Exploring Preferences for a Digital Single-Session Intervention for Adolescent Siblings of Youth With Cancer.

BackgroundAdolescents’ nonsuicidal self-injury (NSSI) leads to distress that affects the whole family system, and siblings are reported to suffer from disrupted family communication and functioning. So far, no studies have examined the quality of relationships between adolescents with NSSI and their siblings. The aim of the present study was to examine the sibling relationship quality of adolescents with NSSI, adolescents with other mental disorders without NSSI (clinical controls, CC), and adolescents without current or past experience of mental disorders (nonclinical controls, NC).Methods139 female adolescents aged 13–20 years (mean age = 16.18 years, SD = 1.62, NSSI: n = 56, CC: n = 33, NC: n = 50) and 73 siblings aged 10–28 years (mean age = 16.88 years, SD = 4.02, 60.3% female) participated. Self-report measures were used to assess psychopathology and sibling relationship quality.ResultsSiblings reported a wide range of negative emotional and familial consequences, such as feeling left alone with their sister’s issues or a distressing family situation, as a result of their sister’s NSSI. Siblings of adolescents with NSSI experienced significantly more coercion in the relationship with their sister compared to CC (d = 1.08) and NC (d = 0.67) siblings, indicating an imbalance of dominance and control in their relationship. Further, adolescents with NSSI reported significantly less warmth and empathy in the sibling relationship and higher rivalry scores between their siblings and themselves than NC adolescents, suggesting higher levels of parental favoritism among parents of adolescents with NSSI compared to NC parents (d = 0.93). Among siblings of adolescents with NSSI, high levels of warmth, conflict, and empathy were significantly associated with internalizing problems. For adolescents with NSSI a significant association was found between internalizing problems and coercion and externalizing problems and similarity.ConclusionsGiven the negative impact of NSSI on siblings’ emotional well-being and family life, efforts should be made to offer siblings psychoeducation and support to help them cope with the emotional and familial consequences of their sister’s NSSI. Given adequate support, siblings can in turn be a source of emotional support for their sister.

Objective: To elucidate the experiences of being an adolescent sibling in a family that includes a child with cerebral palsy (CP) and pain, from the perspectives of siblings and parents.Methods: Seven siblings and 10 parents were individually interviewed to systematically analyse the experiences of siblings and parents with children with CP and pain. The interviews were analysed by using qualitative content analysis according to Graneheim and Lundman.Results: The theme ‘Making pain common ground for support’ and three categories combined the non-disabled adolescent sibling and parental experiences of the child’s pain, and point to the need for support of the non-disabled siblings. Dysfunctional coping influences the siblings’ daily life and future health. Siblings wanted closer contact with the Development Centre in order to alleviate their negative emotions.Conclusions: As Development Centre physiotherapists meet the families to the child with CP, they can be a link to the sibling. Physiotherapists can educate siblings on pain and how to better cope with stress and emotional discomfort caused by their sibling’s CP and pain.

BackgroundWhen adolescents develop anorexia nervosa (AN), this impacts the family system and puts healthy siblings at risk of mental health problems. Siblings need support and age-appropriate information about the diagnosis to prevent negative mental health outcomes. However, evidence-based support for siblings is limited. The current study aimed to explore siblings’ perceptions of AN and parents’ beliefs about siblings’ understanding expressed within an intervention programme for siblings and parents.MethodsThis qualitative study employed a hybrid approach, integrating deductive thematic analysis using the common sense model of self-regulation as a coding framework with inductive thematic analysis. The data materials comprised (1) interviews conducted by clinicians with siblings about the AN diagnosis, (2) siblings’ understanding of AN as expressed in sibling groups, (3) parents’ beliefs about what siblings understand expressed in parent groups, and (4) parent-sibling conversations about AN. Video and audio recordings of the data were transcribed and analysed. The sample comprised nine siblings of European descent, aged 8 to 15 years, and their parents. All siblings had a sister with clinically confirmed AN.ResultsThe siblings had limited knowledge and expressed uncertainties about AN across the five themes identity (label and symptoms), causes, consequences, treatment, and timeline. In the inductive analysis, two additional themes were identified. The first, Parental perspectives on siblings’ understanding, had two sub-themes: AN as a confusing and complex disorder, and Discrepancy between siblings’ understanding of AN and parents’ beliefs about their understanding. The second theme was Barriers to communication about the diagnosis.ConclusionsThe results extend knowledge about informational support needs in siblings of adolescents with AN. Insights into what siblings and parents of adolescents with AN share about the diagnosis in different contexts can be used to guide the adaptation of interventions and policies.Trial registrationClinicalTrials.gov NCT04056884.

BackgroundMental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but...

Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users' needs. This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932.

Celiac disease (CD) is known to be more prevalent in first-degree relatives of patients. In this retrospective cohort study of 609 relatives between 1994 and 2016, we investigated the effect of sex, HLA type, and age at time of index celiac diagnosis. Pearson's chi-square test and Kaplan-Meier survival analysis were used as statistical analyses. CD screening was carried out for 427 relatives (70%), resulting in a prevalence of 15%. HLA typing in 335 relatives showed HLA-DQ2/DQ8 positivity in 87.5%. In 63% of children and all parents, celiac disease was diagnosed at first screening. It was diagnosed significantly more often in females, HLA-DQ2 homozygosity, and children (all p < 0.05). In children aged 0-1year at time of index diagnosis, celiac disease was diagnosed after consecutive screening in 58%, after 3.9 ± 2.5 (max 10)years (p < 0.001).Conclusion: Future screening policies for relatives of celiac patients should include retesting, especially in HLA-positive relatives younger than 10years of age. In addition, one-time celiac-specific antibody testing alone could be sufficient to rule out the disease in adolescent siblings and parents of newly diagnosed celiac patients. What is Known: • Celiac disease is more prevalent in first-degree relatives of celiac patients (risk 3-12%). • HLA-DQ2 homozygous sisters/daughters are at highest risk (25%). What is New: • If younger than 10years of age, repeated testing is necessary in HLA-DQ2/DQ8-positive first-degree relatives when celiac disease is diagnosed in a family. • One-time celiac-specific antibody testing alone could be sufficient to rule out the disease in adolescent siblings and parents of newly diagnosed celiac patients.

To explore parents' and adolescents' motives for accepting/declining participation in the ALL2008 trials and adolescents' involvement in the decision-making process. Children and adolescents with acute lymphoblastic leukaemia treated on the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol were eligible for two randomizations testing 6-mercaptopurine treatment intensifications to improve efficacy and Asparaginase de-escalation to reduce toxicity. We recently reported that while adolescents favoured treatment reduction, parents of young children favoured treatment intensification. A qualitative, exploratory study. A maximum variation sampling strategy was used. Five adolescents aged 12-17years, six parents of adolescents and five parents of children aged 1-12years were interviewed in the period March-May 2015. Data were analysed using content analysis. Adolescents and parents emphasized the importance of adolescents' active participation in decisions regarding enrolment into clinical trials. A majority of adolescents were either final or collaborative decision-makers. Parents stated that in case of disagreement, they would overrule the adolescents' decision. There were no differences between motivations of preferences held by parents of children or adolescents, respectively. Decisions were based on subjective values attributed to cure contra toxicity and individual preferences for either standard or experimental treatment. The possibility of a negative outcome induced fear of decisional regret and distress by the parents, yet they invested considerable trust in the physician's expertise. Our findings highlight the importance of adolescents' active involvement in consent conferences. Research on management of disagreements between adolescents and parents in trial decisions is needed.

The demand for scalable interventions to address loneliness and other mental health challenges is high. Digital single-session interventions (SSIs) have shown promise to radically increase access to evidence-based mental health support. However, the average effects of existing SSIs on mental health problems are small. One approach to improving SSI design is to understand users’ experiences—specifically, their reports of which parts of SSIs elicit “Aha! moments.” Although Aha! moments are frequently posited to be an important mechanism for change in psychotherapy, their potential to spark lasting change has not been empirically tested. Accordingly, this mixed-methods investigation includes (1) a qualitative thematic analysis of participant-reported Aha! moments and (2) a quantitative analysis of Aha! moments’ importance as predictors of intervention satisfaction and lasting change in loneliness. This pre-registered mixed-methods study leveraged data from two randomized controlled trials (total n = 693) testing a digital, self-guided SSI focused on decreasing loneliness. 261 of these participants reported experiencing an Aha! moment during the SSI, and 188 (ages 18–73) provided qualitative responses describing what part of the intervention caused their Aha! moment. Qualitative responses were extracted for three coders to complete a thematic analysis. Participants who received an SSI were more likely to endorse Aha! moments than participants in a control condition (p < 0.01). 11 themes emerged from participants’ self-identified Aha! moments during SSIs which were subcategorized. Of the intervention content codes, cognitive restructuring (N = 60, 31.91%) was the most frequently endorsed. Of the personal user experience codes, validation (N = 17; 9.04%) and self-reflection (N = 17; 9.04%) were most frequently endorsed. In both trials, Aha! moments were strongly associated with intervention satisfaction (ps < 0.01). In one trial, but not the other, participants who endorsed Aha! moments showed larger 8-week reductions in loneliness than those who did not (p[trial 1] = 0.23, p[trial 2] < 0.01). Participant-reported Aha! moments may be valuable for informing brief intervention design. Future work developing SSIs for loneliness may benefit from focusing on cognitive restructuring, exposure, and social skills training. ClinicalTrials.gov NCT05687162 (Study 1 retrospectively registered on July 10, 2024, Study 2 registered on April 20, 2023); Study 1: https://osf.io/8bth2 (June 23, 2023), Study 2: https://osf.io/nvd79 (July 3, 2023), Qualitative secondary analysis: https://osf.io/49db6 (December 24, 2023).

BackgroundThe university years are a developmentally crucial phase and a peak period for the onset of mental disorders. The beliefs about the changeability of negative emotion may play an important role in help-seeking. The brief digital growth mindset intervention is potentially scalable and acceptable to enhance adaptive coping and help-seeking for mental health needs in university students. We adapted the Single-session Intervention on Growth Mindset for adolescents (SIGMA) to be applied in university students (U-SIGMA). This protocol introduces a two-armed waitlist randomized controlled trial study to examine the effectiveness and acceptability of U-SIGMA in promoting help-seeking among university students in the Greater Bay Area.MethodsUniversity students (N = 250, ages 18–25) from universities in the Greater Bay Area will be randomized to either the brief digital growth mindset intervention group or the waitlist control group. Participants will report on the mindsets of negative emotions, perceived control over anxiety, attitude toward help-seeking, physical activity, hopelessness, psychological well-being, depression, anxiety, and perceived stress at baseline and the 2-week and 8-week follow-ups through web-based surveys. A 30-min digital intervention will be implemented in the intervention group, with a pre- and post-intervention survey collecting intervention feedback, while the control group will receive the link for intervention after 8 weeks.DiscussionThis protocol introduces the implementation plan of U-SIMGA in multi-cities of the Greater Bay Area. The findings are expected to help provide pioneer evidence for the effectiveness and acceptability of the brief digital intervention for university students in the Chinese context and beyond and contribute to the development of accessible and effective prevention and early intervention for university students’ mental health.Trial registrationHKU Clinical Trials Registry: HKUCTR-3012; Registered 14 April 2023. http://www.hkuctr.com/Study/Show/7a3ffbc0e03f4d1eac0525450fc5187e.

This study examined relationships among maternal and paternal parenting styles, patterns of involvement in adolescent sibling conflict, and sibling relationship quality. Students ( N = 272) in grades 9 and 11 from a public high school in a metropolitan area of the Northeastern US completed measures of parenting styles, parental sibling conflict intervention styles, sibling closeness, sibling support, and sibling warmth and conflict. An authoritative parenting style was associated with sibling support and closeness. Cluster analyses identified gender-specific patterns of parental involvement. Participants reporting maternal or paternal coaching involvement style reported greater sibling warmth compared with those who did not report such patterns. The results highlight indirect and direct relationships between parental behavior and sibling relationship quality. In addition, the study identifies the existence of a meaningful typology of parental involvement in sibling conflict.

Suicidal ideation and behaviours are common among adolescents. Parents play a fundamental protective role in the prevention of adolescent suicide, but many describe feeling ill-equipped in their caretaking role. This is despite prior research indicating that it is important for these parents to feel empowered to emotionally support their adolescent if they are experiencing suicidality. An online parenting program could offer parents flexible access to evidence-based parenting strategies. However, there are limited digital resources for these parents and, further, very little is known about how an intervention could be designed to support the empowerment of these parents. Therefore, the aim of the current study is to explore how an existing evidence-based, digital parenting intervention, Partners in Parenting (PiP+), could be adapted through co-design to empower parents. Four parents who have lived experience of caring for a suicidal adolescent, four young people who experienced suicidality during adolescence, and four experts in youth mental health/suicide prevention participated in four sets of co-design workshops to innovate adaptations to PiP+ to empower parents of suicidal adolescents. Affinity mapping was used to analyse and interpret findings. Three key themes highlight how a digital intervention could be innovated and adapted to empower parents caring for a suicidal adolescent. Specifically, for parents to feel empowered to parent a suicidal adolescent, a digital intervention should support them to (1) “deal with the now”; (2) “acknowledge needs and understand their role”, and (3) “hold hope for the future”. Further, ten sub-themes were developed illustrating different concepts related to these themes. Findings highlight how technological features could support parents to feel more empowered when caring for a suicidal adolescent. In conclusion, the proposed technological features illustrate how digital interventions can be adapted to empower parents in their role of emotionally supporting and managing the suicide risk of their adolescent.

BackgroundIntimate partner violence (IPV) is a prevalent public health issue associated with multiple physical and mental health consequences for survivors. Digital interventions can provide low-threshold support to those experiencing IPV, but existing digital interventions have limited efficacy in improving the safety and mental health of IPV survivors. Digitally adapting an integrative intervention with advocacy-based and psychological content holds promise for increasing the efficacy of digital interventions in the context of IPV.MethodsThis study examines the needs, acceptability and usability of an integrative digital intervention for people affected by IPV. We used the think-aloud method and semi-structured interviews with a sample of six people with lived experiences of IPV and six service providers. We analyzed the data using thematic analysis.ResultsWe identified the increasing general acceptance of digital support tools and the limited capacity of the current support system as societal context factors influencing the acceptance of and needs regarding digital interventions in the context of IPV. An integrative digital self-help intervention offers several opportunities to complement the current support system and to meet the needs of people affected by IPV, including the reduction of social isolation, a space for self-reflection and coping strategies to alleviate the situation. However, potentially ongoing violence, varying stages of awareness and psychological capacities, and as well as the diversity of IPV survivors make it challenging to develop a digital intervention suitable for the target group. We received feedback on the content of the intervention and identified design features required for intervention usability.ConclusionAn integrative digital self-help approach, with appropriate security measures and trauma-informed design, has the potential to provide well-accepted, comprehensive and continuous psychosocial support to people experiencing IPV. A multi-modular intervention that covers different topics and can be personalized to individual user needs could address the diversity of the target population. Providing guidance for the digital intervention is critical to spontaneously address individual needs. Further research is needed to evaluate the efficacy of an integrative digital self-help intervention and to explore its feasibility it in different settings and populations.

Purpose: A diagnosis of pediatric cancer can leave healthy siblings with limited access to support. Technology-mediated interpersonal interactions have been noted among adolescent and young adults with cancer and may be an effective source of support for adolescent siblings of children with cancer. In this study, we understand how adolescent siblings use technology to connect with their support network and how their technology use changes after their sibling's cancer diagnosis. Methods: Participants included a national sample (N = 24) of adolescents aged 12-17 who had a sibling diagnosed with cancer in the last 2 years (up to 3 years if still receiving curative-focused treatment). Ecomaps were cocreated with participants to identify sources of social support and modality of interactions. Interviews were transcribed, coded, content analyzed, and descriptively summarized. Results: Adolescent siblings (mean = 14.2 years) perceived technology as a tool to maintain support from their established personal network, rather than a way to expand sources of social support. Most did not seek support or information about cancer outside their known network, preferring information to come from parents or trusted network members. Siblings identified video calls as an important resource for connecting with parents, their sick brother or sister, and others to receive emotional support and companionship. Conclusions: Findings suggest that adolescent siblings of children use technology to connect with their established network for support, an important finding for designing assessments and interventions for this population. Future inquiry should explore these differences, identify unmet needs, and inform acceptable, effective interventions to augment support.

BackgroundExisting mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms.ObjectiveWe aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko minicourses on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior.MethodsWe used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program.ResultsThe SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen dz=−0.81, 95% CI −0.85 to −0.77) and REFRAME (P<.001, Cohen dz=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (P<.001, Cohen dz=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen dz=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research.ConclusionsVery brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports.

Rural households have established various informal strategies to cope with unanticipated shocks. These existing coping strategies are receiving renewed interest, particularly in the context of climate change and in terms of the role they do, and can play, in enhancing households' adaptive capacity. An improved understanding of these strategies, and the factors that influence their application, may support the design of locally relevant adaptation strategies. We explored the nature and prevalence of unanticipated shocks, including natural hazards, experienced by households in two villages in Venda, South Africa, with the villages selected, in part, because of notable differences in precipitation. We considered the influence of shock type, and household- and location-specific characteristics, on the use of various household-level coping strategies. We report on semi-structured interviews, administered to 170 randomly selected households, and a participatory rural appraisal. Almost 90% of households reported the experience of at least one unanticipated shock over a prescribed 5-year period, with natural hazards reported by 42%. The type of shock experienced and various household-level characteristics, such as households' access to human and financial capital, influences households' coping response. Households' access to natural and social capital allowed for the protection of ex-ante coping options. Overall, our findings indicate that when possible, households actively manage their coping strategy portfolio, both in response to the shock experienced and in anticipation of future shocks. Generally, households' informal, ex-post coping options appear to be insufficiently robust for the covariate nature of natural hazards, suggesting the need for interventions that support households’ existing coping portfolio. • Households apply different coping strategies depending on the shocks they face. • Savings help households face natural hazards but risk being depleted by frequent hazards. • Forest products were rarely used to cope with natural hazards, suggesting limitations. • Natural and social capital allows for the protection of households' assets and savings. • Households' access to human and financial capital affects their coping choices.