Rising prevalence of depression and widening sociodemographic disparities in depressive symptoms among Filipino youth: findings from two large nationwide cross-sectional surveys

Youth depression is a critical target for early intervention due to its strong links with adult depression and long-term functional impairment. In low- and middle-income countries (LMICs) like the Philippines, limited epidemiological data hampers mental health service planning for youth. This study analyzed nationally representative survey data from 2013 (n=10,949) and 2021 (n=19,178) to estimate the prevalence of moderate to severe depressive symptoms (MSDS) among Filipinos aged 15-24years, using the 11-item version of the Center for Epidemiologic Studies Depression Scale. Survey-weighted analyses revealed that MSDS prevalence more than doubled from 9.6% in 2013 to 20.9% in 2021. The rise was most pronounced among females (10.8% to 24.3%), non-cisgender or homonormative individuals (9.7% to 32.3%), youth with primary education or less (10.8% to 26.5%), youth from economically disadvantaged households (10.6% to 25.1%) and youth who were separated, widowed or divorced (18.3% to 41.3%). Disparities in MSDS also widened over time, with some groups bearing a disproportionate burden. These findings underscore the need to expand accessible, high-quality mental health services for youth in LMICs, such as the Philippines. Continued monitoring and targeted interventions are essential to address the rising burden of depression, particularly among underserved and disproportionately affected groups.

Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.

Prevention of Depression in Children and Adolescents

OBJECTIVES Sexual orientation disparities in adolescent depressive symptoms are well established, but reasons for these disparities are less well understood. We modeled sexual orientation disparities in depressive symptoms from late adolescence into young adulthood and evaluated family satisfaction, peer support, cyberbullying victimization, and unmet medical needs as potential mediators. METHODS Data were from waves 2 to 6 of the NEXT Generation Health Study (n = 2396), a population-based cohort of US adolescents. We used latent growth models to examine sexual orientation disparities in depressive symptoms in participants aged 17 to 21 years, conduct mediation analyses, and examine sex differences. RESULTS Relative to heterosexual adolescents, sexual minority adolescents (those who are attracted to the same or both sexes or are questioning; 6.3% of the weighted sample) consistently reported higher depressive symptoms from 11th grade to 3 years after high school. Mediation analyses indicated that sexual minority adolescents reported lower family satisfaction, greater cyberbullying victimization, and increased likelihood of unmet medical needs, all of which were associated with higher depressive symptoms. The mediating role of cyberbullying victimization was more pronounced among male than female participants. CONCLUSIONS Sexual minority adolescents reported higher depressive symptoms than heterosexual adolescents from late adolescence into young adulthood. Collectively, low family satisfaction, cyberbullying victimization, and unmet medical needs accounted for >45% of differences by sexual orientation. Future clinical research is needed to determine if interventions targeting these psychosocial and health care–related factors would reduce sexual orientation disparities in depressive symptoms and the optimal timing of such interventions.

Sexual orientation disparities in adolescent depressive symptoms are well established, but reasons for these disparities are less well understood. We modeled sexual orientation disparities in depressive symptoms from late adolescence into young adulthood and evaluated family satisfaction, peer support, cyberbullying victimization, and unmet medical needs as potential mediators. Data were from waves 2 to 6 of the NEXT Generation Health Study (n = 2396), a population-based cohort of US adolescents. We used latent growth models to examine sexual orientation disparities in depressive symptoms in participants aged 17 to 21 years, conduct mediation analyses, and examine sex differences. Relative to heterosexual adolescents, sexual minority adolescents (those who are attracted to the same or both sexes or are questioning; 6.3% of the weighted sample) consistently reported higher depressive symptoms from 11th grade to 3 years after high school. Mediation analyses indicated that sexual minority adolescents reported lower family satisfaction, greater cyberbullying victimization, and increased likelihood of unmet medical needs, all of which were associated with higher depressive symptoms. The mediating role of cyberbullying victimization was more pronounced among male than female participants. Sexual minority adolescents reported higher depressive symptoms than heterosexual adolescents from late adolescence into young adulthood. Collectively, low family satisfaction, cyberbullying victimization, and unmet medical needs accounted for >45% of differences by sexual orientation. Future clinical research is needed to determine if interventions targeting these psychosocial and health care-related factors would reduce sexual orientation disparities in depressive symptoms and the optimal timing of such interventions.

This study aimed to explore current data collection and feedback practice, in the form of monitoring and evaluation, among youth mental health (YMH) services and healthcare commissioners; and to identify barriers and enablers to this practice. Qualitative semi-structured interviews were conducted via Zoom videoconferencing software. Data collection and analysis were informed by the Theoretical Domains Framework (TDF). Data were deductively coded to the 14 domains of the TDF and inductively coded to generate belief statements. Healthcare commissioning organisations and YMH services in Australia. Twenty staff from healthcare commissioning organisations and twenty staff from YMH services. The umbrella behaviour 'monitoring and evaluation' (ME) can be sub-divided into 10 specific sub-behaviours (e.g. planning and preparing, providing technical assistance, reviewing and interpreting data) performed by healthcare commissioners and YMH services. One hundred belief statements relating to individual, social, or environmental barriers and enablers were generated. Both participant groups articulated a desire to improve the use of ME for quality improvement and had particular interest in understanding the experiences of young people and families. Identified enablers included services and commissioners working in partnership, data literacy (including the ability to set appropriate performance indicators), relational skills, and provision of meaningful feedback. Barriers included data that did not adequately depict service performance, problems with data processes and tools, and the significant burden that data collection places on YMH services with the limited resources they have to do it. Importantly, this study illustrated that the use of ME could be improved. YMH services, healthcare commissioners should collaborate on ME plans and meaningfully involve young people and families where possible. Targets, performance indicators, and outcome measures should explicitly link to YMH service quality improvement; and ME plans should include qualitative data. Streamlined data collection processes will reduce unnecessary burden, and YMH services should have the capability to interrogate their own data and generate reports. Healthcare commissioners should also ensure that they provide meaningful feedback to their commissioned services, and local and national organisations collecting youth mental health data should facilitate the sharing of this data. The results of the study should be used to design theory-informed strategies to improve ME use.

This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women. Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method. Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms. There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.

ObjectivesThis study aimed to explore current data collection and feedback practice, in the form of monitoring and evaluation, among youth mental health (YMH) services and healthcare commissioners; and to identify barriers and enablers to this practice.DesignQualitative semi-structured interviews were conducted via Zoom videoconferencing software. Data collection and analysis were informed by the Theoretical Domains Framework (TDF). Data were deductively coded to the 14 domains of the TDF and inductively coded to generate belief statements.SettingHealthcare commissioning organisations and YMH services in Australia.ParticipantsTwenty staff from healthcare commissioning organisations and twenty staff from YMH services.ResultsThe umbrella behaviour ‘monitoring and evaluation’ (ME) can be sub-divided into 10 specific sub-behaviours (e.g. planning and preparing, providing technical assistance, reviewing and interpreting data) performed by healthcare commissioners and YMH services. One hundred belief statements relating to individual, social, or environmental barriers and enablers were generated. Both participant groups articulated a desire to improve the use of ME for quality improvement and had particular interest in understanding the experiences of young people and families. Identified enablers included services and commissioners working in partnership, data literacy (including the ability to set appropriate performance indicators), relational skills, and provision of meaningful feedback. Barriers included data that did not adequately depict service performance, problems with data processes and tools, and the significant burden that data collection places on YMH services with the limited resources they have to do it.ConclusionsImportantly, this study illustrated that the use of ME could be improved. YMH services, healthcare commissioners should collaborate on ME plans and meaningfully involve young people and families where possible. Targets, performance indicators, and outcome measures should explicitly link to YMH service quality improvement; and ME plans should include qualitative data. Streamlined data collection processes will reduce unnecessary burden, and YMH services should have the capability to interrogate their own data and generate reports. Healthcare commissioners should also ensure that they provide meaningful feedback to their commissioned services, and local and national organisations collecting youth mental health data should facilitate the sharing of this data. The results of the study should be used to design theory-informed strategies to improve ME use.

Managed care organizational complexity and access to high-quality mental health services: Perspective of U.S. primary care physicians

Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW. A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles. Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service. The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."].

Racial/ethnic disparities in midlife depressive symptoms: The role of cumulative disadvantage across the life course.

Objectives Following the outbreak of COVID-19, social distancing restrictions limited access to face-to-face mental health services in Western Australia (WA), necessitating a rapid transition to non-face-to-face alternatives, including telehealth. The current study investigated barriers and facilitators to telehealth access and engagement, and preferences for child and youth mental health service delivery during and beyond COVID-19. Methods Three participant groups were recruited via social media and partner organisations, and completed a tailored online survey: i) young people (14–25 years) who had ever accessed or attempted to access mental health support or services (n = 84), ii) parents of young people with a child aged 0–25 years who had ever accessed or attempted to access mental health support or services with or on behalf of their child (n = 68), and iii) professionals working in the child or youth mental health sector (n = 167). Results Regarding barriers to engagement, young people were primarily concerned with the privacy implications of telehealth and its efficacy relative to face-to-face alternatives. Parents and clinicians were more concerned with the technological pitfalls of telehealth (e.g., internet-connectivity, picture/sound issues). Telehealth’s accessibility was highlighted as a facilitator for all groups. Although certain participant groups were considered to be more suited to telehealth than others, most participants endorsed a blended approach to the future provision of mental health services. Conclusions To facilitate a blended approach to the delivery of child and youth mental health services, participants recommended more reliable and affordable internet access, implementing funding models that support telehealth delivery, and training for clinical staff. KEY POINTS What is already known about this topic: At the time of writing, Western Australia has been fortunate enough to resist a large-scale outbreak of COVID-19, making the state relatively unique in its experience of the pandemic. Despite this, the state has experienced periods of social distancingrequirements and associated impact on mental health service provision. Young people have been especially susceptible to mental health decline during the pandemic. Social distancing requirements have necessitated the rapid transition of mental health service provision from face-to-face to non-face-to-face alternatives. What this topic adds: Findings from this study provide localised insights into barriers and facilitators to engagement with non-face-to-face service delivery from the perspective of children and young people, carers and mental health professionals. Despite concerns about the relative efficacy of telehealth compared to traditional face-to-face services and challenges with technology, the majority of young people, parents, and mental health professionals in the study felt that moving forwards, child and youth mental health services should be provided using a flexible, blended approach where both face-to-face and non-face-to-face options are available.

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded. The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation. Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing. Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement. MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.

What Is Causing the Ongoing Youth MH Crisis?