Addressing Youth Mental Health Research Articles

Strengthening Youth Emotional and Behavioral Well-Being Through Community-Academic Partnership: The EMPOWER Project.

The onset of mental health issues frequently starts during adolescence, where one third of adolescents who are 14 years and younger receive a mental health diagnosis. The state of youth mental health is a major public health concern. The EMPOWER project was developed during the COVID-19 pandemic to address youth mental health. The EMPOWER project is a partnership between two after-school programs and an academic mental health hospital in Toronto, Canada, that aims to bolster youth mental well-being. In this Practice Note, we share our community-based participatory research process of how we built the EMPOWER partnership and highlight our lessons learned so far. Through EMPOWER, we aim to codesign, deliver, and evaluate a scalable, evidence-based, and community-informed youth mental wellness curriculum that will be implemented in after-school programs.

Determinants of sexual and reproductive health concerns among youngsters in Albania during COVID-19 pandemic

The COVID-19 pandemic has affected all communities, including youngsters. Our aim was to assess the key sexual and reproductive health (SRH) concerns of young people in Albania during the pandemic as well as the factors associated with the main health concern. A cross-sectional study was carried out in Albania in 2021. Multivariable logistic regression analysis was used to assess the association of being concerned about mental health & psychological well-being, urgency for mental health information, and difficulty in getting mental health information with independent variables. In total 340 youngsters aged 14-30 years participated (66% female, 89% Albanian ethnicity, about 20% belonging to the LGBT community). Mental health & psychological well-being were the main SRH topics youngsters were concerned about, reported by 48% of them. About 37% of youngsters had an urgent need for mental health information during the pandemic and 18% experienced difficulty in getting this information. Being part of the LGBT community was associated with a significantly higher likelihood of being concerned about mental health (OR=3.15;95%CI:1.36-7.33), being in urgent need of mental health information (OR=3.68;95%, CI:1.63-8.32) and experiencing difficulties in getting mental health information (OR=3.48;95% CI:1.49-8.13). Higher household income levels also increased the likelihood of being concerned about mental health (OR=4.28;95%CI:1.55-11.77) and being in urgent need of mental health information (OR=4.15;95%CI:1.43- 12.01). In conclusion, young people in Albania have been concerned about various SRH topics during the COVID-19 pandemic, but the major concern was mental health & psychological well-being, especially for the LGBT community. The findings should guide future interventions for addressing youth mental health concerns in emergency situation.

Coping Power-Rural: Iterative Adaptation of an Evidence-Based Preventive Intervention for Rural Upper Elementary and Middle Schools

Abstract Background Educators in rural schools are uniquely situated to address youth mental health disparities, yet often face challenges in delivering mental health supports. This paper describes the process of adapting the evidence-based Coping Power program, a small group prevention program for youth with aggressive behavior problems, to be a two-tiered (Tier 1 and Tier 2), transdiagnostic intervention to improve fit and feasibility for rural upper elementary and middle schools. Method Identified challenges with the Coping Power program for rural areas included program length, substantial staffing and resource requirements, lack of universal programming, low caregiver engagement, and co-occurring problems. Initial adaptations included a classroom and small group format implemented by school staff, teacher consultations integrated into coaching and co-facilitation, and a technology-supported caregiver component. Implementer feedback forms, coaching notes, and individual interviews informed the iterative development and feasibility testing process. Results Between 2019 and 2023, thirteen schools across six rural districts implemented the program. Student curriculum revisions included order and relative emphasis of content, classroom and small group overlap, necessary simplification of concepts, improved contextualization to the rural setting, and the addition of student workbooks. Supports for implementers included fully developed lesson plans and slides, a comprehensive implementation manual, video lesson overviews, action-focused training, and a 3-session coaching model to support implementer preparation and sustain motivation. Teacher and caregiver infographic text “nudges” were improved to promote generalization of concepts across settings. Discussion By partnering with school-based implementers, the adapted program holds promise to be more feasible and appealing for rural schools than the original model. This fully developed program is now ready for larger-scale testing in rural schools.

Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges.

Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.

Objectively Quantifying Pediatric Psychiatric Severity Using Artificial Intelligence, Voice Recognition Technology, and Universal Emotions: Pilot Study for Artificial Intelligence-Enabled Innovation to Address Youth Mental Health Crisis.

Providing Psychotherapy, particularly for youth, is a pressing challenge in the health care system. Traditional methods are resource-intensive, and there is a need for objective benchmarks to guide therapeutic interventions. Automated emotion detection from speech, using artificial intelligence, presents an emerging approach to address these challenges. Speech can carry vital information about emotional states, which can be used to improve mental health care services, especially when the person is suffering. This study aims to develop and evaluate automated methods for detecting the intensity of emotions (anger, fear, sadness, and happiness) in audio recordings of patients' speech. We also demonstrate the viability of deploying the models. Our model was validated in a previous publication by Alemu et al with limited voice samples. This follow-up study used significantly more voice samples to validate the previous model. We used audio recordings of patients, specifically children with high adverse childhood experience (ACE) scores; the average ACE score was 5 or higher, at the highest risk for chronic disease and social or emotional problems; only 1 in 6 have a score of 4 or above. The patients' structured voice sample was collected by reading a fixed script. In total, 4 highly trained therapists classified audio segments based on a scoring process of 4 emotions and their intensity levels for each of the 4 different emotions. We experimented with various preprocessing methods, including denoising, voice-activity detection, and diarization. Additionally, we explored various model architectures, including convolutional neural networks (CNNs) and transformers. We trained emotion-specific transformer-based models and a generalized CNN-based model to predict emotion intensities. The emotion-specific transformer-based model achieved a test-set precision and recall of 86% and 79%, respectively, for binary emotional intensity classification (high or low). In contrast, the CNN-based model, generalized to predict the intensity of 4 different emotions, achieved test-set precision and recall of 83% for each. Automated emotion detection from patients' speech using artificial intelligence models is found to be feasible, leading to a high level of accuracy. The transformer-based model exhibited better performance in emotion-specific detection, while the CNN-based model showed promise in generalized emotion detection. These models can serve as valuable decision-support tools for pediatricians and mental health providers to triage youth to appropriate levels of mental health care services. RR1-10.2196/51912.

Understanding and Addressing Youth Mental Health: Challenges and Strategies

The tumultuous phases of adolescence and early adulthood, marked by a whirlwind of physiological, emotional, and psychological changes, form the foundation of an individual’s identity and resilience. This research paper unfolds an intricate narrative—a deep exploration of the multifaceted realm of youth mental health. The weight of academic expectations, the ebb and flow of peer dynamics, the intricate tapestry of familial relationships, and the ever-present societal benchmarks all contribute to the complex matrix of factors that either nourish or erode youth mental health. The urgency of unraveling this complexity stems from an ethical imperative and a pragmatic realization—the mental well-being of our youth not only shapes individual destinies but also reverberates through the very fabric of our society. We confront not only the challenges but also the barriers that obstruct young individuals from seeking assistance. The stubbornness of stigma erects barriers that hinder vulnerable youth from accessing the support they deserve. Limited awareness of available resources and concerns about confidentiality compound these obstacles, creating a chasm between struggling youth and the avenues of aid. These barriers compel us to devise strategies that erode stigma, propagate awareness, and build bridges towards confidential and accessible mental health support.

An integrative framework of family processes to predict East Asian American youth’s mental health problems

ABSTRACT No existing conceptual framework can describe the family precursors and dynamics that explain East Asian American (EAA) youth’s mental health problems in their cultural context. To address this conceptual gap and better elucidate EAA youth’s mental health issues, we present a conceptual framework that combines two existing theories: the triadic model of family process and acculturation gap-distress theory. We selected these two theories because they address youth mental health problems as a common outcome explained by family domains and complement each other by addressing certain processes in more depth. Using a cultural lens that allows researchers to reconstruct assumptions of theory in specific cultural contexts, the presented integrative framework of family processes identifies how universal and East Asian-specific aspects of familial factors influence the mental health problems of EAA youth. This framework is intended to guide future research efforts on EAA youth development and provide preliminary guidelines for social workers working with EAA families to provide culturally responsive care and services.

Fight, Flight, or Freeze?: Equine-Assisted Learning as a Means to Explore Anxiety, Self-Efficacy, and Agency in Rural Youth During COVID-19

Background: Given the emerging information about the COVID-19 pandemic's detrimental impacts on youth well-being, it is paramount to consider interventions that may mitigate these consequences, especially those available in socially distanced, outdoor settings. Further, adolescents in rural settings are at a significant disadvantage for accessing critical mental health services; therefore, novel, community-based approaches are necessary to support youth wellness efforts. Purpose: This study sought to address youth mental health challenges exacerbated by the COVID-19 pandemic in rural Montana by combining mindfulness techniques with Equine Assisted Learning. Methodology: The study applied a mixed methods phenomenological case study. Surveys and participatory observations/ interviews provided a foundation for multi-phase data analysis. Descriptive statistics and paired samples t-tests were used to analyze quantitative data; multi-phase qualitative coding (open, focused, and values coding) was utilized to analyze interview and observational data. Findings: Participants’ anxiety levels were greatly reduced following the intervention; mixed outcomes resulted from self-efficacy measures. Qualitatively, the findings demonstrate alignment between course topics, goals, and outcomes. Implications: Results suggest the potential for EAL to reduce anxiety levels in youth and increase self-awareness and agency in application of strategies to manage anxiety. Questions surrounding Bandura's self-efficacy scales arose as a result of this research.

Principal Perspectives on Addressing Youth Mental Health Within Schools

Principal Perspectives on Addressing Youth Mental Health Within Schools

Two prominent Houston providers join forces to address youth mental health

Soaring demand for behavioral health services among adolescents since the start of the COVID‐19 pandemic has brought together two major health care organizations in the Houston area. Texas Children's Hospital and The Menninger Clinic have established an affiliation that will provide quicker access to specialized care for area youths who are experiencing suicidality or other major mental health concerns.

Youth-focused Design and Regulation in eHealth Can Help Address the Mental Healthcare Crisis

An ongoing mental healthcare crisis has been exacerbated by COVID-19, particularly for youth. However, one unexpected effect of this pandemic is that access to digital mental healthcare has rapidly expanded. We argue that eHealth interventions, including telehealth and mobile interventions (mHealth), can effectively address mental health challenges, reduce costs for individuals and institutions, and broadly expand access to mental healthcare. For the promise of eHealth to be fully realized, FDA regulation must thoughtfully balance the promotion of evidence-based interventions with broad public accessibility. Furthermore, youth involvement throughout the design process and consideration of youth-specific needs when establishing regulations are critical to the success of eHealth in addressing youth mental health in the United States.

Australian School Staff and Allied Health Professional Perspectives of Mental Health Literacy in Schools: a Mixed Methods Study

Schools are an ideal setting to base mental health literacy programs as the learning environment is already established. Mental health literacy represents how to obtain and maintain good mental health and should be incorporated into the school curriculum. Collaboration with key stakeholders in youth mental health, such as school staff and allied health professionals, is critical in ensuring needs are addressed, and programs are sustainable. This study aimed to understand the perspectives of school staff and allied health professionals towards mental health literacy within Australian schools. An exploratory qualitative and quantitative survey was completed by 88 participants across Australia. Results indicated that school staff feel less competent to deliver mental health literacy content and perceive their training did not address mental health education compared to allied health professionals. Most mental health programs reported to be implemented within schools were social and emotional learning programs. School staff viewed mental health programs to strengthen academic performance less than allied health professionals. Thematic analysis of qualitative data identified that participants viewed mental health knowledge, where and how to seek help, and coping skills as vital content to cover in a school-based mental health literacy program. This study reveals that school staff need sufficient training and resources to address youth mental health literacy. Though mental health literacy is lacking in the Australian school system, the perspectives of school staff and allied health professionals in this study provide key ideas and considerations for the future development of school-based mental health literacy programs for youth.

Scaling up community-delivered mental health support and care: A landscape analysis.

The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.

Caring for adolescents and young adults with attention-deficit/hyperactivity disorder in primary care: seizing opportunities to address youth mental health needs.

To provide primary care providers (PCPs) with updated practical guidance around the assessment and management of attention-deficit/hyperactivity disorder (ADHD) in adolescents and young adults (AYA). Of the three different presentations of ADHD delineated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the Predominantly Inattentive presentation is the most common among AYA. Multiple rating scales exist to assist clinicians in identifying ADHD symptoms and monitoring treatment effects. Importantly, ADHD frequently persists into adulthood with negative impacts in many life domains if left untreated. It is important for PCPs to provide support for AYA as they transition to adulthood, as treatment adherence often drops sharply at that time, and, once treatment is discontinued, it is rarely restarted. Further, clinicians should be aware of the negative psychological, behavioral, and social impacts that COVID-19 has had on AYA with ADHD. AYA with ADHD often seek care first from PCPs. However, diagnosis and management of ADHD among AYA are challenging, and many clinicians feel ill-equipped, creating concern that many youth may go undiagnosed and untreated. Despite these long-standing challenges, recent advances have opened up critical opportunities for PCPs to proactively address ADHD in primary care settings and make a profound impact on youth as they seek to realize their full potential.

Heterogeneous Patient Graph Embedding in Readmission Prediction

The number of youth seeking mental health services has been increasing in the past decade. Accurate prediction of hospital readmission is a contributing factor in addressing youth mental health problem and healthcare service utilization. Medical records are an important source of information for readmission prediction, however utilizing such records in the context of mental care, requires overcoming two impeding challenges: the diversity of service utilization (e.g., using psychiatric vs. overdose vs. trauma clinics all for the same underlying mental health reason) and the heterogeneity of data associated with each service. Graph Neural Network (GNN) is shown to be promising in performing classification or regression tasks when input data bears a complex structure. In this research, we propose using graph embedding to first generate patient graph that captures episodic emergency department visits and the complex service utilizations of the patient. We then use GNN for readmission prediction. For embedding and training purposes, we utilize more than 4,000 unique mental health patients data over 19 years. To evaluate our approach we systematically compare a variety of of GNN models with four RNN models, namely LSTM, Bi-LSTM, GRU, and Bi-GRU. Our experimental evaluation demonstrates that encoding the complex interrelationship between features of a patient using graph embedding and GNN improves the performance of the predictive model compared to RNN counterparts.

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

“It’s Something That We All Need to Know”: Australian Youth Perspectives of Mental Health Literacy and Action in Schools

Young people expressed concern about their mental health before COVID-19, and these concerns have escalated in response to the pandemic. A lack of knowledge, stigma and unfamiliarity with how to seek help contribute to low self-efficacy in mental health care. There is a need for school settings to include mental health education, or mental health literacy (MHL), to address youth mental health needs. Evaluation of school-based MHL programs often occur without the consultation of key stakeholders, such as young people. This study aimed to understand young people’s experience of mental health education in their school and their perspectives of how future mental health education can be tailored to suit their needs. Four online group discussions were conducted with 13 participants aged 11 to 18 years old. Eight main themes were generated from these discussions: (1) limited mental health education and understanding in school, (2) struggle to help seek, (3) negative mental health attitudes, (4) desired content about mental health education, (5) understanding of mental health, (6) school as a place for support, (7) suggestions for mental health education, and (8) ways for schools to be responsive to youth needs. All the young people in this study expressed concerns around the lack of mental health education in their schools and indicated that this must change for the wellbeing of all youth.

Surgeon General Calls for Action to Address Youth Mental Health Crisis

One in three high school students reported persistent feelings of sadness or hopelessness, while suicide rates for young people rose 57% in a decade. More child and adolescent psychiatrists are needed.

Behavioral Activation as an \u2018active ingredient\u2019 of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis

BackgroundPsychological interventions such as behavioral activation (BA) that focus on overt behaviors rather than complex cognitive skills may be developmentally well-suited to address youth mental health problems. The current systematic review synthesized evidence on the characteristics, effectiveness and acceptability of behavioral activation (BA) to examine its role as a potential ‘active ingredient’ for alleviating depression and anxiety among young people aged 14 to 24 years.MethodsEvidence across the following sources were synthesized: (i) randomized control trials (RCT) evaluating interventions where BA has been used as a standalone intervention or as part of a multicomponent intervention, (ii) qualitative studies examining the acceptability of BA as an intervention or as a coping strategy among young people with lived experiences. Consultations with a youth advisory group (YAG) from India were used to draw inferences from existing evidence and identify future research priorities.ResultsAs part of the review, 23 RCTs were identified; three studies examined BA as a standalone intervention, and the remaining studies examined multicomponent intervention where BA was a constituent element. The intervention protocols varied in composition, with the number of intervention elements ranging between 5 to 18. There was promising but limited evidence in standalone interventions for thse effectiveness of BA for depression. The impact of BA in multicomponent interventions was difficult to evaluate in the absence of focal assessment of activation outcomes. Evidence from 37 additional qualitative studies of youth lived experience literature, corroborated by the YAG inputs, indicated that young people preferred using behavioral strategies similar to BA to cope with depression in their own life. Themes indicated that the activities that are important to an individual and their socio-contextual factors need to be considered in the planning and implementing BA intervention. Evidence for the use of BA in anxiety was limited across data sources.ConclusionsOverall, there was preliminary empirical evidence for the effectiveness and acceptability of BA for youth depression. Further research is needed to examine the components and mechanisms that contribute to its effectiveness as an active intervention ingredient for depression and anxiety.

Adolescent Mental Health Problems and Adult Human Capital: Findings From the South African Birth to Twenty Plus Cohort at 28 Years of Age

PurposeWe investigated associations between adolescent internalizing and externalizing problems and adult human capital in a non-Western setting. Little is known about adolescent mental health problems and adult outcomes in low- and middle-income countries, many of which are characterized by high levels of adversities. MethodsData came from the Birth to Twenty Plus cohort, started in Soweto, Johannesburg, South Africa, in 1990. We estimated associations of internalizing and externalizing problems at the age of 14 years with self-reported educational, employment, welfare receipt, psychosocial (psychological distress, criminality, substance use), interpersonal (social isolation, intimate partner violence, partnership status), and HIV outcomes at the age of 28 years. ResultsAdolescents with high internalizing problems were less likely to have completed secondary school or be formally employed and more likely to report psychological distress. Those with high levels of externalizing problems were more likely to report adulthood criminal activity and substance use. We found significant associations between internalizing and externalizing problems and intimate partner violence. There was no association between adolescent mental health problems and welfare receipt, HIV, social isolation, or partnership status. Men were more likely to report incomplete secondary education, no formal employment, criminality and substance use, social isolation, and no serious relationship, whereas women were more likely to experience psychological distress and be in receipt of welfare. ConclusionsAdolescent mental health problems are associated with long-term negative adult functioning under varying socioeconomic conditions. Interventions to recognize and address youth mental health problems in low- and middle-income countries are needed to avert serious adverse adult and societal consequences.