpatients acknowledge the necessity of seclusion whilst advocating for reduced seclusion.
Disordered eating behaviours and basic psychological need satisfaction: the mediating role of anxiety symptoms in preadolescents
Marshall TE, Thomas KS, Weinstein N and Vanderwert RE
According to self-determination theory, satisfied basic psychological needs can be a protective factor for psychopathology, including eating disorders and anxiety symptomatology. However, most research has focused on adolescent and adult populations, with less work examining perceived basic psychological need satisfaction from parents in younger samples who report anxiety and disordered eating. This cross-sectional study aimed to investigate whether basic psychological need satisfaction from parents was associated with disordered eating in preadolescents and whether anxiety mediated this relation. A total of 211 preadolescents were recruited from primary schools across south Wales (mean age = 10.27 years, age range = 9-11 years; 49.3% female). Children completed self-report questionnaires on their basic psychological need satisfaction when with parents, as well as disordered eating and anxiety symptoms. It was found that higher needs satisfaction was associated with lower disordered eating and anxiety, with stronger relations found in girls compared with boys. Furthermore, anxiety was found to mediate this relationship. Results suggest that basic psychological needs satisfaction may play an important role in the early emergence of co-occurring disordered eating and anxiety symptoms in boys and girls. The importance of considering anxiety symptoms in future work investigating needs satisfaction in the context of disordered eating and eating disorders is discussed.
Mapping the contextual mental health interventions for perinatal adolescent mothers with self-reported common mental symptoms (anxiety and depression) in sub-Saharan African countries: a scoping review
Tembo CP, Portsmouth L and Burns SK
: Early preventive interventions may support adolescent mothers' mental health during the perinatal period. However, adolescent maternal mental health interventions have received little empirical research attention. This scoping review maps the evidence on interventions appropriate for adolescent mothers during the perinatal period in Sub-Saharan African countries.: The process was guided by the Joanna Briggs Institute's methodology for scoping reviews. Five databases, MEDLINE, EMBASE, PsycInfo, CINAHL, Google Scholar, and ProQuest, were searched for citations of studies published from 2000. The reporting is according to Preferred Reporting for Systematic Reviews and Meta-analysis (PRISMA).: The initial search of databases resulted in 2 757 records. After duplicates were removed, 311 records were screened, and eight records included. Interventions included five key strategies: cognitive behavioural therapy; group problem-solving; psychoeducation; psychosocial group counselling; and integrated mothers and babies course and early childhood development group-based intervention. None of the interventions specifically targeted adolescent mothers, however. There is limited evidence of interventions specific to adolescent mothers. There is a need for the development, implementation and evaluation of specific interventions relevant to this population group.
Evaluating the efficacy of a school-based Finnish Gutsy Go programme in enhancing adolescents' positive mental health, experience of social inclusion, and social competence
Ahrnberg H, Appelqvist-Schmidlechner K, Mustonen P, Fröjd S and Aktan-Collan K
The Finnish Gutsy Go programme is a positive youth development intervention designed to enhance adolescents' psychosocial well-being by enabling eighth-grade students to develop and execute good deeds within the community. This study aimed to explore the effect of the Gutsy Go programme on adolescents' positive mental health, experience of social inclusion, and social competence using a quasi-experimental study design. Data were collected with electronic questionnaires at baseline ( = 236 programme participants and = 303 controls) and follow-up two weeks after the programme ( = 126, 54.2% programme participants and = 103, 34.1% controls). Analyses included paired samples -tests and mixed ANOVA analyses. A statistically significant intragroup change across time was detected in the level of cooperation skills among programme participants ((127) = -2.460, = 0.015) but not among controls ((102) = 1.088, = 0.279). Statistically significant main effects were found for the intervention group on the experience of social inclusion ((1, 1) = 9.34, = 0.003, η = 0.040), cooperation skills ((1,1) = 5.28, = 0.020, η = 0.020), and empathy ((1,1) = 6.44, = 0.010, η = 0.030) across time. The Gutsy Go programme could be beneficial in improving adolescents' experience of social inclusion, cooperation skills, and empathy. More studies are needed to address the effects of the programme more firmly.
Developing and validating a scale to measure trauma-informed practices used by teachers in inclusive schools in Ghana and the United Arab Emirates
Opoku MP, Elhoweris H, Moustafa A, Miezah D, Shah H and Al Murshidi G
Research on trauma-informed practices is common in Western countries, but non-Western countries have made minimal contributions in this regard. This study aimed to develop an instrument which could be used to measure perceived competence of teachers in the implementation of trauma-informed practices for students with disabilities in Ghana and the United Arab Emirates (UAE). The Teacher Trauma Management Scale (TTMS), developed using the trauma framework by the Substance Abuse and Mental Health Services Administration was used to collect data from 514 teachers in Ghana ( 270) and the UAE ( = 244). Data were subjected to confirmatory factor analysis) and a two-way factorial analysis of variance was conducted. While one hypothesis was supported by the study findings, the other was only partially supported. The findings provided theoretical and structural support for the newly developed TTMS in a non-Western context. This study highlights the need to develop contextual trauma management training models or a curriculum for training teachers.
Caregiver strain and its predictors among parents of autistic children: a cross-sectional study
Nighat A, Ahmer Z, Ovais M, Athar FB and Baig LA
This study estimates the frequency and predictors of caregiver strain (CGS) among parents of autistic children. Demographic details and CGS were collected through a validated tool from 403 parents of autistic children in Karachi, Pakistan. Regression modelling was performed to report associations between social, behavioural, and communication problems and socioeconomic predictors of CGS. Results were reported using adjusted beta-coefficients with 95% confidence intervals. In total, 88.3% of the parents reported moderate to severe CGS. A high family income (β = -4.31, 95% CI -7.55, -0.11), and caregiver's higher level of education (β = -4.73, 95% CI -8.84, -0.61), along with care-recipient age group (β = -9.35, 95% CI -15.17, -3.52) significantly predicted lower CGS. Diagnosis of more than 5 years (β = 7.57, 95% CI 2.36, 12.79), tendency to self-harm (β = 10.75, 95% CI 6.62, 14.88), and social withdrawal in the care-recipient (β = 4.56, 95% CI 1.68, 7.44) were significantly associated with higher CGS. Parents of children on the autistic spectrum suffer from high CGS. There is a need to introduce tailored parenting interventions at the individual and community levels to help parents reduce the CGS, ultimately benefiting their child.
Navigating social and academic isolation: a qualitative exploration of American university students' perspectives and experiences early in the COVID-19 pandemic
Lawston A, Lowsky L, Ross M and Hackman C
To qualitatively explore the multifaceted impacts of the early months of the COVID-19 pandemic on the lives of American university students. Undergraduate students in general education courses at a mid-sized public Western U.S. university were recruited to complete a Qualtrics survey that evaluated their perceptions, beliefs, and behaviours towards COVID-19. Thematic analysis identified prevailing themes regarding the positive and negative changes to students' lives during the pandemic. Participants included undergraduate students ( = 241) between the ages of 18 and 24 (74.7% women), with 49.4% identifying as White. Thematic analysis of the survey identified several codes encompassed by six key themes: (1) shifting social interactions; (2) wellness; (3) school; (4) financial changes; (5) loss of experiences; and (6) political turmoil. Some students identified positive consequences (e.g., more family time, more flexible schedule), while almost all students reported negative consequences (e.g., difficulty with time management and organisation, loss of job or income) of the COVID-19 pandemic. University communities should consider providing additional academic, financial, and mental health resources to students to further mitigate the lasting consequences of the pandemic.
Teachers' views and experiences of student mental health and well-being programmes: A systematic review
Goodwin J, Behan L and O'Brien N
In schools, teachers are often tasked with implementing mental health and well-being programmes. However, little is known about teachers' views on and experiences with implementing these programmes. The aim of this systematic review was to explore teachers' views and experiences of mental health and well-being intervention programmes developed to promote and protect student mental health. A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, APA PsycArticles, APA PsycInfo, British Education Index, Education Full Text (H.W. Wilson), ERIC, Social Sciences Full Text (H.W. Wilson), and SocINDEX with Full Text. Seven papers met the inclusion criteria. Teachers reported several challenges to the successful implementation of mental health and well-being programmes, including a lack of time allotted in the curriculum, insufficient training, and inadequate interagency support. There was evidence of conflicting opinions regarding the role of teachers in supporting students. It is recommended that mental health and well-being are viewed as central to schools' ethos and that teachers are adequately prepared to implement programmes.
Letter to the Editor
Happell B